he challenges that face new chairs in an academic anesthesiology department are numerous. A shortage of anesthesiologists, particularly those interested in an academic career, fiscal restraints due to reduced reimbursements, increasing self-pay (i.e., no pay) patients and declining resident/fellowship applicants are only a few examples. Those few of us willing to take on such a monumental task, however, know that we will significantly impact our anesthesiology profession in the future. Moderate-sized programs such as ours at the Medical College of Georgia (MCG) in Augusta face additional challenges for academia. There are only two anesthesiology residency programs in Georgia. We are about two hours away from Emory University in Atlanta, a large, well-established academic program in a metropolitan city. We are “the other guys,” (though we do have the Masters Golf Tournament). Clinical responsibilities and resident education are an integral part of who we are, but nationally funded research will determine our success as a true academic center.

I believe that our department is like many others across the country. The department was in survival mode a few years ago with an interim chair and interim dean for too many years, and we are working hard to climb out of that position. I was the first chair recruit of our new dean, and this has certainly built a bond between us that gives us a determination that we both succeed. In rebuilding our department, however, it is important that we build our research program along with resident education and clinical care. I will discuss some of my efforts to date and hope that you can add to my suggestions as we try to revive or develop many academic anesthesiology centers across the country. Our profession will definitely benefit from this endeavor.

My first approach was to listen and learn from the “masters.” I was fortunate to have tremendous support and guidance from those who had built academic departments. Richard J. Kitz, M.D., spent many hours with me reflecting on his illustrious career, telling me what worked and even a few things that did not work. Such information is invaluable to a new anesthesiology chair. One can also read much of this in his book This Is No Humbug! where he and others reflect upon building the Massachusetts General Hospital (MGH) into a premier academic anesthesiology program.¹ I also learned much from 1989 ASA President James F. Arens, M.D., regarding organized medicine and resident education. This is an often-overlooked ingredient in academic departments, but it is a valuable resource as well.

Negotiating support from the dean is essential during the recruitment process. The dean can “make or break” any academic anesthesiology program today. Remember, you are never more valuable than the day before you start. Seed money, laboratory space and equipment are essential for providing the right environment such that recruitment of talented individuals who can support the rebuilding process is possible. When I arrived, there was a mostly-unused 800-square-foot dog laboratory, and we negotiated for more than 2,500 square feet of renovated space with new equipment for both small animal studies and molecular biology experimentation. Our research is focused on two specific areas: 1) sickle cell disease with emphasis on nitric oxide therapy and vascular inflammation and 2) mechanisms of anesthesia. It is essential for a department of our size to stay focused on a limited number of projects due to limited resources.

Importantly, our research is complementary to other academic departments and our university’s overall academic mission. A limited, well-focused endeavor along with collaboration from other departments, such as genomics, physiology, vascular biology and pharmacology, to name a few, enhances our own research and expands our capabilities. Our dean understands and supports our research goals and philosophy.

Recruitment of key personnel is another essential factor. Beyond dean support, this is the next most difficult endeavor. Most established investigators are unwilling or unable to move as it takes years to establish a productive laboratory. Therefore it is important for new chairs to identify “up and coming” academic investigators. Future “star” investigators, coupled with opportunities for laboratory space, equipment and start-up funds to develop their own career identity, are crucial in attracting our next academic research leaders. Additionally recruitment of laboratory personnel and postdoctoral students from around the world provide resources that can further anesthesiology research and enhance collaboration with other academic centers; we have recruited from Mexico, Germany, India and the National Republic of China. All recruits have been excellent. After 18 months of renovation and equipment set-up, we are operational and ready to submit two RO-1 grants this spring.

Clinical research should not be forgotten and also provides opportunities for National Institutes of Health (NIH) funding. Hospital administration must support this philosophy. Clinical infrastructure, such as computerized anesthesia record keeping systems in the operating rooms, is important. This is more powerful than a research nurse as all data can be downloaded in real time into the computer, and data can be queried to address specific questions and then analyzed. This process greatly supports the clinically based researcher and is cost-effective. Our hospital administrator purchased the Phillips CompuRecord system as part of my recruitment package, and we can follow a patient from our preoperative clinic through the operating room and the postanesthesia care unit. Our clinical research focuses on the role of inflammatory markers in the preoperative setting with short-term and long-term outcomes. This focus emphasizes our department’s commitment to a genuine and substantive perioperative care perspective as a base for “comprehensive clinical care and research.”

Corporate sponsorship “when performed responsibly and ethically” can be a catalyst to nationally funded clinical studies. I view corporate sponsorship as a starting point and not an endpoint to research development of junior staff. Other medical specialties, such as cardiology, appear further ahead of us in utilizing this funding resource for clinical trials and drug development. Clinical studies also are valuable to our residents. With proper mentoring, clinical research can inspire residents to pursue fellowships and, hopefully, an academic career. It is often difficult for residents to imagine working in a laboratory de novo without the inspiration of a clinical question to investigate. Creating a “thematic link” between the basic sciences and clinical research is important; they complement each other, create more opportunity for translational research and build a culture where clinical and basic scientists can “talk” to each other. Unfortunately academic clinical mentoring is nearly a lost art in our specialty. We are working hard at MCG to inspire our staff to challenge residents so that they question the current practice and design studies that improve patient care. To that end, we had several resident presentations at this year’s ASA Annual Meeting. My goal is to have residents submit high-quality Foundation for Anesthesia Education and Research (FAER) grant proposals within the next few years.

New or revived academic programs, such as ours, need support from our ASA. It could come in many forms, such as special consideration by FAER to encourage programs like ours to apply for research funding. Such programs could come in the form of an “RFA” directed solely at smaller academic programs to encourage residents/fellows or junior staff to compete for funding of clinical or bench research projects.

The challenge of the chair is that expectations of staff have changed, and the days of the “triple threat” are nearly extinct, soon only to be found on the Discovery Channel. For one person to publish in Nature, to be the Teacher of the Year and to be the best clinician on staff is no longer realistic in our current environment. Therefore I offer to my dean that our department will achieve all these goals, but not every individual. I believe clinical and resident education or research and resident education should take separate paths. Anyone who can do all three missions well is an exception and should be rewarded. However, those choosing research need protected time and should demonstrate productivity within a reasonable time period. Our department is too small to allow everyone nonclinical bench time, so we have invested our departmental research time in a few. As we grow with funding, we hope that we can increase this number. The initial years are the most difficult. In our department, we are essentially building a research program from scratch.

The challenge to build a truly academic anesthesiology research program is enormous but essential. Our residency education programs and anesthesiology profession as a whole must work together to rebuild the spirit of adventure in research — the task is too large for many programs to handle alone. We do have outstanding researchers in our field, and we need many more. We should not limit our research dollars to only the major centers. Other programs, particularly with new academic chairs, will grow if given the opportunity to do so. It is a necessity for our future.


Reference:

1. Kitz RJ. This Is No Humbug! Reminiscences of The Department of Anesthesia at the Massachusetts General Hospital. Boston, MA: Massachusetts General Hospital; 2002.

C. Alvin Head, M.D., is Professor and Chair, Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta, Georgia.