Cite as: Reddy A, Cortes A. The role of anesthesiologists in supporting workforce diversity via education and community engagement. ASRA Pain Medicine News 2024;49. https://doi.org/10.52211/asra080124.008.

Anesthesiologists play an important role in increasing Diversity, Equity, and Inclusion (DEI) efforts. While some anesthesiologists may believe that their reach and influence are limited to the perioperative area, they reflect the diverse communities they serve. In this commentary, we will discuss the contribution of anesthesiologists in academic medical centers diversify the physician workforce through various initiatives and deliberate mentorship programs.

Historically, anesthesiology has been male-dominated; in 2021, 26.1% of active anesthesiologists were practicing females and 37% worked in academic anesthesiology.^1,2 From 2013-2019, a downward trend has been observed in the number of female anesthesiology trainees, and the percentage of underrepresented minorities has remained steady yet persistently low.³ According to the Association of American Medical Colleges, 5.3% of practicing anesthesiologists identified as Black or African American, 0.3% identified as American Indian or Alaskan Native, and 5.7% identified as Hispanic in 2021.^4–6 Within pain fellowship programs, 3.7% of trainees identified as Black, and 2.9% identified as Hispanic between 2008-2019.⁷

Trends in gender identity have been understudied as well. Still, the most recent American Board of Anesthesiology diplomate data show that about 89.4% of respondents to DEI surveys identified as cisgender, and 79.3% of respondents identified as heterosexual.⁸ LGBTQ+ populations face legislative challenges alongside workplace discrimination and harassment, thus increasing the risk of burnout for these underrepresented populations.⁹ In comparison to the general U.S. population, these statistics highlight a marked underrepresentation of minorities within the field. Even at the subspecialty level, such as neurosurgical, cardiothoracic, and pediatric anesthesia, current DEI data has underlined the underrepresentation of women and minorities. ^10–13 This trend is similarly seen at the level of leadership at the American Society of Anesthesiologists (ASA), with 21.1% of respondents identifying as female and 6.0% identifying as minorities.¹³

Establishing mentorship programs can foster an environment of inclusivity and provide a mutual educational benefit for both mentees and mentors.

Nonetheless, efforts to recruit a diverse cohort of anesthesiologists are being implemented at the organizational and residency program levels. Improvement in the representation of ethnic minorities, women, and the LGBTQ+ population has been shown to improve healthcare access and outcomes.¹⁴ Increasing numbers of under-represented minority physicians may increase patient-physician racial/ethnic concordance, associated with higher patient satisfaction,¹⁵ and may improve compliance with therapeutic protocols and preventative measures.¹⁶ The importance of increasing workforce diversity in regional anesthesia and pain medicine is underscored by the potential to mitigate disparities, such as peripheral nerve block utilization within the subspecialty.¹⁷

DEI initiatives at the national scale have been established in response to the lack of adequate representation of the underrepresented in medicine (URiM) within the field. One such National Institutes of Health (NIH) funded program called RADAR (Raising Anesthesia Diversity and Antiracism) was formed to achieve three goals: (1) engage underrepresented or historically minoritized college students to attract them to medicine and involve medical students to attract them to anesthesiology; (2) facilitate the development of community spirit and offer mentorship and support networks for residents, fellows and early-career faculty; and (3) provide curated resources and structured education on diversity and anti-racism for senior leaders in anesthesiology.¹⁸ This program also fosters relationships in the community by inspiring students to pursue medicine via partnerships with local school systems.

Physicians can play a role in large-scale organizations such as RADAR to improve outreach to their local communities while also creating opportunities for early exposure to anesthesiology in the school years. Many premier institutions have developed similar programs to promote the recruitment of underrepresented minorities into the healthcare profession.¹⁹ Hospital for Special Surgery’s department of anesthesiology spearheads a yearly healthcare immersion program targeted towards URiM high school students from New York City public schools.¹⁹ In this weekend program, the students are exposed to medical simulations, skills workshops (eg ultrasound scanning, intubation, vascular access, acupuncture,) and problem-based case discussions.¹⁹ Another example includes a community outreach program at the Massachusetts General Hospital Cardiac Anesthesia Group via heart dissection labs in public schools.²⁰ At Johns Hopkins, the Pathways in Medicine: Discovery Lab was established to recruit underrepresented minorities into academic anesthesiology programs and reduce the “leaky pipeline” where lower levels of representation of underrepresented minorities are seen at higher levels of the profession.²¹ Similarly, at Yale, there is a yearly anesthesia workshop alongside the Yale Pathways to Science program in which faculty and residents volunteer their time to teach New Haven high school students about anesthesia. Students rotate through various workstations, including an ultrasound station, where they scan volunteers, are taught to identify nerve anatomy, and practice needling techniques on ultrasound training blocks to simulate peripheral nerve block placement.

ASA has hosted the Doctors Back to School (DBTS) Program since 2016.²² DBTS provides early exposure to careers in medicine for underrepresented middle school students.²² During this one-day visit, ASA member physicians and medical students visit a local middle school and lead several classrooms in interactive activities, including ultrasound scanning, heart and lung examination, and basic CPR and airway management techniques. The variety of these experiences intentionally exposes students to the depth and breadth of anesthesia as a field and profession.

Anti-bias education is vital to increasing awareness of the disparities in DEI. At the Johns Hopkins University School of Medicine, the department of anesthesiology created electives that target health equity in anesthesiology for visiting medical students, residents and fellows.²¹ Educational initiatives, such as electives for medical students, can be utilized to promote DEI education further and create an avenue for future anesthesiology residents to take part in these efforts.

For physicians in training, DEI education is provided early in residency and to medical students applying for the National Resident Matching Program. Mentorship is important in helping residents and medical students feel supported and included in their specialty of interest; in anesthesiology, mentorship remains underutilized and understudied. Underrepresented minorities are unaware of mentorship opportunities at trainee and junior-faculty levels.²³ The establishment of mentorship programs can foster an environment of inclusivity and provide a mutual educational benefit for both mentees and mentors.

Despite a greater interest in DEI work in anesthesiology, funding for DEI research and interventions is also necessary. The NIH has historically underfunded research in healthcare equity and outcomes research in marginalized communities with only limited increases in funding for these initiatives.²⁴ Advocacy for increased funding in this field will be vital to support the recruitment of a diverse workforce in anesthesiology and subsequently improve healthcare outcomes in marginalized patient populations.

Conclusion

Playing a role in physician-led DEI education requires involvement in national organizations, workplaces, local medical schools, and other educational institutions. Educational outlets at these scales will encourage the participation of attending anesthesiologists in mentorship roles for underrepresented trainees, allow residents and medical students to spur change within their communities, and recruit a diverse cohort of physicians for future generations.

References

1. Active Physicians by Sex and Specialty, 2021. AAMC. Available at: https://www.aamc.org/data-reports/workforce/data/active-physicians-sex-specialty-2021. Accessed June 10, 2024.
2. Faculty Roster: U.S. Medical School Faculty. AAMC. Available at: https://www.aamc.org/data-reports/faculty-institutions/report/faculty-roster-us-medical-school-faculty. Accessed June 10, 2024.
3. Jahshan A, Aoun M, Dekhou A, et al. The underrepresentation of women and ethnic minorities in anesthesiology. J Natl Med Assoc 2022;114(1):26-9. https://doi.org/1016/j.jnma.2021.09.005
4. Active physicians who identified as Black or African-American, 2021. AAMC. Available at: https://www.aamc.org/data-reports/workforce/data/active-physicians-black-african-american-2021. Accessed October 16, 2023.
5. Active physicians who identified as American Indian or Alaska Native, 2021. AAMC. Available at: https://www.aamc.org/data-reports/workforce/data/active-physicians-american-indian-alaska-native-2021. Accessed October 16, 2023.
6. Active physicians who identified as Hispanic (Alone or With Any Race), 2021. AAMC. Available at: https://www.aamc.org/data-reports/workforce/data/active-physicians-hispanic-alone-or-any-race-2021. Accessed October 16, 2023.
7. Odonkor CA, Leitner B, Taraben S, et al. Diversity of pain medicine trainees and faculty in the United States: a cross-sectional analysis of fellowship training from 2009-2019. Pain Med 2021;22(4):819-28. https://doi.org/10.1093/pm/pnab004
8. Diversity, equity, and inclusion data report. https://www.theaba.org/wp-content/uploads/2022/12/ABADEIassessmentreport.pdf. American Board of Anesthesiology. Published January 2021. Accessed October 16, 2023.
9. Reece-Nguyen T, Afonso AM, Vinson AE. Burnout, mental health, and workplace discrimination in lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual anesthesiologists. Anesthesiol Clin2022;40(2):245-55. https://doi.org/10.1016/j.anclin.2022.01.002
10. Sumler ML, Capdeville M, Ngai J, et al. A call for diversity: underrepresented minorities and cardiothoracic anesthesiology fellowship education. J Cardiothorac Vasc Anesth 2022;36(1):58-65. https://doi.org/10.1053/j.jvca.2021.09.028
11. Yu S, Tavarez-Mora F, Milam AJ, et al. Matters of the heart: examining motivating factors and unconscious bias in the adult cardiothoracic anesthesiology fellowship. J Cardiothorac Vasc Anesth 2023;37(7):1160-8. https://doi.org/10.1053/j.jvca.2023.02.044
12. Theard MA, Flexman AM, Smith M. Diversity, inclusion and equity in the Journal of Neurosurgical Anesthesiology: A Look to the Future. J Neurosurg Anesthesiol 2020;32(4):283-4. https://doi.org/10.1097/ANA.0000000000000711
13. Toledo P, Duce L, Adams J, et al. Diversity in the American Society of Anesthesiologists leadership. Anesth Analg 2017;124(5):1611-16. https://doi.org/10.1213/ANE.0000000000001837
14. Estime SR, Lee HH, Jimenez N, et al. Diversity, equity, and inclusion in anesthesiology. Int Anesthesiol Clin2021;59(4):81-5. https://doi.org/10.1097/AIA.0000000000000337
15. Takeshita J, Wang S, Loren AW, et al. Association of racial/ethnic and gender concordance between patients and physicians with patient experience ratings. JAMA Netw Open 2020;3(11):e2024583. https://doi.org/10.1001/jamanetworkopen.2020.24583
16. Nguyen AM, Siman N, Barry M, et al. Patient‐physician race/ethnicity concordance improves adherence to cardiovascular disease guidelines. Health Serv Res 2020;55(Suppl 1):51. https://doi.org/10.1111/1475-6773.13398
17. Umeh UO. Examining disparities in regional anaesthesia and pain medicine. Br J Anaesth 2024;132(5):1033-40. https://doi.org/10.1016/j.bja.2024.02.015
18. Wixson MC, Mitchell AD, Markowitz SD, et al. Raising anesthesiology diversity and antiracism: launching a national initiative. Anesth Analg 2022;134(6):1185-8. https://doi.org/10.1213/ANE.0000000000005817
19. Umeh UO, Li CJ, Beckman JD. Embracing Diversity: A Healthcare Immersion Program for Underrepresented High School Students, Creating a Pipeline for Diversity in Medicine. ASRA Pain Medicine 2023;48. https://doi.org/10.52211/asra110123.003.
20. Woodward E, Lai Y, Egun C, et al. How cardiac anesthesiology can help “STEM” the tide of under-representation of minorities in science and medicine. J Cardiothorac Vasc Anesth 2018;32(2):631-5. https://doi.org/10.1053/j.jvca.2017.06.031
21. O’Conor KJ, Young L, Tomobi O, et al. Implementing pathways to anesthesiology: promoting diversity, equity, inclusion, and success. Int Anesthesiol Clin 2023;61(1):34-41. https://doi.org/10.1097/AIA.0000000000000386
22. Zhou S, Brown DP, Barreto Chang OL. ASA 2023 doctors back to school program returns to the classroom. ASA Monitor 2024; 88:32 https://doi.org/10.1097/01.ASM.0001004808.54837.b7
23. Ergun S, Busse JW, Wong A. Mentorship in anesthesia: a survey of perspectives among Canadian anesthesia residents. Can J Anaesth 2017;64(4):402-10. https://doi.org/10.1007/s12630-017-0816-1
24. Boulware LE, Corbie G, Aguilar-Gaxiola S, et al. Combating structural inequities — diversity, equity, and inclusion in clinical and translational research. N Engl J Med 2022;386(3):201-3. https://doi.org/10.1056/NEJMp2112233