To the Editor:—
The article by Schwinn and Balser1and the accompanying editorial by Warltier and Knight2succinctly and persuasively emphasize a current problem within the specialty of anesthesiology. The number of trained and committed physician scientists entering our academic workforce is diminishing, resulting in a “brain drain” of sorts. There can be little argument with the statement of the problem, but, as suggested by the different solutions offered, there is a variety of responses. Schwinn and Balser suggest that mandatory research training at the end of residency would hook some on the research fever, while Knight and Warner suggest a more integrated approach: mix the research experience with the clinical training, especially for those emerging from combined degree programs. Both of these approaches hold merit, and some combination should be tried, depending on the institution and circumstances. Creativity will be paramount.
But we offer another, longer range solution to what we view to be a substrate deficiency. We simply must face up to the fact that the image we have created for our specialty does not reflect our commitment to cutting-edge science, where we seek to understand pharmacology, neuroscience, biophysics, cardiovascular science, or health services research. Our image is of the fast track to financial security. No wonder our trainees are not interested in investing the additional time it takes to become a scientist. This also presents the possibility that adding a mandatory research component to the clinical fellowship will have the unintended consequence of decreasing enrollment in clinical fellowships; certainly this would be counterproductive. We therefore believe that our efforts would have a greater impact earlier in the educational pathway, at the undergraduate level and early in medical school. For example, it is likely that your associated university has a research fair of some kind, intended to link work/study and other interested undergraduates with a job in research—be it patient-oriented or laboratory research. Upon attending such a research fair at the University of Pennsylvania, we were astonished by the level of interest in our work and also the underrepresentation from other School of Medicine departments. This is a huge opportunity to get our science, our questions, our unique environment, and our skills to a potential group of recruits very early, which can only serve to disseminate more and better information and improve our image. Early integration into the medical school curricula can be of benefit as well. For example, members of our faculty teach epidemiology, cardiovascular medicine, pulmonary medicine, neurosciences, bioengineering, and doctoring, in addition to the required and elective clinical rotations in anesthesiology, pain, and critical care. Another example of early involvement is medical simulation, a rapidly growing educational tool to which all medical students will be exposed. Anesthesiology is a clear choice for leading such efforts. By exposing those students to the vast expertise and research experiences of anesthesiologists earlier in the course of their education, students with research interests and experience may recognize the opportunities to ask and answer questions that might not traditionally be considered “anesthesiology” but that certainly fit within those fields many of us believe can be advanced through our work. Similarly, anesthesiologist investigators must speak to diverse audiences. Present your research to surgeons, neurologists, and pulmonologists as well as those in the basic sciences. Join graduate groups and attend student retreats. During a recent neuroscience graduate group retreat, a student asked us, “So what does anesthesia have to do with neuroscience?” Having an opportunity to educate such poorly informed views should enhance our ability to recruit the “right stuff.” Of course, achieving these goals requires that your best people be involved in the instruction and that successful teachers be incentivized along the lines of the most productive clinicians. The benefits are less tangible and longer term, but no less important.
Finally, our trainees across the board (medical students, residents, fellows) are not blind to what goes on around them. They see and hear faculty struggling with grants and papers, and they read the news regarding National Institutes of Health funding and government budgets. Therefore, many view the physician scientist route as a difficult one. It is essential that they see the benefit, not only in terms of intellectual satisfaction, but in terms of what they contribute to the future of the discipline, and how they are treated and valued by their colleagues and the department leadership.
In summary, this is not a simple problem of adding a year to the educational continuum, or of assigning mentors to our residents or junior faculty. This will require a recalibration of what we value in our discipline; how we reward those involved in lower-financial-yield areas of education and research; and, most of all, portraying anesthesiology, pain management, and critical care as a vibrant, intellectually stimulating, and challenging field that can impact areas beyond those traditionally taught by the anesthesiologists in the first 2 yr of medical school.
*University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania. email@example.com