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Letters to the Editor
August 2002

In reply

Arch Otolaryngol Head Neck Surg. 2002;128(8):982-983. doi:

Dr Koempel's letter points to several problems associated with research in academic otolaryngology programs. First, he highlights the massive average debt incurred by graduating medical students, which imposes enormous pressures on decisions about the length of training. The National Institutes of Health has recognized this obstacle and offered to repay $35 000 of medical student loans for students participating in 2 years of research training. The money is not taxed as income, and it retires debt, reducing the accumulation of interest and increasing the monetary effect of this repayment. Thus, the federal government has already recognized and taken action to deal with this problem.

A second problem relates to fellowships currently offered in otolaryngology. Do these fellowships prepare their graduates for a clinical job, a career in research, or both? The lack of preliminary data obtained during fellowship training makes the aspiring new faculty member in academic medicine less competitive for outside funding. This, in turn, transfers the burden of support for the new faculty member from external sources to the academic department. Success with outside funding to protect time spent in research would have eased the dilemma for Dr Koempel and his current employer. The National Institutes of Health has multiple mechanisms that support budding investigators, as do the Academy and most academic institutions. Thus, the chances of obtaining external funding are not bleak if one is equipped with adequate training and some preliminary data acquired during a fellowship.

While startup funds from academic departments are useful, they can only be a beginning. First, competition and outside peer review strengthen one's research skills. Second, most departments are not wealthy enough to set aside ongoing individual funding for research, especially in these times of declining clinical reimbursement. If young faculty members assume that their salaries should be equivalent to those working full time clinically, additional issues are raised. Should full-time clinicians within the department be taxed (ie, their salaries reduced) to support the efforts of those interested in research? Can the average clinical faculty of 8 support a new faculty member's research effort? What percentage of the young faculty member's research efforts can be supported, and for how long? Will this strategy produce clinicians who devote part of their career to research and who will subsequently obtain outside funding? How do the rewards of a successful research career balance the monetary rewards of a successful clinical practice?

I applaud the Academy's efforts to endow research funds. While this adds to the amount of funds currently available, I do not think it solves the problem. Otolaryngologists need to think outside the box and look to new solutions. Would Dr Koempel advise medical students that the path to a successful academic career is a residency followed by a clinical fellowship and that a research career will start with the gift of protected time and startup funds from his or her future employer?

Money is important, but research starts with the fire within. Innate curiosity forces one to ask questions. Seeking the answers to these questions requires knowledge of the scientific method, something not learned as a 10% hobby or a 4-month research rotation within residency training. We must encourage at least some future academic otolaryngologists to prepare in new ways: novel for our specialty, but not new to academic medicine. Financial sacrifices clearly create an obstacle, and current and future leaders must work to reduce them, but the solution involves more than just time, material, and space.