For clinical anesthesiologists in academia, there has been a longstanding expectation that, in addition to clinical work, a certain amount of time should also be devoted to research, journal publications, managing residents, or other academic pursuits. While those expectations still exist in some institutions, other are embracing the notion that, as clinical demands grow, academic institutions must compete for the best clinical anesthesiologists – often by forgoing academic expectations altogether. ASA Monitor spoke to experts on each side of the debate to see how institutions approach these standards and what the future holds.

For many academic institutions, as has long been the standard, clinician anesthesiologists are often expected to devote time to academic pursuits. “While the primary focus is on patient care, there is an expectation that the clinician anesthesiologist will make scholarly contributions,” said Daniel J. Cole, MD, FASA. Dr. Cole is Professor of Clinical Anesthesiology at the University of California at Los Angeles, President of the Anesthesia Patient Safety Foundation, and an ASA Past President (2016). “This may include engagement in the discovery of new knowledge, writing book chapters or reviewing articles for journals, or making presentations at medical education meetings. In addition, clinician anesthesiologists are often working with residents and are expected to manage the care of the patient and teach the resident the knowledge, skills, judgement, and the soft skills of being a board- certified anesthesiologist.”

“Academic health systems across the country are undergoing rapid growth in the clinical footprint, which has created a reckoning about what it means to be a clinician in academia.”

Those expectations are changing at the University of California, San Francisco. “Academic health systems across the country are undergoing rapid growth in the clinical footprint, which has created a reckoning about what it means to be a clinician in academia,” said Michael Gropper, MD, PhD, Professor of Anesthesia and Perioperative Care and Chair at the University of California, San Francisco. “Traditionally, every faculty member who was a clinician anesthesiologist was expected to have significant academic productivity, but if we continue to have that expectation, we will never have enough clinicians to do the work that's needed in a growing health system. Now, we need to hire pure clinicians into academic systems who historically would have gone into the private sector.” Dr. Gropper noted that as the clinical demands in academic health systems grow, it's become clear that traditional academic expectations are outdated. “One of the biggest misunderstandings we have today is that to work in an academic setting, you need be a really dedicated academician; that is not necessarily true. What you need to be is a good clinician who wants a career with opportunities.”

Whether an academic institution holds traditional standards or is evolving toward a more clinical focus, unique expectations often come with the position. For those with academic expectations, “Clinician anesthesiologists are often involved in leadership within the department, the health care system, and/or the school of medicine,” Dr. Cole said. “There is an expectation that they will participate in the committee structure and contribute to the overall function and output of the department and specialty and its scholarly mission. Community outreach in some avenue is also highly desired.”

Even in those institutions that are embracing a fully clinical standpoint, some aspect of research and study-related expectations may be involved. “If you are providing anesthesia care in a case at an academic institution, more than likely, the patient is part of a study or clinical research,” Dr. Gropper said. “The expectation is that you will help facilitate that, for example, by getting extra blood samples. In addition, this often entails a more robust quality improvement (QI) program, where the clinician anesthesiologist is expected to participate in the QI process in a structured way. This provides an opportunity for the anesthesiologist to gain experience in research, without the expectation of writing a grant or publishing a paper. “We provide the infrastructure to understand what research we are performing and to become involved without the expectation of vast amounts of academic work,” Dr. Gropper noted.

Clinician anesthesiologists in academic centers also have the opportunity to work with more complex patient populations, as most academic institutions are referral centers for the most critically ill and complex patients. “In academic centers, we are developing new therapies and caring for patients who can't be cared for in the private setting,” Dr. Gropper remarked. “The clinician anesthesiologists must be fluent in very complex patient care and are expected to participate and contribute to cutting-edge treatments.”

While the position may entail additional expectations, it also offers an abundance of opportunity that can't be found in the private setting, according to Dr. Gropper. Academic centers offer a chance to explore options other than clinical work, such as research, administration, and education. “It makes a big difference as one moves through their career and gets older – the ability to develop other interests and skills within their work that aren't available in the private sector.”

For Dr. Cole, this is most evident in work with residents. “Academic settings offer the opportunity to engage with residents and pass along skills to the next generation, while showing enthusiasm and a willingness to learn.”

Mentoring in academic medical centers allows anesthesiologists the opportunity to introduce those residents to the impact of anesthesiology care on a larger scale. Dr. Gropper cites a certain satisfaction in working in settings allowing physicians to provide care without any concern for the patient's insurance, ability to pay for care, or institutional profit. “Academic centers have a higher percentage of Medicaid and Medicare patients, but we provide the optimal care possible, and that's a big part of our mission and an advantage of the academic setting,” he commented.

This concept is the crux of the anesthesiologist's contribution to health care at large. Dr. Gropper added, “We're working on health care policy, access to care, and diversity development. We're doing research, treating different racial and ethnic groups equally in the care we provide, and training the next generation of anesthesiologists to continue that important work,” he said.

Kelly Wolfgang is a freelance writer with over 10 years of experience in medical journalism. She holds a master's degree in organizational psychology from Pennsylvania State University.