Paving the Way for Representative Leadership in Anesthesiology

By June 26, 2019Uncategorized

Along with becoming an excellent clinician, many anesthesiologists also have the objective of becoming involved in physician leadership. This could take the form of a leadership position at the departmental level, such as Chief or Vice-Chief of Anesthesiology, leadership at the hospital level, working on policies that affect all departments, or leadership in the multiple professional society groups, such as the American Society of Anesthesiologists and various local organizations. While the field of anesthesiology is swiftly diversifying to include those traditionally under-represented in medicine, leadership positions lack the same level of representativeness. Although the past twenty years has seen great progress towards diversifying leadership, continued improvement is still needed.

To commence, it is important to underscore that physician involvement in leadership is essential for driving change. Practicing anesthesiologists understand the very nature of delivering medicine in the perioperative and surgical setting, including stressors, roadblocks, challenges and opportunities. Anesthesiologists’ insight is salient at the departmental and hospital level for initiating policy changes. In line with this, it is also prudent to have a diversity of experiences and opinions at the decision-making table, to ensure that the highest proportion of needs are being heard. Female anesthesiologists thus provide a particularly important voice to be heard.

In a broad sense, the number of female clinicians pursuing surgical fields has trailed below the number of males. Anesthesiology as a field has similarly aligned with this trend. In 2007, approximately 25% of anesthesiologists under 36 years of age were female, although this number has increased to about 40% as of 2013[1]. This gender disparity exists despite concerted efforts by academic medical centers to encourage female medical school graduates to pursue fields such as anesthesiology.

Moreover, the proliferation of female anesthesiologists into high-profile leadership positions has drifted behind, even with the relative increase of women in anesthesiology. In a recent issue of Anesthesia and Analgesia, Toledo et al explored diversity in the anesthesiology workplace with respect to female clinicians[2]. Based on a large-scale survey, it was concluded that the percentage of female anesthesiologists who were involved in leadership in a professional organization was about 10% lower than the national average of such clinicians in the workforce. Moreover, the proportion of female physicians who achieve leadership in the hospital or academic medicine setting was found to be strikingly low, currently sitting at about 6%-17%. The data supports that female anesthesiologists are not currently represented equally in leadership roles.

Therefore, it is important to consider what measures can facilitate equality in anesthesiology, and especially in anesthesiology leadership roles. One program that has been implemented in the field is the establishment of formal mentorship programs specific to female leadership in medicine. By starting at the medical school and residency program level, female anesthesiologists-in-training who are interested in exploring leadership can be matched with current leaders in the field, developing skills and learning the undercurrents of the landscape as they train. In addition to formal mentorship opportunities, it may be useful to gain objective, non-biased metrics on the current state of leadership on a micro-level, such as surveys of individual hospitals. In this way, hospitals and clinics can assess their own progress in diversifying the leadership field, whilst developing solutions that account for their specific ecosystem. Lastly, increased visibility and published research on this issue will serve as an impetus for change.

Anesthesiologists have always served as leaders in the OR, hospital, and professional societies alike. Moving forward, it is important to continue the discussion, and therefore spur change, towards a more representative leadership establishment in the field of anesthesiology.

[1] Baird, Matthew D, et al. “Regional and Gender Differences and Trends in the Anesthesiologist Workforce.” RAND Corporation, American Society of Anesthesiologists, 2015,

[2] Leslie, Kate, et al. “Women, Minorities, and Leadership in Anesthesiology.” Anesthesia & Analgesia, vol. 124, no. 5, 2017, pp. 1394–1396., doi:10.1213/ane.0000000000001967.