Valerie E. Armstead, MD, DABA, Professor of Clinical Anesthesiology, Temple University Lewis Katz School of Medicine/Department of Anesthesiology, Philadelphia.
Valerie E. Armstead, MD, DABA, Professor of Clinical Anesthesiology, Temple University Lewis Katz School of Medicine/Department of Anesthesiology, Philadelphia.
Maya J. Hastie, MD, EdD, Associate Professor of Anesthesiology, Program Director, Adult Cardiothoracic Anesthesia Fellowship, and Co-Director, Faculty Development and Career Advancement Program, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Maya J. Hastie, MD, EdD, Associate Professor of Anesthesiology, Program Director, Adult Cardiothoracic Anesthesia Fellowship, and Co-Director, Faculty Development and Career Advancement Program, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
The Association of University Anesthesiologists (Anaesthetists was replaced with Anesthesiologists) formed in 1953 and was the brainchild of four distinguished academic anesthesiologists who, at the time, represented three Ivy League institutions on the Northeast coast of the United States (asamonitor.pub/2ZDvr9U). The initial exclusive nature of the research-focused organization was born out of necessity due to the economic, political, and social issues that impacted health care and the emergence of the then-new specialty of anesthesiology (Anesth Analg. 1992;74:436-53).
Over time, the organization that had a stringent set of nomination requirements and an absolute membership cap of 100 members or less in 1970 has relaxed its nomination criteria to limitlessly include candidates who have scientific achievements outside of the laboratory or primarily have achievements in education. Interestingly, embedded in the original 11 proposals written by Dr. Austin Lamont (co-founder of the University of Pennsylvania Department of Anesthesiology & Critical Care) for the foundation of the organization was prescient language that addressed the possibility of dealing with issues that would be recognized as falling under the umbrella of diversity and inclusion. Dr. Lamont wrote with parenthetical comments added by Dr. Emmanuel Papper:
“...consideration of other matters of interest (e.g., socio-economic relations, residencies, teaching, etc.) should have no place in the programs of the group's meetings. There is no reason, however, why the members of the group should not decide informally among themselves to stay over an extra day to discuss these matters if they wish. Should the members of the group eventually prove to be sympathetic and congenial and should the matters mentioned above ... be still of moment at that time, consideration should then be given to enlarging the purposes of the group. But, at least as regards socio-economic matters, it seems likely that any stand this group might adopt would be supported by a considerable number of anaesthetists who would not be eligible for membership in the group” (Anesth Analg. 1992;74:436-53).
Of note, one of the organizations with whom the original AUA was at odds was the American Medical Association (AMA), which was a segregated organization at that time. Ironically, at the time of the writing of this article, the president of the AMA is an African American woman. In essence, despite its regrettable history of segregation and lack of inclusion, the AMA seems to have responded to its 21st century diversity wakeup call.
Therefore, while the underlying good intention of the AUA has been to pursue a path of diversity and inclusion, it is apparent that the timeliness of enacting this change is overdue. In recognizing that in education as well as in industry, organizations that have diversity function better, the AUA formed a diversity task force, spear-headed by the immediate past president, Dr. Jeanine Wiener-Kronish and facilitated by Dr. Robert Whittington. The task force had its first session within the schedule of the 2019 AUA meeting in Montreal, Canada.
A major challenge in addressing issues of diversity and inclusion that has been identified among professional organizations such as the AUA is a lack of data to determine the scope of the task. Therefore, a survey of AUA members was conducted in October 2019 to determine the demographics of AUA members. The survey instrument was sent to 1,111 registered members of the AUA. Of those, 475 responses were collected with a robust response rate of 43%. The respondents to the survey mostly identified as men (74%), as Caucasian (78%), and as 51 years of age or older (68%). In addition, 43% of all respondents were older than 61 years of age. Around 25% of AUA members who responded to the survey were women. Less than 3% of respondents identified as either African American or Hispanic.
Underrepresentation of women and minorities in the AUA is a symptom of their overall underrepresentation in academic anesthesiology. The causes of this underrepresentation are complex and continue to be explored. Similar to other societies in anesthesiology, the AUA is taking a bold stance to reflect on its current state and to look at ways of increasing diversity.
“Underrepresentation of women and minorities in the AUA is a symptom of their overall underrepresentation in academic anesthesiology.... Similar to other societies in anesthesiology, the AUA is taking a bold stance to reflect on its current state and to look at ways of increasing diversity.”
Efforts to increase diversity may come at a potential cost for underrepresented groups. The phenomenon of service fatigue of underrepresented minorities, women, and LGBTQ individuals becomes evident when those individuals are tapped to represent their identity on committees in addition to performing employment duties. This service fatigue is recognized as a potential source of stress. Lack of cultural competency in the workplace also subjects these individuals to microaggressions that can take a mental as well as physical toll. On the other hand, the sense of accomplishment and pride of being a member of an organization with lofty goals for achievement in academic anesthesiology, despite recognized or unrecognized challenges, are often viewed as a satisfying means to an end (asamonitor.pub/36I48wI).
Most importantly, the AUA recognizes that advocacy, mentorship, empathy, and geniality from its members form the basis of great relationships that engage current members and attract new members. The AUA lauds members who have encouraged individuals to join despite their trepidation of not being considered worthy or not having AUA members in their academic institutions to assist in the nomination process. AUA members who take ownership in the AUA member nomination process by writing letters of nomination or recommendation and have encouraged other members of the AUA to do so are essential to promoting diversity and inclusion.
Sometimes it takes a village, but the extra effort of individuals to contribute what they can will help raise the future generation of academic anesthesiologists in an ever-increasingly diverse world.
