Time to Step Up and Do Our Part to Address Sex Inequalities in Cardiothoracic Anesthesiology

Published:December 17, 2021DOI:https://doi.org/10.1053/j.jvca.2021.12.014
      To the Editor:
      Strong female representation within cardiothoracic anesthesiology is critical to patient care, research, and education. However, the number of women in cardiothoracic anesthesiology fellowship has remained stagnant at fewer than one-third of trainees during the last decade.
      • Ngai J
      • Capdeville M
      • Sumler M
      • et al.
      A call for diversity: Women and cardiothoracic anesthesiology fellowship education [e-pub ahead of print].
      This lack of sex diversity in the cardiothoracic anesthesiology pipeline is problematic and requires in-depth analysis and actionable change.
      • Ngai J
      • Capdeville M
      • Sumler M
      • et al.
      A call for diversity: Women and cardiothoracic anesthesiology fellowship education [e-pub ahead of print].
      ,
      • Capdeville M.
      Gender disparities in cardiovascular fellowship training among 3 specialties from 2007 to 2017.
      Concurrently, the adversities encountered by currently practicing female cardiothoracic anesthesiologists have significant implications for the sustainability of sex diversity and also must be identified and addressed.
      In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Methangkool et al
      • Methangkool E
      • Brodt J
      • Kolarczyk L
      • et al.
      Perceptions of gender disparities among women in cardiothoracic anesthesiology.
      examined female cardiothoracic anesthesiologists’ perceptions of the impact of their sex on their professional development and career advancement. Analysis of survey data from 153 female cardiothoracic anesthesiologist respondents revealed the shared perception that being female negatively influenced their career advancement (40.5%), financial compensation (31.3%), promotion (29.6%), and academic authorship (24.8%), which is very concerning.
      Encouragingly, the study by Methangkool et al
      • Methangkool E
      • Brodt J
      • Kolarczyk L
      • et al.
      Perceptions of gender disparities among women in cardiothoracic anesthesiology.
      also revealed some positive observations. First, the majority (57%) of the female respondents hold significant leadership roles, and second, most (64.2%) earned their position within 5 years of independent practice.
      • Methangkool E
      • Brodt J
      • Kolarczyk L
      • et al.
      Perceptions of gender disparities among women in cardiothoracic anesthesiology.
      This coincides with the progress of increasing female academic authorship, including within this journal.
      • Pagel PS
      • Freed JK
      • Lien CA.
      Gender differences in authorship in the Journal of Cardiothoracic and Vascular Anesthesia: A 28-year analysis of publications originating from the United States, 1990-2017.
      However, undeniably, more work still needs to be done. Methangkool et al
      • Methangkool E
      • Brodt J
      • Kolarczyk L
      • et al.
      Perceptions of gender disparities among women in cardiothoracic anesthesiology.
      have identified opportunities for improvement that anesthesiology departments should pursue alongside their continued efforts to increase the sex diversity of their cardiothoracic anesthesiology faculty.
      The onus of championing sex equality should not solely be on women, with men merely as bystanders. Male anesthesiologists must recognize the existence of sex inequalities and collaborate with their female colleagues to address the areas that women perceive as discrimination. For meaningful change to occur, male anesthesiologists, who currently make up 75% of the profession, must be allies and professionally advocate for their female colleagues just as they would for each other.
      One specific area in which men are positioned to help is supporting female scholarship. Methangkool et al's study revealed that <50% of the female respondents have given a national presentation, and a quarter perceived sex as affecting authorship opportunities.
      • Methangkool E
      • Brodt J
      • Kolarczyk L
      • et al.
      Perceptions of gender disparities among women in cardiothoracic anesthesiology.
      Unfortunately, these findings also parallel sex disparities on journal editorial boards and in academic promotions, for which publications are an essential consideration. Prolifically publishing groups should be conscious of their team's composition and avoid a “boys club” culture. In the goal of striving toward true sex equality, men should invite women into their academic spaces and bridge the mentorship gap until the number of female leaders inevitably increases. Recruiting female junior faculty interested in research ultimately will benefit everyone through increased group productivity and networking opportunities with up-and-coming researchers.
      Likewise, male anesthesiologists must practice a zero-tolerance policy when they witness mistreatment of their female colleagues. Methangkool et al's survey revealed an alarmingly high incidence of derogatory comments (55.6%), intimidation (57.8%), microaggressions (69.6%), and sexual harassment (25.2%), most commonly perpetrated by surgical attendings.
      • Methangkool E
      • Brodt J
      • Kolarczyk L
      • et al.
      Perceptions of gender disparities among women in cardiothoracic anesthesiology.
      To combat mistreatment, every anesthesia provider should enforce an environment of safety, respect, and inclusion with the same ferocity they would with the American Society of Anesthesiologists’ practice guidelines. Ultimately, men and women are in it together to take the best care of their patients.
      The lack of sex diversity in cardiothoracic anesthesiology is an essential topic of discussion. Articles, such as those by Methangkool et al,
      • Methangkool E
      • Brodt J
      • Kolarczyk L
      • et al.
      Perceptions of gender disparities among women in cardiothoracic anesthesiology.
      encourage readers to reflect on sex equity and advocacy at their own institutions. At Ohio State University, a diverse cardiothoracic anesthesiology division has a female majority, is led by 2 female cochiefs, and sponsors a female-directed fellowship program. However, areas that need improvement must be confronted, such as the relatively fewer opportunities for female academic scholarship. This is perhaps especially true for newer female faculty, who may experience difficulty breaking into established research groups. Male researchers can and should do better from now on to be more inclusive of female colleagues in research work, as discussed in this letter. Actions speak louder than words, and now is a time for actions to do the talking.

      Conflict of Interest

      M.E. is a consultant for Boston Scientific.

      References

        • Ngai J
        • Capdeville M
        • Sumler M
        • et al.
        A call for diversity: Women and cardiothoracic anesthesiology fellowship education [e-pub ahead of print].
        J Cardiothorac Vasc Anesth. 2021; (Accessed December 22)https://doi.org/10.1053/j.jvca.2021.06.032
        • Capdeville M.
        Gender disparities in cardiovascular fellowship training among 3 specialties from 2007 to 2017.
        J Cardiothorac Vasc Anesth. 2019; 33: 604-620
        • Methangkool E
        • Brodt J
        • Kolarczyk L
        • et al.
        Perceptions of gender disparities among women in cardiothoracic anesthesiology.
        J Cardiothorac Vasc Anesth. 2021; (Accessed December 20)https://doi.org/10.1053/j.jvca.2021.11.015
        • Pagel PS
        • Freed JK
        • Lien CA.
        Gender differences in authorship in the Journal of Cardiothoracic and Vascular Anesthesia: A 28-year analysis of publications originating from the United States, 1990-2017.
        J Cardiothorac Vasc Anesth. 2019; 33: 593-599

      Linked Article

      • A Call for Diversity: Women and Cardiothoracic Anesthesiology Fellowship Education
        Journal of Cardiothoracic and Vascular AnesthesiaVol. 36Issue 1
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          ALTHOUGH Elizabeth Blackwell became the first female graduate of a United States medical school in 1849, more than 170 years later, women continue to struggle for full acceptance and equality within the medical profession. Today, women remain underrepresented at all levels of graduate medical training and professional practice, not only as practitioners but also in academic leadership,1-3 professional advancement,4 and research and grant awards.3,5
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