At its core, anesthesiology is a clinical specialty dedicated to understanding, optimizing, and preserving the fundamental tenets of life. As physicians, we routinely assume responsibility for ventilatory support, improve oxygenation, and augment hemodynamic parameters, all while suppressing memory formation, blocking perception, and combatting pain. Though most clinicians do not consider themselves scientists, the truth is that anesthesiologists constantly utilize the scientific method. We form hypotheses about what may ail our patients in the ORs, ICUs, and pain clinics; we rapidly intervene using a robust pharmacologic armamentarium; and we verify (or refute) our ideas about the patient’s underlying pathophysiology.

Anesthesiology has a storied history of scientific discovery. In fact, in their review at the turn of the millennium, the editors of the New England Journal of Medicine recognized the development of anesthetics as one of humankind’s greatest breakthroughs (N Engl J Med 2000;342:448). Our specialty has laid the foundations for modern intensive care, cemented in part by Dr. John Severinghaus’ engineering of pO2 and pCO2 electrodes and blood gas analyses, and by Dr. Peter Safar’s development of modern cardiopulmonary resuscitation, which has enabled survival of gravely ill patients in need of critical care services (Anesth Analg 2015;120:663-70). Seminal publications by Dr. Henry Beecher set the standard for ethics in clinical research and remain as important today as they were more than a half century ago.

“Today, we find ourselves at a critical junction. Workforce shortages place immense strain on anesthesiology across the country and threaten the health of our specialty’s research.”

Further building on anesthesiology’s history of scientific commitment and excellence, the Multicenter Perioperative Outcomes Group (MPOG) was established 15 years ago as a visionary big data repository. Today, the MPOG consortium has grown to include more than 100 investigators from more than 50 hospitals across 20 states. It houses perioperative data drawn from 28 million cases containing 63 billion physiologic observations and nearly 500 million medication records. MPOG has facilitated novel retrospective as well as prospective clinical research designed to improve patient care and provide robust feedback to clinicians. It serves as a testament to anesthesiology’s living legacy to enhance patient safety.

Today, we find ourselves at a critical junction. Workforce shortages place immense strain on anesthesiology across the country and threaten the health of our specialty’s research. It is therefore more important than ever to define and advocate for anesthesiology’s moonshot. Fundamental questions remain unanswered, which anesthesiology is ideally positioned to address. These questions include insights into the nature of consciousness itself, into the fabric of memory, and into the neuropsychiatric illnesses where general anesthetics have an increasingly recognized ability to reset ailing brains. Anesthesiology has additional opportunities to lead in the scientific discovery of nonaddictive and novel analgesics that are devoid of opioid-agonist activity, which could combat pain in entirely new ways. Anesthesiology could be developing new therapies to induce hibernation-like states that slow metabolism and consequently circumvent otherwise irreversible ischemic damage – protecting the brain in the setting of a stroke, the heart in the setting of an MI, donor organs prior to transplant surgery, and all vulnerable tissues in the setting of polytrauma.

Discovery and innovation are crucial to advancing anesthesiology, and fundamental insights in basic science and clinical and translational research can be aided through advocacy. Mirroring how anesthesiology itself continues to grow and change, the physician’s role has similarly expanded beyond one-on-one patient interactions to address shared issues. The Rally for Medical Research in Washington, D.C. is one forum through which the Anesthesia Research Council (ARC), ASA, and FAER have gained the ear of policymakers to emphasize the importance of funding for medical research and for the National Institutes of Health to address key issues affecting our patients. This fall, FAER collaborated with the National Academy of Medicine (NAM) to appoint an early-career anesthesiology scholar as the first-ever FAER NAM Fellow. This Fellow will work with the National Academies of Science, Engineering, and Medicine and will participate in public policy alongside National Academy members.

Recent experiences in Washington, D.C. this past May have underscored the importance of physician advocacy, particularly for anesthesiologists (Thorac Surg Clin 2024;34:77-84). During the 2024 ASA LEGISLATIVE CONFERENCE, the society advocated for three primary issues critical to our specialty: opposing the weakening of Veterans’ health care standards, holding health insurance companies accountable, and expanding access to naloxone. While these efforts are crucial to ensuring that today’s patient needs are met, the future of our specialty hinges on addressing multiple concerns and ensuring that we, as advocates, are present to champion the future of anesthesiology in research. Our advocacy efforts, reinforced by the knowledge gained from the ASA LEGISLATIVE CONFERENCE, should be directed toward advocating for a future where anesthesiology continues to thrive and innovate.

Just as research is vital for the advancement of anesthesiology as a specialty, physicians play an integral role in contributing to efforts to improve health care in our society. However, this can only happen if physicians are active in the policymaking process through legislative bodies advocating for our patients’ basic science and clinical needs. Evolving trends in health care necessitate a broader role for physicians. We must step beyond the limits of the traditional physician-patient relationship and embrace our roles as advocates for systemic improvements and scientific discovery. Through advocacy, education, and a commitment to a shared value in improving the care we provide today and tomorrow, we can navigate the complexities of modern health care and ensure that we continue to provide the highest quality care to our patients today and into the future.