IN response to the difficulty of obtaining research funds from the National Institutes of Health and other sources, the American Society of Anesthesiologists (ASA) began using peer-review mechanisms in 1973 to fund initial projects by promising young anesthesiologists, with the intention that this work would improve their ability to compete for research funding. A new organization, Foundation for Anesthesia Education and Research (FAER), was formed in 1986 to encourage promising young anesthesiologists to pursue academic careers and to facilitate the expansion of research in anesthesiology. Table 1summarizes the financial support and chronology of program development by ASA and FAER.
FAER sponsored four types of awards from 1987–1996, all focusing on beginning investigators in anesthesiology. A fifth program focused on clinical research by similar investigators was initiated in 1997.
In 1995, a survey of former recipients of research funding from FAER and ASA was conducted to evaluate the effectiveness of FAER programs. Similar studies of the effectiveness of medical research training had been conducted in the 1980s by a variety of groups, as reported by the Institute of Medicine Committee on Addressing Career Paths for Clinical Research. The 1995/1996 FAER survey asked specific questions about current research efforts, institutional appointment and rank, subsequent funding, and mentoring of anesthesiology trainees in an attempt to measure the success of its former grant recipients.
In July 1995, 296 survey forms were sent with individualized cover letters requesting former recipients to complete the forms and return them in preaddressed, stamped envelopes. All former recipients of ASA or FAER research funding from 1973-June 1995 were included in the mailing.
To evaluate the success of the former recipients, the one-page survey contained questions on percent of time currently devoted to clinical practice, research, education, and administration; faculty or other institutional rank (to measure promotion); subsequent funding (by categories and including years, dollar amounts, and specific sources); and the number of research trainees for whom the recipient had served as a mentor. Another commonly used measure of academic success is publication in peer-reviewed journals, and such information was obtained from MEDLINE searches. In addition to the questions, each survey form was printed with the individual recipient's name, current address (from the ASA Directory), institution at which the FAER grant was made, and year and type of FAER funding. The form also requested open-ended written comments on the effect of FAER programs on the recipient's career development. A cover letter, personalized on the basis of the participant being either an ASA or FAER award recipient, member of the Association of University Anesthesiologists, and chair of an academic anesthesiology department, accompanied each survey form. Only one letter and survey form were sent to those individuals who had received two FAER grants.
To enhance the response rate, the August 1995 issue of the ASA Newsletter announced to all ASA members that FAER was conducting the survey. Former grant recipients who had not received questionnaires were asked to contact the FAER office for their copies. In October 1995, reminder postcards were mailed to grant recipients who had not returned questionnaires. The November 1995 ASA Newsletter contained preliminary data and reminded former recipients to complete and return their questionnaires. In October 1996, a second questionnaire was mailed to all 132 nonresponders at addresses published in the 1996 ASA Directory. Chairs of all academic anesthesia departments were sent letters asking for their help in locating persons not listed in the directory and in encouraging any nonresponders in their departments to complete the questionnaires.
Data from the questionnaires were tabulated and analyzed. For recipients who had received more than one FAER grant, data were attributed to the first award program. Comments were copied into a separate computer file for retrieval based on specific topics or key words.
As of February 15, 1997, FAER had received 234 (79% response rate) completed questionnaires. Nearly three quarters (74%) of the ASA starter grant recipients (1973–1986) returned the survey, and 81% of all FAER award recipients responded. Table 2shows the numbers of survey respondents and award recipients for each type of grant.
Of the 234 respondents, 224 reported academic rank (Table 3). The amounts of time (median percent, range for award category) spent in clinical care (42%, 40–60), research (30%, 15–50), education (8%, 7–14), and administration (5%, 3–10) were variable. It is clear that most recipients devote a substantial amount of time to the practice of clinical anesthesiology. In general, the amount of time devoted to research was lower for recipients of educational research grants and for those who had become more senior at the time of the survey. The latter devoted more time to administration. Recipients of research fellowships and young investigator awards spent approximately half their time in research.
Subsequent Research Funding
Although the survey form asked for years, dollar amounts, and specific sources of subsequent research funding, responses varied from “yes” to detailed answers. Respondents listed 7 separate National Institutes of Health institutes, 8 other federal sources, 28 private (nongovernmental, nonindustrial) foundations, 34 pharmaceutical companies, 16 anesthesia equipment manufacturers, and 5 “other” sources of research funding. The major source was the National Institutes of Health, which accounted for almost $63 million (63%). The next largest category was pharmaceutical companies, which contributed $16,499,517 (16%) for studies by former FAER recipients.
The total subsequent research funding reported by the 234 respondents was $100,506,150, ranging from $0 to > $3 million per person. Several respondents gave no dollar amounts or only listed their most recent 5 yr of funding. Respondents who had received educational research grants subsequently received $1,004,000 from other sources. Survey respondents who had been awarded fellowships received $3,516,357 after their FAER funding. The ASA starter grant recipients accounted for $50,349,237 in subsequent funding. FAER research starter grant recipients were awarded $22,194,531 from other sources. Young investigator award recipients received $23,442,025 from other sources.
Detailed data on the amount of ASA awards given before 1983 were estimated based on personal files.* Combining these estimates with FAER records from 1983–1994, comparisons can be made between the total dollars spent by ASA or FAER on the grant programs and the subsequent research funding obtained by the survey respondents. Survey respondents who had received their ASA or FAER funding in 1973–1994 subsequently received a total of $100,506,150 in research funds. During that same period, all ASA and FAER awards amounted to $5,781,779. The ratio of dollars of subsequent funding to ASA/FAER award dollars was 17.4:1. Figure 1shows the amounts awarded by ASA/FAER and subsequent amounts received by the award recipients of that same year.
Twenty-one individuals received more than one ASA or FAER grant. Of those 21, 18 responded to the survey. The second grant amount was not counted among the subsequent funding for those former recipients but was included in the ASA/FAER total spent. All second ASA or FAER grants represent a total of $1,125,157.
Each FAER program requires that award recipients have a research adviser or mentor who must write a letter of commitment to the project, which accompanies the application. These mentors guide the young researchers and provide role models. Many of the former grant recipients in turn have become mentors to other young investigators.
The survey data show that members of the group of 234 respondents have served as mentors to 1,004 young researchers. The questionnaire categorized the types of mentorships as FAER grant recipients (n = 63); FAER applicants, unfunded (n = 75); and other (n = 866). More than half the mentorships were reported by the ASA starter grant recipients (n = 514), probably because they had more years during which to act as mentors than the more recent recipients and possibly because of their higher faculty rank (see subsequent section).
Another widely accepted indication of success in academic medicine is faculty rank. The seniority of the ASA starter grant recipients is evident from the fact that 61% of the respondents from this program reported their faculty rank as professor, and 86% reported either professor or associate professor. Only six respondents reported no longer working in academic anesthesiology.
At the time of the survey, ten of the former recipients were chairs of academic anesthesia departments, nine of whom were from the ASA starter grant group and one of whom was from the FAER research starter grant group. The survey did not identify former chairs.
Many factors affect when faculty ranks are awarded. Longevity may be one factor and is displayed Table 3. Clearly, earlier award recipients were more likely to be professors, although years since award was not a consistent predictor of faculty rank.
The questionnaire asked respondents to “comment on how the FAER award enhanced your career development.” Slightly more than half the respondents (56%) returned one or more comments. There were 249 separate statements. The most frequent comments focused on setting up a laboratory and gathering data for subsequent research applications (44%) and protecting research time (24%). The former is a stated goal of FAER grants, and the latter reflects the FAER requirement that the recipients be guaranteed a specific amount of time to devote to the project by the chair of the recipient's department. Other common comments included the following: enhancement of success in publication, learning of scientific and management skills; recognition as a potential researcher; collaboration with excellent mentors; development of clinical research skills; and pursuit of interesting and sometimes less traditional research questions.
Eight comments indicated that the ASA/FAER award had little effect on the recipients' career development. Two of the eight mentioned that, although they are no longer in academic medicine, they still use the skills learned during their FAER-funded studies.
Apart from the survey, a MEDLINE search was performed for each grant recipient from the time of the ASA or FAER grant to the current period. The search included original research articles, scientific reviews, and editorials but not abstracts or non-peer-reviewed articles. By type of grant received, the mean numbers of publications listed per respondent were 2 for educational research grants, 8 for anesthesiology research fellowships, 20 for ASA starter grants, 9 for FAER research starter grants, and 8 for young investigator awards (Table 2). As expected, nonrespondents published fewer articles. Publications and journals not included in Index Medicus are not listed in MEDLINE; therefore, authors may have published more articles than were counted in this process; however, in addition to original research reports, some peer-reviewed editorials and review articles may have been inadvertently counted.
Before this survey, there had been a general consensus that FAER funding had had a positive effect on the career development of young investigators in anesthesiology. This survey gathered data to support this statement, using measures of subsequent funding and faculty rank and declarations of the influence of FAER on the investigators' careers. In addition to data and declarations, many of the respondents sent donations to support future FAER investigators.
The rate of return on the initial research investment by ASA and FAER is 174:1 for the 1973–1994 period. It should be noted that this is an underestimate of the total return because some respondents provided less than complete information (see “Results, Subsequent Research Funding” section) and because recipients of FAER awards in recent years have applications awaiting funding decisions by the National Institutes of Health and others.
Other measures of success include funding awarded to and publications authored by trainees of the ASA and FAER recipients. This instrument did not gather names of the trainees, so these questions cannot be addressed at this time.
Several studies of effectiveness of biomedical research training programs were conducted in the 1980s, and all used three basic criteria: subsequent research funding, career progress, and publications (numbers and citation counts). In the FAER survey, subsequent research funding and faculty rank are indicators of the first two measures. MEDLINE searches were used to collect data on numbers of publications. The response rate of 79% in this study is similar to or better than that in other surveys.
A separate MEDLINE search revealed no similar study of research support of anesthesiologists early in their careers regarding their career progress. Some studies have been conducted for a few other medical specialties. For example, compared with findings of a 1986 study by the Association of Professors of Medicine in conjunction with the Association of American Medical Colleges, which found that “the median research effort of M.D. faculty in departments of medicine was 25 percent …,”the anesthesiologists responding to this survey appeared to have slightly more time devoted to research (mean, 31%; median, 30%).
The Institute of Medicine reported that industry support of biomedical research overall has increased from 31 to 48% from 1980–1990, whereas federal government support (most of which comes from the National Institutes of Health) decreased from 59 to 41%. Former FAER/ASA recipients appear to have received a substantially higher proportion of their funding from federal sources (69%).
A limitation of this study is that there are no records of applicants who did not receive FAER funding and thus no ability to compare the relative success of funded versus unfunded applicants. Likewise, there are no similar data on the research funding, faculty rank, or publications of nonapplicants. Therefore, the success of FAER/ASA grant recipients may reflect (1) the ability of the ASA Committee on Research peer-review processes to select those who continue to be successful in academic anesthesiology and in attracting research support, or (2) the contributions of seed money to early career development and continuing research endeavors. Clearly, the individual awardees are the ones primarily responsible for the achievements evident in the results of this survey.
The goals of the ASA Committee on Research and FAER include the encouragement of scholarship and research in anesthesiology. The results of this survey demonstrate that those goals have been achieved by the recipients of awards from ASA and FAER. Measures of success were time currently spent on academic pursuits (percent of time devoted to research, teaching, and administration); number of times the anesthesiologists had been mentors to less experienced investigators; promotion to higher academic ranks; and subsequent research funding. Further, 97% hold academic rank, which is impressive in the current health-care environment. Perhaps most important, the former recipients themselves believe that this funding made a critical difference in their careers, and they support continuing the programs with their written comments, their time and effort as mentors and reviewers, and their monetary donations to FAER. There is substantial evidence from this survey, therefore, to justify support of ongoing FAER programs, to energize the search for additional sources of funding for FAER programs, and to consider expanding FAER activities. A follow-up survey is planned for 2000.
*Early ASA records have been discarded.