Career National Institutes of Health funding and scholarship of chairpersons of academic departments of anesthesiology and surgery.

THE alarm has been sounded—again. Just as it is widely accepted that research is important for the development, advancement, and future of the medical specialty of anesthesiology, so too is it clear that we have a problem because there are not enough qualified and capable investigators. A recent article in ANESTHESIOLOGY 1 and an accompanying editorial highlight the sad state of research in our specialty, noting that departments of anesthesiology receive less than 1% of National Institutes of Health (NIH) dollars. This is an amount essentially unchanged from 30 yr ago despite unprecedented recent growth in the NIH budget and increased size of academic departments of anesthesiology in university hospitals. Likewise, over the past few years, there have been numerous forums and articles in newsletters sponsored by the American Society of Anesthesiologists, the Association of University Anesthesiologists, and the Foundation for Anesthesia Research and Education lamenting the fact that few trainees and young anesthesiology faculty choose to prepare themselves for a career as physician investigators and that fewer still succeed in procuring and maintaining NIH funding over the long term. The reasons for this predicament are undoubtedly quite complicated. Workforce shortages and the economic attraction of private practice probably play a role, as do an increasing clinical workload and generational differences of work ethics and attitudes about lifestyle. However, this is not a new problem. In an editorial written more than 20 yr ago about this issue, a thenleader of our specialty and chairperson of a major academic department, reflecting on missed opportunities for scientific advancement of our specialty, called research in anesthesiology the “road not taken” and stated that “the potential of the trainees is greater than the expectations of the faculty” and that “we must examine ourselves to see if we are willing to take the responsibility for the tremendous intellectual growth that could await our specialty if we have the wisdom to encourage it.” One group ideally positioned to encourage such intellectual growth is academic department chairs. Arguably, department chairs are best positioned to raise the academic expectations of their trainees and faculty and to support and encourage their research and intellectual pursuits. Moreover, having risen to the highest positions within their departments and universities, department chairs provide a valuable index of the state of academic accomplishment within our specialty. This begs the question of whether academic anesthesia chairs, by virtue of their own research and scholarship experiences and accomplishments, are prepared to effectively guide trainees and faculty in their research and academic careers. This is relevant inasmuch as anecdotal reports and some data suggest business management skills are increasingly important for appointment as a chair of anesthesiology and that chairs themselves view research, scholarship, and federal funding as being less important credentials for the job than they were in 1990. Accordingly, in this study, we examined the career track record of current chairpersons of academic anesthesiology departments in the United States in obtaining funding from the NIH for clinical or basic research and in publishing in journals cited by PubMed. To control for institutional differences and benchmark anesthesiology chairs against another specialty, we compared the performance of anesthesiology chairpersons to their counterparts in surgery within the same institutions on these same measures. This article is accompanied by an Editorial View. Please see: Evers AS, Miller RD: Can we get there if we don’t know where we’re going? ANESTHESIOLOGY 2007; 106:651–2.