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The canary is dead

2003; Wiley; Volume: 58; Issue: 9 Linguagem: Inglês

10.1046/j.1365-2044.2003.03362_2.x

1365-2044

Roberta Jackson, Jon Stamford, L. Strunin,

Sepsis Diagnosis and Treatment

In bygone days there was a serious hazard in mining coal: explosion. Gas would be ignited by the lamps miners carried, and the ensuing explosion would generally carry them to an early meeting with their maker. Miners soon learnt to take canaries into the mines with them, the sensitivity of the birds to low levels of gas providing an early warning system. A lifeless bird on the cage floor was a clear signal that explosion was imminent and the miners could take action. Sometimes they did not spot the dead bird until too late, and were caught anyway. Professor Harmer's recent editorial on the current state of academic anaesthesia (Harmer. Anaesthesia 2002; 57: 733–5) can be seen as a look at the cage. We are sad to report that the first canary is on the floor of its cage, and the explosion of academic anaesthesia looms. The canary in question is our own department, dismantled by its parent medical school as part of a restructuring exercise in response to the 2001 Research Assessment Exercise (RAE). The belated realignment by HEFCE of its funding assignment algorithm meant that the medical school, instead of looking forward to an anticipated 40% increase in its funding allocation, suddenly found its budget cut by more than a third. Faced with an instant four and a half million pound funding shortfall, the school was forced to shed several academic departments, anaesthesia among them. But is this a purely local disaster or can we draw a wider lesson from this outcome for anaesthesia as an academic discipline? Firstly, it is worth saying that the RAE, as an instrument, is almost tailor-made to penalise clinical specialties. These are not recognised individually but are submitted for RAE scrutiny under broader banners (clinical lab science, hospital-based subjects, etc.). In our case, the laboratory and clinical sides of the department's output were split and the output rating thus diluted. Second, and this is a problem for many clinical subjects, there is the difficulty of balancing clinical commitments with research interests. There is no longer any room for those academics who were able to reconcile a clinical caseload with the chance to do some research ‘on the side’. The RAE takes little account of the modest proportion of time available to clinicians for research – unless they can produce their four papers in highly ranked journals, it is probably better that they do no research at all. Then they do not dilute the efforts of others. Fundamentally, we are governed by a system in which part-time research is actively discouraged. The days of the gentleman scientist are probably gone for good. The third factor, as Professor Harmer noted, is the lack of grant income. Anaesthesia is widely held, and not just by anaesthetists, to be an area that rarely attracts major research council funding. Ultimately, this becomes a self-fulfilling prophecy: departments without serious grant support are not considered to be doing serious research. In turn, departments that are not thought to do serious research do not receive serious funding. This is a very difficult cycle to break. At least one of us has been advised by a senior officer of a research charity (off the record) that, if one wanted to secure major grant income, a change of address would be prudent; pragmatic advice perhaps but still rather dispiriting. Academic anaesthesia has always struggled to do meaningful research in the face of scientific prejudices. The restructuring of medical training in the 1990s has meant that few young doctors are prepared to press the pause button on their careers in order to do research. The loss of these research fellows has hit academic anaesthesia particularly hard. Sadly, what Calman started, the RAE looks like finishing. The main result of a loss of academic anaesthesia is the loss of academic anaesthetists with its attendant implications for teaching. As Professor Harmer notes, anaesthetists are uniquely qualified to provide some essential portions of the undergraduate curriculum. However, the new consultant contract ties many down to their clinical sessions. Little mention of teaching is made, let alone reward guaranteed. This medical school is currently ‘re-badging’ many of its clinical academics to the NHS but already expects them, optimistically, to continue to teach for no reward. Perhaps the privilege of teaching is reward enough? There is no reason to assume that this scenario will not be repeated by other medical schools as they attempt to sort out their funding issues. Ultimately, the outcome may be doctors who have difficulty in recognizing the ill patient and how to care for them as a consequence of a lack of knowledge of anaesthesia, critical care and pain management. Be afraid. Be very afraid. It is clear that academic anaesthesia is losing out in the battle for funding, and thus for survival. Perhaps there needs to be a change in the paradigm in which we work. One solution might be to grasp the nettle ourselves, and take it away from the medical schools. We already have a national structure of schools of anaesthesia co-ordinated by and receiving legitimacy from our Royal College, and there is no reason that they could not expand to take up the load, with consequent benefits to all concerned. Funding would have to be sourced, possibly from central government, but it would ensure the future as outlined above. It might even be possible to persuade the NHS to contribute. After all, it has a vested interest: many modern anaesthetic-led developments tend to shorten expensive intensive care and hospital stays, thus saving the health service money. A good example that has emerged from our department (among a number of places) in recent years is the patient-at-risk concept [1]. This canary is dead. The speciality must decide on action, and quickly lest it be caught in the explosion.