To the Editor:-We read with great interest Dr. Longnecker's Rovenstine Lecture ("Navigation in Uncharted Waters: Is Anesthesiology on Course for the 21st Century?") on his vision of the future of anesthesiology.  We were especially interested in his comments on the decline in the number of American medical school graduates (AMG) entering anesthesiology and the response by the academic programs to this decline.
The recent decline in the number of American medical school students pursuing anesthesiology as a career through the National Residency Matching Program (NRMP) has been well documented.  Current medical students may be discouraged from anesthesiology as a career because of a perceived lack of postgraduate practice opportunities as publicized in recent articles and the lay press. [3,4]
Although the decline in the number of AMGs has resulted in difficult adjustments for many academic programs, it is important that we continue our efforts to attract the best and brightest medical students as future leaders for our specialty. By maintaining and expanding the commitment of high quality anesthesiology departments to continued excellence in clinical care and research and active medical student education programs, our specialty should be able to recruit the best medical students into anesthesiology. [5,6]
Benefits may arise from departmental efforts in producing high quality research and obtaining extramural funding (e.g., NIH grants). Among the many factors that may attract an applicant to apply, interview, and match to a program, the “prestige” or “reputation” of a program is significantly more important to prospective anesthesiology than nonanesthesiology residents.  Research activity (grossly reflected by the amount of NIH funding) is an important contribution to the “reputation” of a program.
We compared the relationship between NIH funding and the percentage of residents matched through the NRMP from 1993 to 1995 (Table 1). During this period, total NIH funding awarded to departments of anesthesiology around the country held steady with 169 grants awarded to 43 different institutions for a total of 33.7 million dollars in 1995. The top 20 anesthesiology programs in terms of NIH funding had a much higher percentage of residents matched when compared with the average of all anesthesiology programs. Even programs with some NIH funding did better than the average. Figure 1shows this relationship in a graph form.
One should not conclude that increasing the amount of NIH funding or research at a program will automatically lead to an increase in residents matched. There are limitations in our analysis that could not account for factors such as self-limitation of the number of NRMP positions available (thus resulting in a higher percentage of applicants matched). In addition, prospective residents are more concerned about the diversity of training, house officer satisfaction, and didactics than the “prestige” of a program.  However, an increase in NIH funding may lead to an increase in “reputation” and visibility to medical students and their advisors. This may be especially important in a smaller pool of high quality applicants who may be applying to fewer programs.
As we point out, academic programs that maintain a high level of academic quality (as measured by the amount of NIH funding in this case) may attract a higher percentage of AMGS through the NRMP. Furthermore, as Dr. Longnecker mentions, several ways that academic programs are responding to the declining number of AMGs entering anesthesiology may have long-term detrimental consequences.  Despite difficult times, academic programs should resist curtailment of research and clinical commitments to ensure the future of our specialty.
Christopher L. Wu, M.D.
Assistant Professor of Anesthesiology
Jay Yang, M.D., Ph.D.
Associate Professor of Anesthesiology, Pharmacology and Physiology
Denham S. Ward, M.D., Ph.D.
Professor and Chairman; University of Rochester School of Medicine and Dentistry; Department of Anesthesiology, Box 604; University of Rochester Medical Center; 601 Elmwood Avenue; Rochester, New York 14642
(Accepted for publication April 24, 1997.)