It's a symptom, I tell myself on repeat. My own words becoming a mantra. My research finding on self-assessed confidence levels, my interactions with Rico Suave, and the nagging in my gut telling me sexism and bias in anesthesia are the disease.
It could be argued that the profession of nurse anesthesia was founded on implicit gender bias. Nurses were selected to perform anesthesia under surgeon supervision, contributing to a hierarchical setting within the operating room1. At its inception, anesthesia was undesirable work for medical doctors and, thus, left to nurses, a traditionally female-dominated profession. As the profession of anesthesia has evolved from the art of keeping a patient alive during surgery to a more technically driven and evidence-based practice, both physician and male CRNA presence has increased. Of note, the field of anesthesia has undergone drastic masculinization, which has negatively impacted female CRNAs. Male physician anesthesiologists have historically competed directly with female CRNAs for job opportunities leveraging the “caring” aspect of nurse anesthesia against female providers and highlighting the more “scientific” advances of male physician-led care.
The evolution of the nurse anesthesia profession has contributed to culture, for women, that inherently places their practice at a disadvantage. Undermining working women’s self-esteem contributes to a female CRNA’s doubt of her skill levels and abilities, known as imposter syndrome. Additionally, many female providers are likely to face outside factors that influence their careers and abilities for upward career mobility. In addition to their anesthetic duties, many female CRNAs also balance child-rearing, childcare, and household duties with their work in anesthesia. The demands of motherhood may limit the opportunities for female CRNAs.
References
1. Lindsay, S. Gendering work: the masculinization of nurse anesthesia. Canadian Journal of Sociology. 2007; 32(4):429-449. doi:10.2307/20460664
2. Gonzalez LS, Fahy BG, Lien CA. Gender distribution in United States anaesthesiology residency programme directors: trends and implications. Br J Anaesth. 2020;124(3):e63-e69. doi:10.1016/j.bja.2019.12.010
3. Vajapey SP, Weber KL, Samora JB. Confidence gap between men and women in medicine: a systematic review. Current Orthopaedic Practice. 2020; 31(5):494-502.