“Keep your head down.”

“Just tolerate the practice because you are a woman, that’s just the way things work.”

When a senior faculty member in the anesthesiology department says this to female anesthesia residents, it’s already bad. It’s even worse when it’s a senior female doctor telling another young female doctor this.

This is a true account, and it’s not from 2 decades ago when Dr.  Rekha Chandrabose was just starting her residency in anesthesiology. The sad reality is that this was only two years ago, and published Casey Nagy, a consultant who led and authored Climate Review of Department of Anesthesiology University of Wisconsin-Madison.

In 2007, Dr. Chandrabose was one of only three women in her class of 12 for that residency in anesthesiology. In 2015, she founded Women In Anesthesiology, a non-profit professional and personal support network for women anesthesiologists.

“We were traversing new ground.  As residents, we had few role models, and little idea of how to network, leverage our skills, and lobby for equitable treatment.  There were very small numbers of women in general, and zero women as Professor level faculty or in leadership roles,” Dr. Chandrabose noted.

Unlike those senior female faculty members that were telling younger residents to “keep their head down,” Dr. Chandrabose “felt a desire and an obligation to serve the residents who were following them.”

And those residents are growing. In the 2009 Anesthesia Quality Institute's report Anesthesia in the U.S., 23% of anesthesiologists were female. In 2013, the proportion of female anesthesiologists was 25%. While it may appear small, it is still increasing. In 2018 an estimated average of female anesthesiologists in the US across four ethnicity/race is at 26.5%.

A study by RAND Corporation in 2015 noted the increasing number of young female physicians becoming anesthesiologists, “but the pay of those women lags behind their male peers, even after accounting for differences such as hours worked and experience.”

Fast forward four years, is gender inequality still an issue? Is anesthesiology still an all-boys club? Not if the new statistics are anything to go by, where thought leadership in this field is led by women anesthesiologists. Not only are they on the rise in numbers, but in confidence and competency as well.

Recognizing Female Thought Leaders on Anesthesiology

The American Society of Anesthesiologists (ASA) has recognized some of the exemplary women in the industry. Three women anesthesiologists have already been awarded the Distinguished Service Award (DSA), the highest recognition the organization gives its members annually.

Recipients are recognized for “Outstanding clinical, educational or scientific achievement, contribution to the specialty and/or exemplary service to the Society.”

Virginia Apgar was an obstetric anesthesiologist who invented Apgar scoring, a health assessment system for a newborn child immediately after birth. She was recognized by ASA in 1961. Following her was Gertie Marx, the “mother of obstetric anesthesia” who received her reward in 1988.

Betty Stephenson was the next to join the roster of distinguished awardees. She was recognized in 2000 having served as ASA’s past president in 1991.

Stephenson is one of 3 women anesthesiologists elected as president of the society since 1935. More recently, Jane C.K. Fitch held the position in 2014, and the current president is Linda J. Mason.

Today’s leaders in female anesthesiology share some of their thoughts behind this growth, and what needs to happen next.

Dr. Karen Sibert is UCLA’s first-ever Director of Communications for the Department of Anesthesiology and Perioperative Medicine. She specializes in thoracic anesthesiology, including anesthesia for procedures on the lungs and esophagus at the Ronald Reagan UCLA Medical Center. She is among LifeWIRE’s influential Top 10 Anesthesiologists to Follow on Twitter.

In her blog aPennedPoint , she writes “to be happy in their practice anesthesiologists need to develop the right balance of backbone and flexibility. Most of the time, I simply think of myself as the physician who’s taking care of the heart, lungs, and the rest of the patient’s needs while the surgeon takes care of the surgical problem. We each have our jobs.”

Dr. Marjorie Stiegler, another one of 4 women anesthesiologists in the  LifeWIRE’s Top 10 Anesthesiologists on Twitter list, is an accomplished physician leader on patient safety, and author of two books. She is a board member of Women In Anesthesiology and serves nationally on the ASA Patient Safety and Education Committee, and the Anesthesiology Quality Institute Committee for the Anesthesia Incident Reporting System.

She believes that patient care should be championed by all, and that there shouldn’t be any “battle for supremacy” among healthcare providers. In a published article, Stiegler wrote: “My respect for others (and their respect for me) should not be based upon hours or years of training, number of nights and weekends sacrificed, or initials after our names. Here’s one thing I know with conviction:  We all have value. It is not necessary to marginalize each other to take pride in our own worth.

Dr. Rita Agarwal is a Pediatric Anesthesiologist and a clinical professor of anesthesiology, perioperative and pain medicine at Stanford. She is the elected chair of the American Academy of Pediatrics Section on Anesthesiology and Pain Management.

In her article about Sexism, Harassment, and Women in Anesthesiology, she wrote “I am part of the generation of women who started medical school in the 1980s. The women I knew were fearless, ambitious, strong, and believed firmly in our equality. We suspected that we would need to work at least twice as hard, and be twice as smart, to get the same level of recognition as some of our male colleagues. We expected and prepared for bias, harassment and possibly even misogyny.”  

Dr. Sasha K. Shillcutt, is a Cardiac Anesthesiologist, an Associate Anesthesiology Professor at the University of Nebraska College of Medicine, and Vice Chair of Strategy and Innovation there. She blogs about women empowerment with a “goal to create a community of #braveenough women who can share, encourage and empower one another.”

“I started a group, a small group, with other women like me, to encourage one another. That group grew. It’s 8,000 strong now…and very, very, powerful.The funny thing is, this group has immense power. It helps women back on their feet, empowers them to negotiate, helps them navigate parenthood and working in medicine, and gives them an opportunity to amplify their research and work,” Shilcutt shares on her blog.

They are but a few of the amazing women in medicine, and they are proudly anesthesiologists. The list is long. But what makes them the best among us or what makes anyone the “best” is they bring a unique perspective on their own, as women but also as practising doctors and researchers.

To those who still feel women should "keep their head down" better keep your heads up now and watch out for these any many more women who are out to continue to make many significant contributions to health and medicine.