Anesthesiology physician scientists in academic medicine: a wake-up call.

PHYSICIAN scientists perform biomedical research ranging from fundamental molecular studies to clinical trials. As such, physician scientists have a pivotal role in the biomedical research enterprise. The foundation for physician scientist leadership in the subspecialty of anesthesiology is highly dependent on the success of young investigators as they develop independent careers involving basic and clinical investigation. Hence, a leading priority of anesthesiology must be to nurture the academic careers of physician scientists within the specialty. Over the past decade, during a period of budgetary expansion by the National Institutes of Health (NIH), the number of NIH grant applications from physicians, in contrast to the number of grant proposals from Ph.D. scientists, has been slow to increase. Likewise, growth in NIH awards to physicians working in anesthesiology departments has also been slow. Junior clinical anesthesiology faculty across the country find their ability to develop NIH-funded research programs limited by inadequate or overly fragmented research start-up time and by inconsistent approaches to research mentoring. In concert, the recent abrupt decrease in rate of growth of NIH funding now threatens not only the pace of our progress, but survival of physician scientist activity within anesthesiology. Based on these observations, anesthesiology is at risk of losing its status as a respected academic discipline within the broader biomedical community. Based on historic analysis of periods of limited NIH budgets, critical analysis of anesthesiology research training programs relative to peer academic specialties, and considering the forecasted continued high demand for clinical manpower in our academic medical centers, we present the case for radical change in our approach to training within the specialty. Although effective solutions will require significant sacrifice by all sectors of the specialty, we propose that modest steps are far too late and will no longer succeed. This article, while seeking to inform and educate, is above all a passionate call for decisive action.