We wish to thank Dr. Nemergut for his informative comments regarding the financial pressures surrounding research funding and graduate medical education. Dr. Pryde’s suggestion that “the failure to produce academically-oriented anesthesiologists has less to do with the aptitude and character of selected applicants and more to do with the unsavory aspects of the current culture within US academic medicine” may be more of a tangential comment than an alternative view. Both De Olivieria’s article1
and our Editorial2
focused on the criteria used to select residents, with emphasis on whether research training and publications were predictive of successful match. Neither the article nor the Editorial addressed whether our training programs are encouraging or discouraging residents from embarking on academic careers. Indeed, we are unaware of data indicating that there has been a negative change or failure to attract young anesthesiologists to University faculties.
Although we appreciate Dr. Pryde’s view of academic anesthesiology as an “ethically challenged” and “morally questionable healthcare-for-profit motivated endeavor,” we do offer an alternative view. The 21% incidence of dissatisfaction and a desire to leave the academy cited by the author is a statistic from a survey related to all of academic medicine, not primarily to academic anesthesiology. Further, the survey provides neither a comparator of dissatisfaction with community practice nor historical controls for rates of dissatisfaction with academic practice in prior years. We clearly recollect the events of the late 1990s when most academic anesthesia departments were severely understaffed due to substantial departures of faculty members toward community practice coupled with inability to attract graduating residents to faculty positions; this is decidedly not the situation today.
There are undoubtedly financial and regulatory strains on academic anesthesiology, but we believe that the burdens on academic anesthesiology are currently no different than on medicine as a whole. Medicine is changing dramatically, in part because of public awareness and demands for greater accountability with increasing concerns for safety and better outcomes. There is a greatly increased awareness of variability in medical performance and the incredible cost of medical care is impinging on other public mandates, including education and research. The public is demanding that resident and attending physicians perform at higher standards because they are paying for their training through Medicare dollars. The training of physicians is becoming more regulated and rigorous, and future clinicians will be more tested, more reliable, and perhaps more capable. There are unintended consequences of these new demands, including reduced time and resource for faculty and resident scholarship, which may have negative impact on academic culture.
Dr. Pryde’s comments do not speak to the issues regarding the training of future researchers in anesthesia, which remains vital to our specialty and requires an understanding of the demands of research funding, mentoring, and access to research support. Anesthesiology must change to provide greater value to the health of the public, and academic anesthesiology will need to remain a leader in this transformation. Advances in anesthesiology are considered among the biggest improvements in patient care and safety in the past century, and our role in patient safety has been lauded by many. Attracting academically talented residents into anesthesiology and helping them to develop into successful investigators is paramount to our continued success in leading improvement in medicine. Remorse about the “lost Camelot” of academic medicine of a century ago should not prevent us from pursuing these goals.
Lee A. Fleisher, M.D.,* Alex S. Evers, M.D., Jeanine Wiener-Kronish, M.D., John A. Ulatowski, M.D., Ph.D., M.B.A.
*Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania. email@example.com
1. de Oliveira GS Jr, Akikwala T, Kendall MC, Fitzgerald PC, Sullivan JT, Zell C, McCarthy RJ. Factors affecting admission to anesthesiology residency in the United States: Choosing the future of our specialty. ANESTHESIOLOGY. 2012;117:759–760
2. Fleisher LA, Evers AS, Wiener-Kronish J, Ulatowski JA. What are we looking for? The question of resident selection. ANESTHESIOLOGY. 2012;117:230–1 (Accepted for publication November 30, 2012.)
© 2013 American Society of Anesthesiologists, Inc.