Posts Tagged ‘American Society of Anesthesiologists’

How are two-career households with children — let alone single-parent households — going to manage with daycare centers and schools closed, perhaps for a long time to come? What damage will this do to career progress and earning potential if one parent must cut back on work? Will childcare demands inevitably delay or derail partnership or academic promotion?

When I was a young mother — my two youngest children are only 17 months apart — life revolved around childcare arrangements. As newly fledged attendings, my husband and I both wanted to practice full time, and with the confidence of youth we assumed we could make it work. For a time, we had a live-in nanny. As the babies turned into children old enough for school, we still needed a full-time nanny for drop-off, pick-up, and the days when the kids were sick and needed to stay home. We accepted the fact that a third or more of our joint income would be spent on childcare and other support services so that we could both keep working as physicians and stay sane.

But what if there had been no school?

Today, it’s hard to fathom the impact that the COVID-19 pandemic is having on families trying to find solutions to their childcare needs with the closure of private and public schools alike. Who’s going to watch, let alone educate, the kids? A nanny, no matter how conscientious and loving, may not be a good educator. When one parent has to work less in order to supervise learning at home, often that job falls to the mother. What happens to her career?

The vicious downturn cycle

As of early July, the Census Bureau estimates that half of American adults live in households that lost job income this spring. Many anesthesiologists lost income too during the periods in March and April when elective surgery in many states went on hiatus to keep beds open for COVID-19 patients.

In California, the CSA surveyed members and found that 74% reported experiencing financial hardship this spring, with medium and small private practices faring worse than academic departments. There was no overall difference in perceived economic hardship between men and women in anesthesiology, though women reported being furloughed or given involuntary vacation more often than men: 41% vs. 26% of survey respondents.

When people lose their jobs or work remotely, demand for childcare services plummets. The National Association for the Education of Young Children reports that on average, enrollment in childcare centers is down by 67%. Many that were operating on a slim margin have already gone out of business. The centers that remain open to serve essential workers are facing huge additional expenses for staff, PPE, cleaning supplies, and duplicate equipment and toys to allow cleaning after each use. At least 40% of the remaining childcare centers are likely to go out of business unless significant government assistance arrives soon. People trying to return to work after lockdown — in anesthesiology or any other field — are having trouble finding high-quality early childcare.

“It’s much harder for me to find safe childcare to be able to work,” said one woman anesthesiologist in a private conversation. Another in academic practice commented, “It’s very stressful for the mom!” A third woman is worried because her current au pair leaves in August but the new one may not be able to enter the country due to the hold on visas.

Many of us assumed optimistically that the school closures of the spring would be short-lived, and that September would mark the end of “learning from home”. That doesn’t appear likely. California’s Governor Newsom announced on July 17 that most California public and private schools will not reopen when the academic year begins.

In some states, elite private schools have more latitude to reopen than public schools as they can afford to reduce class size and adapt to strict infection control regulations recommended by the CDC. But many private religious schools that serve less wealthy families were in financial trouble even before the full effect of the pandemic hit. The Roman Catholic Boston archdiocese, for example, has already shuttered 10% of its schools permanently. No one knows yet how many students actually will be able to return to school this fall.

Even if schools reopen where state government permits, it isn’t clear that teachers will agree to return to work. In a July 19 New York Times op-ed, a teacher wrote that she is willing to take a bullet for her students, but exposing herself and her family to COVID-19 would be like asking her to take that bullet home. “It isn’t fair to ask me to be part of a massive, unnecessary science experiment,” she wrote. “I am not a human research subject. I will not do it.”

In anesthesia, you can’t “phone it in”

What are women in anesthesiology going to do if schools don’t reopen? If your job is purely administrative, or you can run a preop clinic using telemedicine, you might be able to work remotely. But you can’t “phone it in” if your job is delivering anesthesia to humans.

“I don’t see how this school year is going to work,” said one woman anesthesiologist. “It’s a hot mess.”

A recent New York Times article noted that women overall are doing less paid work since the COVID-19 lockdown began. Whether they worked remotely most of the time or not, though, they ended up being responsible for more of the home schooling this spring than their male partners. The survey also reported that mothers were primarily responsible for home schooling even when couples otherwise shared childcare duties. A sociologist commented, “What terrifies me for the future is if it will push women out of the labor force in a way that will be very hard to overcome.”

Women in anesthesiology also report a disproportionate share of responsibility for their children learning from home.

“Luckily my husband is a stay-at-home dad,” said one anesthesiologist, “but he was not cut out to homeschool. I felt like I had to be his foreman to make sure the kids got everything done while working full clinical hours with in-house call. Definitely an adjustment for all of us. I’m in AZ so I don’t see things getting better soon. This could really last the whole academic year.”

Another woman said her hours were reduced early in the pandemic. “I’m working now but will probably need to cut way down if schools don’t open,” she said. Another anesthesiologist said that she has had to adjust her schedule this spring to work more nights and weekends in order to be home more in the daytime, but “assuming no in-person school, I will most likely have to work less.”

Still another anesthesiologist said she is back at work now since elective surgery resumed, “but am desperately looking for a solution should regular school not be an option. I’d likely have to pull back significantly and fear it would be the end of me…”

Poor prognosis for women’s advancement?

 COVID-19 does not affect everyone’s career equally. The journal Nature Human Behavior reported the results of an April survey of principal investigators in the US and Europe concerning their research productivity during the pandemic. Their findings indicate that “female scientists, those in the ‘bench sciences’ and, especially, scientists with young children experienced a substantial decline in time devoted to research. This could have important short- and longer-term effects on their careers, which institution leaders and founders need to address carefully.”  

The authors concluded that the most important variable was having a young dependent. Scientists with at least one child five years old or younger experienced a 17% larger decline than others in the time they could spend on their research as a result of the pandemic.

 There are no easy answers to the question of how severely or permanently women’s careers will be damaged by the disruption of the COVID-19 pandemic. The ASA’s Committee on Women in Anesthesia is planning a thorough survey of ASA members on the effect of COVID-19 on academic productivity and career potential. It will be distributed about September 1 for anticipated publication in early 2021, and should shed more light in a quantifiable way on all these issues.

The unhappy fact is that the careers of women in medicine who, like me, chose to have children, have depended on the army of other people — mostly women — who took care of those children. We relied on the nannies, the preschool teachers, the elementary and high school teachers, the after-school programs, and don’t forget the housekeepers. If they can’t work because their own children need to be watched and helped to learn from home, all of us are at economic risk. The scaffolding behind our careers was fragile all along, but it was too scary to think about it up to now.

Until we collectively support the common-sense public health measures that will control the pandemic, we risk the collapse of our economy and our educational system, and the wellbeing of millions of children who need all the benefits of school. Women’s careers will be part of the collateral damage.

Author’s note:  This article was written in July 2020 for the September issue of the American Society of Anesthesiologists monthly magazine, the ASA Monitor, and published online ahead of print.

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Luhby T. Half of US adults live in households that lost income in pandemic. Online publication at CNN.com, July 17, 2020. https://www.cnn.com/2020/07/17/politics/lost-income-jobs-covid/index.html

Hertzberg L, Merzel M. COVID-19 Economic Impact Survey, conducted on behalf of the California Society of Anesthesiologists. Personal communication from Dr. Linda Hertzberg, ASA Director from California.

National Association for the Education of Young Children. Holding on until help comes: A survey reveals child care’s fight to survive. Online publication July 13, 2020. https://www.naeyc.org/sites/default/files/globally-shared/downloads/PDFs/our-work/public-policy-advocacy/holding_on_until_help_comes.survey_analysis_july_2020.pdf

Centers for Disease Control and Prevention (CDC). Considerations for Schools. Website publication last updated May 19, 2020. https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/schools.html

Massachusetts State House News Service. Future of private schools in question with wave of closures. Online publication of MassLive.com, June 10, 2020. https://www.masslive.com/news/2020/06/future-of-private-schools-in-question-with-wave-of-closures.html

Martinson R. Please don’t make me risk getting COVID-19 to teach your child. Online publication of the New York Times, July 18, 2020. https://www.nytimes.com/2020/07/18/opinion/sunday/covid-schools-reopen-teacher-safety.html

Miller C. Nearly half of men say they do most of the home schooling. 3 percent of women agree. Online publication of the New York Times, May 6, 2020. https://www.nytimes.com/2020/05/06/upshot/pandemic-chores-homeschooling-gender.html?action=click&module=RelatedLinks&pgtype=Article

Myers K, Tham W, Yin Y, et al. Unequal effects of the COVID-19 pandemic on scientists. Nature Human Behavior, online publication July 15, 2020. https://www.nature.com/articles/s41562-020-0921-y

 

Elegy for giant conventions

ANESTHESIOLOGY 2019 may have been the last old-school, convention-size, professional meeting I will ever attend. I could be wrong, but it may mark the end of an era. Disruptive change to the convention business model was inevitable, though hastened by COVID-19. On June 5, ASA leadership announced that the 2020 annual meeting will be virtual — for the first time, but perhaps not the last. Does this news herald disaster or opportunity?

When I was a resident attending my first ASA annual meeting, the huge convention center struck me as the mother lode of anesthesiology knowledge, with lectures and workshops that couldn’t be found anywhere else. Today, I wonder why I would travel across the country to attend a refresher course lecture in a freezing-cold meeting room, when I can watch similar content on YouTube or VuMedi for free, in comfort?

Professional associations could take this moment to move decisively into the video/podcast market. Speakers could record their own lectures, pro-con debates, and panel discussions, and societies like ASA and CSA could post all the content on proprietary video and podcast channels for members to access year-round. Think of the money we could save in travel and the cost of renting convention centers. Giant conventions at the ASA level are limited to only a few cities, most of which wouldn’t be my choice to visit.

The future of exhibit halls?

Corporate interest in buying exhibit space at anesthesiology meetings was fading fast, even before COVID-19. Why pay to send people and equipment to exhibit halls when mergers and acquisitions have centralized all the purchasing power? As recently as ten years ago, many anesthesiologists were able to influence which laryngoscopes or epidural kits their departments would order. Today, people who negotiate purchasing contracts typically work in the central offices of health systems, not in operating rooms. Today, most of us can do little more than complain about our inadequate stock of video laryngoscopes or the maddening electronic health record we’re compelled to use.

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Tech entrepreneur Josh Linkner gave the keynote speech at this year’s ASA annual meeting in San Francisco, delivering a rousing talk designed to leave the audience inspired with a can-do attitude and new hope for the survival of anesthesiology as a profession.

It should be a good talk; Mr. Linkner clearly has given it plenty of times. According to national speakers’ bureaus, the 48-year-old “innovation and creativity speaker” and “New York Times bestselling author” charges from $30,000 to $50,000 a pop for his keynote addresses, and guarantees a “fast-moving and entertaining” experience for listeners with “real takeaway value.”

So what did we get for our money?

We learned from Mr. Linkner about five “big ideas” that he believes are the keys to driving innovation in any field:

Every barrier can be penetrated

Video killed the radio star

Change the rules to get the jewels

Seek the unexpected

Fall seven times. Stand eight.

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Watching and working in ASA officer election campaigns for the past several years has been a deeply unsettling experience.

The ASA’s officers today are outstanding anesthesiologists, dedicated to their profession and to the organization. But the process of electing them, from my viewpoint, is a dysfunctional endurance test, fraught with barriers to entry and hobbled by tradition.

Imagine a hybrid of ritualized Kabuki theater and a high-school campaign for homecoming queen, and you’d be close. And yet the results have binding effects on a 50,000-member, multimillion-dollar specialty society whose work affects the professional lives of all ASA members.

We need to reevaluate and redesign this system sooner rather than later for the health and long-term future of the organization. Here is a glimpse of some of the fundamental problems.

While in theory offices come open for election every year, in reality it’s taboo to challenge an incumbent officer.

There are no term limits. An incumbent officer can be reelected indefinitely. So anyone thinking about running for office has no certain knowledge of what year an office may become vacant.

People may announce their intention to run for a given office years in advance of when the office is likely to become vacant, with the intentional effect of discouraging anyone else from running in opposition. (Think of dogs marking their territory.)

The campaign process is prohibitively expensive at personal cost to the candidates, often involving travel to multiple state society meetings. The cost alone is a barrier to entry for younger physicians, as is the time away from work and family.

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Once again, it’s Physician Anesthesiologists Week, and it’s a great time to celebrate our specialty’s many successes and accomplishments.

But we’re wasting an opportunity if we don’t also take this week to consider the state of the specialty today, and what it could or should mean to be a physician anesthesiologist 20 or 30 years from now.

There is no question that a seismic shift is underway in healthcare. Look at how many private anesthesiology groups have been bought out by—or lost contracts to—large groups and corporations; look at how many hospitals have gone bankrupt or been absorbed into large integrated health systems. Mergers like CVS with Aetna are likely to redefine care delivery networks. Where does a physician anesthesiologist fit into this new world?

An even better question to ask is this: Is your group or practice running pretty much as it did 20 years ago? If so, then my guess is that you are in for a rude awakening sometime soon. One of two scenarios may be in play:  either your leadership is running out the clock until retirement and in no mood to change, or your leadership hasn’t yet been able to convince your group that it can no longer practice in the same expensive, antiquated model. As one academic chair said ruefully, at a recent meeting, “They’re like frogs being slowly boiled. They just don’t feel what’s happening.”

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