Naileshni Singh, MD
It is often said that the physician workforce should reflect the demographics of the patient population; this is especially important for women, who represent most patients seeking medical care in the United States. Medicine in general, including anesthesiology, has made significant strides in increasing the number of women enrolled in medical school and undergoing residency training. (1) However, pain medicine still faces significant disparities.
The majority of chronic pain patients seeking care at a pain clinic are women, yet their clinicians are most likely to be male. Data from the Association of American Medical Colleges (AAMC) shows that while self-identified women comprise 34% of applicants to anesthesiology residencies, they are less than 21% of applicants to pain medicine fellowships (2023) and noted to be less in than other anesthesia based subspeciality fellowships. (2, 3) Between 2019-2023, the number of women applicants to pain medicine fellowships have decreased. (2) Doshi et al analyzed self-reported data from 56 academic pain medicine programs between 2017-2018 and found that women comprised only 25% of pain medicine trainees. (4) However, the authors also noted that the representation of women amongst trainee classes increased when the program director or other faculty and leadership positions were held by women, highlighting the need for mentorship by women for women. Unless pipelines are maintained, developed, and supported, the future could hold more disparities for women in some specialties like my own.
When I served as pain medicine fellowship director at the University of California, Davis Division of Pain Medicine, I was surprised as to why more women did not chose pain medicine as a subspecialty. I found the field to be an excellent balance between thought-provoking clinic and interventional procedures. I recognized that listening with an empathetic ear to a patient’s suffering while being able to provide potential cutting-edge solutions to be extremely rewarding for myself. Most days, my patients are thankful and grateful for the care that they have received. Such feedback can’t be given easily by a heavily sedated or anesthetized patient!
Doshi and Bicket recognized factors that discouraged women from pursuing pain medicine in their aptly entitled publication: “Why aren’t there more female pain medicine physicians?” (4) They outlined the following barriers: lack of opportunities for career advancement, disparities in financial compensation, failure to recognize efforts, and meager support in seeking leadership positions. Recognition of these disparities and thoughtful mentorship and sponsorship may be part of the solution. (5) I have had mentors support my research through their own funding streams, nominate me for committee chair positions, advocate for salary support for my work with the medical school, and just as importantly, allow me the time to grow my clinical, education, and research practices. While grateful for these chances, I will never know if my experiences would have been better as a man, but I suspect so! Now, as mentor to a female assistant professor, I actively look for opportunities to engage my mentee. I want to give her both the support that I received but also support her in ways that I needed and maybe didn’t get. For this year’s National Women Physicians Day, I ask that you recognize our field’s advancements in attracting women to anesthesiology but also its shortcomings in filling pain medicine fellowship slots. If the trends continue, gender disparities in this important anesthesiology-based subspeciality will worsen over time leading to adverse effects for patient care and health systems.
- Association of American Medical Colleges. The State of Women in Academic Medicine: exploring pathways to Equity, 2018–2019. Available at: https://www.aamc.org/data-reports/faculty-institutions/report/state-women-academic-medicine. Accessed January 31, 2024.
- Association of American Medical Colleges. ERAS® Statistics. Available at: https://www.aamc.org/data-reports/data/eras-statistics-data. Accessed January 31, 2024.
- Doshi T.L., Bicket, M.C. Why Aren’t There More Female Pain Medicine Physicians? Review Reg Anesth Pain Med. 2018 Jul;43(5):516-520. doi: 10.1097/AAP.0000000000000774.
- Doshi, T.L., Richter, H.C., Salisu, M., Samen, C. Representation of Women in Pain Medicine Fellowships in the United States, 2017-2018. Pain Med. 2020 Feb 1;21(2):e62-e67. doi: 10.1093/pm/pnz274.
- Diallo M.S., Wright, C.C., Tolbert Coombs, A.A., Vetter 4, T.R. Assuring the Groundwork for Success: Mentorship, Sponsorship, and Allyship for Practicing Anesthesiologists. Anesth Analg. 2023 Oct 1;137(4):754-762. doi: 10.1213/ANE.0000000000006646. Epub 2023 Sep 5.