Mary Dale Peterson, MD, MSHCA, FACHE, served as ASA’s fourth female president, leading the society at the highest level in 2019-20. Notably, she followed female colleague Linda J. Mason, MD, FASA (2018-19) and preceded Beverly K. Philip, MD, FACA, FASA (2020-21). That was an unprecedented string of female leadership at a time of unprecedented societal challenges. Dr. Peterson’s experience in population health and her “show up and raise your hand” philosophy served ASA well during the early days of the COVID pandemic.

Dr. Peterson started her career in 1984 as one of two pediatric anesthesiologists at Driscoll Children’s Hospital. She has since climbed the ranks of the Driscoll Health System in south Texas, now serving as their Executive Vice President and Chief Operating Officer.

Dr. Peterson has always felt a calling to her line of work. “I wished I could have loved dermatology or something that would have been 9-to-5 instead of choosing pediatric anesthesia,” she joked, “But that’s not what I love. I did pediatric cardiac anesthesia, and I was on call every other night for five years because that is what was needed and I love.”

She has overseen and driven tremendous expansions and improvements to the Driscoll Health System throughout her various roles there. Before being named ASA President and Driscoll Health System EVP and COO, she managed an ICU for 12 years and served as the CEO of a health plan system. Currently, Dr. Peterson works entirely on the administrative side. “The day I cleared out my locker was a sad day for me, but it was necessary for the work I was doing. I still enjoyed being actively involved in the clinical space, but people around me said, ‘We really need all of your time in these other areas.’ Eventually, it got to the point where I knew that (administration) was where I could help the most.” The ASA Monitor caught up with Dr. Peterson and talked about what being ASA President at the beginning of COVID looked like, and much more.

What do you consider to be the most significant accomplishment of your career thus far?

It was an honor to lead the ASA as president, and it just happened to be through very challenging times. I’m also proud of the clinical work I’ve done as the second pediatric anesthesiologist in our children’s facility, building up the cardiac surgical program and the ICU, and the period where I worked primarily on population health. After 30 years in clinical medicine, working on the preventative side was very fulfilling.

Decreasing the number of preterm births and other preventable diseases in children in our region of south Texas is very important to me. We started with a premature birth rate of 15.1%, and we got it down to around 9% before COVID. For me, it wasn’t just a statistic. It meant that more children were born without hearing loss, blindness, cerebral palsy, or any other constellation of things that happen when babies are born prematurely.

You became ASA President during the initial COVID outbreak. How did you navigate such unprecedented times?

It was challenging. Our associations had not done a lot of disaster planning, but I have lived on the Gulf Coast my entire life, so I am accustomed to a Hospital Incident Command System and disaster planning. I have been through several environmental disasters. I used some of that mindset and worked with my very experienced counterpart, ASA CEO Paul Pomerantz. He put together the team that he needed from a staff perspective. Then I put together what I called the COVID-19 Council, like an Incident Command System in a hospital. There were a lot of key people in that group, and we committed to meeting at least weekly. I think when you’re in a crisis, you must have your key people at the table – subject matter experts that you need and can rely on.

Setting priorities and communicating are the other essentials in a crisis. In my mind, the priorities were pretty clear. First, we needed to protect our physicians and other anesthesia professionals so that they could take care of their patients, both now and in the future. The first statement that we released was about the importance of access to N95 masks for anesthesiologists.

You worked with the U.S Food and Drug Administration (FDA) and the White House to help make more ventilators available. Can you share that experience?

I happened to be on a White House task force call. I was the last one added to the list, and the call was kind of a free-for-all after the President, Vice President, and Surgeon General introduced themselves.

There were different leaders all talking about separate issues, from telemedicine and telemedicine payment to mental health. I was thinking to myself, “Those are not my concerns at this point. That isn’t a priority.” The priority should be saving lives in our ICUs, and we can deal with telemedicine and payments later. I had to be a persistent and loud voice on the phone, advocating that our priority should be the imminent shortage of ventilators.

After the call, my phone rang with the 202 area code – which I know is Washington, D.C. – and it was Dr. Deborah Birx calling and explaining to me that the problem was more dire than I thought. They were predicting a shortage of 200,000 ventilators in the U.S. (with only 10,000 in the strategic stockpile). I told her we could repurpose 80,000 anesthesia gas machines (AGMs). That is just an example of setting priorities during a crisis, as I mentioned earlier.

How did the White House and/or FDA help you to make those 80,000 AGMs available as ventilators?

This is where the strength and depth of the ASA came through. Robert (Butch) Loeb, MD (ASA Committee on Equipment and Facilities), Jeff Feldman, MD (Anesthesia Patient Safety Foundation), and Alexis Carmer, MD (an anesthesiologist who was also Senior Staff Fellow at the FDA), all worked together along with the major AGM manufacturers to come up with the guidance to convert our AGMs to ICU ventilators. This work was already done before the White House Task Force call. We knew what was happening in the rest of the world with the shortages of ventilators, oxygen, and drugs. This foresight was in the nick of time. We held a virtual town hall, with over 8,000 participating, to explain the protocols for conversion as well as ventilation strategies in COVID patients. The very week this strategy was deployed in New York City, they ran out of conventional ICU ventilators.

How has female leadership in anesthesiology changed throughout your career?

About 10%-15% of my class in medical school were women. Now women make up 50% of those classes. Not to say it wasn’t difficult, but we had some pioneers ahead of us that helped to pave the way. The first anesthesiologist in Texas was a woman, Dr. Claudia Potter.

I’m still concerned that we’re not attracting enough female medical students to the field of anesthesiology. It pains me to say that a higher percentage of women are going into general surgery than into anesthesia. I think we have to share that it is a wonderful profession for women. Is it challenging? Yes, and I have done a lot of on-call in my career. But there are jobs within anesthesiology where you don’t have to do as much of that.

What do you think can be done to bring more women into the field of anesthesiology?

I think programs where anesthesia is a rotation early on, either at the end of the second year as a preceptorship or somewhere in that third-year track, would attract more people, including women.

It’s also helpful if there are role models in the anesthesia department. I was lucky because I went to a medical school with a strong anesthesia department. I took the anesthesiology elective later on at school, and some of the women faculty told me they thought I would be a very good fit for the field.

What advice would you like to offer to young anesthesiologists?

Show up and raise your hand. We’re in a very exciting time in medicine. There are a lot of challenges, but I think it’s a great time to be a physician and, most importantly, to be an anesthesiologist, which I consider the best specialty. To make the most of it and to get the most joy out of it, show up for other things besides just patient care. Raise your hand! Be a part of the problem solvers, be a part of the solutions, not just a complainer. I think you’ll get much more joy out of your professional life when you’re able to give back and improve the system of care and your profession.

What are you working on now?

South Texas is a very underserved area. We’re clocking in at 200 below the national average as far as pediatric specialists go. I am always thinking of how we can better support our current amazing workforce and prevent burnout. Fostering a supportive workplace environment is a particular focus of mine at the moment.

Other than that, I am working on a few very exciting projects right now. I am working to increase our ICU capacity since we have been at full capacity for 18 months. Our system is building a freestanding children’s hospital along the Texas-Mexico border, an area with over 1 million people and no dedicated children’s hospital. We are due to open by next summer. Hiring over 700 staff and 60 physicians has been challenging, but we are halfway there.

Lastly, our system is working to address the mental health crisis in children by increasing our community access programs. We are integrating mental health professionals in primary care offices, piloting a program that will place mental health professionals in six of our public schools, and making the Positive Parenting Program accessible to families in our community.