Reader response

Myron Yaster MD

From Randall Flick, MD, MPH, Mayo Clinic and Jennifer K. Lee, MD, Johns Hopkins University

Thanks to you and your colleagues for yet another interesting and provocative PAAD: “Wages really do appear to fall when women enter an occupation” August 28, 2024 (https://ronlitman.substack.com/p/wages-really-do-appear-to-fall-when). Though the SPA has no relationship with the PAAD, we felt it was important to respond to a recently raised issue.

The PAAD discussion of pay equity happened to coincide with a text that one of us received anonymously offering criticism of the Women’s Empowerment and Leadership Initiative (WELI).  For those that may not be aware, the WELI program was established by the SPA as the brainchild and passion of its founder Dr. Jenny Lee in collaboration with Drs. Nina Deutsch and Jamie Schwartz. Jenny is the Senior Associate Dean for Women in Science and Medicine as well as a Professor of Anesthesiology/Critical Care Medicine and Pediatrics at Johns Hopkins University.  WELI is intended to address the widely recognized need to provide women in pediatric anesthesia with the necessary tools to succeed in their careers, including the attainment of leadership positions.

Past discussions in the PAAD highlighted the persistent pay discrepancy between men and women in anesthesia (“Achieving equity for women in anesthesiology” 02/23/204 https://ronlitman.substack.com/p/achieving-equity-for-women-in-anesthesiology) and “Gender compensation disparity in anesthesiology” 02/02/2022 https://ronlitman.substack.com/p/gender-compensation-disparity-in ).  The August 28/2024 PAAD provides insight into reasons for gender pay differences and the negative consequences these differences have not only on women but also on men.  Today’s PAAD relied heavily on the insights of one its authors, Dr. David McClain, an economist who cites Jorgen Harris’ work on the negative salary effect of women entering the work force. Both men and women experience a decrease in pay as their occupations employ more women. This article provides the academic underpinning for an enlightening discussion.  Thanks to Dr. McClain for bringing a perspective not usually included in the PAAD.  For those interested, the article by Dr. Harris cited in the journal Labour Economics is quite lengthy and a bit difficult for the non-economist to follow. But one passage caught our eye:

 Alternately, discrimination may push women to work in lower-paying occupations than similar men, because women may face greater barriers in high-paying male-dominated occupations than they do in similarly skillful but lower-paying female dominated occupations. These barriers can take many forms, such as lower likelihood of promotion (Thomas, 2019; Maume, 1999), reduced access to mentorship and networking (Chen et al., 2015), or higher rates of discrimination and sexual harassment (Parker, 2018)

Harris J., Labour Economics, 2022 

WELI is intended to address some, if not all, the barriers described by Harris in the above excerpt and has been phenomenally successful in doing so.  The reader is referred to publications describing the success of the program.^1-3

Now to the anonymous text recently sent to Dr. Lee’s personal cell phone…

“Dr. Lee,

The Women’s Leadership and Empowerment Initiative (sic) isn’t fair for us men.

Women already substantially outperform us men in school, and they continue to do so more and more each year. It isn’t fair that they also receive exclusive leadership and empowerment opportunities while us men continue to struggle. The gender education gap grows wider each year, it’s terrifying. Women are taking over everything nowadays.”

As you can see, the author of the text raises a legitimate concern.  Let’s reflect for a moment; the author of the text is telling us something that he is uncomfortable signing his name to.  Something really important for us as leaders to hear.  The reluctance to openly discuss difficult issues should concern us as much as the issue itself.  We thank the sender and encourage others to respond to the PAAD with their thoughts.

With regard to WELI, this program is indeed gender based and therefore exclusive. However, the author somewhat misunderstands the purpose of WELI and to an extent conflates the demographic changes in entry and early career levels relative to the barriers women often encounter in leadership and advancement. These barriers are clearly evident when one looks at the persistent gender disparity among leaders in departments of anesthesiology and medical schools across the country and indeed the world.^4,5  It is this disparity that was and remains WELI’s primary focus. 

Nevertheless, the Society’s and WELI’s leadership recognize the changing demographic and need for a more inclusive approach, especially to support early career anesthesiologists.  At the Spring SPA conference, WELI leaders began to work on a new program that we are tentatively calling AGILE (Anesthesiologists Growing, Innovating, Leading and Engaging).  Recognizing the changing demographics and needs of our field, AGILE’s goals are to provide entry level and early career pediatric anesthesiologists -- regardless of gender -- with the knowledge and skills needed to navigate the non-clinical aspects of professional practice in both academic and non-academic anesthesiology. AGILE’s vision includes providing basic business skills, such reading and understanding a balance sheet and compensation models, hiring and firing, and negotiation, along with many of the same networking opportunities that are foundational to  WELI’s success.  AGILE is intended to provide content in an easily digestible format that fits within the demands of full-time clinical work.  We hope to bring AGILE to the membership in 2025 or 2026.  Be patient with us.  Creating content takes time and everyone at WELI is a passionate and committed volunteer.

Let us finish by encouraging individuals to feel welcome to reach out to any of us who comprise SPA’s and WELI’s leadership. We want to hear your concerns, ideas, expectations and even your compliments.  We welcome all, anonymous, or otherwise. We especially encourage respectful dialogue to create a new level of understanding and appreciation for everyone.

References

1.           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 2021;133(6):1497-1509. (In eng). DOI: 10.1213/ane.0000000000005740.

2.           Deutsch N, Yanofsky SD, Markowitz SD, et al. Evaluating the Women's Empowerment and Leadership Initiative: Supporting mentorship, career satisfaction, and well-being among pediatric anesthesiologists. Paediatric anaesthesia 2023;33(1):6-16. (In eng). DOI: 10.1111/pan.14596.

3.           Margolis RD, Berenstain LK, Janosy N, et al. 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. Paediatric anaesthesia 2021;31(9):944-952. (In eng). DOI: 10.1111/pan.14247.

4.           Harbell MW, McMullen KB, Kosiorek H, Kraus MB. Women Representation in Anesthesiology Society Leadership Positions. Anesthesia and analgesia 2023;137(6):1171-1178. (In eng). DOI: 10.1213/ane.0000000000006465.

5.           Hertzberg LB, Miller TR, Byerly S, et al. Gender Differences in Compensation in Anesthesiology in the United States: Results of a National Survey of Anesthesiologists. Anesthesia and analgesia 2021;133(4):1009-1018. (In eng). DOI: 10.1213/ane.0000000000005676.