Despite the perceived lack of visibility of LGBTQ+ anesthesiologists, many of us work proudly alongside most of you in community practices, academic medical centers, and ambulatory surgery centers. Many of you may know who “we” are, and collectively the anesthesiologist community takes care of LGBTQ+ patients with the same expertise, compassion, and respect as any other patient. However, 2023 has been a tumultuous year for the LGBTQ+ community, and much attention has been placed on LGBTQ+ issues due to the almost unprecedented number of legislative bills appearing in state legislatures. As of June 1, 2023, over 520 anti-LGBTQ+ bills had been introduced into state legislatures across the country with a variety of potentially harmful implications to LGBTQ+ patients (asamonitor.pub/44P6O8c). This marks a record for the amount of anti-LGBTQ+ legislation introduced in the United States within one year. The small handful of bills that have been overturned by the courts only serves to reduce some of the existential anxiety experienced by LGBTQ+ patients/community, LGBTQ+ anesthesiologists, and ASA members. Unfortunately, we know very little about LGBTQ+ demographics within the field of anesthesiology – primarily due to a lack of available data.

In order to better support our LGBTQ+ ASA members, as well as our LGBTQ+ patients, ASA has created an Ad Hoc LGBTQ+ Committee to explore various facets impacting LGBTQ+ anesthesiologists and the LGBTQ+ community at large. This ad hoc committee is an initiative by ASA to begin addressing LGBTQ+ topics in anesthesiology, enfranchise LGBTQ+ ASA members to feel represented and included, and to build bridges for education, open communication, and understanding throughout the organization. The mission of the Ad Hoc LGBTQ+ Committee is to assist ASA in creating safe and inclusive workplaces where every LGBTQ+ anesthesiologist and resident can bring their full, authentic self to work in order to enable them to do their best work every day. This is the first time an LGBTQ+ group within ASA has formally existed to tackle complex and oftentimes controversial subject matter.

Identifying as LGBTQ+ ranks as one of the most significant independent risk factors for burnout among anesthesiologists and is associated with nearly double the risk compared to anesthesiologists who do not identify as LGBTQ+ (Anesthesiol Clin 2022;40:245-55). This risk ranks third, behind only working 40+ hours a week and a perceived lack of support at work. To better address this issue, we need to understand why LGBTQ+ anesthesiologists are particularly at risk and how to best support them within our physician/ASA community. Unfortunately, as of August 2023, we do not know what percentage of anesthesiologists identify as LGBTQ+, how many are ASA members, or who participates in organizational medicine. Capturing this information will be essential in helping to support this subgroup of anesthesiologists and create a pathway for ASA to incorporate outreach and strategies to mitigate burnout.

When it comes to mentorship, networking, and professional development, we know all too well that “representation matters.” It is instinctual to gravitate to people we feel are similar to us on any number of characteristics. Historically, this has occurred with female medical students often seeking and identifying women physicians as mentors; the same also occurs for many minorities. LGBTQ+ medical students experience a myriad of obstacles when seeking out LGBTQ+ mentors in anesthesiology. In health care settings, it may not be particularly comfortable or safe for LGBTQ+ anesthesiologists to be “out” at work. This adds an additional layer of complication for seeking mentorship. There have been efforts to develop a national LGBTQ+ anesthesiology network, but even those are early in development. Like any grassroots effort, it requires at least some form of connection linking a student or anesthesiologist to the network itself. In an effort to create visibility and a way to reach others, the new Kaiser Permanente Bernard J. Tyson School of Medicine in California has created an “out list” for LGBTQ+ medical students and faculty members to self-identify (asamonitor.pub/466T1La). Bolstering and improving upon existing efforts to generate a network of LGBTQ+ anesthesiologists for the purpose of mentorship and networking will positively impact those already in the field. It will also help attract the best and brightest medical students by sending a message that our specialty desires and supports everyone.

Addressing disparities in LGBTQ+ patient care begins with improving LGBTQ+ related education during anesthesiology training. There is a notable deficit in LGBTQ+ patient care education in the current anesthesiology curriculum. This is, in part, due to a dearth of research, evidence-based studies, and available data, but it is also due to a general knowledge gap in our field. Like many other underrepresented groups in medicine, LGBTQ+ patients experience significant health care disparities. More robust research efforts and public health initiatives are required in order to reduce harm to this population.

One example of a pressing LGBTQ+ topic requiring better peer education concerns gender-affirming care (GAC) (PLoS One 2022;17:e0261039). Studies show that GAC greatly improves quality of life and reduces overall psychological distress, substance use, and suicide risk for the transgender population – in the latter by a factor of nearly 50% (JAMA Surg 2021;156:611-8). Further education and research about GAC will help improve our understanding and how we can best care for patients in the perioperative sector undergoing this process.

The Ad Hoc LGBTQ+ Committee will be conducting an overall assessment in two phases. Phase 1 will be comprised of an overall evaluation of the existing LGBTQ+ landscape within ASA. A formal review of the assessment conducted by McKinsey consultants on behalf of the ASA Committee on Professional Diversity will also be analyzed to determine what information pertinent to LGBTQ+ physicians can be utilized as foundational opportunities. Phase 2 will encompass recommendations for future action by the ASA Executive Committee and Board of Directors. The Ad Hoc LGBTQ+ Committee aims to better understand how LGBTQ+ anesthesiologists identify and interface with ASA, how ASA can best provide professional resources for LGBTQ+ physicians at all stages of their careers, and understand the dynamics among health care organizations and clinicians who provide GAC and LGBTQ+ related care. The Ad Hoc LGBTQ+ Committee also hopes to understand and identify barriers for LGBTQ+ medical students entering anesthesiology residency training programs and further examine and address the underlying causes and solutions for burnout among LGBTQ+ anesthesiologists.

The ASA Ad Hoc LGBTQ+ Committee was formed to bring together a diverse group of physicians with a broad array of expertise with the goal of providing collective insights on issues that warrant attention in the preoperative sphere. The Ad Hoc LGBTQ+ Committee welcomes opinions and perspectives from everyone in ASA so that we can truly establish open communication in a safe, respectful manner. We recognize we all have our own inherent perspectives, journeys, and even biases. We hope that we can collectively come together to serve our LGBTQ+ ASA members and patients equitably.