Eugene P. Sinclair, M.D.

s an anesthesiologist in private practice, I have taken for granted the benefits of anesthesiology-related research, innovation and new knowledge and the improved patient care that flows from them. The current environment in which academic anesthesiology departments struggle, however, threatens the scientific foundation of our specialty in ways that are unique in our history.

The May 2003 edition of the NEWSLETTER carried an article¹ written by Bruce F. Cullen, M.D., who was Vice-President for Scientific Affairs at the time. His article gave an account of the improvements in patient care and safety that followed the entry of increasing numbers of physicians into anesthesiology beginning in the 1940s. He listed the contributions of numerous academic anesthesiologists that resulted in better patient care.

Dr. Cullen reminded us that until the 1940s, the administration of anesthesia had been regarded as a technical skill relegated to nurses and other nonphysicians. As more physicians entered our specialty, respect for anesthesiology as a medical discipline had increased by the 1980s in parallel with the improvements in patient care.
Despite the remarkable achievements of anesthesiology over the decades from the 1940s through the 1980s, Dr. Cullen notes with regret that the adverse economic climate of recent years has been devastating for academic anesthesiology. The phenomenon has variously been called the academic anesthesiology crisis or “The Perfect Storm.”²

Discriminatory payment policies are the root cause for the erosion of the scientific foundation of our specialty. All anesthesiologists have been harmed by the Medicare anesthesia conversion factor and share with other physicians the financial erosion caused by the illogical Medicare Physician Payment Update Formula. Academic anesthesiologists are additionally harmed by an adverse payer mix and the Medicare Teaching Rule, which halves their payment when they supervise two residents concurrently.

The financial pressures on academic anesthesiology departments have resulted in devastating faculty recruitment and retention difficulties. For those who remain, the attrition rate in academic anesthesiology has reduced faculty numbers to such an extent that the demands of providing clinical care restrict time for scholarly activities, which are the source of innovation and improved care.

Historically high regard for anesthesiology as a scientific discipline stands in contrast to its current status as discussed in a recent article³ and accompanying editorial⁴ in Anesthesiology. The former points out the physician scientist’s role of translating science into practice and sounds “A Wake-up Call” for our specialty. The latter discusses the fact that the suitability of anesthesiology as a medical specialty for the development of an academic career for physician scientists is currently questioned within the academic medical community. The authors, Debra A. Schwinn, M.D., Ph.D., Jeffrey R. Balser, M.D., Ph.D., Paul R. Knight, M.D., Ph.D., and David C. Warltier, M.D., Ph.D., are anesthesiologists who rank among the most accomplished physician scientists in the United States. Their concerns must be heeded by all of us.

ASA and academic leaders have studied this enormous challenge and are working to strengthen the scientific foundation of anesthesiology. ASA officers and Washington staff regularly and extensively report efforts in legislative and regulatory affairs in this NEWSLETTER. Some of the ASA activities that encourage interest in the science of anesthesiology and that recognize achievements are:

• Excellence in Research Award;

• Presidential Scholar Award;

• Residents’ Research Essay Contest Awards;

• Scientific and Educational Exhibit Awards at the Annual Meeting; and

• Financial support to the Foundations.

The Mission of the Foundation for Anesthesia Education and Research is to:

• Promote the generation of new knowledge in anesthesiology that advances patient care.

• Foster career development of anesthesiologists dedicated to research and education in perioperative, critical care and pain medicine.

Noteworthy among its activities to secure the future of our specialty are recently establishing:

• The Academy of Anesthesia Mentors;

• Medical Student Anesthesia Research Fellowships; and

• An increase in the number of and funding for other grant categories.

The mission of the Anesthesia Patient Safety Foundation is to ensure that no patient is harmed by anesthesia. Its notable current activities are:

• Work on long-term surgery and anesthesia outcomes;

• The High Reliability Organization initiative; and

• Award grants for patient safety research.

Each generation of anesthesiologists has built upon the achievements of its predecessors and made our specialty better than it was when they entered the field. In this article, I have pointed out the unique socioeconomic milieu in which our generation is addressing that challenge. The arduous process of strengthening the scientific foundation of anesthesiology has begun. Its ultimate success requires the commitment of all anesthesiologists.

Remember the words of James E. Cottrell, M.D., past ASA Vice-President for Scientific Affairs and Past President (2003):

“In the long run, our best investment in the future of anesthesiology is our commitment to the science of anesthesiology.”

References:
1. Cullen BF. Innovation and discovery: The future of our specialty. ASA Newsl. 2003; 67(5):2,4.
2. Temper KK, Gelman S. Surviving the perfect storm: Challenges faced by our training programs. ASA Newsl. 2001; 65(2):22-24.
3. Schwinn DA, Balser JR. Anesthesiology physician scientists in academic medicine: A wake-up call. Anesthesiology. 2006; 104(1):170-178.
4. Knight PR, Warltier, DC. Anesthesiology residency programs for physician scientists. Anesthesiology. 2006;104(1):1-4.
5. Cottrell JE. Anesthesiology and public outreach — But who is the public? ASA Newsl. 2004; 68(3):3,7.


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