Women in Anesthesiology Leadership: The Time is Now

Abstract

THE LACK of gender equity in medicine has been discussed and published in academia for more than 3 decades. Although there is no lack of published research showing significant inequity in compensation, promotion, and advancement into leadership among women physicians compared to male physicians, barriers to gender equity for women in medicine, specifically for women in anesthesiology, remain.1Carr PL Raj A Kaplan SE et al.Gender differences in academic medicine: Retention, rank, and leadership comparisons from the National Faculty Survey.Acad Med. 2018; 93: 1694-1699Crossref PubMed Scopus (231) Google Scholar,2Lautenberger DM, Dandar VM, Raezer CL. The state of women in academic medicine: the pipeline and pathways to leadership, 2013-2014. Association of American Medical Colleges. Available at: https://store.aamc.org/the-state-of-women-in-academic-medicine-the-pipeline-and-pathways-to-leadership-2013-2014.html. Accessed February 2, 2023.Google Scholar Routinely, reasons, and perhaps excuses, are cited as the reason for the disparity. Often cited is the limited pipeline and too few women represented over time when, in reality, the reasons that limit an equal number of women rising to full academic promotion and leadership advancement are a lack of equal opportunities for professional development, incomplete networking support, and inadequate sponsorship. Additionally, each year there is an attrition of women in anesthesiology. Although women leave medicine and anesthesiology for individual and family-centric reasons, it is possible to offer equitable options for advancement that are compatible with one's well-being, including appropriate family leave and equal access to compensation, time, promotion and leadership development. It is time—beyond time—to acknowledge the compelling, attainable, and ethical solutions for attaining gender equity now. The Women in Cardiothoracic Anesthesia group, established in 2018, takes action to ensure gender equity in this important anesthesia subspecialty. The special article A Call for Diversity: Women, Professional Development and Work Experience in Cardiothoracic Anesthesia called out important barriers to women achieving equality and equity in their chosen specialty.3Ngai J Capdeville M Sumler M et al.A call for diversity: Women, professional development, and work experience in cardiothoracic anesthesiology.J Cardiothorac Vasc Anesth. 2022; 36: 66-75Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Importantly, they named a lack of mentorship, discriminatory culture, and divergent compensation as primary contributors to the existing promotion, compensation, and leadership disparities that exist in anesthesiology at large, and cardiothoracic anesthesiology, specifically, across the United States. These realities in our specialty have persisted for decades, and without adopting specific strategies to equalize opportunities for promotion, compensation, access to time, and professional development investment, change in the future is unlikely. A recent (2023) article in International Anesthesiology Clinics by Spitzer, Garcia-Marcinkiewicz, and Malinzak offered additional insight into the barriers that limit equity for women in anesthesiology. These authors agreed that women in anesthesiology experience significant bias in the workplace that limits their equity and advancement. They named individual bias as a source of discrimination against women in anesthesiology, and they offered specific solutions for gender inequity, including “addressing individual bias, closing the knowledge gap on the scope of bias, deliberate representation, strengthening professional networks, and organized efforts to create policies that address gender inequity in the workplace.”4Spitzer Y Garcia-Marcinkiewicz AG Malinzak EB. Programmatic approached to achieving equity for women in anesthesiology.Int Anesthesiol Clin. 2023; 61: 42-48Crossref Scopus (2) Google Scholar The authors also paid attention to lifetime activities unique to women, such as pregnancy, and to inequitable distribution of domestic responsibilities as additional contributors to the attrition of women in medicine and anesthesiology, and challenges that women face in achieving equality in the workplace. Many recent initiatives to reduce the gender disparity in medicine and anesthesiology have focused on institution-specific assessments of equity and processes to improve opportunity, development, and compensation locally. This is important work. Equally important, however, is the national work that must ensue to demand systemic changes in our specialty that ensure gender equity. National and State Component Societies and their representative leadership must commit to strategies to identify gender inequities, and must further call out institutions and practices that promote and allow inequity to exist. These same societies must lead by example through the equitable, deliberate, and sustained representation of women at all levels of leadership. Professional medical societies have long been a pathway for academic promotion and institutional leadership. Society meetings provide collaborative networking opportunities for publications, speakerships for anesthesiologists to stand on stages and be seen and heard, and opportunities to emerge as content experts within societies. Unfortunately, as the authors Ngai et al. referenced in their special article in this issue, the representation of women in national professional anesthesiology society leadership is significantly lagging. Similar to the slow change of women in editorial positions over a decade, professional societies often have leadership terms that span 6-to-10 years or longer, making change at the top slow and not representing the gender makeup of the society or readership.5Bissing MA Lange EM Davila WF et al.Status of women in academic anesthesiology: A 10-Year Update.Anesth Analg. 2019; 128: 137-143Crossref PubMed Scopus (63) Google Scholar,6McMullen K Kraus MB Kosiorek H et al.Representation of women as editors in anesthesiology journals.Anesth Analg. 2022; 134: 956-963Crossref PubMed Scopus (12) Google Scholar Radical changes in structural leadership pathways and selection are needed within our anesthesiology medical societies, grant review boards, and editorial boards for any real change to occur. A strong professional network is a key factor for women to advance into leadership positions7Yang Y Chawla NV Uzzi B. A network's gender composition and communication pattern predict women's leadership success.PNAS. 2019; 116: 2033-2038Crossref PubMed Scopus (62) Google Scholar; however, the majority of medical society leadership are men. From national speaker selection to distinguished service awards to leading committees, professional society leadership has been slow to advance women into leadership positions.8Silver JK Ghalib R Poorman JA et al.Analysis of gender equity in leadership of physician-focused medical specialty societies, 2008-2017.JAMA Intern Med. 2019; 179: 433-435Crossref PubMed Scopus (80) Google Scholar, 9Ellinas EH Rebello E Chandrabose RK et al.Distinguished service awards in anesthesiology specialty societies: Analysis of gender differences.Anesth Analg. 2019; 129: e130-e134Crossref PubMed Scopus (24) Google Scholar, 10Shillcutt SK Lorenzen KA. Whose voices are heard? Speaker gender representation at the society of cardiovascular anesthesiologists annual meeting.J Cardiothorac Vasc Anesth. 2020; 34: 1805-1809Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Immediate improvement in women in leadership at the society and institutional level starts with leadership succession planning as key in the strategic planning of the organizations. So often, we hear, “women need better mentors,” and yet what we know from the literature is that women are over-mentored and under-sponsored. At the institutional, organizational, and societal levels, we need leaders—who, statistically at every level, are predominantly men—to sponsor women into these positions. Instead of accepting the common thinking error of “women sponsor, and help the women,” improving gender inequity requires a shift in a leadership mindset that ensures ethical leaders sponsor both women and men into positions in which they are given opportunities to succeed. Although mentorship may be a key metric associated with career satisfaction, mentorship alone will not advance equity in medicine.11Ayyala MS Skarupski K Bodurtha JN et al.Mentorship is not enough: Exploring sponsorship and its role in career advancement in academic medicine.Acad Med. 2019; 94: 94-100Crossref PubMed Scopus (107) Google Scholar,12Chandrabose RK Pearson ACS. Organizing women in anesthesiology.International Anes Clin. 2018; 56: 21-43Crossref PubMed Scopus (17) Google Scholar Women simply cannot advance in spaces where they are not invited to the table, are undervalued or underpaid, or do not have access to opportunities to even apply for leadership candidacy. In their special article, Ngai et al. pointed out the important research that showed women report the drive to advance into leadership positions and academic promotion at similar levels to men. When assessing men and women for leadership potential, studies have found men are judged by their potential leadership skills, whereas women are judged by their performance. As we sit in rooms to discuss candidates and leadership succession planning, we must be aware of our unconscious bias to overlook the leadership potential of women candidates in anesthesiology and our preference for male leadership.13Player A Randsley de Moura G Leite AC et al.Overlooked leadership potential: The preference for leadership potential in job candidates who are men vs. women.Front Psychol. 2019; 10: 755Crossref Scopus (27) Google Scholar,14Carnes M Morrissey C Geller SE. Women's health and women's leadership in academic medicine: Hitting the same glass ceiling?.J Womens Health (Larchmt). 2008; 17: 1453-1462Crossref PubMed Scopus (201) Google Scholar If we find ourselves struggling to identify “qualified” candidates, the question should not be the common retort “where are the qualified women?” but rather “do we have a small and biased candidate pool?” and “who have we potentially discounted?” There are several strategies to address the critical thinking errors that leaders often have when it comes to strategies to address gender inequity in anesthesiology. Similar to the fault in thinking we do not have any qualified women, blaming women or thinking women cannot do the job as well as men is a common critical thinking error that influences groupthink in times of leadership decision-making. We call on our fellow leaders in anesthesiology, institutionally, and in our societies, to assess from the top how these commonly biased thinking inaccuracies can lead to a lack of women in leadership.15Shillcutt SK Silver JK. Barriers to achieving gender equity.J Cardiothorac Vasc Anesth. 2019; 33: 1811-1818Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar The fastest way to ensure our spaces are equitable is to have women at every level of anesthesiology leadership. As Ngai et al. stated, as leaders, we need to assess our own biases and be brave enough to lead change in systems that restrict women in leadership to ensure equitable succession planning. We believe the path forward is for women in leadership, and that time is now. Creating equity in leadership begins at the top, in every space where decisions are made. Questions to ask should be, are women there? Why or why not? Whose voices are heard, and who is represented? Once we as leaders begin to evaluate our own unconscious and implicit biases, only then can we see people who may be excellent leadership candidates. She may be standing right in front of us. Dr. Shillcutt is the owner of Brave Enough LLC. Dr. McQueen is a GE Healthcare Consultant. A Call for Diversity: Women, Professional Development, and Work Experience in Cardiothoracic AnesthesiologyJournal of Cardiothoracic and Vascular AnesthesiaPreviewDESPITE THE ACHIEVEMENT of parity in medical school matriculation decades ago,1 female physicians across specialties continue to face barriers in their professional development. Women in cardiothoracic anesthesiology (CTA) are a growing and increasingly vocal minority in a medical subspecialty that has been dominated by men throughout history. Approximately 36% of United States medical school faculty anesthesiologists are women,2 and women account for 29% of cardiothoracic anesthesiologists.3 These latter women face unique challenges in the often-stressful and dynamic environment of the cardiothoracic operating room. Full-Text PDF