uture historians of anesthesiology may report that the last 30 years have been the best of times for our specialty. Our academic and private practice departments are respected by their peers; the best and brightest of American and international medical graduates continue to apply for our residency positions, rebounding from a recruitment downturn in the early 1990s resulting from an erroneous estimate of an oversupply of anesthesiologists and threats of decreased reimbursements under the proposed Clinton Administration health care plan. Patient safety continues to improve despite the fact that 40 percent of the surgery population is greater than 65 years of age and an alarming percentage of patients present with major co-morbidities, including morbid obesity, diabetes and hypertension. Reimbursement for our services has been substantial; in 2004, the median income for anesthesiologists trailed only that of diagnostic radiologists, orthopedic surgeons and gastroenterologists and had increased by $85,000 in only seven years. In 2007, ASA and its Committee on Economics persuaded the AMA Relative Value Scale Update Committee (RUC) that anesthesia work values under the Resource-Based Relative Value Scale (RBRVS) system were undervalued, resulting in increased Medicare reimbursements averaging $16,000 annually for every ASA member.

Yet those of us who are enjoying these good years need to recall that it has not always been so. Throughout the first half of the 20th century, our specialty struggled against active opposition. In medical schools, we struggled to establish anesthesiology as an independent academic specialty; that struggle was mimicked in private practice environments where some wanted anesthesiology to be a subsection of surgery while others viewed anesthesiology as an institutional technical service. The key battle to bill independently for our services rather than receiving a percentage of a surgeon’s professional fee consumed many years. Similarly, it took decades of effort to establish the American Board of Anesthesiology as an independent board and for anesthesiology to become an independent section within AMA.

What, you might ask, does our specialty’s triumph over obstacles and its current enviable position have to do with supporting FAER? Everything, I would answer.

While it is true that success has a thousand fathers, the root cause of the respect our specialty earned, the new knowledge that we generated, the improved patient outcomes that our care has provided, and the ability to attract outstanding medical graduates and educate them to be caring, knowledgeable and skilled physicians was the development of an adequate number of outstanding academic departments. It is only in our academic anesthesiology departments that new knowledge is developed, that medical students are exposed to the excitement and importance of our daily practices, and where today’s private practitioners were educated and prepared to succeed in a complex practice environment.

With the great privilege that we have enjoyed for the last several decades goes a heavy responsibility to help ensure that the future of the specialty is at least as bright as its past.

FAER is the leading source of initial research grants that allow young investigators and educators to conduct sophisticated research and subsequently win National Institutes of Health funding that allows them to remain in academic careers. Despite the importance of FAER to academic anesthesiology and despite the role our training institutions have played in our successful careers, individuals and practice groups contributed only $166,616 to FAER’s total income of $3,773,134 in 2007. We can and must do more.

Two quotations more than 30 years apart relate to the issue I raise in this article:

“A discipline not continually engaged in an active and imaginary program of research is dead, and will not advance”

Richard J. Kitz, M.D., and Julien F. Biebuyck, M.B., D.Phil., Anesthesiology. 1974; 40:211-214.

“We must produce new anesthesiologists who are better trained than we have been to pounce on opportunities that allow our specialty to extend tentacles into all facets of health care”

Mark Warner, M.D., 2005 Emery A. Rovenstine Memorial Lecture, Atlanta.

With privilege goes responsibility: We have a duty to our specialty and its future. Please support FAER for a tomorrow as bright as our present.

John B. Neeld, Jr., M.D., is a partner in Northside Anesthesiology Consultants and a staff anesthesiologist, Northside Hospital, Atlanta. He was ASA President in 1999, and is Chair, ASA Delegation to AMA.

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