It’s déjà vu all over again or maybe not!
Myron Yaster MD, Jamie McElrath Schwartz MD, and Allison Fernandez MD
In today’s PAAD we will be reviewing an editorial1 and an original article2 on gender equity and representation of women in leadership positions in medicine and anesthesiology. Before throwing your coffee cup (or a brick) at your computer screen and thinking in the immortal words of Yogi Berra, “it’s déjà vu all over again”, the results of today’s article are surprising and a great relief. Harbell et al. found that women in Anesthesiology and “particularly in the Society for Pediatric Anesthesia (SPA) and the Society for Obstetric Anesthesia and Perinatology (SOAP) had a significantly higher proportion of women leaders as compared to their number of women members. Importantly, the authors found a statistically significant increase in the percentage of women presidents over a 40-year period.”2
Wow! I think the findings and editorial are both unexpected and sensational. How did this change happen, particularly in pediatric anesthesia? I think there are some obvious answers (WELI) 3-5 that were missed in the editorial and can be summed up by a famous quotation from Abe Lincoln: “The most reliable way to predict the future is to create it”. Myron Yaster MD
Editorial
Malinzak EB, Huffmyer JL. Leadership in Anesthesiology: Striving for Equity, Maintaining Momentum. Anesth Analg. 2023 Dec 1;137(6):1167-1170. doi: 10.1213/ANE.0000000000006576. Epub 2023 Nov 16. PMID: 37973131.
Original article
Harbell MW, McMullen KB, Kosiorek H, Kraus MB. Women Representation in Anesthesiology Society Leadership Positions. Anesth Analg. 2023 Dec 1;137(6):1171-1178. doi: 10.1213/ANE.0000000000006465. Epub 2023 Apr 3. PMID: 37010958.
It is an all too familiar refrain: “There have been equivalent numbers of men and women enrolled in medical school for over 20 years, yet women in medicine remain underrepresented in leadership.”1,6 What constitutes leadership? Harbell et al. “examined the percentage of women holding professional society leadership positions in 13 anesthesiology societies in 2021. Society leadership positions comprehensively included presidents, vice presidents and/or presidents-elect, immediate past presidents, secretaries, treasurers, assistant secretaries/treasurers, board of directors, council members, and committee chairs.”1,2 They then compared their findings to the percentage of women anesthesiologists in the workforce.
“A total of 13 societies were included in this study: Association of Anesthesia Clinical Directors (AACD), ASA, American Society of Regional Anesthesia and Pain Medicine (ASRA), Association of University Anesthesiologists (AUA), Society of Academic Associations of Anesthesiology and Perioperative Medicine (SAAAPM), Society for Ambulatory Anesthesia (SAMBA), Society of Cardiovascular Anesthesiologists (SCA), Society for Education in Anesthesia (SEA), Society for Neuroscience in Anesthesiology and Critical Care (SNACC), Society for Obstetric Anesthesia and Perinatology (SOAP), Society for Critical Care Anesthesiologists (SOCCA), Society for Pediatric Anesthesia (SPA), and Trauma Anesthesiology Society (TAS).”2
“Overall, women held 32.6% (189/580) of all anesthesiology society leadership positions in 2021. Women consisted of 38.5% (5/13) of presidents, 17.6% (3/17) of presidents-elect/vice presidents, and 45% of secretaries/treasurers (9/20). The board of directors/council members composed of 30.0% (91/303) women, and 34.2% (90/263) of committee chairs were women (Table 1 in the paper). The percentage of women holding society leadership positions was significantly greater than the percentage of women anesthesiologists in the workforce (P < .001), as was the percentage of women as committee chairs (P = .003).”2
Harbell et al. found that “overall, women held 33% of leadership positions, which is greater than the proportion of women anesthesiologists in the workforce (26%). This percentage is also greater than the proportion of women leadership in the 30 major medical specialty societies (25.2% in 2008–2015.”2 “However, the Society of Cardiovascular Anesthesiologists had a significantly higher percentage of women society leaders than women members. Further exploration of this society, its culture, and what initiatives have been used to encourage women in leadership is needed.”2 The Society for Pediatric Anesthesia had the highest percentage of woman leaders (47.6%) and highest percentage of women as active members (52.7%). The Society for Obstetric Anesthesia and Perinatology (SOAP) also falls in the top 5 highest percent women leaders (38.9%). Pediatric and obstetric anesthesiology tend to have higher proportions of women anesthesiologists, and these subspecialities may have reached a critical mass enabling more women to obtain leadership roles.”2
Harbell et al. and Malinzak suggest that success in achieving anesthesiology leadership roles in certain areas “may stem from having a high proportion of women anesthesiologists in those subspecialties.” We disagree! We see growth of women’s leadership as an intentional effort, with SPA leading the way.
Since 2019, SPA has set in motion a deliberate plan to improve the women’s leadership pipeline through the formation of the Women’s Empowerment and Leadership Initiative (WELI).3-5 We’ve discussed WELI in several previous PAADs. In essence: “The WELI program encompasses 6 domains: (1) promotion and leadership, (2) networking, (3) conceptualization and completion of projects, (4) mentoring, (5) career satisfaction, and (6) sense of well-being. These domains are supported by activities intended to foster connections, provide leadership and career development education, disseminate information, assist with goal setting, and improve mindfulness and well-being.”4 Indeed, many of the proposals to level the playing field and presented by Mainzak and Harbell et al. in their editorial and paper, such as improving mentorship and sponsorship, are exactly what WELI does and explains why SPA has been so successful. Similarly, the SCA has a Women in Cardiothoracic Anesthesia (WICTA) Special Interest Group. The purpose of this group is to provide networking and support of women via sponsorship, networking, mentorship, research grants and education. (https://scahq.org/membership/wicta/) . Academic institutions and other societies including the ASA should use initiatives like WICTA and WELI as a blueprint to improve the pipeline of women leaders.
Today’s editorial and original article are affirmations of the great strides and accomplishments of SPA and WELI. If you’ve been a WELI participant and would like to share your experiences or if you have any other thoughts about today’s PAAD, send to Myron who will post in a Friday reader’s response.
References
1. Malinzak EB, Huffmyer JL: Leadership in Anesthesiology: Striving for Equity, Maintaining Momentum. Anesth Analg 2023; 137: 1167-1170
2. Harbell MW, McMullen KB, Kosiorek H, Kraus MB: Women Representation in Anesthesiology Society Leadership Positions. Anesth Analg 2023; 137: 1171-1178
3. Schwartz JM, Wittkugel E, Markowitz SD, Lee JK, Deutsch N: Coaching for the pediatric anesthesiologist: Becoming our best selves. Paediatr Anaesth 2021; 31: 85-91
4. Schwartz JM, Markowitz SD, Yanofsky SD, Tackett S, Berenstain LK, Schwartz LI, Flick R, Heitmiller E, Fiadjoe J, Lee HH, Honkanen A, Malviya S, Cladis FP, Lee JK, Deutsch N: Empowering Women as Leaders in Pediatric Anesthesiology: Methodology, Lessons, and Early Outcomes of a National Initiative. Anesth Analg 2021; 133: 1497-1509
5. Margolis RD, Berenstain LK, Janosy N, Yanofsky S, Tackett S, Schwartz JM, Lee JK, Deutsch N, Sinskey JL: Grow and Advance through Intentional Networking: A pilot program to foster connections within the Women's Empowerment and Leadership Initiative in the Society for Pediatric Anesthesia. Paediatr Anaesth 2021; 31: 944-952
6. Nonnemaker L: Women physicians in academic medicine: new insights from cohort studies. N Engl J Med 2000; 342: 399-405