Academic anesthesiologists have been the foundational cornerstone of anesthesiology for advancing the specialty and providing for the future and critical need for trained personnel. Over 25 years ago, Dr. David Longnecker said, “We have the opportunity, to set the course for this discipline, especially during this interval of fundamental change in our health care system. We can stay the course, or we can change. I think you know my choice. I concur with Yogi Berra, who said ‘When you come to a fork in the road, take it’” (Anesthesiology 1997;86:736-42). We are still undergoing significant changes in our health care system, and academic anesthesiology departments are instrumental in training the next generation of anesthesiologists to lead this change.
The benefits of academic anesthesiology
Most academic anesthesiology programs train not only physicians but also a significant number of allied health care professionals, including nurse anesthetists and anesthesiologist assistants. Approximately 30% of recently trained anesthesiologists join academic anesthesiology (J Clin Anesth 2020;64:109810). There are numerous reasons to enter an academic anesthesiology department. The benefits include a very rewarding and challenging clinical practice, along with a significant opportunity to pursue either research, education, or leadership. All academic anesthesiology departments require a dedicated, skilled, and robust clinical work force to meet challenging, cutting-edge patient care needs while also embracing education and participating in system-wide planned research goals and initiatives. This is possible because clinicians can focus on patient care and teaching activities while leadership teams take care of administrative, contracting, financial, and other day-to-day mundane but critically important system-wide items. Most academic departments have subspecialty divisions or sections that allow for close collaboration with their subspecialty surgeons and proceduralists. Like group private practice, but even more so in academic anesthesiology, the relationships that are built over time with the different teams are one of the most rewarding aspects of academic practice because it ensures outstanding clinical care while also contributing to education, research, and development. Most new techniques and procedures are developed in academic centers, often leading to local, national, and international contribution and eventual adoption for patient benefit.
Academic anesthesiology practices are collaborative and are either part of a medical school or university system and interact with hospitals. This interaction can take place in a variety of ways. For instance, at the University of Minnesota, all physicians belong to a multi-physician practice plan. This multi-physician group is part of a large health care system that includes hospitals, ambulatory care centers, and clinics. Anesthesiology becomes an integral segment of the large health care system. Members of the anesthesiology department interested in leadership training will represent the department in different areas of this health care system. These large systems also provide the opportunity for subspecialty ACGME-recognized fellowship training. Subspecialty trained anesthesiologists with an interest in education and research will usually work in these subspecialty areas while also having the opportunity to interact and dedicate time in other subspecialties such as cardiac anesthesiology and critical care. Thus, being part of a large health care system surrounded by education and research affords anesthesiologists significant stability and an opportunity to dedicate their careers.
The quantity and type of research and an opportunity to enhance oneself in an academic anesthesiology practice varies from place to place. Research programs can include traditional basic science and clinical and translational research in all areas of medicine. Research programs may also include areas such as patient safety and quality, outcomes, health care disparities, and the use of large databases. Several academic departments have well-established physician scientist training programs or pathways for those with a serious research interest. These pathways may include advanced degree programs such as a master's in public health, master's in clinical research, master's in business administration, a degree in jurisprudence, and others. Many medical schools and universities have scholarships or tuition assistance programs for faculty who are inclined to pursue these types of degrees. Not everyone in an academic department needs to be a primary investigator. Many research projects are now being carried out using research teams from multiple departments, schools, and countries. These teams give individuals the opportunity to participate in the overall research mission, which can be professionally very satisfying. Being part of a collaborative multidisciplinary research team is also one of the very professionally rewarding and enjoyable aspects of academic anesthesiology. As indicated earlier, education is a vital role of an academic department. All academic departments are engaged with education of medical students, residents, and fellows. They may also be engaged in the training of nurse anesthetists, anesthesiologist assistants, undergraduates, graduate students, and even high school and middle school students. In 2013, Margaret Wood proposed that academic anesthesiology departments need to train future academic anesthesiologists in four broad categories: master clinician, clinical innovation, scholarship/investigation, and clinical resource stewardship (Anesth Analg 2013;116:1-3). There are numerous opportunities to develop innovative training programs in these broad areas.
Opportunities in education
Educational opportunities for faculty are extensive and widely available and include traditional bedside and OR teaching, but also curriculum development, curriculum evaluation, simulation development and evaluation, and educational research. Many individuals with a passion for education are pursuing advanced degrees in education and medical education. There are also leadership opportunities in education beyond the traditional roles of the program director, and assistant and associate program directors for the core residency and fellowship programs. There are opportunities to serve as a member of and chair important departmental educational committees such as the resident and fellow selection committee, program evaluation committees, clinical competency committees, and so on. Many academic anesthesiology departments are engaged in undergraduate medical education while serving as course directors or faculty in a variety of medical student courses and rotations. Those choosing academic anesthesiology typically love working with students and look forward to a satisfying career by doing so.
Academic anesthesiology departments are also widely engaged in the administrative service needs of their health care systems, which again presents many opportunities for faculty engagement and leadership. These include the traditional departmental-based committees, but also include committee service at the medical school, university or university system level. Committee service and leadership opportunities are available in the hospital and hospital system for those interested in these types of roles. Anesthesiologists are uniquely suited for many of these roles because of the obligatory exposure to all surgical and procedural specialties and the required basic understanding of OR management and operations. Many anesthesiologists interested in leadership in these areas are pursuing advanced degrees such as a MBAs or master of healthcare administration. Of course, there are also countless opportunities to become involved with local regional, state, national, and international medical and specialty societies.
Academic anesthesiologists are compensated not only financially but also with academic time. The latter affords individuals and teams opportunities to promote the educational and research mission of the department and health system at local, national, and international levels. The clinical work distribution is not as intense as in private practice, and vacation time varies by institution. Different departments provide diverse opportunities and support for career advancement. Academic practices offer great stability and are not likely targets for takeover by equity-backed, shareholder, and corporate entities. In addition, most academic institutions are addressing diversity by new policies that are being recognized and implemented by leadership (J Cardiothorac Vasc Anesth 2021;35:18-21). This should attract individuals with diverse backgrounds.
In conclusion, the future of academic anesthesiology is quite strong (see Figure). It affords anesthesiologists the ability to fulfil their career objectives in a sustainable and usually a robust environment. The work hours and lifestyle are different from that of private practice. The focus is less on monetary gain and more on a career dedicated not only to patient care but also to teaching, research, and advancement in a mentally stimulating environment.