Broken pipes

Myron Yaster

Olubukola O Nafiu, Aleda M Leis, Wendy Wang, Matthew Wixson, Lara Zisblatt.  Racial, Ethnic, and Gender Diversity in Pediatric Anesthesiology Fellowship and Anesthesiology Residency Programs in the United States: Small Reservoir, Leaky Pipeline.  Anesth Analg  2020 Oct;131(4):1201-1209. PMID: 32925341

Look, there’s no way around it, the last 18 months have been hellacious.  With the conviction of Derek Chauvin in the very public 9 and a half plus minute execution of George Floyd almost one year ago there was a collective, national sigh of relief.  But should there have been?  Racism, subtle, overt, long-standing, structural has been the “original sin” of America since the time of the founding fathers. (as an aside, while on vacation, I finished reading Ron Chernow’s biography of Alexander Hamilton…if you haven’t read it, run, and I do mean run and get it or download it asap! Everything we’ve been experiencing is really nothing new and has been a current in American politics from the beginning).  As pediatric anesthesiologists we think of ourselves as being above all of this, enlightened, caring yada yada…indeed, if anything we are “anti-racists”…but are we?

This paper by Nafiu et al. is really a call to arms and action.  Their study reveals an unsettling truth, namely, as a profession, we’ve made tremendous strides in fixing gender diversity and increasing Asian Americans into our practices, but have done a terrible, piss poor job of training and recruiting black, Hispanic, and Native American trainees.  In my former practice (Colorado), there are virtually no black housestaff, fellows, or attendings…nada…zero! Nationally the numbers revealed in this paper are simply startling (< 5%) and have not really changed in decades.  Magnifying the issue is that more than half of the children born in the US are now from ethnic minority groups.  To the best of my knowledge this is the first publication that has addressed ethnic and diversity in anesthesiology training programs (if the pipeline is broken or leaky fixing the workforce will be difficult or impossible).

This paper is really a call to action.  The pipeline from high school to college to medical school is simply broken.  The Society for Pediatric Anesthesia has recently formed a Diversity and Inclusion committee and has had spectacular success with its Women Empowerment and Leadership Initiative (WELI) (thank you Jenny, Nina, Jamie, and others!).  Perhaps the WELI model should be expanded or remodeled for under-represented minorities as an urgent step forward.  Finally, we shouldn’t be waiting for another 10 or 20 years to address this.  Perhaps our leaders and departments need to be judged on how well they recruit underrepresented minorities as well as by how many NIH grants and papers they publish in journals.  Myron Yaster MD