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Equitable Roadmap: Navigating Challenges for Black Anesthesiologists in the United States 

Betelehem Asnake, MD, MS

The field of anesthesiology in the United States plays a critical role in ensuring the well-being of patients during surgical procedures, yet the landscape remains marked by health disparities. Several published studies indicate that racial and ethnic disparities exist in anesthesia care. Memtsoudis et al found that Black, Native American, Asian, and Pacific Islander patients were more than twice as likely to have general anesthesia than regional anesthesia.1 Another study reported that Hispanic/Latinx patients were half as likely to receive regional anesthesia for knee and hip surgeries.2  Baetzel et al. found that Black children < 5 years were less likely to be given oral anxiolytics, and Black children < 15 years were less likely to have parental presence for anesthesia induction compared to White children.3 

The race concordance hypothesis asserts that racially minoritized patients who share the same race and ethnicity with their provider have improved quality of communication, patient satisfaction and better health outcomes.4-7  For example, Moore et al found that patients with race concordance preference felt more comfortable with their provider, perceived that it was easier to build a rapport with their provider, and emphasized the value of representation for themselves and their children.8 Another study examining 1.8 million hospital births in the state of Florida between 1992 and 2015 suggest that newborn-physician racial concordance is associated with a significant improvement in mortality for Black infants.9 However, the lack of underrepresented minority (URM) providers has made it difficult for URM patients to seek healthcare from URM providers of the same race and/or ethnicity.  

Anesthesiology continues to be among the medical subspecialties with the lowest representation of Black physicians. Based on the 2021 AAMC physician specialty data report, out of 38,648 anesthesiologists in the United States, only 2062 identify as Black or African American, comprising just 5.3% of all anesthesiologists, despite Black individuals constituting 14% of the population.10 Deep-rooted systemic racism and discriminatory practices have perpetuated disparities in medical education, limited access to resources, and hindered career opportunities.11 The legacy of these historical injustices continues to influence the experiences of Black anesthesiologists, creating obstacles that extend beyond individual achievement. 

Black anesthesiologists face a multitude of obstacles hindering their career progression, compounded by the responsibility of addressing significant health disparities within their community. This reflection delves into the multifaceted nature of these obstacles, focusing on institutional barriers. Its aim is to chart a strategic path forward—a roadmap contributing to the ongoing efforts for inclusivity in the medical profession. 

To comprehend the challenges faced by Black anesthesiologists, we must first acknowledge the historical context that has shaped the trajectory of Black professionals in the medical field. 

One of the central pillars of these historical challenges lies in disparities in education. Throughout much of American history, Black individuals were systematically denied access to quality education, particularly in medical schools. Several discriminatory practices have hindered under-represented pre-medical students from accessing medical schools. Among these barriers are financial disadvantages faced by many underrepresented pre-medical applicants who cannot afford the costs associated with the MCAT, preparation courses, and private academic consulting for additional support. Additionally, the lack of social capital where having a family member, friend, or neighbor who is a physician is not commonplace, thus limiting opportunities for shadowing and gaining clinical experience.12 

A recent UCLA study looking at over 81,000 pre-medical students further confirms that Black, Hispanic and Native American students were more likely to face challenging barriers which include parents without a college degree, attending a low-resourced college, having difficulty affording MCAT preparatory materials and having more pre-medical school debt. These barriers decreased their likelihood of applying to and attending medical school. The study also found that Asian, Black, Hispanic and Native American students were more likely than white students to have an advisor negatively impact their choice to pursue a career in medicine.13 

Within the institutional framework of medical academia, Black anesthesiologists grapple with a lack of representation in leadership roles. The scarcity of mentors and role models exacerbates feelings of isolation, hindering professional growth and contributing to the underrepresentation of Black individuals in the field. The absence of diverse perspectives at decision-making levels including medical admission offices perpetuates a cycle of limited opportunities for advancement, further compounding the challenges faced by Black anesthesiologists. 

The impact of implicit bias within the medical system extends beyond the professional realm to affect patient care. Studies reveal disparities in healthcare outcomes for patients of color, reflecting systemic biases that can be perpetuated by healthcare professionals.14 Black anesthesiologists find themselves navigating this ethical dilemma, striving to ensure equitable healthcare while contending with the pervasive biases ingrained in the profession. The intersectionality of their roles as both caregivers and members of marginalized communities emphasizes the importance of addressing these disparities. 

Overcoming the challenges faced by Black anesthesiologists in the United States requires a multi-faceted approach that addresses historical disparities, institutional barriers, and promotes inclusivity. Here are several recommendations: 

Diversity and Inclusion Initiatives Medical institutions should implement and strengthen diversity and inclusion initiatives specifically tailored to anesthesiology. These initiatives should include mentorship programs, networking opportunities, and affinity groups to provide support and guidance for Black anesthesiologists. 
Health Equity Training Integrate health equity training into medical education and residency training programs. This training should emphasize the recognition and mitigation of health inequities, structural racism, cultural and structural competency, implicit biases and fostering empathy among healthcare professionals. By raising awareness, future anesthesiologists can contribute to a more equitable and patient-centered healthcare system. 
Leadership Representation Promote increased representation of Black anesthesiologists in leadership roles within medical institutions. Diverse leadership not only serves as a model for aspiring professionals but also influences institutional policies and practices, fostering a more inclusive environment. 
Mentorship and Sponsorship Programs Establish robust mentorship and sponsorship programs that connect Black anesthesiologists with experienced professionals in the field. This support is crucial for career development, providing guidance, and helping navigate challenges unique to the profession. 
Targeted Recruitment and Retention Strategies Develop and implement targeted recruitment strategies to attract a diverse pool of candidates to anesthesiology programs. Outreach and retention efforts should focus on eliminating barriers to entry, providing financial support, and creating a welcoming environment for underrepresented individuals. 
Research on Disparities Encourage and support research initiatives that investigate healthcare disparities, especially those related to anesthesia. This research can contribute to evidence-based practices and policy changes that address systemic issues and promote equitable patient care. 
Cultural Sensitivity in Patient Care Incorporate cultural sensitivity training into the ongoing professional development of anesthesiologists. This ensures that healthcare providers are equipped to provide equitable and culturally competent care, addressing disparities in patient outcomes. 
Collaboration with Professional Organizations Collaborate with professional organizations, such as the American Society of Anesthesiologists or the California Society of Anesthesiologists, to develop and implement initiatives that specifically target the challenges faced by Black anesthesiologists. Collective efforts can amplify the impact of diversity and inclusion initiatives. 
Advocacy for Policy Changes Advocate for policy changes at both institutional and governmental levels that prioritize diversity, equity, and inclusion in medical professions. This includes policies that address disparities in hiring, promotion, and professional development. 
Transparent Reporting and Accountability Implement transparent reporting mechanisms for diversity metrics within medical institutions. Regularly assessing and reporting on progress fosters accountability and helps identify areas for improvement in promoting diversity and equity. 

By implementing these recommendations, the medical community can work towards a more inclusive and equitable environment for Black anesthesiologists, ultimately improving the representation and experiences of individuals within the field. 

The challenges faced by Black anesthesiologists in the United States represent a microcosm of broader issues within the medical profession. By acknowledging historical legacies, dismantling institutional barriers, and fostering inclusivity, the field of anesthesiology can move towards a future where Black professionals are afforded equal opportunities and representation. Recognizing and overcoming these challenges is not only essential for the well-being and professional fulfillment of Black anesthesiologists but is integral to ensuring the delivery of high-quality, equitable healthcare for all. The journey towards equity in medicine requires collective efforts to transform a system that has long perpetuated disparities based on race and ethnicity. 

References 

  1. Memtsoudis SG, Besculides MC, Swamidoss CP. Do race, gender, and source of payment impact on anesthetic technique for inguinal hernia repair? J Clin Anesth. 2006;18:328–333. 
  1. Memtsoudis SG, Poeran J, Zubizarreta N, Rasul R, Opperer M, Mazumdar M. Anesthetic care for orthopedic patients: is there a potential for differences in care? Anesthesiology. 2016;124:608–623. 
  1. Baetzel A, Brown DJ, Koppera P, Rentz A, Thompson A, Christensen R. Adultification of Black children in pediatric anesthesia. Anesth Analg 2019; 129(4): 1118–23. This study is one of only a handful of studies investigating anesthesia-specific pediatric racial disparities. The findings of this study suggest that anesthesia-provider implicit bias may underlie differences in the management of preoperative anxiety between Black and White children. 
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  1. Moore C, Coates E, Watson A, de Heer R, McLeod A, Prudhomme A. “It’s Important to Work with People that Look Like Me”: Black Patients’ Preferences for Patient-Provider Race Concordance. J Racial Ethn Health Disparities. 2023 Oct;10(5):2552-2564. doi: 10.1007/s40615-022-01435-y. Epub 2022 Nov 7. Erratum in: J Racial Ethn Health Disparities. 2022 Dec 19;: PMID: 36344747; PMCID: PMC9640880. 
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