ASRA Pain Medicine Update

Jennifer Szerb, MD, FRCPC

 In the 21^st century, society is becoming increasingly aware of the need for gender representation, equality, and diversity. Although the number of female physicians in leadership roles is increasing, more female leaders are still needed in the field of medicine. Recently, I had an opportunity to interview Jennifer Szerb, MD, FRCPC. Jennifer is a professor in anesthesia and pain medicine at Dalhousie University in Halifax, Canada. She was the chair of the Regional Anesthesia Section of the Canadian Anesthesia Society. She also founded and directed the regional anesthesia program in Halifax.

Since my abstract presentation of Doctors Against Tragedies (DAT) card games as an educational tool for the public and university students at the ASRA World Congress in April 2018, Jennifer has initiated her own DAT chapter in Halifax. There, she recruited a team of medical students to help advance this important health advocacy project. Jennifer demonstrates a passion for education and career advancement for the next generation of anesthesiologists. She is also actively involved in global health and teaches regional anesthesia in Rwanda, Bolivia, and Guyana.

Viv: You are recognized as a leader in regional anesthesia. What are your secrets of success?

Jennifer: There is no single amazing secret; it all comes down to hard work. When you are trying to build a regional program, start small, working with surgeons who are receptive to regional anesthesia techniques. You don’t have to win over all of the surgeons and your colleagues at once. I gave a huge number of presentations and grand rounds on regional anesthesia as well as workshops designed to improve the skills of my non–regional anesthesia-trained colleagues. I was the only anesthesiologist with a regional fellowship at my hospital, so I worked on developing a strong cohesive group with the basic block tool box. They became the core regional group that eventually staffed an out-of-operating-room block room. With strategic recruitment, we now have a thriving team of fellowship-trained regionalists.

Networking is also an important aspect; when I was president of the Regional Anesthesia Section at the Canadian Anesthesia Society, I connected with some prominent figures in regional anesthesia across the country.

Viv: How do you define success?

Jennifer: With a regional anesthesia program, success is not just measured in terms of number of blocks or patients’ clinical outcomes. The regional anesthesia program at Dalhousie includes academic activity with active research, fellowship experience, and teaching anesthesia residents. Furthermore, regional anesthesiologists are actively involved with the acute pain service and overall quality improvement when it comes to perioperative pain management.

Success comes when you can hand over leadership of a program to a dynamic young leader and to assume the role of mentor. It is very gratifying to know that the program will endure without me and to see it evolve to encompass all levels of academic achievement.

Viv: What are the qualities of being a good leader?

Jennifer: I am not so sure I can put myself in that category. I have tried to lead by example in my commitment to each patient, dedication to the learners’ experience, support for my colleagues, and acknowledgement of the contributions of our incredibly hardworking block room staff. I would have to say that in my interactions with surgeons and administrators, I have had my share of conflicts, including people who have reported me for various rule infractions. So I would say you have to be like a bulldog with a bone between your teeth. Hold on to your goals with tenacity. Often, achieving change in an institution is as hard as changing the course of the Titanic by 3 degrees.

Let’s not forget that women have achieved leadership positions precisely the same way as men: through sacrifice, being freed up from family responsibility, and ambition. It is a myth that as a female leader you can have it all.

Viv: What has been a defining moment for you in your academic career?

Jennifer: This is a tough question: There is no one defining moment. My research was boosted tremendously when our team received the 2015 ASRA Best of Meeting Award for our abstract, “Histological Confirmation of Needle Tip Position During Ultrasound-Guided Interscalene Block: A Randomized Comparison of Intraplexus and Periplexus Approach.” Achieving the rank of full professor in 2016 was important not only for me personally, but also for increasing the female representation at that level.

Viv: How do you gain support from your department and colleagues and garner recognition?

Jennifer: First and foremost, clinical expertise and technical skills are respected. Research achievements and the ability to teach are less visible overall and therefore undervalued. It’s all about how you can demonstrate the benefits to patients, support people to achieve success in their careers, and retain your sense of humor.

Viv: Do you think men and women are different in terms of the level of support and recognition they receive?

Jennifer: I have always worked in a very egalitarian department with a strong group of women at all stages of their careers. The extra challenge for both young men and women comes when attempting to attain promotion through the academic ranks. The criteria for achieving professor, no matter what academic stream, require a demonstration of regular research output. This is challenging without protected time, because evenings and weekends are devoted to raising children. The glass ceiling occurs because young anesthesiologists are busy with their families, whereas academic promotion requires an additional workload leading to imbalance and often necessitates a partner willing to be chief cook and bottle washer at home.

Viv: Have you had any strong mentors who helped you along your path to success?

Jennifer: My fellowship director, Dr Desirée Persaud, immediately comes to mind. She was an amazing teacher and someone I have always tried to emulate. I still report my progress to her, such as just passing the European Diploma in Regional Anesthesia exams in 2018.

Viv: What qualities made that mentor successful? Any advice on mentorship?

Jennifer: Mentorship is about being available to listen, offer advice, and support. Basically, it’s about being a wise sounding board through the struggle to attain career advancement. Anesthesia departments should have a formal process where junior staff are paired with senior staff to help with career path planning. On a personal level, I had to seek advice externally from a career counselor, which was very valuable and I highly recommend.

Viv: Do we need more female leaders? Why do women struggle to get into leadership positions?

Jennifer: This is a loaded question. It implies that female leaders will behave differently than male leaders in terms of their style of leadership—for example, being more nurturing than their male counterparts. Let’s not forget that women have achieved leadership positions precisely the same way as men: through sacrifice, being freed up from family responsibility, and ambition. It is a myth that as a female leader you can have it all. When I poll my junior female colleagues, they tell me that they still do at least the bulk of the mental activity, scheduling, and home and child care. Rather than beating our breasts and bemoaning the lack of female leaders, we should examine whether work sharing between partners really is happening in the home.

Additionally, to answer this extremely complex question, women choose to spend more time with their kids when they are little. I think we should actually value this and applaud their commitment to raising good, solid citizens.

Finally, I have to go back to my own story: I went back to start an anesthesia residency when I was 39, so my kids were mostly grown. Rather than working full-time, I had one unpaid day a week that allowed me to do administrative and research activity. I sacrificed my income and free time to get where I am. Leadership is not an entitlement; it is something earned.

Viv: What have been the hurdles in terms of getting recognized, especially as a woman in the predominantly male specialty? Any tips for defeating these hurdles when women want to advance in their career?

Jennifer: Recognition for women is no different than for men. It is about achievement. However, women have an extra hurdle to attain academic, research, clinical, and teaching deliverables, because they often do more than their fair share of childcare, and homemaking. I think that the concept of giving women a step up with more protected time would be a huge help in terms of putting them on a level playing field.

Viv: Do you think one can do the best in both worlds? Any advice for the young generation regarding this aspect.

Jennifer: Academic promotion and a balanced life are an oxymoron. Here is my advice for the younger generation: There is a trajectory to any career—focus on your family and make sure you and your kids are okay. You have plenty of time to focus on academic deliverables and leadership roles when you turn 40. After 14 years of general practice, I did not start my anesthesia career until I was 44. And recognize your limits: Never be afraid to say no if a task is too overwhelming. I used to do a talk at the Canadian Anesthesia Society about top articles of the year in regional anesthesia and read almost every regional published paper for a year. It was a huge challenge, and I could not sustain this.

Viv: What are your thoughts about the #MeToo movement in the medical profession? Is it going to bring about a cultural change in medicine?

Jennifer: I am happy to say that as far as I know, sexual harassment does not occur in my work environment. Unfortunately, I cannot say that for bullying and disrespectful behavior. There is definitely a difference in the way male surgeons interact with junior female anesthesiologists that they would not dare try on senior male anesthesiologists. I think we should have open discussion and conflict training involving all staff. It is not enough to have a poster saying this is a respectful workplace. Hard work is not the cause of burnout and workplace stress. Harassment creates a toxic environment for all.

Viv: Should there be more in the way of wellness for women in medicine? How can there be more protection and support for women in the workplace and society?

Jennifer: Many young women and men with families in anesthesia do not work full-time so they can be with their families. This is not something that is given to them; it comes at the cost of income. Being a bit more generous with protected paid academic time may be a way to support them.

The media devotes much attention to topics such as physician burnout and wellness. I don’t think we have enough emphasis on how lucky physicians in North America are. They have a steady income and are often self-employed with no supervisor to report to. They live in nice houses, take holidays, and send their kids to good schools. That’s not always true for other parts of society, who may face job loss and little savings. So, if you are feeling self-pity, involve yourself in global health. I have been an active volunteer with the Canadian Anesthesiologists’ Society International Education Foundation, and I am planning to go on my fifth trip to Rwanda for a month of teaching. When I come home, I am going to kiss my anesthesia machine and my wall oxygen. I am going to feel lucky taking a hot shower and going for a walk in the park. Let’s start putting our lives in perspective.

Viv: What do you think the best way is to foster diversity and inclusion in our subspecialty? Do you think ASRA is moving toward embracing diversity?

Jennifer: I think ASRA can congratulate itself on already being extremely diverse. I am amazed when I go to a meeting to see regionalists from all over the world.