Is there sexism among surgeons? Some answer with emphatic 'yes'
(Editor's note: Have you experienced sexism in your position? Or do you know of a good way to avoid this problem creeping up in your program? Contact Joy Dickinson, Executive Editor, at [email protected].)
It started with an attempt at humor by the then president-elect of the American College of Surgeons. He wrote an editorial for last year's Valentine's Day publication for members that attempted to take a humorous look at male/female relationships. The editorial, which later was retracted by the college, said that semen was a mood enhancer for women and referred to a study of female college students and said those who had unprotected sex were less depressed than those whose partners used condoms.
The article resulted in strong negative responses from some of the college's female members, among others. The author met with the college's board and apologized, but his editorial still resulted in his resignation from his posts as editor in chief of the college's newspaper and president-elect. Beyond the initial controversy, the editorial led to discussion of whether female surgeons — about 10% of the college's members — are considered equals in a male-dominated field. One anonymous online commenter, who identified herself as a female surgeon, said, "Women surgeons have always been and CONTINUE TO BE treated deplorably by some of their male counterparts (particularly the very old men) female surgeons receive inappropriate and harassing verbal and physical attention."
The charge of sexism seems to be backed up by a white paper about disruptive physician behavior based on a survey of 840 physicians by the American College of Physician Executives (ACPE).1 (See results from that survey, as well as a discussion of the need for policies, below.) Among the respondents, 73% were male, and 27% were female. One respondent reported being a witness to the "creation of an intolerable work environment for a female physician by a male colleague who was condescending, bullying, and refused to acknowledge her supervisory role in the practice."
One blogger for The New York Times commented that while women make up about 50% of medical school students, less than one-third go into surgery, which she attributed in part to the perception of male discrimination.2 This trend is backed by just-released research that found women who expressed intent at the time of medical school graduation to become certified in surgery were more likely than men who had similar intentions at graduation to become certified by boards other than the the American Board of Surgery. Study author Dorothy A. Andriole, MD, FACS, Washington University School of Medicine, St. Louis, said, "That women were more likely than men to leave the surgery workforce to pursue certification in other specialties is an issue worthy of attention by the profession and the American College of Surgeons, which seeks to recruit and retain women surgeons as fellows in the organization."
The blogger for The New York Times said research indicates that more than half of female surgeons, once they are practicing, report feeling demeaned, and she said about one-third report they have been the object of inappropriate remarks that were sexist. Some female surgeons are afraid to complain, said one chairwoman of surgery quoted by the blogger.
One study found that female surgeons "are more vulnerable to discrimination, both obvious and covert."4 The same study said female surgeons are subject to a glass ceiling in terms of pay and leadership, and the authors cited manifestations of sexism in the medical environment as one of the three major causes.
Policies and education
What's the solution to avoiding sexism in your outpatient surgery program?
"Clear and well-communicated expectations of employees are the first step," says J.E. (Betsy) Tuttle-Newhall, MD, FACS, professor of surgery, Saint Louis University, division chief of abdominal transplantation, Cardinal Glennon Medical Center, both in St. Louis, MO. "Education about what constitutes boorish behavior at time of hire, and ongoing education regarding sexism and other forms of discrimination is essential to prevent and address any issues that may arise."
Hospitals and surgery centers accredited by The Joint Commission must have a code of conduct that defines "acceptable and disruptive and inappropriate behaviors," and they must have a process for dealing with the inappropriate behaviors.
The Joint Commission requires accredited organizations to educate healthcare workers at all levels and to adopt a "zero-tolerance" stance toward the worst behaviors.
"However, discrimination for any reason can be dangerous to the patients cared for, disrupts team building, and adversely affects the business and work environment of the system," Tuttle-Newhall says. For that reason, "Each facility should have their own policies and procedures, but should certainly hold people accountable for their behavior." That accountability should include firing physicians, when necessary, for repeated behavior violations, she says.
Awareness of the problem of sexism is needed, says Susan L. Orloff, MD, FACS, professor of surgery, chief, Division of Abdominal Organ Transplantation, adjunct professor, Department of Microbiology & Immunology, Oregon Health & Science University, chief, Portland VA Medical Center Transplant Program, all in Portland. "There has to be an open mind from leadership as well as a willingness to accept feedback from their employees to know whether a problem exists in their institutions," Orloff says.
Be proactive, she advises. Orloff says that rather than waiting for staff members to report a problem, ask them: Has this happened to you? Are there any issues surrounding this problem that you'd like to discuss?
"There has to be awareness, acceptance, and a willingness to receive feedback, and then desire for change," she says.
Reference
- MacDonald O. Disruptive Physician Behavior. May 15, 2011. Accessed at http://bit.ly/j2mlcR.
- Chen PW. Sexism Charges Divide Surgeons' Group. April 15, 2011. Accessed at http://nyti.ms/ikpEay.
- Andriole DA, Jeffe DB. Certification by the American Board of Surgery among US medical school graduates. JACS 2012; 214(5):806-815.
- Zhuge Y, Kaufman J, Simeone D, et al. Is there still a glass ceiling for women in academic surgery? Annals of Surgery 2011; 253(4)637-643. Doi: 10.1097/SLA.0b013e3182111120.
Resource
The Association of Women Surgeons has a "Code of Ethics" available at http://bit.ly/IakgD5.
Properly investigate reported incidences Mechanisms for reporting and investigating sexist behavior among physicians are necessary, say sources interviewed by Same-Day Surgery. In a survey conducted by the American College of Physician Executives (ACPE), 20% of female respondents said they strongly disagreed that their facility has a clear, well-enforced policy on disruptive behavior, compared to 11% of male physicians.1 Only 17% of females strongly agreed that there was a structured method to report incidences of disruptive behavior, while 27% of males strongly agreed. Females who were surveyed reported that they were less comfortable than males with reporting and confronting incidences of disruptive behavior. The females also said they were less likely to feel well-prepared to deal with such incidents. A female surgeon or other staff person who has been offended by sexist remarks or behavior must be willing to report the offense, says Susan L. Orloff, MD, FACS, professor of surgery, chief, Division of Abdominal Organ Transplantation, adjunct professor, Department of Microbiology & Immunology, Oregon Health & Science University, chief, Portland VA Medical Center Transplant Program, all in Portland. "If it's not reported, it doesn't exist," Orloff says. A reporting system must be established, and there must be non-conflicted investigation of any complaint, says J.E. (Betsy)Tuttle-Newhall, MD, FACS, professor of surgery, St Louis University, division chief, abdominal transplantation, Cardinal Glennon Medical Center, both in St. Louis. "I think education is a key part of prevention and also when an incident happens that is intolerable," Tuttle-Newhall says. "There must be accountability and full disclosure of the incident with a 'debriefing' so that the entire staff understands what happened, why it was wrong, and how the organization plans to move ahead." The leaders of an organization "must follow through on any issues with honesty and full transparency and have a no-tolerance policy for any discrimination, whether it is related to gender, race, or sexual orientation," Tuttle-Hall says. "Some discriminatory behavior can be classified under the 'disruptive behavior' category for physicians, and there are anger management programs, sensitivity trainings, etc." (For resources to address disruptive physicians, go to http://scr.bi/nBz2u.) In terms of setting expectations, "it should come down from the top," Orloff says. The persons responsible for the daily running and steering of the organization must lead, Tuttle-Newhall says. "This means holding people to the expectations of their employment, any code of conduct or behavior within the facility, making sure the surgeons and physicians follow the professional guidelines and behavior guidelines that ensure safe patient care, and compliance with national standards," she says. In 2010, The Joint Commission approved the reinstatement of a requirement prohibiting discrimination for medical staff membership and clinical privileges. The requirement was deleted in 2003 because it was thought to be covered elsewhere in the manual, but that proved to not be fully accurate. An element of performance (EP) was added to Medical Staff (MS) standards MS.06.01.07, which addresses the granting of privileges, and MS.07.01.01, which addresses appointment to the medical staff. The requirements apply to hospitals. Reference
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