What have you noticed about general attitudes toward DEI in medicine and how they may (or may not) have changed in recent years?
There is an increasing momentum toward DEI initiatives and efforts throughout healthcare in response to research repeatedly showing the harms caused by healthcare disparities. Research funding, education curricula, and general support have increased in an attempt to better understand the impact that diversity, equity, and inclusion has within the medical field. However, this support looks different for the various underrepresented minority communities and oftentimes the LGBTQ+ community is not classified as underrepresented by many medical organizations (although we know this to be true).
For the LGBTQ+ community, DEI research often tries to identify the healthcare disparities endured by our members while also bringing to light the intricate differences that each part of our community faces. One of the best examples of this in recent years is the nationwide attention being given to the importance of gender-affirming care for our transgender and gender-diverse community. We have to continue confronting discrimination and finding ways to best support our trans and gender diverse patients and their families.We hear a lot about “representation” in the medical field. Can you give us an idea of what this means for patient experience and why that’s important?
LGBTQ+ representation in the medical field is incredibly important for many reasons, including improving patient outcomes due to increased clinical trust and achieving increased preventative healthcare for our community. In my opinion, most of our influence, as LGBTQ+ anesthesiologists, can be found in the preoperative setting or in the ICUs at the bedside.
We shouldn’t underestimate the impact we may have on patients when they know their anesthesiologist is also a part of the LGBTQ+ community. I’ve witnessed numerous patients and their parents visibly relax and exhale in the preoperative area when I enter the room as my authentic self wearing visible signs of LGBTQ+ pride: a rainbow lanyard, Pride lapel pins, unicorn scrub cap, and usually with fabulous fingernails. Once, I watched a mom in tears pat her trans son on the shoulder and say “See - you’ll be OK son!” They had been incredibly concerned about facing healthcare discrimination and were relieved to know that I’d be his anesthesiologist and perioperative advocate.Same question, but now focusing on medical practitioners: Why do you think representation should be a focus, not just for quality of care today but also as we look to attract future physicians to the specialty of anesthesiology?
The truth is LGBTQ+ representation in anesthesiology is still lacking across the entire specialty, in large part due to lack of mentorship/sponsorship and lower perceived LGBTQ inclusion within our specialty and training programs. For instance, I personally never knew or worked with a gay anesthesiologist during medical school and I never had an LGBTQ+ anesthesiologist mentor guiding me during those formative years of medical school.
A common theme I hear each year from my mentees is how difficult it is for LGBTQ+ applicants to know where they can apply for residency/fellowship and be safe, included, and perhaps even celebrated. It is vitally important that we make it clear during the application process that LGBTQ+ applicants are welcome and accepted within our specialty. As we recruit more LGBTQ+ anesthesiologists, our visibility will naturally increase.
As LGBTQ+ anesthesiology attendings, I believe we have an obligation to show the next generation that they can find meaningful work within the specialty, surrounded by supportive colleagues, and are still able to serve the LGBTQ+ community in meaningful ways. I encourage everyone to find some way to become involved with the Medical Student Pride Alliance (@MSPA_National
), a national society for LGBTQ+ pre-med and medical students.
And speaking of LGBTQ+ anesthesiology representation, I’d like to send a HUGE congratulations to Dr. Jesse Ehrenfeld, who is a gay anesthesiologist, and was just elected as the President-Elect of the American Medical Association!What are some of the key challenges you’re trying to solve for right now? Where are the barriers, and also the opportunities?
The key challenges we face regarding LGBTQ+ representation in anesthesiology are primarily centered around mentorship and recruitment, physician burnout, and the overwhelming need to become gender-affirming care champions for our patients. We need to renew our focus and devote resources to high-quality LGBTQ+ anesthesiology mentorship and pipeline programs. We need to ensure that LGBTQ+ anesthesiologists are visible, effective, passionate, and willing to help those that are coming behind us. I am often the only LGBTQ+ anesthesiologist at the table and I am determined to find ways to create more seats at that table for better representation.
I believe the biggest barrier we face to achieving this goal is the lack of a nationwide LGBTQ+ anesthesiology community. Many professional societies have affinity groups, but we lack an organized, nationwide community. In an effort to combat this, I created a Twitter account for LGBTQ+ anesthesiologists (@LGBTQIAnesth
) and I would love it if all the LGBTQ+ anesthesiologists reading this would follow that account so we can begin building this much-needed networking community. A well-organized community would also help with exchanging ideas, networking, identifying mentorship relationships, possibly sponsoring research projects, and supporting each other, since we recently learned that being LGBTQ+ is an independent risk factor for increased burnout among anesthesiologists
The last challenge I hope to make an impact on is the anesthesiologists' role in gender-affirming care for our transgender and gender diverse patients. Transgender patients are vulnerable within the healthcare setting and often face discrimination, particularly in the hospital setting.
Anesthesiologists are uniquely poised to be advocates for trans and gender-diverse patients given our role as perioperative physicians. Through perioperative staff education, electronic medical record programming, and a better understanding of pharmacologic considerations for these patients, anesthesiologists can serve as advocates in this role and help provide a more positive and affirming perioperative experience for these patients. I encourage everyone to read the incredible articles focusing on gender-affirming perioperative care published by Dr. Remigio Roque
and also Dr. Luis Tollinche
. Is there anything you’d like to talk about that we haven’t yet covered?
I want to encourage all the LGBTQ+ anesthesiologists out there to find ways to get involved with DEI work at their own institutions, medical schools, professional societies, etc. Let’s all find ways to actively mentor the next generation of LGBTQ+ anesthesiologists and provide them with the tools that we were not given during our own training. With concerted efforts, we can make anesthesiology more LGBTQ+ friendly just by being our authentic selves at work and by ushering in a new, passionate generation of LGBTQ+ anesthesiologists.
I am always open to suggestions, collaborations, and projects, so please feel free to reach out to me (@reece_nguyen
). Thank you for your time today!
Dr. Reece-Nguyen [he/him] is a board-certified general and pediatric anesthesiologist and Clinical Assistant Professor at Stanford Children’s Hospital where he serves as a diversity, equity, and inclusion leader in his department, throughout Stanford Medicine, and at the National level as Chair of the Diversity, Equity, and Inclusion committee of the Society for Pediatric Anesthesia.