In Reply:-Drs. Wu, Yang, and Ward conclude that there is an apparent relationship between NIH support for research and success in the recruitment of applicants into anesthesiology training programs. I share their interest in this relationship and offer three caveats regarding the relationship. The first involves the applicability of the NRMP data. Typically, only about one half of all residents enter anesthesiology through the NRMP mechanism, presumably because participation in the NRMP match is required only for medical students, but not for physicians who may enter the CA1 year independently. Thus, the sample data represent only a fraction of the total recruitment into the training programs.

Second, whether the apparent association is causal or casual is a matter of conjecture, as the authors indicate. Career choice is influenced by a number of motivational factors, ranging from the pure (e.g., altruism, intellectual curiosity, etc.) to the practical (e.g., financial security, prestige, etc.), and motivational factors are notoriously difficult to define accurately.

Finally, the type of research scientist may be a more important factor than the total research support. High NIH rankings achieved by nonclincians who have little involvement with clinical faculty and residents may be of limited benefit to resident education, whereas clinician-scientists may have profound influences on graduate medical education. Clinician-scientists are best prepared to bring bench discoveries to the bedside (or OR table), and often they emphasize the importance of critical thinking, not clinical dogma, as the basis of quality medical practice. Further, they are excellent role models for medical students who are evaluating the merits of the various medical specialties, especially when these clinician-scientists have early and continued contact with medical students throughout the curriculum.

Above all, these authors lend additional support to the view that continued accomplishment in all domains, including research accomplishment, will be required to attract the superior applicants into anesthesiology in general, and to specific programs in particular.

David E. Longnecker, M.D.

Robert D. Dripps Professor and Chair; Department of Anesthesia; University of Pennsylvania Health System; 4 North Dulles Building; 3400 Spruce Street; Philadelphia, Pennsylvania 19104–4283

(Accepted for publication April 24, 1997.)