Anesthesiology residency programs for physician scientists.

DRS. Schwinn and Balser are to be commended on their outstanding article entitled “Anesthesiology Physician Scientists in Academic Medicine: A Wake-up Call.” Their “call to arms” regarding the urgency of developing the next generation of physician scientists in anesthesiology may serve to further help shake us out of our complacency. These authors have nicely documented the problem and presented easily understood data that support their position as well as their strategy for changing the current culture in the anesthesiology community. However, the situation may actually be worse than they suggest. Drs. Schwinn and Balser are correct that we are not well regarded as a specialty that is supportive of careers for serious physician scientists. We need only to recall the comments made during a general discussion session at a recent national meeting of the Medical Scientist Training Program (MSTP) Directors (the authors are currently [P. R. K.] or formerly [D. C. W.] directors of their institutional MSTPs) that specifically queried whether anesthesiology was suitable as a medical specialty for an MSTP student to develop a academic career as a physician scientist. Even more compelling is the observation that only 10 National Institutes of Heath grants were awarded to anesthesiology departments in 2004. Therefore, not only are we not training an adequate number of new physician scientists in anesthesiology, but we also do not have a sufficient number of academic faculty that can serve as role models. The latter exponentially compounds the problem of the former. The Schwinn and Balser article is published at a time in which at least part of the academic community of anesthesiology leaders is beginning to become aware that this is a critical issue. Articles about this subject have started to appear with increasing frequency, and now may be the time when a paradigm shift in our specialty can be accomplished. We are in great need of establishing a mechanism that not only will produce the next generation of physician scientists for anesthesiology but will also increase our share of the research support available to all physician scientists. Until we do this, we will not be invited to a place at the table by the other academic specialties. Schwinn and Balser have invited others to consider their “position in light of other alternatives for ‘corrective action,’ and to advocate for these positions.” Therefore, as the authors have encouraged, we too would like to join in this debate. Having accepted the premise that our specialty is currently deficient in physician scientists and that our prospects for the future are not looking too bright either in this regard, how should we begin to attack this issue? One approach defined by the German philosopher Immanuel Kant in his epistemology and metaphysics work is to allow reason to develop a rule of action for achieving a given end. This hypothetical imperative could be stated in our case in the following form: If you wish to obtain more physician scientists, you must first determine what sort of prospects are available for recruitment. This is an intuitive basic first step toward solving the problem and, like all hypotheses, may be modified or reworked as we gain experience. Drs. Schwinn and Balser opine that a potential solution is to increase the number of Accreditation Council for Graduate Medical Education (ACGME)–accredited clinical fellowships and lengthen and redesign them to encourage research activity. By this approach, they predict that more physician scientists will be available for recruitment to academic institutions. Although this strategy would certainly increase the pool of anesthesiologists that have been exposed to research, it must also be emphasized that the majority of residents training in anesthesiology will and should practice in the community and not in academic centers. If the solution of the authors of this article is followed, we in anesthesiology training programs would be requiring that most residents lengthen their training time as well as be exposed to research so that we can recruit a few faculty who will have an interest in a career as a physician scientist. This global alteration in the residency may result in reduced numbers of graduating medical students entering our specialty. Furthermore, this approach seems to be in conflict with the national mood regarding residency training. There is clearly a movement by a number of medical specialties to decrease their duration of training to encourage greater numbers of medical students to consider those specialties. Therefore, we have somewhat of a concern regarding the efficacy of the approach suggested by Drs. Schwinn and Balser. We do not agree that all of the legitimate subdisciplines in anesthesiology must have ACGME-accredited fellowships. Furthermore, although lengthening and redesigning any fellowship to encourage significant research activity is a step in the right direction, it should be available to those to whom it may appeal, This Editorial View accompanies the following article: Schwinn DA, Balser JR: Anesthesiology physician scientists in academic medicine: A wake-up call. ANESTHESIOLOGY 2006; 104:170–178.