Achieving equity for women in anesthesiology
Rebecca Margolis DO, FAOCA, Jennifer Lau, MD and Myron Yaster, MD
Over the past 2+ years of writing the PAADs, I’ve come to the belated realization that many of the movies that framed and defined my world view are unknown to many of you. In reading today’s article by Spitzer et al.1 in the International Anesthesiology Clinics I kept thinking of Ginger Rogers, who with her dance partner Fred Astaire, defined elegance, glitz, and the joy of movement and dance during the depression years of the 1930s. In light of today’s PAAD, it makes perfect sense that Fred got the lion’s share of the credit, even though Ginger did everything that Fred did but backwards and in high heels. For those unfortunate few of you who have never seen this pair and may have no idea of what I’m talking about, I am attaching a favorite video clip from their timeless classic Top Hat. Myron Yaster MD
Original article
Spitzer Y, Garcia-Marcinkiewicz AG, Malinzak EB. Programmatic approaches to achieving equity for women in anesthesiology. Int Anesthesiol Clin. 2023 Jan 1;61(1):42-48. PMID: 36374567
“Almost 40% of women physicians go part-time or leave medicine altogether within six years of completing their residencies.”2 This staggering loss of talent from reasons such as burnout, disillusionment, and family needs is a five-alarm fire in medicine and our specialty.. “Overworked, undervalued, harassed, and silenced. These are the sentiments of many women in anesthesiology. Many of the challenges encountered are synergized by a climate and culture that enable and fails to adequately address these issues. Gender disparities within anesthesiology exist because of systemic barriers and biases, limited number of women in anesthesiology leadership, and limited mentorship”.1
We’ve discussed many of the issues raised by Spitzer et al. in several previous PAADs including recruitment, retention, mentorship, sponsorship, coaching, and how to empower women in anesthesiology.3, 4 If these are issues that resonate with you and/or you’d like to know more about it this is a great foundational article to read.
This article brings up several issues that we cannot adequately cover in one PAAD. However, in today’s PAAD we want to discuss one in particular: “anesthesiologists and pregnancy”. Spitzer et al. open this discussion as follows: “Pregnancy and motherhood have a tremendous impact on sex discrimination in anesthesiology.5 A woman’s peak fertility often coincides with residency training and early career, a time when one’s career trajectory becomes established. This is also the time when the sex gap in academic promotion and productivity widens”.1 While the biologic timing of parenthood is not within our control, the culture we create in regards to parenthood, and in particular motherhood, is something we DO have power over and it is here that we as a specialty have failed our mothers.
“Sixty percent of anesthesiology residents reported a negative stigma around being pregnant and having children during training, and about half of trainees reported feeling discouraged from becoming pregnant or breastfeeding during training. Difficulties faced by women who are pregnant during training include inadequate maternity leave, insufficient access to lactation facilities at work, and negative culture surrounding pregnancy during training. Because of obstacles pertaining to motherhood, 1 in 10 female anesthesiologists would counsel a student against a career in anesthesiology”.1, 6 In a period of time where the demand for anesthesiologists is high, this is terrible.
“Given the negative stigma associated with pregnancy in residency training, many women delay pregnancy until their early career, which typically occurs in the early 30s, leading to a higher likelihood of infertility. Infertility can lead to substantial depression, anxiety, burnout, and family planning regrets”.1 It also leads to the need for very expensive fertility therapies that are often not covered by insurance. “Contributing factors to the high rate of infertility among women in medicine may include stressors intrinsic to training, long hours, and night shifts”.7
The authors continue: “Women anesthesiologists are also more likely to have pregnancy complications and miscarriages than the general population”.1 There is a higher incidence of spontaneous abortion, premature labor, preeclampsia, and babies requiring NICU care. We have no idea if the partners of male anesthesiologist’s have similar issues. Finally, Spitzer et al.1 point out that women anesthesiologists cannot work remotely postpartum to ease the transition back to work and face the added challenge of maintaining lactation in the perioperative setting. Many practices do not have convenient lactation facilities, and many do not provide sufficient break time and adequate relief staff to make pumping possible.
The good news is that we can we do things to make this better. Adequate and compensated parental leave, accessible lactation facilities and breaks to use them, mentorship to navigate parenthood and keep talented physicians in the specialty (mothers AND fathers!). We must ask ourselves if we value the women in our specialty? Also do we value parents in our specialty because one could make the argument that fathers feel many of these stresses too. If the answer is yes, then we must look at if our lack of support is because we cannot or if we choose not to change.
We and several others (Drs. Norah Janosy, Kim Strupp, Lynne Ferrari, Susan Nicolson, Peggy McNaull, Laura Berenstain, Lindsey Loveland Baptist, Linda Hertzberg) have been pleading with the leadership of SPA to survey our Society to study these issues more fully without success. If you agree with us that this is important, please reach out to SPA leadership to get this done.
ASA Statement on Lactation Among Anesthesia Clinicians
References
1. Spitzer Y, Garcia-Marcinkiewicz AG, Malinzak EB. Programmatic approaches to achieving equity for women in anesthesiology. International anesthesiology clinics. Jan 1 2023;61(1):42-48. doi:10.1097/aia.0000000000000388
2. Paturel A. Why women leave medicine. Accessed 02/15/2023, https://www.aamc.org/news-insights/why-women-leave-medicine
3. Schwartz JM, Wittkugel E, Markowitz SD, Lee JK, Deutsch N. Coaching for the pediatric anesthesiologist: Becoming our best selves. Paediatric anaesthesia. Jan 2021;31(1):85-91. doi:10.1111/pan.14041
4. Schwartz JM, Markowitz SD, Yanofsky SD, et al. Empowering Women as Leaders in Pediatric Anesthesiology: Methodology, Lessons, and Early Outcomes of a National Initiative. Anesthesia and analgesia. Dec 1 2021;133(6):1497-1509. doi:10.1213/ane.0000000000005740
5. Adesoye T, Mangurian C, Choo EK, Girgis C, Sabry-Elnaggar H, Linos E. Perceived Discrimination Experienced by Physician Mothers and Desired Workplace Changes: A Cross-sectional Survey. JAMA internal medicine. Jul 1 2017;177(7):1033-1036. doi:10.1001/jamainternmed.2017.1394
6. Kraus MB, Dexter F, Patel PV, et al. Motherhood and Anesthesiology: A Survey of the American Society of Anesthesiologists. Anesthesia and analgesia. May 2020;130(5):1296-1302. doi:10.1213/ane.0000000000004615
7. Kaye EC. One in Four - The Importance of Comprehensive Fertility Benefits for the Medical Workforce. The New England journal of medicine. Apr 16 2020;382(16):1491-1493. doi:10.1056/NEJMp1915331