An article in JAMA Surgery recently explored the relationship between physician burnout and sexist and racial/ethnic microaggressions against surgeons and anesthesiologists (JAMA Surg March 2021). A significant relationship was discovered linking increased rates of burnout to gender and racial/ethnic minority status. The survey that formed the basis for this study was done in the several months prior to the outbreak of the COVID-19 pandemic. It is therefore not surprising that burnout later increased and physician wellness suffered during the COVID-19 pandemic. In anesthesiology, systemic problems already existed in the areas of scheduling, caregiving, productivity and promotions, wellness, mental health, and burnout, but the pandemic worsened their effects on many members.

When then-ASA President Mary Dale Peterson, MD, FASA, asked me last year to speak with ASA members who had expressed concerns about the effects of the COVID-19 pandemic on the careers of women anesthesiologists, I never imagined the things that we would subsequently accomplish. With a small group of ASA committee chairs and other interested individuals, we crafted an open letter to the larger ASA about our concerns (asamonitor.pub/3wL9TFC), which ASA Monitor Editor-in-Chief Steven L. Shafer, MD, placed online. In that piece we stated:

“We wish to acknowledge the tremendous burden COVID-19 has created for health care workers across all specialties and profession lines. These challenges are certainly not unique to anesthesiologists, nor to physicians in general, and they are not limited to women. We recognize that many men working in our field function as primary caregivers at home and are impacted in the same ways we describe below. Nevertheless, a strong evidence base continues to demonstrate a gendered division of domestic work and indicates that in most families with male-female partnerships, including the families of female physicians, the burden of childcare responsibilities still falls disproportionately on the female partner...

We believe the COVID-19 pandemic is an opportunity to rethink the way we support women, and working parents in general, in anesthesiology and its subspecialties, and to create a more sustainable model for personal and professional balance among our workforce.”

At Dr. Shafer's suggestion, we also created a Change.org petition (asamonitor.pub/3p80a9C) asking ASA to formally address the issues we raised. Among them were the following:

  • Short-term scheduling flexibility, potentially including alternative schedules for working parents with children attending school from home (e.g., evening or weekend shifts) and/or job-sharing options

  • Creative and adaptive childcare and schooling options, including consideration of on-site emergency childcare whenever possible

  • Long-term job security, with thoughtful allowances for necessary leave without penalty or impact on academic, leadership, and/or partnership promotion

  • Consideration for adjusted benefits to better enable working parents to cope with new challenges at home

  • Support for workplace re-entry programs after necessary periods of absence

  • A collaborative approach at creating peer support networks and resource sharing within and between institutions.

Over 1,300 individuals signed the petition.

Lastly, we crafted a resolution for the ASA House of Delegates (HOD) (asamonitor.pub/34BQjQ6) specifically asking ASA to address these issues with the creation of an ad hoc committee that would report back in a timely manner to the larger membership. This resolution was passed by the HOD at its second meeting in December 2020, the committee was appointed in January, and the work began.

Since I assisted the original group of concerned members with navigating the ASA governance process (and no good deed goes unpunished), ASA President Beverly Philip, MD, FASA, asked me to chair the Ad Hoc Committee on Systemic Life Imbalances. In addition, Dr. Shafer asked me to edit the themed articles on “The Burden of COVID-19” for this issue of the Monitor. The work of these two groups (committee and Monitor article authors) has proceeded in parallel. The committee is working on documents for the ASA website with ideas and recommendations on scheduling flexibility, caregiving models, productivity and career promotions, and wellness. I am hopeful these will be available on the ASA website by the time you are reading this. In addition, together with the Committee on Physician Well-Being, the committee is developing a “Statement on Creating a Culture of Well Being for Healthcare Workers” that will make recommendations on these items for consideration by the ASA HOD.

“These were always present, but the pandemic made many long-term systemic issues more apparent, and in many cases worse.”

Some, but not all, of the authors who wrote for this issue of the Monitor serve on the ad hoc committee. The Monitor has given us the opportunity to explore other areas where the pandemic has laid bare areas of inequality, lack of resources, and lack of access in health care.

These are addressed in the pieces on minority communities (Kimberley R. Nichols, MD, FASA, Semhar J. Ghebremichael, MD, and Nichole L. Taylor, DO), medical education (Elizabeth B. Malinzak, MD), pediatric anesthesiology (Mara Kenger, MD and Amy Vinson, MD, FAAP), and ECMO (Lovkesh Arora, MD, Ameeka Pannu, MD, and Somnath Bose, MD FASA). In addition, we looked more deeply into the effects of the pandemic in the areas we have already mentioned in staffing in an academic department (Zachary Deutch, MD), women physicians in general (Stephanie Byerly, MD, and Kristina L. Goff, MD) and women in academics and research (Shahla Siddiqui, MD, MSc, FCCM).

It is time for ASA to examine and work on the systemic problems in our communities and personal and professional aspects of our lives that many of us encountered over this past year. These were always present, but the pandemic made many long-term systemic issues more apparent, and in many cases worse. The articles in this issue of the ASA Monitor should convince you that we need to continue to tackle this work. It is not about “work-life balance”; it is about creating a more sustainable model of professional practice coupled with a well-considered culture of well-being for health care workers.

Linda B. Hertzberg, MD, FASA, Chair, Ad Hoc Committee on Systemic Life Imbalances, Fresno, California, and Park City, Utah.

Linda B. Hertzberg, MD, FASA, Chair, Ad Hoc Committee on Systemic Life Imbalances, Fresno, California, and Park City, Utah.