By Ludwig Lin, MD
Black physicians have persevered in the face of racial inequity and professional challenges in this country for nearly two centuries, and have achieved success in every subspecialty. Nevertheless, challenges remain – in particular in our field of anesthesiology – where black physicians remain underrepresented, notably in leadership positions. In honor of Black History Month, Dr. Ashley Oliver shares her journey through medicine as a black American cardiac anesthesiologist and her hopes for her and our profession’s futures. As she acknowledges, she is a black woman; yet, she is also Jewish, biracial, the daughter of two physicians, an escaped humanities major, a Film Studies PhD drop-out, and an avowed social justice warrior. Exactly because of all of those different layers, she exemplifies our argument: diversity is almost always deeper than what meets the eye.
Here’s Dr. Ashley Oliver, in her own words.
The year after my father graduated from college was a tumultuous one: 1968. Many practicing physicians can still remember the events that year that ricocheted through the United States and the world: from Civil Rights, to anti-war movements and devastating assassinations of Robert F. Kennedy and Martin Luther King, Jr. That year, Black students comprised 2% of national medical school enrollment.
In 1970, the AAMC announced its goal to increase the enrollment of Black students to US medical schools to 12%. My parents were matriculants to Tufts Medical School in 1973. That year at Tufts, of 152 first year students, 13 (8.5%) were Black and 34 (22%) were women. While the class was shy of demographic targets, my parents – a Jewish American woman from New York and a Black American man from Delaware – still recall the feeling of optimism they shared that the future of medicine would resemble a more diverse future rather than its homogenous, exclusive past. Unfortunately as is well-known, these demographics did not reflect national numbers at the time, nor we have made enough progress along racial lines in the diversity of our profession in the intervening half century. In the academic year 2018-2019, only 7.1% of matriculants to US medical schools identified as Black or African American.
Not only are we operating from an overall deficit of Black trainees, but the distribution of our small numbers continues to be narrow. As is well documented, Black medical students are more likely to choose careers in primary care, obstetrics and gynecology, and internal medicine. These specialties indisputably address national race-based health disparities and provide care for millions of Americans. However, we continue to face a dire shortage of Black trainees going into other fields: neurosurgery, dermatology, orthopedics, interventional radiology, otolaryngology, and closer to home: anesthesia and our subspecialties. According to the AAMC, 5.7% of active physicians in all specialties and 5.3% anesthesiologists identified as Black or African-American in 2021.
Here’s some good news: the benefits of increased diversity are by now well-known and robustly described across numerous industries, including medicine. We have already proven that anesthesiologists are leaders in the perioperative home: shaping the landscape of outcomes, improving safety and quality care for our patients. Many of us are already urgently committed to diversifying our field in general anesthesiology and at the state and national level through pioneering work at the CSA and the ASA. This must continue, and we must continue to support efforts of our subspecialties to improve diversity and the mentorship of Black and other historically underrepresented groups among the ranks of society leadership. Most academic departments and anesthesia societies now have justice, equity, diversity and inclusion (JEDI) appointments or committees, and the CSA likewise has been a leader in thinking about the future of our profession in this regard.
As a nascent Black cardiac anesthesiologist, these are the problems that keep me up at night. The task is clear: if we want to make change in the future of health in our country, we must be committed to the eradication of stubborn race-based disparities in chronic disease states like cardiovascular disease. While one of only a handful of Black fellows in US adult cardiothoracic anesthesia programs this year, I’ve dedicated myself to forging partnerships with other anesthesiologists, my surgeons, and with interventional cardiologists to improve outcomes and reduce incidence of these diseases. I hope as my career unfolds that I will be able to partner with you too, as we collaborate to improve health and quality interventions for our patients, generate new research that helps us understand barriers to care, and train anesthesiologists of the future.
If we can do this, we may bring ourselves closer to achieving goals outlined over fifty years ago by the AAMC. We know that changing the face of our profession is more than a surface adjustment: we seek to redress centuries of inequity and structural racism, and in so doing, contribute to a fresh future. When we achieve this, we will be rewarded with more accurate and effective research, a more resilient and diverse workforce, a better understanding of the range of human experience in health and illness, and better care for all our patients, regardless of their race, gender or ethnicity.
Please check out the podcast interview with Dr. Oliver that is being released in parallel to this article. Some highlights from that conversation. (The transcript has been edited for clarity.)
How did you go from being a PhD candidate in Film Studies, to medical school and now the cardiothoracic operating room? And how does being a black cardiac anesthesiologist move the needle forward in terms of equity and representation?
“[For] people who know me well [growing up] and my research interests in the humanities, [who] knew me as an organizer as a college student on the south side of Chicago, I think they would have been surprised [of my choice to pursue anesthesia, because of] the stereotypical picture of anesthesiologist behind the drapes doing a crossword puzzle, disconnected from patient care, and happiest when patients are asleep… [and it’s true,] I am interested in the human story and the human experience, and I love listening to people. [And yet, in anesthesia], the connections that I make with my patients are so indelible and feed me every day. There is never a day when I don’t enjoy going to meet a patient pre-operatively, hear what their concerns are, talk with them about their plan for rehabilitation after surgery, promise to that patient and their family that I am going to be with them, that I’m going to stand with them and take the absolute best care of them. In the specialized world of cardiac anesthesia, I’m deeply rewarded by the teams that I get to work with [in the OR]; [it is] an incredible privilege and just so exciting.
How do you understand your journey in relation to the journey of your parents?
My mother is a Jewish American woman. She grew up in New York: her father was a dentist and her mother was a schoolteacher who stayed home to take care of the children. My mother went to college and graduated in the 1970s and really wanted to go to medical school. There was not a strong appetite to admit women into medical school at that time, and the prevailing thought was that if you gave a spot away to a woman you would eventually lose a doctor later when she went off to have her own children. My mother herself was originally 1 of 3 children, and she lost her younger brother to osteosarcoma when he was an adolescent. That devastating loss propelled her to persevere despite bias against women physicians and to fight for a career to care for others. She had to apply to medical school many times over and even to this day reminisces about a secretary at the medical school where she was eventually admitted. [This secretary] advocated on my mom’s behalf and said “we have to admit this young woman: she has to have a spot here.” I think a lot of us can recognize the importance of advocacy and sponsorship when it comes to charting advances in increasing diversity in stories like this.
My father had his own hills to climb to achieve the privilege of taking care of others as a physician. He is from Wilmington, Delaware, and his parents only went to high school. His mother was so smart – she graduated first or second in her class in high school – but, as a black American woman she faced insurmountable challenges in going to college. She desperately wanted to go to college, but her family had no money to send her. She was actually admitted to a small college in Connecticut, and when the college found out that she was black American they rescinded her admission and scholarship. My grandmother had a lot of anger about that, and she instilled in her children the relentless desire to achieve academically. And she successfully did that: all of her 4 children went to college.
So, it wasn’t that long ago that some of the things that I take for granted, like enrolling in medical school, were prohibitively difficult for women and Black Americans. It’s easy to forget how recent all this history actually is.
What are your thoughts about being approached to talk to the CSA about Black History Month?
My initial thoughts about being asked to sit down for a conversation about black history month is acknowledging I can’t speak for all physicians of color, all Black American women, all Black women physicians. We need to allow for this space of intersectionality, and acknowledge that there are lots of experiences in this country.
And yet, I’m honored to be invited to talk in this space. if there’s one message that I could put out, it’s that Black History Month is an annual opportunity to reflect on what could be called either a long history of racial tension in this country or a long history of attempts at racial reconciliation. Because the truth of the matter is that both of these processes have been going on for as long as we’ve had racial difference as a concept.
If we can move ourselves to have a curious and inquisitive lens about the role race has played in health and disease in our country every Black History Month, it will I think go a long way towards moving the needle towards racial reconciliation. Of course, part of Black History Month can be celebratory of many things: celebratory of the people who have made contributions to our field, to culture, and to the country. But I think it should also be a chance to see what we can be doing next ,and how can our conversations move forward; what do we need to do differently? So… that’s my hope both for this space but also for how we use the month going forward.