During the program, median secondary goal productivity was 0.57 secondary goals per 5 nonclinical days (25th–75th interquartile range = 0.38–0.77). Figure 1 shows that most (>50%) of our new faculty achieved a secondary goal productivity of <1 secondary goal per 5 nonclinical days (18/20; P = 0.0004). Therefore, most of our new faculty took more than a calendar month to accomplish a secondary goal.
As a secondary analysis, Figure 2 shows changes in primary and secondary goal productivity of the 15 faculty who had appointments in the department before the start of the program, comparing their productivity during the program to their productivity before the program. For primary goals, the Hodges-Lehman estimate for the median productivity change is +0.58 primary goals per 50 nonclinical days, (95% CI = −0.04 to +1.21); P = 0.068. For secondary goals, the Hodges-Lehman estimate for the median productivity change is +0.18 secondary goals per 5 nonclinical days (95% CI = 0.02–0.35); P = 0.021. Because of the small sample size, borderline P values, and lack of randomization of sequence, we cannot conclude that program goal productivity increased during the program period.
As an additional secondary analysis, we tested for and detected association between the amount of program-based financial support and primary goal productivity (P < 0.0001; τb = 0.76, 95% CI = 0.59–0.94). Among the 17 faculty achieving <1 primary goal per 50 nonclinical days, the median amount of program-based financial support was $0 (range: $0–$8000). Among the other 3 faculty who achieved >1 primary goal per 50 nonclinical days (Fig. 1), the median support was substantially larger (65% of all new faculty program financial support), but cannot be specified to maintain confidentiality (see first paragraph of Methods). There was no association between the amount of financial support and secondary goal productivity (P = 0.83, τb = −0.04, 95% CI = −0.41 to +0.32).
Our primary hypotheses were not supported. Even in the setting of a structured faculty development program, most new junior faculty required >50 nonclinical days to achieve a primary program goal and >5 nonclinical days to achieve a secondary goal.
A key question is whether other academic anesthesia departments providing equivalent levels of support for all new junior faculty might observe similar levels of nonclinical productivity for their average new junior faculty. We contend our observations are likely to be relevant to other departments for 2 reasons. First, the P values for primary goal (P = 0.0026) and secondary goal productivity (P = 0.0004) are sufficiently small as to have a strong likelihood of reproducibility by others.13 Second, our program took place in a clinical and educational environment similar to many academic anesthesia departments. Specifically, our department is currently composed of 64 faculty (57 clinical faculty), 40 residents (clinical anesthesia years -1, -2, and -3), 39 certified registered nurse anesthetists, 23 student registered nurse anesthetists, and 11 fellows, who collectively care for patients in 41 operating rooms, 40 critical care beds, and 2 pain clinics. These characteristics place our department near the “average” of Untied States academic anesthesia department in size and scope.9
Another key question is whether our observations are of potential value to other academic anesthesia departments. We contend that they are because academic anesthesia chairs reported that their 2 most difficult management challenges were “fostering research and scholarship” and “maintaining revenue to support faculty.”14 This report is the first in anesthesia to describe a system to categorize nonclinical (research, teaching, and nonclinical service) activities (primary and secondary goals) and to quantify new faculty productivity in accomplishing these activities. Accordingly, our methods and findings regarding the nonclinical productivity of new junior anesthesia faculty, and departmental investment in developmental support (nonclinical time, mentorship, and financial) to attain it, may serve as models and benchmarks for other departments when they assess the nonclinical (academic) performance of their faculty and/or in financial planning to support such activity.
Primary program goals placed emphasis on investigation and published scholarship. During the 2-year program period most (>50%) of our new faculty required >50 nonclinical days (a year’s worth of nonclinical time) to accomplish a primary program goal. We suggest that this level of academic productivity is not sufficient to start or sustain traditional research careers, garner external funding, or to earn tenure. Likewise, most departments will find it challenging to justify and sustain department-wide nonexternally funded nonclinical time at the level provided in this program (~25%) with an average primary goal (academic) productivity at the level we observed. Although some individual faculty members will exceed this average level of productivity, our focus is the majority, or average, faculty member. We observed an association between program-based financial support and primary goal productivity. Because most primary program goals were research related, and because most of our faculty had <30% nonclinical time, faculty who engaged in research or major project development needed additional assistance to organize and conduct such projects. Therefore, the association between financial support and primary goal productivity is expected. However, we wish to emphasize that the projects preceded the funding, not the other way around. Program-based financial supported primary goals, but it did not create or lead to the projects per se.
During the 2-year program period, many more secondary program goals were accomplished than primary program goals (324.5 vs 44.5, respectively) and, accordingly, median secondary goal productivity was more than 10-fold greater than primary goal productivity. Secondary program goals largely consisted of educational activities, (e.g., teaching in departmentally sponsored continuing medical education courses, mentorship of student and resident projects, and high scores in didactic and clinical teaching), managing clinical divisions, and participation in hospital committees. Although first-authored case reports, book chapters, and national level abstracts and presentations also satisfied secondary goal requirements (which may be considered forms of traditional scholarship), these comprised only 12% of the secondary goals that were accomplished by our new faculty. The vast majority of secondary goals accomplished by our new faculty were more closely aligned with promotion criteria in the clinical track, emphasizing education, direct patient care, and the management and development of clinical practice systems. There was no association between the amount of financial support and secondary goal productivity (P = 0.83, τb = −0.04, 95% CI = −0.41 to +0.32). Because most secondary program goals accomplished by our new faculty were derived directly or indirectly from clinical and/or teaching activities, additional support beyond existing staff and secretarial support was rarely needed to accomplish secondary goals. Therefore, the lack of association between program-based financial support and secondary goal productivity is expected.
Almost all (19/20, 95%) of our new faculty were physicians and, of this group, most (14/19, 74%) received <30% nonclinical time. Accordingly, most of our new faculty functioned as clinician-educators, with most (>70%) of their professional time and effort going to providing direct patient care and teaching in that context. Most (>80%) of the secondary program goals that were accomplished by our new faculty were derived directly or indirectly from clinical and/or teaching activities. Thus, we hypothesize that the majority of new anesthesia faculty are most familiar with the activities of the clinician-educator and are psychologically and experientially prepared to engage in these activities as soon as they become faculty.
In contrast, even though most of our new physician faculty had fellowship training (15/19 physicians, 79%), most had low primary goal productivity, and some (7/19, 37%) had none. This is consistent with the lack of formal research training and experience offered by most 12-month clinically focused fellowships in anesthesia subspecialties.1,2 The structure and content of our new faculty development program met Reves’2 recommendations for: (1) encouragement and incentives to engage in research, (2) assistance in identifying and accessing resources needed to achieve their goals, and (3) individualized formal mentorship and professional development plan. Even though the program appeared to be well regarded by the new faculty, it is not clear that it actually affected goal productivity, particularly primary goal productivity. Based on our findings, we hypothesize that department-level faculty development programs, by themselves, may not be able to substantively increase the traditional academic (research) productivity of the average faculty member in our specialty.
Our results show that even with an intensive development program to support and promote nonclinical productivity, 20% to 25% (departmentally funded) nonclinical time is not likely to be sufficient for most new faculty to be productive in research at levels that can lead to or sustain traditional academic advancement and garner external funding. We agree with Reves2 that, for our specialty to increase its contribution to biomedical research, anesthesia faculty would need to be paid less, in order to decrease the cost and increase the amount of nonclinical time for research. However, currently, recruiting and retaining new anesthesia faculty while paying lower salaries (in exchange for more nonclinical time) may be practically impossible because of resident perceptions of their medical school debt.15 Thus, the current balance between salary and nonexternally funded (departmentally funded) nonclinical time favors faculty productivity in secondary academic activities, and these may need to be the objective for most new anesthesia faculty. Secondary academic activities are an excellent pathway for anesthesiologists’ increasing involvement in systems based practice, informatics, quality improvement, and other medical director roles outside of traditional operating room care.
Two major, and largely unavoidable, limitations of this report are its observational nature and small sample size (n = 20). Participating new faculty were aware that: (1) they were participating in a new experimental program, (2) their nonclinical productivity was being monitored, and (3) their program and advisor assessments would be known to program leadership. Accordingly, both their behaviors and assessments of program effectiveness may have been influenced as a result of a Hawthorne effect (special attention) and/or their lack of anonymity. Observational studies with small sample sizes may lack statistical power to detect relationships (e.g., change in goal productivity) and, even when P values are significant (i.e., <0.05) such studies may have low reproducibility.13 In order to have larger sample sizes than reported here, individual departments (e.g., our department) will need to collect nonclinical productivity data over many years. However, it is possible that pooling of nonclinical productivity data from noncontemporaneous groups of faculty may not be valid. Alternatively, larger sample sizes could be obtained if multiple anesthesia departments were to collaborate to establish highly similar development programs with uniform assessments of nonclinical productivity. However, to our knowledge, at the present no other academic anesthesia departments in the United States have a program of this type, so data pooling is not currently possible. Measuring the effect of faculty development programs on academic productivity requires either: (1) randomizing new faculty to program participation or not (control), or (2) observing and comparing the productivity of faculty in development programs with faculty who are not (control). Because both of these approaches have major limitations, we elected to have faculty serve as their own historical controls, comparing their nonclinical productivity during the program with nonclinical productivity in the immediate preprogram period (n = 15).
As suggested by Reves2 and by Schwinn and Balser,1 at the present, it appears that most new junior anesthesia faculty are not prepared to be investigators after completing residency or fellowship training. Although our department-level faculty development program was evidence-based,3–5 goal-oriented,7,8 and well regarded by new junior faculty, it is not certain that it increased primary goal (academic) productivity. Our results suggest that, even with an structured development program and a substantive amount of nonclinical time, anesthesia departments should expect that most new faculty will need a considerable start-up period, at least 2 calendar years, before traditional academic (primary) goals can begin to be accomplished, if at all. Nevertheless, this level of departmentally funded academic productivity is not likely to develop or sustain faculty research careers or to be financially sustainable for most anesthesia departments. In contrast, new junior faculty appear to be much more productive in activities that are more directly related to their principal daily activities, namely, (1) providing clinical care and teaching in that context, and (2) developing and managing clinical care systems. Encouraging new anesthesia faculty to focus on these latter activities will not reverse our specialty’s challenges in biomedical research, but is a potential pathway toward their success and anesthesiologists’ widespread involvement in clinical enterprises.E
APPENDIX I: DEPARTMENT OF ANESTHESIA NEW FACULTY DEVELOPMENT PROGRAM
- I. Concepts and Principles
- 1. The department’s goal is to create an environment to aid, foster, and support the professional development of the faculty.
- 2. Each faculty member’s development is individualized, based on their unique goals, interests, and strengths.
- 3. The areas for development are clinical care, teaching, scholarship, service, and professionalism as defined as
- a. Clinical care: To increase quality (doing what you do well) and proficiency (increasing the variety of things you can do and/or the skills you possess).
- b. Teaching: To increase effectiveness in both clinical and didactic settings.
- c. Scholarship: To create new knowledge and disseminate it.
- d. Service: To advance the needs and goals of the department, college, hospital, profession, or society.
- e. Professionalism: To exhibit personal conduct that is consistent with and promotes each of the other areas.
- 4. Responsibilities of each faculty member.
- a. Each faculty member needs to define his/her professional goals.
- b. Each faculty member needs to develop plans to meet his/her goals.
- c. Each faculty member is expected:
- (i) To be accountable for resources provided to him/her (e.g., nonclinical time, funding).
- (ii) To meet their goals within a defined time frame.
- (iii) To meet the expectations of the department.
- 5. The Department is responsible for providing faculty with:
- a. Nonclinical (academic) time.
- b. Academic resources (funding, computer support, educational support).
- c. Advice, counseling, mentorship, and progress assessments.
- II. Program Aims and Construct
- 1. The aim of the New Faculty Program is to encourage and support academic development of new faculty through the provision of structure, resources, advice, written expectations, and defined end points.
- 2. The Program will initially apply to all Associates and Assistant Professors who are in their first or second year.
- 3. The Program will take place over 2 years. After 2 years, the conventional processes of faculty development and annual reviews will continue to be in place.
- 4. The aim of the New Faculty Program is to establish:
- a. The department’s expectation of new faculty that they will continue to develop as clinicians, teachers, and scholars.
- b. The department’s expectation that senior faculty will share their experience and expertise and be engaged in the growth of the new generation of faculty.
- c. A culture of shared values regarding what it is to be an academic anesthesiologist at the University of Iowa.
- III. Program Resources and Oversight.
- 1. The department of Anesthesia will provide each new faculty member supplemental financial support over the 2-year period of the Program to aid academic and professional development.
- a. Additional departmental funding may be provided through other mechanisms, such as Lundsford fellowships, etc.
- 2. All requests to utilize Program funds are to be in the form of a written proposal to justify the expenditures (aims, goals, end points).
- 3. Funds may be used to support:
- a. Nonclinical days (NCA) beyond the level assigned by the Department Head.
- (i) The “cost” of each NCA day (~$1200/d) is based on faculty salary and cost to cover clinical duties.
- b. Project support personnel (research nurses, data collection/analysis).
- c. Project development materials (software, assays, etc.).
- 4. Funds may not be used to support travel or meeting attendance except as individually approved by the Department Head or Vice Chair for Faculty Development.
- 5. The Vice-Chair for Faculty Development will be primarily responsible for Program oversight, reporting to the Department Head.
- IV. Senior Faculty Advisors
- 1. Each new faculty member will be paired with 2 senior members of the faculty who will serve as advisors.
- a. Advisors are selected by the Department Head and Vice Chair for Faculty Development.
- 2. Advisors are encouraged to make themselves available to their advisees as freely as possible (daily, weekly, monthly), providing council with regard to:
- a. Clinical care issues and questions.
- b. Approaches to clinical teaching.
- c. Approaches to didactic teaching.
- d. Initiation and development of new and creative ideas and projects, of either a scholarly and/or clinically innovative nature.
- 3. The new faculty member and both of his/her advisors are expected to meet as a group at least every 3 months to discuss progress.
- a. The Vice-Chair for Faculty Development and/or Department Head will participate in the group meeting at least every 6 months.
- 4. Written Reviews by the advisors:
- a. At month 6 of the Program (usually, December–January), the 2 advisors will serve as the primary reviewers for the annual academic review.
- b. At month 12 of the Program (June–July), the 2 advisors will provide a brief (≤1 page) review that documents meetings that have taken place and their joint assessment of the new faculty member with regard to clinical service, teaching, and academic/professional development.
- c. At month 18 of the program (usually, December–January), the 2 advisors will serve as the primary reviewers for the annual academic review.
- d. At approximately 2 years into the program (June–July), the 2 advisors will provide a brief (≤1 page) final review that documents meetings that have taken place and their joint assessment of the new faculty member with regard to clinical service, teaching, and academic/professional development.
- 5. At 1 year into the program, the Department Head will assess the relationships between the new faculty and their advisors and the effectiveness of the interactions.
- a. Criteria for the assessment will be based primarily on the attainment of goals (Sections VI. and VII.).
- b. Advisors may be reassigned at the discretion of the Department Head.
- V. New Faculty Seminar Series
- 1. Approximately every 2 months (12 sessions over 2 years), new faculty are expected attend a seminar in a series specifically emphasizing elements essential to new faculty development.
- a. Seminar topics will be presented on an alternating year-A/year-B cycle such that each year’s new faculty will receive the entire 2-year series, without repetition.
- 2. The New Faculty Seminar Series will be directed by the Vice-Chair of Faculty Development, who is responsible for its content and scheduling.
- a. Examples of content include: (1) University and collegiate requirements for promotion; (2) public speaking; (3) writing for publication; (4) essential software skills (Word, PowerPoint, Excel); (5) time management, etc.
- 3. New faculty members are expected attend at least 75% of all seminars (8/12 over 2 years).
- VI. Early Goals
- 1. At the end 6 months in the Program (usually, December-January), each new faculty member is expected, with the assistance of his/her advisors, to define in writing a series of goals to be obtained by the end of the 2-year Program (see Section VII).
- a. Alternative goals may be defined with preapproval of the Department Head.
- 2. At the end of 1 year in the Program, the new faculty member is expected provide a brief (≤15 minutes) summary of activities directed toward accomplishing their goals/aims (above) to their advisors, the Vice-Chair for Faculty Development, and the Department Head.
- VII. Two Year Goals
- A. Specialized Training/Skills
- At the end of 2 years in the Program, the new faculty member is expected to have accomplished at least 1 of the following goals. (Alternative goals may be defined with preapproval of the Department Head).
- 1. Completion of the Department of Anesthesia Clinical Trials Seminar Series.
- 2. Enrollment and continued participation in the K30 Program.
- 3. Enrollment and continued participation in an advanced degree program (e.g., Masters in Public Health, Masters Medical Education, PhD).
- 4. Participation in at least 4 College of Medicine-sponsored teaching workshops.
- 5. Participation in a least 2 multiday clinical or research workshops sponsored by either a national anesthesia/critical care society (e.g., American Society of Anesthesiologists, Society of Cardiovascular Anesthesiologists, International Anesthesia Research Society, American Society of Regional Anesthesia), or other academic institution (e.g., Harvard Simulation Course).
- B. Primary Goals
- At the end of 2 years in the Program, the new faculty member is expected to have accomplished at least 1 of the following goals. (Other primary goals may be defined with preapproval of the Department Head).
- 1. A manuscript has been submitted to a peer-reviewed journal
- a. The new faculty member is the first author.
- b. Only original research or review articles qualify.
- c. Only established in-print journal qualify.
- (i) Internet-based journals are excluded.
- 2. An IRB-approved clinical trial or record-review study is started.
- a. The new faculty member is the primary investigator.
- b. At least 30% of the expected patient enrollment has been completed.
- 3. A grant for funding external to the department is submitted.
- a. The new faculty member is the primary investigator.
- b. The grant request is to exceed $10,000.
- 4. An Animal Care and Use Committee-approved laboratory-based study is underway.
- a. The new faculty member is the primary investigator.
- 5. Establishment of a new clinical program or service that has been originated and/or directed by the new faculty member.
- 6. Establishment of a new teaching program with formal curriculum that has been originated and/or directed by the new faculty member.
- a. Any University of Iowa student group qualifies.
- C. Secondary Goals
- At the end of 2 years in the Program, instead of achieving at least 1 of the primary goals (above), the new faculty member may meet expectations by accomplishing at least 5 of the following secondary goals. Each accomplishment in a category qualifies—for example, 3 case reports counts as 3, 2 semesters of medical student teaching counts as 2. Other secondary goals may be defined with preapproval of the Department Head.
- 1. Acceptance of a case report to a peer-reviewed journal.
- a. The new faculty member is the first author.
- b. Internet-based journals are excluded.
- 2. Acceptance of an abstract for a national level meeting.
- a. The new faculty member is the first author.
- 3. Acceptance of chapter in a book or monograph.
- a. The new faculty member is the first author.
- 4. Participation as a coinvestigator in a clinical trial.
- 5. Serve as a Carver College of Medicine medical student course instructor for at least 1 semester.
- 6. Departmental medical student didactic teaching scores in the top 25th percentile for an academic year.
- a. To qualify, the new faculty member must give at least 5 medical student didactic teaching sessions over the year.
- 7. Anesthesia resident didactic teaching scores in the top 25th percentile for an academic year.
- a. To qualify, the new faculty member must give at least 4 resident didactic teaching sessions over the year.
- 8. Anesthesia resident clinical teaching scores in the top 25th percentile for an academic year.
- a. Any resident teaching award (“Teacher of Year” or “Excellence in Education”) also qualifies.
- 9. Presentation at a national level meeting:
- a. Abstract.
- b. Problem-based Learning Discussion leader.
- c. Challenging case presenter.
- d. Refresher Course lecturer.
- e. Panel Discussion speaker.
- f. Workshop instructor.
- 10. Serve as faculty mentor for a medical student or resident presentation at the level of the College of Medicine or regional meeting (e.g., MARC).
- 11. Presentation of lecture or workshop at a departmentally sponsored Continuing Medical Education (CME) activity (e.g., Regional Anesthesia Study Center of Iowa, Iowa Anesthesia Symposium).
- 12. Administrative Responsibility:
- a. Director of Clinical Division (Ambulatory Surgery, Pediatrics, Critical Care).
- b. Fellowship Director (Critical Care, Regional Anesthesia).
- c. Curriculum Director for defined major resident clinical rotation (e.g., Pediatrics, Orthopedics, Cardiac, Neuroanesthesia).
- d. Director or Associate Director of Residency or Medical Student Clerkship.
- 13. Participation as a member of a departmental, collegiate, university, hospital, or professional committee:
- a. Department: Resident competency committee, resident applicant interview committee, etc.
- b. Hospital: Pharmacy and Therapeutics committee, Critical Care committee, Sedation Committee, etc.
- c. Professional: Service as member of professional society committees (e.g., American Society of Anesthesiologists, Iowa Society of Anesthesiologists, Society of Critical Care).
- 14. Coauthorship of any publication (paper, abstract, chapter, letter-to-the-editor) will count as one-half (0.5) of a secondary goal.
- a. Internet-based forums do not qualify.
Dr. Franklin Dexter is the Statistical Editor and Section Editor for Economics, Education, and Policy for the Journal. This manuscript was handled by Dr. Steven L. Shafer, Editor-in-Chief, and Dr. Dexter was not involved in any way with the editorial process or decision.
Name: Bradley J. Hindman, MD.
Contribution: This author helped design the study, conduct the study, analyze the data, and write the manuscript.
Attestation: Bradley J. Hindman has seen the original study data, reviewed the analysis of the data, approved the final manuscript, and is the author responsible for archiving the study files.
Name: Franklin Dexter, MD, PhD.
Contribution: This author helped design the study, analyze the data, and write the manuscript.
Attestation: Franklin Dexter has seen the original study data, reviewed the analysis of the data, and approved the final manuscript.
Name: Michael M. Todd, MD.
Contribution: This author helped design the study, conduct the study, and write the manuscript.
Attestation: Michael M. Todd approved the final manuscript.
aThe information is provided as online supplement to the published manuscript at http://www.anesthesia-analgesia.org/content/107/6/1981/suppl/DC1. Accessed December 15, 2012.
bInstructor is an entry level faculty position that does not require Board certification or prior demonstration of teaching effectiveness or scholarship. Faculty may hold the rank of Associate for up to 3 years.
cOur initial plan was to calculate nonclinical productivity as nonclinical days per goal (days/goals). However, some faculty accomplished zero primary goals during the program. Hence, dividing their nonclinical days by their primary goals (zero) resulted in values of infinity. By calculating and reporting nonclinical productivity as goals per nonclinical day (goals/days), faculty who accomplished zero goals had productivity values of zero.
1. Schwinn DA, Balser JR. Anesthesiology physician scientists in academic medicine: a wake-up call. Anesthesiology. 2006;104:170–8
2. Reves JG. We are what we make: transforming research in Anesthesiology. Anesthesiology. 2007;106:826–35
3. Sambunjak D, Straus SE, Marusić A. Mentoring in academic medicine: a systematic review. JAMA. 2006;296:1103–15
4. Flexman AM, Gelb AW. Mentorship in anesthesia. Curr Opin Anaesthesiol. 2011;24:676–81
5. Flexman AM, Gelb AW. Mentorship in anesthesia: how little we know [Editorial]. Can J Anesth. 2012;59:241–5
6. Reich DL, Galati M, Krol M, Bodian CA, Kahn RA. A mission-based productivity compensation model for an academic anesthesiology department. Anesth Analg. 2008;107:1981–8
7. Thorndyke LE, Gusic ME, George JH, Quillen DA, Milner RJ. Empowering junior faculty: Penn State’s faculty development and mentoring program. Acad Med. 2006;81:668–73
8. Gusic ME, Milner RJ, Tisdell EJ, Taylor EW, Quillen DA, Thorndyke LE. The essential value of projects in faculty development. Acad Med. 2010;85:1484–91
9. Kheterpal S, Tremper KK, Shanks A, Morris M. Workforce and finances of the United States anesthesiology training programs: 2009-2010. Anesth Analg. 2011;112:1480–6
10. Bland CJ, Schmitz CC, Stritter FT, Henry RC, Aluise JJ Successful Faculty in Academic Medicine—Essential Skills and How to Acquire Them. 1990 New York: Springer Publishing Company, Inc.
11. Allen TD, Eby LT. Relationship effectiveness for mentors: Factors associated with learning and quality. J Manage. 2003;29:469–86
12. Pellegrini EK, Scandura TA. Construct equivalence across groups: An unexplored issue in mentoring research. Educ Psychol Meas. 2005;65:323–5
13. Shafer SL, Dexter F. Publication bias, retrospective bias, and reproducibility of significant results in observational studies (Editorial). Anesth Analg. 2012;114:931–2
14. Mets B, Galford JA. Leadership and management of academic anesthesiology departments in the United States. J Clin Anesth. 2009;21:83–93
15. Steiner JW, Pop RB, You J, Hoang SQ, Whitten CW, Barden C, Szmuk P. Anesthesiology residents’ medical school debt influence on moonlighting activities, work environment choice, and debt repayment programs: a nationwide survey. Anesth Analg. 2012;115:170–5
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