President's Column: Gender Equity: Where Does CT Surgery Stand?

Keith S. Naunheim, MD, President

STS News, Summer 2018 -- “Look, here comes Dr. Betty Crocker!”

“What’s your favorite journal, honey … Good Housekeeping?”

“What’s a pretty girl like you doing in surgery?”

These are the types of remarks that several senior female cardiothoracic surgeons said they heard from their “mentors” during surgical training. Grossly offensive statements in the 21st century, these were pretty run-of-the-mill remarks 30 years ago. 

It’s my belief that the environment for female trainees has markedly improved since those days, but we cannot yet claim complete enlightenment.

Gender bias and sexual harassment are certainly not limited to the world of cardiothoracic surgery; the reality is that these unwelcome behaviors affect every facet of society in America. While they have been extant for centuries, the #MeToo movement has finally helped bring issues like sexual harassment to the forefront of the American consciousness. It is causing introspection among many men, and I—like many others—have forced myself to try and recall my own behavior, pondering if and when I crossed the line. What was once considered to be just “harmless fun” among the boys is now recognized as being a real injustice.

Failure to appreciate the equal abilities and rights of women can lead not just to sexual harassment, but also to workplace discrimination in the form of gender bias. It’s hard to argue that this has not been true of cardiothoracic surgery in the past, but it’s also important to recognize that many within the specialty, male and female alike, have been battling this form of prejudice for years. Fortunately, there has been some success, as evidenced by the growth of the Women in Thoracic Surgery (WTS) organization, as well as the progressively increasing proportion of women in practice and in the training pipeline.

Still, cardiothoracic surgery is far behind many other specialties with regard to gender equity; thus, STS leaders believe that our association has a responsibility to address it.

Failure to appreciate the equal abilities and rights of women can lead not just to sexual harassment, but also to workplace discrimination in the form of gender bias.

Member Survey

As with most problems, the first corrective steps entail formal recognition and identification of scope. Accordingly, a survey was recently sent by the Society to all members of STS, WTS, and the Thoracic Surgery Residents Association requesting feedback on both sexual harassment and gender bias. These two issues, though perhaps stemming from similar origins, are not exactly the same. While both transgressions may occur consciously or unconsciously, sexual harassment refers to the making of unwanted sexual advances or sexually inappropriate remarks; gender bias refers to workplace discrimination based on gender that impedes the performance of one’s duties and/or the chances for professional advancement. Notably, this survey had the highest number of responses of any STS survey in recent history, a finding which suggests a great level of interest among the membership regarding these topics. Although the full survey results are still confidential because they will provide the basis for a paper that will be submitted to The Annals of Thoracic Surgery, the authors have kindly provided some preliminary results. I can share with you that, while not surprising, the result are nonetheless disappointing.

More than 80% of female respondents reported that they were sexually harassed by other professionals in the form of crude sexual remarks, inappropriate touching, or repeated requests for sexual interaction within the past 10 years. More than 80% of such episodes occurred in the hospital or clinic setting, with the vast majority of such episodes coming from their superiors in the program. Just as discouraging is the fact that in the area of gender bias, only about 20% of female respondents believed that surgeons would be as comfortable with a female chair as with a male chair.

It is true that limitations exist for such surveys; thus, while specific figures cannot be assumed to be perfectly accurate, these results are disconcerting.

So is there a real problem in our specialty? Hell yeah!

Should the Society have a role in addressing the issue? Damn straight!

What steps should the Society take? Great question with no absolute “right” answer.

The good news? Our specialty is improving. There are more women in CT surgery than ever before and they are filling leadership roles both regionally and nationally. Ongoing steps are under way to raise awareness.

Moving Forward

There are means for addressing issues of sexual harassment and gender bias through the enforcement of the Society’s Code of Ethics by our Committee on Standards and Ethics, and STS members having legitimate claims of wrongdoing should never hesitate to utilize the related complaint mechanism available. However, when addressing such broad issues within the specialty, our Society has always preferred the concepts of prevention and self-remediation rather than simply external punishment after the fact. In fact, such self policing has been our standard strategy for many years in the realm of quality improvement.

To that end, we recognize that most health care entities already offer educational opportunities to their employed providers pertaining to sexual harassment and gender bias – and in fact, most already require such participation. (Even the STS staff has had mandatory training addressing these issues.) To augment and advance these existing efforts, it is hoped that when the STS/WTS sexual harassment and gender bias survey results are published, they will spark awareness of these widespread problems and aid in the process of changing attitudes. In addition, WTS will cosponsor a special session at the upcoming STS Annual Meeting in San Diego that will highlight these issues.

So in conclusion, the bad news is that—to no one’s surprise—sexual harassment and gender bias are realities in the world of cardiothoracic surgery, just as they are elsewhere in America and in other places around the world.

The good news? Our specialty is improving. There are more women in CT surgery than ever before and they are filling leadership roles both regionally and nationally. Ongoing steps are under way to raise awareness. The STS membership may not yet be entirely “woke” with regard to gender equity issues, but I am pleased to note that thanks to the age of #MeToo and other factors, we are now moving more quickly in the right direction.