tions on optimizing the management of patients before their disease is clearly identified.

In Lewis’s opinion, there are three regulatory barriers that can hinder emergency care research. “First, under current rules there are many circumstances in which informed consent cannot be appropriately obtained,” he said. “Appropriate consent strategies that will allow investigation of better treatments for those patients are needed. Second, the federalwide assurance program is a significant barrier to prehospital research because it limits participation of community hospitals and smaller EMS [emergency medical services] agencies. We need them for reliable outcomes data. Third, HIPAA [Health Insurance Portability and Accountability Act] regulations are clearly a barrier to much of the health services and outcomes research we need to truly determine the effectiveness of emergency care interventions.”


Jerry Jurkovich, chief of trauma and surgical critical care at Harborview Medical Center and president of the American Association for the Surgery of Trauma, said there is a crisis in U.S. emergency care, as was well documented in the 2006 Institute of Medicine (IOM) reports. Some solutions will be found in better research on how to provide emergency care. There are barriers to advancing this research, however, and these fall under the headings of time, treasure, and topics (Jurkovich was quick to add that it is not due to a lack of talent). With respect to research topics, as mentioned above, emergency and trauma care don’t fit neatly within the disciplinary lines established by the NIH, Agency for Healthcare Research and Quality (AHRQ), and Centers for Disease Control and Prevention (CDC). Some new thinking is needed about how to address this issue. Time and treasure also pose substantial barriers. Jurkovich said time for surgical investigation is hard to come by. Schools and deans depend on surgical income and they lose money when surgeons take time out to do research. Although trauma is the leading cause of death among people aged 1–44, little federal funding goes to research in this area.

NIH salary caps are about 50 percent less than the average academic surgeon makes, which is already 25 percent less than the practicing surgeon makes. The salary cap for federal funds is currently $196,000. “Coincidentally, the average salary for a full-time academician in medicine is $196,000,” Jurkovich said. “I don’t mean to imply—I mean to state directly—that the federal funds are tied to medicine, not to surgery.” He said medicine, pediatrics, and pathology all fall within or under the salary cap, but no other disciplines do, not obstetrics and gynecology, not surgery, not emergency medicine, not radiology. The average salary for a mid-level academic general surgeon is about $298,000. So departments must make up the difference.

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