President's Message: Inclusivity, Diversity, and ASRA’s Celebration of the Year of Women in ASRA
During the June 2019 ASRA Board of Directors meeting, we passed a resolution of inclusivity acknowledging a long-held position: ASRA unequivocally embraces an inclusive environment and supports diversity of thought, gender, appearance, orientation, physical ability, and practice. Issuing a statement such as this changes the equation. In doing so, ASRA’s leadership acknowledges that it will “walk the walk” of diversity, making a conscious effort to achieve appropriate representation of qualified and interested individuals, including women, racial or ethnic minorities, and other individuals in our ranks.
Women are underrepresented in our specialty, and ASRA is committed to improving mentorship and support. The 18th Annual Pain Medicine Meeting represents an effort to better balance the representation of women. Andrea Nicol, MD, chair of this November’s meeting, has done an amazing job virtually eliminating “manels,” or men-only panels. For the first time, you will see women-only panels! Andrea has done so with incredibly talented individuals, some who are new but, we hope, no longer strangers to ASRA. We are truly “stronger together,” which is our theme for the fall meeting.
Diversity is a current conversation in medicine and specifically in anesthesia. Very recent studies specifically demonstrate that women will continue to represent a growing force in the future practice of anesthesiology and research.,
Figure 1: The proportion of female physicians has increased over time.
From Johnson M. The healthcare future is female. AthenaInsight. https://www.athenahealth.com/insight/healthcare-future-female. Updated February 14, 2018. Accessed September 25, 2019. Used with permission.
We see that here at ASRA as well. Of the 68% of ASRA members who report their gender, 25% are female and 75% are male, and therefore reflect the percentage of currently practicing anesthesiologists reported in the literature. The American Society of Anesthesiologists reports that 18% of their 4,551 board-certified pain medicine anesthesiologists are female. However, younger anesthesiologists are estimated to represent a higher percentage of women, with 38% being female. One 2016 study reported that 35% of anesthesiologist trainees are women and that the proportion of female physicians in any specialty is now larger than that of males. Although we are doing well in reflecting our profession, ASRA can do better (Figure 1).
The Society can also do better as we consider meeting faculty and award recipients. Of the 460 ASRA annual meeting faculty members since 2015, we have had 354 male (77%) and 106 female (23%) faculty. Further evaluation reveals that as ASRA leadership has become more aware of equity issues, our commitment to gender diversity has improved. As of this writing, 3 of our 11 board members are women in 2020.
ASRA has done best with gender representation at our freestanding courses. Currently, women represent 30% of faculty for the Introduction to Perioperative Point-of-Care Ultrasound course, 41% of faculty for the Ultrasound-Guided Regional Anesthesia Cadaver Course, and 27% of the faculty for the Musculoskeletal and Pain Ultrasound Cadaver Course (Figure 2).
Figure 2: The proportion of female faculty members has increased for freestanding courses.
We have and will continue to improve faculty gender diversity at our annual meetings. Specifically, during the 17th Annual Pain Medicine Meeting in 2018, 19% of faculty were women. At the Annual Regional Anesthesiology and Acute Pain Medicine Meeting in 2019, 22% of faculty were women (Figure 3).
Figure 3: The proportion of female faculty members has increased at annual meetings.
ASRA has become more intentional with ensuring diversity while maintaining the highest educational quality. Although we have openly discussed the need to avoid “manels” or men-only panels, we will strive to maintain the highest-quality faculty. If that requires a single-gender faculty (male or female), we will move forward and select the faculty that represent the highest level of expertise and teaching ability. The contemporary difference is that final decisions will now occur following significant conscience consideration and exhaustive investigation.
We also recognize imbalances with the awards process. In 2019, only 3 of the 35 Distinguished Service Awards (DSAs) recipients were women; only 2 out of 33 John Bonica Awards were given to women, and only 3 of 46 Gaston Labat Award recipients were women. Neither of the two Presidential Scholar awards were given to women. Recognizing some implicit bias in the process, we have relaxed the timeframe requirements on some awards and grants to allow for career breaks for significant life events such as caring for family and maternity or paternity leave. We also point out the importance of members nominating women for the awards. Moving forward, the Board also has agreed that the DSA could be awarded up to two times a year to allow for additional recognition of deserving members.
ASRA leadership is significantly diverse and a source of future optimism. Women represent 30% of all committee members and 35% of all resident section members. Even more specifically, 33% of those who applied and were appointed for committee positions for 2019 were women. Women hold 42% of all special interest group (SIG) leadership roles. A recent study of ASRA News authorship found that 48% of authors in 2018 were women.
ASRA has taken the unprecedented step to identify 2020 as the Year of Women in ASRA to recognize the achievements of women in the Society and the specialties of acute and chronic pain and regional anesthesia. We particularly want to acknowledge women who have not or may not have achieved recognition in the past. Many are true trailblazers, and we hope to celebrate those who made unique contributions with an ASRA Trailblazers Award during 2020.
Do not look at these steps as patronizing or negative; rather, they serve to recognize where we are today and show by our actions our commitment to being more inclusive and engaging moving forward. The initiative’s ultimate outcome is broadened opportunities for all ASRA members.
Recognizing the need for inclusivity is really just a start. It must be a grassroots effort also taken up by committees, SIGs, and membership to encourage and mentor a more diverse specialty. The Women in Regional Anesthesia and Pain Medicine SIG has taken the lead to support and mentor women striving to develop a career in acute and chronic pain and regional anesthesia. Making ASRA a more diverse and inclusive society will depend on a long-term plan, bringing new and bright young people to the Society, mentoring them, and providing an opportunity for them to demonstrate the value of a diverse and balanced society. For now, let us recognize and celebrate the achievements of women in ASRA and, most of all, personally thank them for being trailblazers.
Note: The ASRA Trailblazer Awards, recognizing female leaders in regional anesthesia and pain medicine, is now accepting nominations at www.asra.com/trailblazers. The deadline to apply is January 15, 2020.
- Bissing MA, Lange EMS, Davila WF, et al. Status of women in academic anesthesiology: a 10-year update. Anesth Analg. 2019;128:137–143. https://doi.org/10.1213/ANE.0000000000003691
- Miller J, Cuba E, Deiner S, DeMaria S Jr, Katz D. Trends in authorship in anesthesiology journals. Anesth Analg. 2018;29:306–310. https://doi.org/10.1213/ANE.0000000000003949
- Luthra S. Pay, but not equity, improves for female anesthesiologists. NPR. Published September 18, 2015. https://www.npr.org/sections/health-shots/2015/09/18/441198354/pay-but-not-equity-improves-for-female-anesthesiologists. Accessed May 28, 2019.
- Johnson M. The healthcare future is female. Published February 14, 2018. https://www.athenahealth.com/insight/healthcare-future-female. Accessed May 28, 2019.
- Tolliver A, Schroeder K, Tamm-Daniels I, et al. Trend of women authors in ASRA News. Abstract 7095 presented at 44th Annual Regional Anesthesiology and Acute Pain Medicine Meeting, April 12, 2019. https://epostersonline.com/ASRASPRING19/node/1279. Accessed May 28, 2019.