As I write this, reflecting on the last 12 months, I find myself thinking back to time spent at ANESTHESIOLOGY® 2021 in San Diego. In some ways, this event represented to me the culmination of another challenging year in both the medical and personal lives of anesthesiology residents among the ongoing burdens of a worldwide pandemic, increased workload in the face of health care shortages of both staff and supplies, and threats to the integrity of the title “anesthesiologist” as referring to physicians only. Despite these challenges, we have seen our share of successes, and there is hope for a bright future. I was fortunate to have the opportunity to attend the ASA annual meeting, and I don't think I was alone in the feeling of relief to be able to have an in-person event and sharing in more than a hint of optimism that seemed to permeate through the convention center.
At the opening keynote lecture, historian and biographer Doris Kearns Goodwin (interviewed by ASA Immediate Past President Beverly Philip, MD, FACA, FASA) drew from her work on the great American presidents of the past and the various traits that were characteristic of their ability to lead through challenging circumstances. She is an excellent storyteller, whose accomplishments permit her to casually name drop the people she's spent time with, including helping Lyndon B. Johnson write his memoirs, exploring the history of the White House with Hillary Clinton while staying the night, and as a guest on “The Late Show with Stephen Colbert”. Hearing her talk about the successes reached by these leaders in the face of overwhelming adversity and on the ashes of failures and shortcomings left me with hope that we will see improvements in the quality of our work and lives if we continue to fight for it. My grandmother in the United Kingdom, while reflecting on the ways the COVID pandemic has impacted her life in London, recently told me, “You know, I think World War II was worse.” I was hit with what previous generations have had to endure and how things did, eventually, get better. Though not without great effort and, of course, time.
The ASA Resident Component House of Delegates also met in San Diego and addressed some other issues facing the specialty. Dr. William McDade, Chief Diversity and Inclusion Officer at the ACGME, spoke to the delegates about issues in graduate medical education pertaining to the lack of diversity in anesthesiology residency programs and in the field as a whole. This is not a particularly new or isolated issue. Anesthesiologist-scientist James Eisenach, MD, delivered the John W. Severinghaus Lecture and, after his first few slides, pointed out that they featured “many old white men.” He was speaking of the figures who laid the foundations of anesthesia research into which he grew his career and remarked on the systemic barriers in academic medicine that produced such disparities in our specialty. Dr. Eisenach unabashedly admitted, “I should have done better.” We can do better. As Dr. McDade reinforced, residents need to support the principles of diversity, equity, and inclusion by learning about ally-ship and disparities in medicine, making efforts to garner interest in anesthesiology among individuals of diverse backgrounds at national meetings and medical student societies, and by gaining a seat on residency selection committees. Barriers to medical school matriculation also undoubtedly play a role in this, but we can do our part.
The House of Delegates meeting also honored the residency programs with 100% ASAPAC contribution records. Anesthesiologists and anesthesiology residents need voices advocating for them to ensure our success as a specialty, not just today but for the coming decades. Most of us have neither the time nor desire to actively participate in politics and advocacy – but those who do so need our support. Don't reflexively delete the emails that will almost automatically contact your member of Congress for you. It will typically take less than five minutes to enter your district and send that message. It is a great time to be completing a residency in anesthesiology, and graduates are entering a market where their services are desperately needed and good jobs are not hard to come by. But issues such as who gets to call themselves an anesthesiologist, independent practice for CRNAs, and the 33% Problem will not get better on their own, and they will affect our ability to practice how we want (and how our patients deserve). We need to support those advocating for us.
I enter my last term as a member of the ASA Resident Component Governing Council at the same time as I work through my final year of residency training. When I attempt to understand the landscape into which I will enter fellowship and practice, I know there are hurdles and uncertainty facing me and my colleagues. Yet I think there is reason for optimism. I saw it in the excitement at returning for an in-person annual meeting. I saw it in the future leaders of the field presenting their posters and speaking at the Resident Component House of Delegates meeting and in the energy of the medical students and residents as they mingled with future employers and industry leaders at the kickoff mixer. I see it in the voices of the residents who authored articles and opinion pieces for this column. It's in the newly elected Resident Component Governing Council leadership and it's in my co-residents and the aspiring residents whose applications I'm sifting through as we enter interview season. Let's not be blinded by optimism (unlikely), but rather let it guide and support us through the next year of challenges, obstacles, failures, and successes.