It was not so long ago that I had the privilege to give a talk on COVID-19 and the Native American response at a Society for Pediatric Anesthesia conference. It was even more recently, in March 2022, that I wrote about my journey to become a pediatric anesthesiologist in the ASA Monitor. I have been fortunate to have had guidance from my mentors that has allowed for these wonderful opportunities.
Mentorship can camouflage itself well. From an assigned mentor, a thoughtful colleague, or an organization, mentorship can provide career guidance or sponsorship, but it can provide a psychological and emotional support system as well. At a young age, I was fortunate to be a part of the Indians into Medicine (INMED) program at the University of North Dakota. When INMED formed in 1973, they recognized that there were too few health professionals in American Indian and Alaska Native (AI/AN) communities and there were also too few AI/AN health professional. As a member of INMED, I participated in a six-week enrichment course each summer that helped establish and mold my interest in science and medicine. In addition to academic enrichment, here I could finally see physicians who had very similar life experiences as mine. At INMED, I felt a sense of belonging in the medical community. The ability to pass that same sense of belonging to the next generations has been rewarding. The University of North Dakota ranks #1 nationally for graduating AI/AN physician – since 1973 they have graduated 274 AI/AN physician (asamonitor.pub/3rjHhC6). The University of North Dakota also ranks in the 100th percentile for medical schools with the highest proportion of medical students identifying as AI/AN.
Where are we today? While there have been significant improvements since 1973, the underrepresentation of AI/AN in medicine, as seen in recent data, is quite discouraging. This disparity is true for AI/ANs matriculating into medical school but also notable when looking at the numbers of practicing AI/AN physician in the U.S. In 2022-2023 data from the Association of American Medical Colleges (AAMC), only 1% of all enrolled medical students self-identified as AI/AN (asamonitor.pub/4895mQ9). The AAMC also has data from 2023-2024, which shows that 258 AI/AN medical students matriculated into U.S. medical schools (asamonitor.pub/4895mQ9). The underrepresentation is further noticeable when looking at the 2021 AAMC State Physician Workforce Data Report. Of the more than 940,000 active U.S. physicians, only 4,104 (0.4%) self-identified as AI/AN (asamonitor.pub/3Re0PF0).
In a timely Lancet article, Victor A. Lopez and colleagues’ comment on this stark underrepresentation. They write, “If AI/AN representation in the physician workforce matched their proportion in the U.S. population, there would be nearly 30,000 AI/AN physicians today” (Lancet Reg Health Am 2023;26:100588). This example paints a dramatic picture demonstrating just how underrepresented AI/AN are in medical schools. Based on their projections, if the annual number of matriculating AI/AN students remained constant, it would take over 100 years to overcome the deficit of AI/AN physicians relative to the 2021 AI/AN population.
According to the 2020 U.S. Census data, 3.7 million people identified as AI/AN (asamonitor.pub/3t7cH3D). The U.S. Census Bureau projects that the AI/AN population in 2060 will be 10.1 million people. There are over 570 federally recognized tribes and over 320 federally recognized reservations; however, more than 50% of enrolled members of a federally recognized tribe live off the reservation or in an urban setting. Anesthesiologists will continue to take care of this population for years to come. It is well documented that AI/AN populations have more barriers to high-quality health care, a higher proportion of the population that is considered poor or low-income, and experience a higher incidence of comorbidities compared to Whites. This inequity in health care demonstrates the need for AI/AN physicians to be an ongoing part of the health care community. The disparity in AI/AN physicians is quite evident, and the number of AI/AN anesthesiologists practicing is quite dismal. According to the “Medscape Physician Lifestyle Report 2017: Race and Ethnicity, Bias and Burnout,” there was not even a listed category in their data/graphs for anesthesiologists who identify as AI/AN (asamonitor.pub/47KbmyW).
While the data may be discouraging at first glance, I am more optimistic. At ANESTHESIOLOGY® 2023 in San Francisco, California, nearly 50 medical students and mentors gathered for a DEI mentoring workshop. The meeting sparked intelligent, thoughtful conversations that will ultimately lead to a significant production in DEI research and literature. Medical students were paired with mentors for a yearlong project of their choice to be submitted at their discretion at the conclusion of the projects. The future is bright. Mentorship will continue to be a part of every anesthesiologist’s career, but its importance is vital to the success of those who are underrepresented in medicine. When one succeeds, we all succeed.
I appreciate the time and effort ASA and the ASA Monitor have given me to write this and share my perspective. These advocacy efforts allow for a more inclusive environment that will strengthen our specialty and our physician workforce. A special thanks to my family, the anesthesiology departments at Duke and Boston Children’s, and all who have mentored and taught me, including Dr. Elizabeth Drum, who has kindly guided me through this process.