Physician scientists in anesthesia

[JoaoMoutinho]

Hi everyone,

MD/PhD student here exploring my options during PhD phase, and I've started to gain some interest in anesthesia but can't find much about physician-scientists in the field, so I figured I'd come here.

A few questions:

1) what are some of the major research questions in anesthesia? Or what are the major challenges from a basic/translational science perspective?

2a) which institutions are leaders in anesthesia research? I've heard Michigan is solid but that's about it.

2b) do any of the anesthesia research powerhouses offer good clinical training as well? I've gotten the impression that for some fields you often get good research training or clinical training but not always both.

3) for the handful of physician scientists in these parts, what are some of the challenges that are unique to MD/PhDs in anesthesia (as opposed to other fields)?

If any of you all could even just recommend some of the leading field-specific journals I could probably dig up some answers to a few of my questions there as well.

Thanks in advance!

Going to tag @Spacedman since I saw the name come up as an MSTP grad in an older thread.

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[kidthor]

...can't find much about physician-scientists in the field, so I figured I'd come here.

The reason you aren't finding much about anesthesia physician-scientists is because there aren't many. A research powerhouse place will have maybe a handful of them (mostly doing things like neuroscience, physiology, or AI). A midrange academic place will often have none. There are some out there who do clinical drug trials and the like. But when it comes down to it the research road takes an extraordinary amount of effort in exchange for a big pay decrease - and most people like to make money. So most people just do clinical anesthesia work.

To answer question 2b - research heavy places typically also offer excellent clinical training. It's not a zero sum game with research vs clinical.

See this article - the median number of publications per year for an academic anesthesiologist is zero:

Examination of publications from academic anesthesiology faculty in the United States - PubMed

The overall publication rate of anesthesiologists associated with medical schools was low in this time period. These data establish the pre-"call to action" baseline of scholarly activity by U.S. academic anesthesiologists for future comparisons. Increased use of structured resident and fellow...

pubmed.ncbi.nlm.nih.gov

 

[Mman]

big name research programs would (off the top of my head) include MGH, Brigham, Penn, Hopkins, Duke, Emory, WashU, UCSF, Stanford, etc.

 

[IMGASMD]

Yale has at least two md/phds in the anesthesia department. One of them is pretty much non clinical, and has a big research army, joint appointment in anesthesia and biomedical engineering. The other is clinical(mostly ambulatory anesthesia) and does research on the side and more as a “hobby” than heavy research presence.

I will start by saying I have a pretty heavy bias against md/phds, because I can never split myself for multiple important tasks at once. And quite frankly, just not smart enough to learn everything.

Anesthesia to me at end of the day practice by doing. If you spent time (especially quality research) doing something else, it’ll be hard to “practice” anesthesia. That being said, both of the professors I mentioned are in more engineering, medical devices and AI realm. There are PhDs (only) who have appointment in anesthesia department, but not MDs, so some of their projects will have MD collaborators.

Let me ask you a question. Since you are already in a MD/PhD program, don’t you have to complete your PhD before graduating med school? Can you go somewhere to do your PhD, that’s not within your school? Just wondering.

There’s something called NIH T32 grant, that’s pretty interesting, you can check it out to see if that will somehow help you to move around.

Lastly, I met Paul Barash, RIP, a few years ago, who I certainly consider a great teacher and clinician in the field. I met him in the OR area. I told him I thought he would be sitting in an office somewhere and writing his next book or off to conference somewhere. He said, he used up all his vacation time already and needed to work; and he loved his clinical time. Take the story for whatever it’s worth to you.

Good luck, op. Rooting for smart and driven people like you.

 

[GassYous]

Yale has at least two md/phds in the anesthesia department. One of them is pretty much non clinical, and has a big research army, joint appointment in anesthesia and biomedical engineering. The other is clinical(mostly ambulatory anesthesia) and does research on the side and more as a “hobby” than heavy research presence.

I will start by saying I have a pretty heavy bias against md/phds, because I can never split myself for multiple important tasks at once. And quite frankly, just not smart enough to learn everything.

Anesthesia to me at end of the day practice by doing. If you spent time (especially quality research) doing something else, it’ll be hard to “practice” anesthesia. That being said, both of the professors I mentioned are in more engineering, medical devices and AI realm. There are PhDs (only) who have appointment in anesthesia department, but not MDs, so some of their projects will have MD collaborators.

Let me ask you a question. Since you are already in a MD/PhD program, don’t you have to complete your PhD before graduating med school? Can you go somewhere to do your PhD, that’s not within your school? Just wondering.

There’s something called NIH T32 grant, that’s pretty interesting, you can check it out to see if that will somehow help you to move around.

Lastly, I met Paul Barash, RIP, a few years ago, who I certainly consider a great teacher and clinician in the field. I met him in the OR area. I told him I thought he would be sitting in an office somewhere and writing his next book or off to conference somewhere. He said, he used up all his vacation time already and needed to work; and he loved his clinical time. Take the story for whatever it’s worth to you.

Good luck, op. Rooting for smart and driven people like you.

Oh man I didn't know that Barash passed. I saw him after he "retired". Seemed like a great guy.

 

[abolt18]

Oh man I didn't know that Barash passed. I saw him after he "retired". Seemed like a great guy.

This is a cool publication about him. Everyone should read it IMO.View attachment Hessel EA, et al- In celebration elbration... of Paul Barash- JCTVA March 2021.pdf

 

[IMGASMD]

This is a cool publication about him. Everyone should read it IMO.View attachment 345659

Loved the part about “servant leader.”

RIP Dr. Barash.

 

[cchoukal]

Research | Anesthesia

anesthesia.ucsf.edu

A reasonable place to start. Generally speaking, anesthesia attracts fewer researchers than other fields. Look for programs with a T32 fellowship so you can get funded, mentored, and in the grant-getting pipeline and culture.

 

[ToKingdomCome]

big name research programs would (off the top of my head) include MGH, Brigham, Penn, Hopkins, Duke, Emory, WashU, UCSF, Stanford, etc.

Michigan has the largest research funding of all anesthesia programs

 

[Mman]

Michigan has the largest research funding of all anesthesia programs

OK, was just going off the top of my head. Upon review it appears George Mashour at Michigan alone outranks essentially every other program in terms of NIH funding. I do not know where to find numbers for non NIH funded research by department.

 

[abolt18]

Michigan has the largest research funding of all anesthesia programs

I believe WashU was 2nd back when I was interviewing for residency ~5 yrs ago. I know WashU also has some hybrid program for research in the middle of residency for OP if interested.

 

[GassYous]

TJ Gan is at Stony Brook, he publishes like a beast

 

[drg123]

Check out WashU's research tracks. They also have several faculty who are clinical anesthesiologists and serious bench researchers

Training Programs | Department of Anesthesiology | WashU Medicine

Learn about WashU's anesthesiology residency programs, fellowships, research opportunities, and the Scholars Program and Academic Scholars Advancement Program.

anesthesiology.wustl.edu

One benefit of OR anesthesiology that supports having a productive research career is that the clinical work is not open ended and is well defined. You do your cases and it's over. No additional work or documentation or patient follow up to distract you when you're doing your research. This is hugely helpful and many other fields do not have this. Something to consider.

 

[JoaoMoutinho]

The reason you aren't finding much about anesthesia physician-scientists is because there aren't many. A research powerhouse place will have maybe a handful of them (mostly doing things like neuroscience, physiology, or AI). A midrange academic place will often have none. There are some out there who do clinical drug trials and the like. But when it comes down to it the research road takes an extraordinary amount of effort in exchange for a big pay decrease - and most people like to make money. So most people just do clinical anesthesia work.

To answer question 2b - research heavy places typically also offer excellent clinical training. It's not a zero sum game with research vs clinical.

See this article - the median number of publications per year for an academic anesthesiologist is zero:

Examination of publications from academic anesthesiology faculty in the United States - PubMed

The overall publication rate of anesthesiologists associated with medical schools was low in this time period. These data establish the pre-"call to action" baseline of scholarly activity by U.S. academic anesthesiologists for future comparisons. Increased use of structured resident and fellow...

pubmed.ncbi.nlm.nih.gov

Interesting article, thanks for sharing. I knew that anesthesia was one of the least research-oriented specialties but I'll admit I didn't know it was that strong.

Wrt the bolded: I've generally gotten the impression from forums for other specialties that many people do tend to view it as a zero sum game, and the anesthesia residents I've spoken to at my home program seem to feel the same way. Glad at least one person disagrees (and hope your answer is the truth, lol).

 

[JoaoMoutinho]

Yale has at least two md/phds in the anesthesia department. One of them is pretty much non clinical, and has a big research army, joint appointment in anesthesia and biomedical engineering. The other is clinical(mostly ambulatory anesthesia) and does research on the side and more as a “hobby” than heavy research presence.

I will start by saying I have a pretty heavy bias against md/phds, because I can never split myself for multiple important tasks at once. And quite frankly, just not smart enough to learn everything.

Anesthesia to me at end of the day practice by doing. If you spent time (especially quality research) doing something else, it’ll be hard to “practice” anesthesia. That being said, both of the professors I mentioned are in more engineering, medical devices and AI realm. There are PhDs (only) who have appointment in anesthesia department, but not MDs, so some of their projects will have MD collaborators.

Let me ask you a question. Since you are already in a MD/PhD program, don’t you have to complete your PhD before graduating med school? Can you go somewhere to do your PhD, that’s not within your school? Just wondering.

There’s something called NIH T32 grant, that’s pretty interesting, you can check it out to see if that will somehow help you to move around.

Lastly, I met Paul Barash, RIP, a few years ago, who I certainly consider a great teacher and clinician in the field. I met him in the OR area. I told him I thought he would be sitting in an office somewhere and writing his next book or off to conference somewhere. He said, he used up all his vacation time already and needed to work; and he loved his clinical time. Take the story for whatever it’s worth to you.

Good luck, op. Rooting for smart and driven people like you.

Research | Anesthesia

anesthesia.ucsf.edu

A reasonable place to start. Generally speaking, anesthesia attracts fewer researchers than other fields. Look for programs with a T32 fellowship so you can get funded, mentored, and in the grant-getting pipeline and culture.

Thanks to both of you for reminders about T32s! Can't believe I didn't think of that earlier. Will definitely see what I can about different programs/people through that.

I believe WashU was 2nd back when I was interviewing for residency ~5 yrs ago. I know WashU also has some hybrid program for research in the middle of residency for OP if interested.

I'll have to look into that, thanks for letting me know! I wonder if they have a PSTP or if they're using the new R38 mechanism. @drg123 thanks to you as well for the suggestion. Hadn't thought much about the whole "shift work" aspect but it's definitely something I am going to keep in mind.

@IMGASMD to answer your question, I don't think I have the option of leaving for my PhD. My program is structured in a traditional 2-4-2 setup where I do 2 years medical school, then do a PhD, then MS3-4. Even though my institution doesn't really have much in terms of anesthesia research I'm in a pretty good spot with a solid mentor and a broadly applicable research focus/skillset. My mentor also tends to collaborate with MDs pretty aggressively, so there is room for me to nudge in a specialty-specific direction.

As far as what you said regarding not being able to do everything, I completely agree. The impression that I get from successful physician scientists I know is that they tend to subspecialize fairly heavily and carve out a niche, which I guess would reduce the number of skills that need to be maintained. I'm sure other people manage to succeed in different ways as well. Unfortunately just not enough hours in the day to be the best at everything, and I think that becomes more obvious when you look at MD/PhDs. Even just the 6 months since I finished MS2 have proven that point to me quite convincingly.

 

[Spacedman]

I agree with much of the comments so far.

1) what are some of the major research questions in anesthesia? Or what are the major challenges from a basic/translational science perspective?

Extending anesthesia outside the OR. Perioperative immunity and inflammation. Big data/closed claims/EMR perioperative outcomes research. Managing opioid use disorder. Mechanisms of chronic pain (our drugs are terrible generally). Prehabilitation. Mechanisms of general anesthesia. Postop cognitive dysfunction, delirium, predictive modeling based on intraop physiology. Ischemic preconditioning. Pharmacogenomics. Periop sleep disorders. Sleep/anesthesia physiology. Repurposing anesthetics as psychiatric drugs. Crisis management. Patient safety algorithms. ML/AI in the OR and ICU to predict organ dysfunction. Drug development - biased opioid agonists etc. Wearable sensor tech. Pediatric anesthetic neurotoxicity. That's a start. The problem in anesthesia is too much breadth - hard for one department to cover all the bases when periop medicine encompasses so much.

2a) which institutions are leaders in anesthesia research? I've heard Michigan is solid but that's about it.

If you want to finish residency and be 80/20, there are a handful of places. Here's a reasonable intro
Top institutions IMO that have the infrastructure to train basic/translational anesthesia scientists, meaning there's more than just a webpage and people have gone through a program successfully, in no particular order: Penn, Cornell, Columbia, Duke, MGH, Stanford, UCSF, Wash U, U Wash, U Mich. The list would be longer with purely clinical research. I'm being unfair to a lot of programs, but there are simply not a lot of places with the leadership, vision and (honestly) cash reserves to support physician scientists. There are surely some up and comers, but I don't know that I'd stake my future on a maybe if I were dead set on doing translational science 80/20 and drawing a competitive anesthesia salary. It's a money loser for any department to pay a full clinical salary to a 75-80% non clinical person while they scrounge for grants. And you would need 2-3 R01s to cover your salary. The department has to support the mission. As others have said, it's hard to convince an MD PhD to work for less so they can do research.

2b) do any of the anesthesia research powerhouses offer good clinical training as well? I've gotten the impression that for some fields you often get good research training or clinical training but not always both.

There is a nearly 90+% overlap between the research powerhouses and the top clinical training programs. Our residency, which has a strong research track, primarily selects candidates on clinical evals. Research cred may help but is not enough to get a residency spot.

3) for the handful of physician scientists in these parts, what are some of the challenges that are unique to MD/PhDs in anesthesia (as opposed to other fields)?

We don't have anesthesia "diseases" to build donor networks. There are a few excellent programs, and unfortunately support for this kind of thing falls off quickly outside the top institutions. On the other hand, if you succeed, it's easier to get visibility as a researcher in anesthesiology than in, say oncology or neurology.

PM me if interested to talk further.

 

[JoaoMoutinho]

I agree with much of the comments so far.



Extending anesthesia outside the OR. Perioperative immunity and inflammation. Big data/closed claims/EMR perioperative outcomes research. Managing opioid use disorder. Mechanisms of chronic pain (our drugs are terrible generally). Prehabilitation. Mechanisms of general anesthesia. Postop cognitive dysfunction, delirium, predictive modeling based on intraop physiology. Ischemic preconditioning. Pharmacogenomics. Periop sleep disorders. Sleep/anesthesia physiology. Repurposing anesthetics as psychiatric drugs. Crisis management. Patient safety algorithms. ML/AI in the OR and ICU to predict organ dysfunction. Drug development - biased opioid agonists etc. Wearable sensor tech. Pediatric anesthetic neurotoxicity. That's a start. The problem in anesthesia is too much breadth - hard for one department to cover all the bases when periop medicine encompasses so much.



If you want to finish residency and be 80/20, there are a handful of places. Here's a reasonable intro
Top institutions IMO that have the infrastructure to train basic/translational anesthesia scientists, meaning there's more than just a webpage and people have gone through a program successfully, in no particular order: Penn, Cornell, Columbia, Duke, MGH, Stanford, UCSF, Wash U, U Wash, U Mich. The list would be longer with purely clinical research. I'm being unfair to a lot of programs, but there are simply not a lot of places with the leadership, vision and (honestly) cash reserves to support physician scientists. There are surely some up and comers, but I don't know that I'd stake my future on a maybe if I were dead set on doing translational science 80/20 and drawing a competitive anesthesia salary. It's a money loser for any department to pay a full clinical salary to a 75-80% non clinical person while they scrounge for grants. And you would need 2-3 R01s to cover your salary. The department has to support the mission. As others have said, it's hard to convince an MD PhD to work for less so they can do research.



There is a nearly 90+% overlap between the research powerhouses and the top clinical training programs. Our residency, which has a strong research track, primarily selects candidates on clinical evals. Research cred may help but is not enough to get a residency spot.


We don't have anesthesia "diseases" to build donor networks. There are a few excellent programs, and unfortunately support for this kind of thing falls off quickly outside the top institutions. On the other hand, if you succeed, it's easier to get visibility as a researcher in anesthesiology than in, say oncology or neurology.

PM me if interested to talk further.

Sorry for the delayed response, got swamped in lab + distracted by holiday.

Thanks a ton for the insight! That website you linked was super helpful, and I think I've gotten some good leads for me to do some more digging. Will definitely send you a PM, and I may revive the thread in the future when I'm in a position to ask more informed questions.