Women, Minorities, and Leadership in Anesthesiology: Take the Pledge

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Diversity in the workforce is associated with improved organizational performance in the corporate world1 and is considered vital to improving outcomes in health care.2 Although diversity has increased in medical schools and residency programs in the United States, the “pipeline” to senior academic positions in American universities for women and members of underrepresented minorities is “leaky,” with few women or minority members reaching the top.3 This parlous situation applies to academic positions in anesthesiology as well.4 However, it is unclear whether this block in the leadership pipeline applies only to academia.
In this edition of the Journal, Toledo et al5 report on a survey about diversity in the leadership group of the American Society of Anesthesiologists (ASA), a member-based organization dedicated to education, research, and advocacy. A total of 595 house of delegates members and state society officers were surveyed, with a response rate of 54%. Fewer women (21.1%) were members of the ASA house of delegates or were state society officers, than were members of the national medical workforce (38.0%) or national population (51.0%), although the percentage of women was similar to the ASA membership (23.0%) and the national anesthesia workforce (24.8%). Underrepresented minorities comprised 6.0% of the ASA leadership, 8.6% of the anesthesia workforce, 8.9% of the national medical workforce, and 32% of the national population (the ASA does not collect racial/ethnic information on its members). Toledo et al5 concluded that “Efforts should be made to increase the diversity of the ASA leadership with the goal to reducing overall anesthesia workforce disparities.” In other words, the leadership should model gender and racial diversity rather than just reflect it. We applaud this suggestion.
The purpose of this editorial is to put the results of Toledo et al’s survey into an international context and to suggest solutions. We take a broad view on leadership, considering it to include many visible and influential roles, such as elected office in a member-based organization; tenure in the higher ranks of an academic institution; a management role in an anesthesia group or health care facility; prominence in conducting, reviewing, and speaking about research; as a champion for quality and safety; and in educational leadership roles. Our main focus is on gender diversity because each nation has a unique mix of indigenous and immigrant people, and data on race/ethnicity are not uniformly collected or reported.
The participation of women in medical and anesthesia education, and in leadership, is similar in the United States and 5 comparable nations (Australia, Canada, Ireland, New Zealand, and the United Kingdom) (Table). The percentage of women in primary medical education is 47% to 55% in these countries. However, anesthesiology recruits a smaller proportion of women than the proportion that graduates from medical school (37%–48%). Few women reach the rank of professor or become department chairs (6%–17%), or are elected to the boards of representative anesthesia organizations (13%–36%). So the leadership pipeline is blocked internationally. What can be done to improve this situation?
Our suggestions for change are a modification of the work of Jennifer L. Martin,6 who proposed “Ten simple rules to achieve conference speaker gender balance” after a basic science conference published a program without a female keynote speaker. Lack of female keynote speakers has been noted at major anesthesiology meetings as well,7 and at least one organizing committee in Australia has adopted Martin’s rules to remedy the problem.8 Similarly, a major grant body in the United Kingdom now requires applicants to demonstrate employment practices that promote women in science.
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