By Ludwig Lin, MD
“Everyone has a different journey, but the time has come now to make sure that we rise.” – Dr. Antonio Hernandez Conte
The California Society of Anesthesiologists has the core mission to support its members, as well as to advocate for patient safety. National Latino Physician Day is a perfect amalgam of all these essential tasks; the demographics of California show an ever-increasing percentage of Latin-X residents, and their well-being and optimal healthcare are best achieved by having physicians that mirror them, as medical literature has repeatedly found. The Latin-X anesthesiologists in California are essential, and very much needed. Here, we feature three anesthesiologists who represent the spectrum of CSA practice environments and career stages. Dr. Viviana Ruiz Barros, a recent graduate of Stanford pediatric anesthesiology fellowship and now at Sacramento Shriners’ Children’s Hospital; Dr. Jennifer Lucero, Vice Chair of Equity, Diversity and Inclusion at UCLA and the David Geffen School of Medicine Associate Dean of Admissions; Dr. Antonio Hernandez Conte, cardiac anesthesiologist at Southern California Permanente medical group and current President of the California Society of Anesthesiologists.
For the full video interview, please visit the CSA YouTube Channel https://youtu.be/Uu4xNM9mWko. Below is a brief excerpt of the inspiring and informative conversation.
CSA: Would you do it all over again?
Viviana Ruiz Barros
Absolutely. I’ve had the pleasure of having younger students reach out to me; it’s uplifting for me when I hear myself talk to them because I absolutely love what I do. I get to help the most needy children in our area, and I bring a lot of happiness to them and their family. I’m there at a moment of very difficult times in their lives. If I had to go through medicine again I would 100% pick anesthesia.
Antonio Conte
Yes, I would do it over again. It’s certainly been a big journey, and sometimes we forget where we started and all of the obstacles and barriers that we faced. You know, when I was 13 or 14 years old, just being interested in science and math – it’s nice to reflect on how far we’ve all come but, I think more importantly, how much more we still have to do.
Jennifer Lucero
I came into anesthesia having trained in OB/Gyn and practiced for 2 years before I changed specialties. I think for me, it was so important for me to think back about why I chose medicine. And my community was really a priority and so I went back and did anesthesia. It’s very rewarding and I’m really grateful.
CSA: How has being Latin-X influenced or impacted your career decisions?
Viviana Ruiz Barros
I think most of us can identify with a moment where seeing somebody who had a similar background or a similar story to us helped us feel empowered or helped us feel like maybe I can do that too – that these folks overcame these challenges, so maybe I can do that too. I have a large number of Latin-X and Hispanic patients, and for them to see somebody that looked like them – there’s just a different connection that forms and I do feel that very frequently.
Antonio Conte
Latin-X physicians know that we’re going to make an impact on the bigger picture. When I interface with a patient, and I hold their hand and I speak to them in Spanish, and I can relate to their background and the circumstances that brought them to being an open heart surgery patient – I’m making an impact. I use my other roles in the CSA and Kaiser Permanente leadership to impact health policy, address systemic barriers to care. It’s a balancing act and I think as anesthesiologists we’re very privileged to be able to work in a lot of different realms and we can switch gears constantly. At the end of the day, where I find the most amount of joy is when I’m taking care of patients and I’m able to relate to them. That’s what it’s all about.
Jennifer Lucero
When I went into medical school, I thought to myself. “I’m going to be a primary care doctor” because that’s me looking at my family, being from South Los Angeles, a high need area and under resourced. I thought, “Oh I can’t be a surgeon… I didn’t even know what anesthesiologist was.”
And so I was very limited in sort of what my perspective was and, I want to be a doctor, and I was so young and I thought that’s not something I can do. That’s not my family – that’s not what we do. None of my family members went to to college. Some didn’t graduate high school and so, I hoped I could be a doctor but there were so many barriers and the education system really pushes back against that.
CSA: Do you ever feel “pigeon-holed” as a minority physician, like you are always “on” to be a representative and flag-bearer?
Viviana Ruiz Barros
I’ve had this conversation with a friend who is not a member of a minority group, and we talked about the different experiences we had growing up and our impact as anesthesiologists. And this friend said, “you know, I’m from Iowa, and nobody tells me I need to go back to Iowa to practice. It’s just not something that’s ever been told to me”.
There are specific groups that – in our case – are being told, “well, you need to go back to this community where you came from, and you have to serve this particular population.” I never thought about it too much until I heard it from this person. So what does that mean for us? It goes back to the question of feeling like you have to be a certain part of medicine in order to have an impact. I remember choosing anesthesiology feeling a little guilty about it because I was not doing one of the core primary care subspecialties that had the highest need. I almost felt that I needed to to explain myself why I was making that choice. But, like Antonio has said, we’re needed everywhere. We’re going to have an impact everywhere.
Antonio Conte
Sure, a lot of times, as we’re arriving into medical school, somehow we’ll get some sort of messaging, from either other physicians or mentors, and they’ll say, “because you’re Latin-X and Hispanic, you really should be a primary care physician and you really should go and serve the community and kind of open a clinic or work in an underprivileged area and work on the frontlines.
It’s interesting because it’s sort of like, well… why? Why would you want to limit my choices – that may not be what I’m necessarily interested in, and our presence is needed everywhere, whether it’s primary care, family practice or any of the surgical and perioperative specialties. There is a bit of bias when Latin-x Hispanic medical students are [shepherded] towards a particular direction, and I think it’s really important for everybody to be true to themselves and say, “No I’m really interested in surgery” or “I’m really interested in OB-Gyn”, or “I’m really interested in anesthesiology”. We need to be everywhere. We can be primary caregivers in the perioperative sector. When I see patients in the cardiac anesthesia clinic and there’s a large percentage of people who are Hispanic and they’ll often say to me, “you’re the very first Latin-X Hispanic person I’ve met in all these years”, certainly in the specialty areas.
CSA: What do you wish for the future generations of Latin-X physicians?
Antonio Conte
The future is going to be very different from where we are today, and we’re going to have to adapt. And we’re going to have to continue to sort of adapt to the challenges that the specialty faces. The workforce shortage is going to make it a lot harder for us, but we just have to be innovative and continue to evolve and adapt. And the last most important thing is that – we’re sitting here, representing the Latin-X Hispanic community, we can’t do it alone with just 6%. We have to rely on and build on our group of allies – people who see us, people who hear us, people who are going to take us to the next level. So… I say, “Reach out; raise your hand; knock on doors. Build your allyship, your ally group, because it’s going to be key for the future.
Jennifer Lucero
I want to encourage the next generation to be their true self – their authentic self – and bring to that to medicine.
That feeling of having to keep your head down and not speak out. Like we all sort of feel like we should just be lucky.
We’re here, right? So I think that the next generation should be empowered to say, “There are inequities. There are problems with this system, and I want to be here in this place to change it.” It’s not a matter of just representing and being in the in the OR’s. It’s a matter of being at the table where the decisions are made, being in these leadership positions where you are in academic medicine and health systems and where you’re driving that change. You are making the decisions where the funds are going, what the programs to support. They’re the ones that are going to make the real difference and understanding that.
We need allyship, but we also need the students that are coming forward to feel like they can be empowered and be their true authentic self and not have to hide.
I am so impressed with the next generation. The students that we recruit to med school – they’re amazing, and they’re going to do really wonderful things. We need to help get them to that next stage, because we have an opportunity to make some real change and build that critical mass.
CSA: What do you all think about the current discussions about Affirmative Action?
Jennifer Lucero
When I think about Los Angeles, the latest census numbers. There’s 48% of the population in Los Angeles that identified as Latin-X. Well, we have less than 10 percent of that applying to medical school. Study after study has shown that reducing health disparities requires folks that are from the communities to go back and care for those patients. And that goes not just for the Latin-X community, but for all communities that have been marginalized.
So what do we do about that? How do we impact change in those communities? How do we help reduce those health disparities? Well – we bring people from those communities into medical school. Well, how do we do that? We play the long game. You know, building out pathway programs. So we have an enormous amount of programs for students who are from lower socioeconomic status; they’re first generation to college, that are from marginalized communities, and we bring them in and we are helping to support them early on. When we look at any applicant for medical school, it’s really important to understand why is it medicine for them, and know their whole person, with their experiences, with their unique challenges that they’ve had to overcome. There’s a road traveled that we look at.
We look at students who come from privilege and what are they doing with their privilege to make a difference for other individuals or communities. It’s not sort of looking at one group or one particular person. It’s looking at the whole picture and looking at how that what has happened to them and society – how that’s impacted their ability to get an education, to go to the next level. It’s that holistic review of an applicant.
Antonio Conte
Affirmative action. It’s a very loaded lightning rod type of word, and since I applied to college the world has changed. The world is smaller, it’s more diverse, and we certainly have to look at things holistically. It’s the entire person’s journey, their narrative, their obstacles, their barriers. What they’ve overcome not just their race or the ethnicity but a whole host of things. So I think in some ways you know I welcome it as a chance for us to reset and figure out a way forward. Where I do see problems occur is after we arrive and after we’ve become physicians… here we are as Hispanic Latin-X, Black, people of color, LGBTQ physicians… how do we progress in the system? How do we get elevated and promoted, and reach those leadership positions?
That’s where it gets really sticky because it’s really easy to pigeonhole us and say, “you know – Jennifer Lucero will be great because she’s Hispanic to be the director of DEI” – but you know what? – she should be the dean of the medical school. It’s time to end that sort of typecasting. Latin-X, Hispanics, Black, persons people of color, LGBTQ people. We need to be elevated everywhere. One of my main missions as the CSA President is to ensure that everyone’s voice is heard, that everyone is seen, and everyone gets elevated. Everyone has a different journey, but the time has come now to make sure that we rise. Just getting through the door and getting our white coat – that’s great. But then there str other steps that have to come with it, and that’s the next part of the conversation.
That I think we really have to deal with – those systemic barriers at these very elite institutions are ingrained. We have to sort of raise our hands and say why not us?
CSA: What are the messages that you want people to take away from this conversation?
Antonio Conte
To encapsulate it, be your own true authentic self, unabashedly so. Don’t be ashamed of any part of you that’s unique and different. You know, really own it, believe in yourself even when others don’t believe.
But know that none of us can do it alone. We’ve got to ask for help. We’ve got to you know seek friends, colleagues, allies and sponsors.
Be part of the solution. Come to the table and bring ideas. Own it. With today’s social media and our technology, every single one of us can be so influential. I don’t think we realize the power. We are such powerful change agents. So just make it happen.