By the CSA Women in Anesthesia Committee
In recognition of the many major accomplishments by women in anesthesia, CSA will be highlighting a variety of women leaders who practice throughout the state, bringing their diverse backgrounds and life perspectives into their work, taking purposeful steps to create pathways for mentorship and sponsorship, and helping support the clinical and research work that is being driven by an increasingly diverse field of anesthesiologists.
Below are two profiles on women making great things happen in anesthesia:
Catherine L. Chen, MD, MPH
- Assistant Professor, University of California San Francisco Department of Anesthesia & Perioperative Care
- Faculty at Philip R. Lee Institute for Health Policy Studies
What is the focus of your current research?
I am focused on health services research – looking at the delivery of health care on the ground in a real-world environment. For example, instead of asking, is Drug A versus Drug B better at treating a given disease, we already have existing research that shows that Drug A works more effectively. Then we try to see if physicians are actually prescribing the better drug in their clinical practice. If they’re not prescribing the better drug, why not? Are the barriers financial? Patient-driven? Physician-driven? We are applying this framework to perioperative resource utilization, and one particular area of interest for this is cataract surgery care. Cataract surgery is the most common elective surgical procedure in older adults in the U.S., so decisions on protocols for this can have big impacts on clinical practice and use of resources. Despite clear guidelines stating that routine preoperative medical testing is not needed before cataract surgery, we’ve seen an overuse of routine preoperative testing for cataract patients, which increases costs and creates unnecessary delays in surgical scheduling, without improving patient outcomes. In fact, these delays can actually lead to patient harm. Falls and fall-related injuries are higher among cataract surgery patients being seen by physicians who order more tests versus those who order less, since delaying surgery that improves vision means these patients have a higher chance of falling while waiting for surgery. We are looking into this to understand how to change physician test-ordering behavior to adhere better to guidelines and improve both resource utilization as well as patient health outcomes.
What are some of the unique challenges for women and minorities moving up the ladder in academic medicine?
The higher up the faculty ranks you go, the fewer women there are. There is high attrition of women and underrepresented minorities at the highest levels of academic medicine. What I’ve seen is that navigating the childbearing years, which is often aligned with the Assistant Professor years, is hard, so there are fewer women who are able to make the jump from Assistant Professor to Associate Professor. Then there is a smaller pool of Associate Professors, so even fewer make the jump to full Professor. Anesthesia department leadership is generally still male-dominated and there are not as many role models to follow as we navigate those mid-career transition years while raising children. I think that sponsorship can play a really valuable role in addressing some of these challenges. Sponsors advocate for opportunities for their sponsees and help them grow, give them opportunities while they are still “young and unproven,” teach them to think strategically, and help them chart a successful career journey.
What’s your advice for young physicians?
I advise all young physicians to find and connect with mentors and sponsors early in your career, and I advise senior physicians to see the value of this work and provide mentorship/sponsorship support to those coming up the ladder behind them. I also think it’s helpful for young physicians to know what your end goal is and work backwards from there – figure out the steps it will take to get there. For me, I was an English major in college, then worked in investment banking. My dad was also an academic physician, but I didn’t want to jump into that path without being sure it’s what I wanted for myself. After I decided to become a doctor and started medical school, I quickly realized that I loved research. I saw research as a way to impact millions of lives, beyond the lives of my own patients that I would take care of in the course of my clinical career. So I made strategic choices in where I applied for anesthesia residency and have been working to position myself for independent grant funding and independent research.
Rita Agarwal MD, FAAP, FASA 
- Clinical Professor of Anesthesiology at Stanford School of Medicine
- Immediate Past President, Society for Pediatric Pain Medicine
- Previous Chair of the Committee on Professional and Public Communications
- American Board of Anesthesiology Exam Committee Member
You have a very international background, how did you find a pathway into medicine?
My mother is from Iran and my father is from India, but they met in England while my mother was studying to be a nurse midwife and my father was a geophysicist. They moved to Iran where I was born, but then we moved to Lebanon, then to England, and then to Houston, Texas as my father worked in oil exploration. There was definitely a culture shock coming from England and then going to Texas A&M for undergrad. I had two main interests in school – ever since I took a biology class in middle school I wanted to be a doctor, but I also loved to write and wanted to be an author. I feel so lucky to have landed in my role where I get to write and practice medicine. Being Chair of the CSA CPPC committee gave me a creative writing outlet that I didn’t have before, and through my practice I also work on academic papers and research.
Do you feel like there were barriers to overcome in your career path?
I remember going to career fairs and being asked what I want to do when I grow up – I always said I wanted to be a doctor, and they often asked me what my backup plan was. That left me dumbfounded, like why are they suggesting I can’t go to medical school or become a doctor? I’m lucky that I found a great mentor in my first year of college. I wasn’t even in his class, but he would post word puzzles and anagrams on his office door, inviting any student who could solve them to come in and have a chat. After I solved a few I finally knocked and went it, and I was able to work in his chemistry lab and get great support that encouraged me to continue pursuing my interests.
What do you love most about your work?
When I was in medical school, I thought I wanted to be a neurologist, but I got to do anesthesia as an elective and that brought me into the OR and I just fell in love with the specialty. Then during my anesthesia residency, I did a peds rotation and I had so much fun and found it so challenging and rewarding. So I really think pediatric anesthesiology is the absolute best fit for me. I enjoy working with children – it’s both intense and incredibly fun at the same time. It’s different than working with adult patients – we rely on our ability to engage with children, tell stories and sing songs and work so hard to make the experience comfortable for them. I also love the interaction with the children’s families. They are scared and it’s a privilege to help children and their families feel at ease, and they are so grateful that we kept their child safe. That feedback is so rewarding. I’m also amazed by how children are so vulnerable and simultaneously so resilient. Seeing this helps me push through any exhaustion or get over a bad day.
How can you advocate for yourself and your career goals as an anesthesiologist?
There’s a misconception that a mentor can only come from within your own organization, but that’s not true. Mentors come in all shapes, sizes, backgrounds and interests, so people starting in practices should look around if they don’t find what they need within their immediate circle. Look outside to associations like CSA and others where there is a strong interest in creating opportunities and building connections.
When I started in practice, my group was a mixed academic and private practice group. I was the first and only university employed faculty at the time (and the only woman), so I had to look elsewhere to find opportunities and connection. Getting involved in medical societies was great way to do that and I engaged with the Society for Pediatric Anesthesia and the American Academy of Pediatrics Section on Anesthesiology and Pain Medicine. I’ve always been an outlier who looked different and had to create my own opportunities. So I would just show up to meetings, and share my ideas and thoughts with these groups, and anything that I committed to doing I did it on time and well. My biggest accomplishment is helping co-found the Society for Pediatric Pain Medicine – we realized there was an interest and need for this specialized group and we were able to build the group with little cost and great success. SPPM is now eight years old and just held a great meeting –lectures are still available online that highlight multi-disciplinary approaches to pain medicine focused on kids. Through this engagement with professional medical societies I was able to find incredible mentors who have been very supportive. I think it’s important for young physicians to know that if they don’t find what they need in their own practice group or institution that they should look outside into other avenues. You just need to find connections with one or two people who support you and make you feel like you matter.