From Elizabeth Malinzak MD Duke University, Immediate Past President, Women in Anesthesiology.
Thank you so much for the kind editorial on our article, “Programmatic approaches to achieving equity for women in anesthesiology” as the Pediatric Anesthesia Article of the Day. We are happy that our article is getting noticed! I am also really thrilled that you put a link to the ASA Statement on Lactation Among Anesthesia Clinicians, as I authored that statement and ushered it through the ASA House of Delegates—it is one of my most proud achievements.
The three of us, and several other women anesthesiologists and representatives of Women in Anesthesiology, are working on a Best Practices for Lactation document to assist anesthesiology practices.
Working to achieve better culture and environments for anesthesiologists who become parents (especially women) has been my passion work in my academic career, and one of my areas of expertise. I am happy to assist SPA in any way with this, as I’m sure Annery, as a fellow SPA member, is as well.
Thank you again for highlighting the article!
From Anonymous
I just wanted to email and say how grateful I am to see your recent email regarding sex discrimination with women anesthesiologists. I’d like to remain anonymous, but wanted to tell you my story. I’m a current peds fellow and have done all my training through a large program which is almost nearly all men. I had my first child at the beginning of my CAX year (from Myron: I’ve removed the location and her CA year to protect her identity). I had asked for a dosimetry badge during my pregnancy which was met with hostility, contempt, anger, and disdain. A program wide email was sent out discussing how concerns about radiation and pregnancy are unfounded. The program refused to provide one for me, so I asked them to keep me out of radiation cases since we have nearly 100 residents and it shouldn’t have been an issue. I was then told (by my female PD), that I was using my pregnancy as an excuse not to work. I was also told by her that if I didn’t start getting along with people, that the program would make sure I had a hard time getting a job in the area. Well about a couple months ago, my peds program (also associated with the larger adult group), gave me a 50/50 peds adult offer as well as my other cofellows. No contracts were signed at the time but the understanding was a 50/50 offer for all of us. They then just recently decided to nix that (didn’t tell the fellows) and then reoffered 3 fellows 100% peds behind our backs. I unfortunately wasn’t one of them, so I am currently scrambling for a job out of state. When I asked why I wasn’t chosen, I was told that I had made a bad first impression as a resident. I have not reported any of what happened to me as a resident to the university or the new chair, but I do have everything documented.
I also was told as a resident when I was 4 months postpartum that I would not be receiving a pump break during the evening and that I should switch to formula to make my life easier (this was at the peds hospital i am now doing my fellowship in). This was before the
formula shortage and I still get chills thinking about if I had allowed them to bully me into abandoning my lactation goals for my child.
As a group we need to be having these discussions, and I applaud you for bringing this to the attention of the PAAD readers. It was really great for me to see that this isn’t an isolated incident and that I’m not alone. I’ve definitely felt like a bad resident and person over all of this.
Please let me know if you have any advice. I haven’t really known what to do about this but I do want to make things better for the women ahead of me. I most certainly have thought about working part time and also certainly thought about leaving anesthesia all together.
From Jerry Parness MD COMMA retired
Myron, this is a favorite topic of mine, and not just because women are relegated to second place status in medicine (and other professions, as well). I always used to say that medicine and science (research), which are endeavors designed to increase the health and well being of our patients, yet exclude its practitioners (male and female) from that dictum. The requirements of subject matter/learning and apprenticeship (read internship/resdency/fellowship) are so institutionally great, that any concerns beyond training and clinical practice, and/or subsequent successful scientific research, are structurally thrown out the window. I still remember when, as a medical student, I was approached by the surgical residency director about going into surgery. I thought about it for maybe ten seconds... Sabastin, at Duke, who wrote the textbook on General Surgery, used to boast- BOAST - that by middle of residency over 50% of his residents (almost all male) were divorced, and by the end of residency even more were. Surgery was your raison d'être. Nothing else mattered. There was not a chance that I would accept such a life.
Anesthesia was more forgiving, and pediatric anesthesia even moreso. It was my practice to get my pregnant residents and fellows out to pump, to just put their legs up a few times a day, and to talk with fellows and residents about career vs. family decisions. We want it all, but, structurally, it is impossible or improbable, unless you have an unbelievably supportive spouse AND/OR can afford devoted live in help.
How do we change the structure of Medicine in the age of corporate institutional medicine, where the financial dictum is to do more with less? I think the pressures on women who want children and families are going to get worse. I think it will get worse for men who want children and families, as well. Capitalism is not concerned with values, only profits. Infusing economic structures with family and academic supportiveness is becoming increasingly difficult. They pay lip service to these ideals, but when push comes to shove, it all goes out the window. Success in these terms will come from group think goals of the providers themselves, supporting each other to have families by filling in, taking calls, encouraging their colleagues with talent and desire to pursue academic goals, without necessarily being able to change institutional and structural attitudes and practices. The institutions have become too large and impersonal for them to see us as individuals, and have lost sight of humanistic goals. My $0.02
From Nancy Glass MD
I have cared for MANY refugee children, especially in hospice care, and I would make a couple of points with respect to today's PAAD:
1) ALL of the refugee families have experienced trauma. ALL. It may look different in one family compared to another, but they have all experienced loss and cultural dislocation, irrespective of the difficulties of their journey to our country. How that trauma manifests differs a great deal, but I have seen it show itself in food hoarding, lying to the care team, giving minimal information (even with native speakers as interpreters), and lots of missed appointments.
2) Given that ALL of these families have been traumatized in one way or another, our physical exam and touching of the child needs to be particularly mindful of a) good explanations beforehand about what and how and why we will examine a body part, b) consent/assent,and c) attention to modesty and privacy. I suspect we can ALL do better in this regard.
I'd like to recommend that my colleagues read a book by current Stanford poetry professor Javier Zamora entitled Solito, a prose memoir in which he recounts his journey from El Salvador to the US, ALONE as a 9 year old (accompanied by a hired coyote and individuals he'd never met before.) When he spoke at Baylor recently (and in multiple interviews online), he recounted his overwhelming fear and anxiety, and relates that he "never" told the truth to teachers or healthcare workers even years after his reunification with his parents.....he was simply too afraid. Years later, he is still processing this trauma. The book is a fast read and definitely worth your time.