Newsletter November 2021: Editorial - The status of women in Anaesthesiology- do we have any problems?

Gabriel M. Gurman, MD
Chief Editor

The question as to why this topic shows up once again in our Newsletter after the splendid editorial written by our co-editor, Dr Liana Valeanu (Gender gap-the discussion is here to stay, ESAIC Newsletter, February 2021) should be asked.

The answer is a double one.

First, because although that editorial was read by almost 450 members, it did not produce any comment in the Newsletter, as everybody was happy to get become familiar with the subject and nothing more.

The second reason is that I had the feeling that this important topic, which is here to stay, as Dr Valeanu put it, must also be approached by a man, too, because the situation in this subject is too important for all of us, so it needs to be discussed again and again.

During all my professional career I have worked with colleagues and peers of both sexes and I must confess that I did not notice any specific gender differences regarding work conditions or performance.

Gradually, the number of female anaesthesiologists increased, and not only once I have heard that our speciality is more appropriate than others for a woman, since the system in most anaesthesia departments offers fixed work schedules, and there is almost always a possibility of replacement in the operating room for those who need to be at home at fixed hours.

Numbers say that there is a discrepancy between the percentage of females among medical school graduates (50%) and that of women anaesthesiologists, for instance around 32-33% in Canada and the UK. This is the situation while more than half of the medical workforce in the UK are females (Bailey EL. Brit J Gen Pract, June 2020).

By the way, I wonder if the same situation characterises the situation in other countries of our continent.

So, what is the problem?

Why is the percentage of male anaesthesiologists higher than that of women’ in our speciality? And another question, in my eyes much more important: are women anesthesiologists unequal work conditions responsible for this situation?

To answer this  I looked into literature and found more than one explanation. It seems (almost certainly) that women anesthesiologists are not treated in the same way as their male peers.

We do not need numbers since things are more than obvious. There are fewer women in academic positions, fewer women directors of departments of anaesthesia, and fewer female speakers at scientific meetings.

The paradox is evident. Female anaesthesiologists are considered as more skilful than men, loco-regional anaesthesia techniques are more successful and safe when performed by women (in my personal opinion), but in many anaesthesia departments, people underestimate women’s performance.

There are some data about the fact that pregnancy could negatively influence the chance of female physicians to get a leadership position. Also, pregnancy is considered as one of the explanations for the fact that the income of women physicians is inferior to that of their male colleagues. This situation seems to be worldwide. Says S. Jain (J Gen Intern Med 2019;34:1362): “We must not financially penalize those who choose to have a family or combine clinical work with other interests, and we must hold regular gender pay reviews to ensure that we close the gender pay gap. If we do not rectify these wrongs, we risk losing valuable and hard-working members “.

The pay gap is another important aspect to be discussed.

In anaesthesia, like in any other speciality or profession, extra time spent at work (night duties, afternoon sessions, etc) occurs to a lesser degree for women, since many women tend to take a larger family/ home responsibility compared to men.”. Is that enough to explain the gender pay gap, which is the reality in many anaesthesia departments?

Finally, one more question: is gender discrimination a reality in our departments of anaesthesia?

I think that the danger is to generalise a situation which could exist in some places, but too many would confirm the fact that sometimes (too many times?) when a position becomes free, a man would be selected to fill it, rather than a woman with the same, or even more, abilities to fulfil the job’s requirements.

I am far from offering solutions, which are supposed to come from those who know the situation much better than me.

But one thing is sure: this reality, bad as it could be, does not leave room for what is called these days tokenism.

Google defines tokenism as: “the practice of making only a perfunctory or symbolic effort to do a particular thing, especially by recruiting a small number of people from underrepresented groups in order to give the appearance of sexual or racial equality within a workforce”. To replace a bad thing with a worse one cannot be a solution.

So what could be the solution?

I think that it has to be found, specifically, in every workplace.

And in order to solve it, one has to check what happens under his/her own eyes, because I believe that things are not the same in every place.

The scope of this editorial is to bring the topic to the attention of our readers and members, but mostly to encourage them to comment, to bring data, to offer solutions, to discuss and to dispute the subject in our Newsletter.

This is an open invitation to each of our readers to contribute, based on their own experience and opinions, to the efforts of a better understanding of what is true and what could be done.

And I would end these notes with a sentence from Dr Valeanu’s editorial: “The gender gap in healthcare will not disappear over the night. A cultural change, together with structural changes, mentorship and advocacy initiates are necessary in order to obtain better workplace environments with no discrimination and universal tolerance. Perhaps this is one of the greatest challenges that the Millennials’ generation will have to solve”.

9 replies

Sarah Saxena
Hi, Interesting topic and definitely men should be included in this discussion... Changes are not going to happen overnight, but the discussion needs to happen... As for a solution: While more present in medical school/ as trainees, women are excluded from leadership positions as these positions tend to be kept for those who work five days of the week... When choosing a leader, why not also include: those who work 4 days a week (and therefore in that group also include a large number of women?) those who took some time off (for maternity leave/ to look after their families/...)
1 month ago
Gabriel M. Gurman, MD. Chief editor
I am very glad that this editorial got so many replies. Thanks a lot to all those who wrote and express their opinion about the topic. But, unfortunately, I found very few proposals for improvement. Do we have to understand that the situation is without remedy? I do encourage our young colleagues to go on and react to all which we published here.
2 months ago
Marcelo S Ramos
At least in my enviroment I canNOT agree that women anesthesiologists are not treated in the same way as their male peers. There is absolutely NO pay gap and I never saw any pay gap since I began working in 1985. I had more female bosses than male bosses during my 35 years of work . Until 2018 I worked in 3 jobs and had 2 female bosses and one male boss, from 2016-18 I had 4 jobs and 3 female bosses. Now I have one male and one female boss. I do NOT agree that there is any subspeciality in which gender makes any difference. The most skilled regional blocker at my two jobs are males, but the main anesthesiologist for transplantation and for cardiac surgery are both female. Neuro surgery and airway management the reference anesthesiologist is male, but kids anesthesia is female. I never had any gender related issue in the speciality.
2 months ago
Dra Mónica Gallegos -Allier
Soy Anestesióloga en la Ciudad de México desde hace casi 34 años, he leído este artículo con mucho interés y me encuentro sorprendida de las opiniones de mis colegas de otros países! Parece que el patrón de conducta hacia y con las mujeres en Anestesia es "universal", no importa si estás ó no, en un país del tercer mundo. Increíble!
2 months ago
Nikoletta R. Czobor
I am an anesthesiologist in Hungary and I have a PhD in clinical anesthesia. In our department there are more female anesthesiologists than male. Despite this: no women as head of departments, no women as board members, no women as director board members....Guys are nice and pretty much good collegues, but to make a carrier here as a women, is almost impossible. I feel it doesn't really matter what you achieved in science, how good you are manually, how good you manage residents and students, how much extra work you do at the expense of you free time...men with clearly poorer working morals are chosen as leaders. It is pretty depressing I think...equality doesn't exist. I love my job, with all its difficulties, and that is the only thing that keeps me working in such circumstances.
2 months ago
In my country gender discrimination is a common rule. Though in other countries women tend to work less hours in order to be there for their families, in ours and in my specific experience women shoulder the big bunch of work while men are paid for doing merely nothing. All duties and afternoon shifts are covered by women, married or not, while the other sex tends to be quite at home. Chosen to be head of department and decision making just by gender and never by expertise or hard work. Only during crises and crashes we r turned to and considered to lift up the situation already unbearable. As for the pay.... What a deception after so much hard work and indefinite working nights away from our family and kids... Unworthy efforts...
2 months ago
Christine du Maine
Our "fixed schedule" means we know when we start, not when we finish. For obvious reasons colleagues complain when it is always the same people that get relieved "on time" (for whatever reason). It is a fact that almost all women in our department work part time (80%) - even though in practice we work more than full time number of hours. Most men work full time. Promotion (pay rise) is based on scientific work. Women with children rarely have time to work on this outside working hours (no time in working hours). This also explains less female speakers at scientific meetings. Women network less, as they tend to go home instead of spending the whole evening in a restaurant after a scientific talk. Networking also gets you a position as speaker at an event. At the same time women do not want to "complain" all the time, as the answer generally is "it was your choice to have children". And "why should people without children have to "pay" (work longer,...) for those with kids?" Although the problem is pretty universal, universal solutions are less obvious, as work regimes and pay systems differ between countries and even hospitals. The obvious answer "get the father's more involved" is not always an option, as their work schedule might not allow for large changes either.
2 months ago
Paulina Seguí
I am from Mexico City, study anesthesiologist in ABC Medical Center(1995-98) and being working here since then. Five years ago, a collegue man asked me to make something for International Women Day so, I organized my friends and gave some talks about how to meassure violence, psychological impact and myself: history of women. For this (published later http://dx.doi.org/10.35366/92924) I made a research, orally and my surprise was that we have always being accepted, but women not always wanted to be in, that fear, social pressure, expectations were common. That some men are violent, machos, but many more don’t! Since then my own perspective changed and now, whenever I have the oportunity I say: violence exists, tokenism, gender gap, etc are real, but there are also lots of men and women that respect, tolerate, seak for common wealth. Lets join them, lets raise our voice without violence, lets speak from our hearts and tell everybody that Universal tolerance (Liked this!) is possible!! We have to talk more in the present, so we build together the future today!
3 months ago
Igor Abramovich
I can agree with most arguments in the article, perhaps not fully with the regional anaesthesia competencies as I think it is not gender-based. Please allow me to comment on what I was able to observe regarding gender equity in the past years. In Germany female anesthesiologists are often removed from the OR, intensive care or any other rooster as soon as they reveal their pregnancy or the HR department finds out about it. This often causes female anesthesiologists in training to either hide their pregnancy to archive their needed training for their speciality or quit the job for a while. Often they are penalised with a long wait to return to their original training rooster after they are back to work. Sometimes I see this causes great female anesthesiologists a high level of frustration as they are either get stuck in their career path or do not get any new possible projects to work on. Maybe this is a reason why a reasonable number of female anesthesiologists quit the job sometimes. And I would agree with the numbers regarding female anaesthesiologists. In my country, women denominate the of entries to medical schools for decades now, but as time goes the number of women who work as an anesthesiologist is decreasing. Generally, I find it interesting that people in our profession often plan way ahead when they should have a family. Often I hear questions like: should I think about getting a family while I am in training? During Med school? After training? In my 40's? I have rarely heard questions like those from friends who work in a different profession. Could this be another sign of lack of support from the current practice for women... and men. So there is enough room for improvement regarding gender equity in our speciality and I am glad the ESAIC is supporting this cause.
3 months ago

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