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The Boston Globe

Health & wellness

Female surgeons note gains, subtle gender bias

Several say many obstacles still in place

The operating room, once an exclusive club for male surgeons, is becoming more welcoming to female surgeons. But the experiences of local doctors suggest that full gender equality has not yet arrived:

 A female surgeon pointedly asks why her patient is late being wheeled into the operating room, and is accused by nurses of being too aggressive.

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 Surgeons meet weekly at 7 a.m. at one hospital, just when some of their female colleagues are home getting their children dressed and fed.

 And several female neurosurgeons and orthopedic surgeons said women in these overwhelmingly male specialties often feel they must work longer hours and operate on more patients than their male colleagues to prove they belong.

The explicit gender discrimination alleged in a high-profile lawsuit settled for $7 million this month against Beth Israel Deaconess Medical Center and its former chief of surgery is rare in Boston hospitals, according to 10 female surgeons interviewed by the Globe. Still, female surgeons can experience subtler obstacles, including pressure to behave a certain way and conflicting family responsibilities.

The number of women entering general surgery has climbed steadily; they now account for more than 35 percent of trainees in the United States. But very few women have moved into leadership roles. And certain surgical specialties long known for their machismo have resisted change. About 5 percent of practicing neurosurgeons and orthopedic surgeons are female.

“We’ve really made strides, but we still have a lot of work to do,’’ said Dr. Susan Pories, president of the Association of Women Surgeons.

In her lawsuit, Dr. Carol Warfield, former head of anesthesiology at Beth Israel Deaconess, accused former surgery chief Dr. Josef Fischer of gender bias that included replying to her male colleagues when she spoke to him, and talking openly about his preference to hire male residents. Fischer and the hospital have denied doing anything wrong.

“There are always going to be some people who haven’t gotten the message,” Pories said, but “for the most part male colleagues are far more respectful than they were 10 to 20 years ago.’’

When she was a medical student and resident during the early 1960s, Dr. Carol Nadelson said, female trainees expected sexist comments. “You had to steel yourself for it,’’ said Nadelson, a psychiatrist who until recently was director of the Office for Women’s Careers at Brigham and Women’s Hospital. “It hasn’t been at that level in a while.’’

Yet, Dr. Dana Fugelso, a surgeon who said Fischer took away her operating room time and secretary while she was out on maternity leave for 12 weeks in 2002 — and then refused to restore them when she returned — believes subtle bias continues. Fischer denied those allegations in court documents included in the Warfield case, saying his policy on operating room time applied equally to all types of leaves.

“If someone today thinks sex discrimination is a thing of the past, they are just not looking,’’ Fugelso said. “It’s more the lack of ability to get promoted into higher academic levels and higher administrative jobs.’’

Several women said they are expected to be nicer than their male colleagues. If a female surgeon demands an operation be done a certain way, she risks getting labeled as pushy and domineering, whereas male surgeons are more often credited with demanding excellence. Other women, including nurses, can be especially critical, they said.

The women were so concerned about being labeled as complainers that they did not want to be quoted by name in the newspaper.

Ellen Zucker, a Boston attorney who represents Warfield and Dr. Nina Shervin, an orthopedic surgeon with a pending gender discrimination suit against Massachusetts General Hospital, said, “In academic medicine, those with power are in an exclusive club and women often are afraid to speak out about their concerns for fear of retribution.’’

An article published in the Annals of Surgery in April 2011 found that women in medicine, and especially surgery, are paid less and promoted more slowly than their male counterparts.

Few women head major clinical departments such as surgery and medicine at Boston’s large teaching hospitals. Mass. General has the highest number of female chiefs — four out of 20. None of the hospitals has a woman in charge of the surgery department.

These leadership positions are important because “the chairs have the power to promote or not, to assign resources and positions or not, so in essence to profoundly influence careers,’’ Nadelson said. They are chosen because they lecture internationally and have “major research credentials,’’ she said. “There are fewer women in this position. They tend to hit their academic stride later because most women physicians have kids.’’

Fewer women have reached the rank of professor. Sixteen percent of the 1,053 “full’’ professors at Harvard Medical School are women, while at Tufts University and Boston University medical schools, 24 percent of professors at the top rank are women.

“Partly it’s women positioning themselves to be ready for those positions,'' Pories said. “The proper kind of mentoring has been missing.’’

Dr. Cristina Ferrone, 40, a surgeon at Mass. General, said her male colleagues and bosses always have treated her fairly. But she said that most male surgeons have spouses who take charge of the children and run the household. Ferrone, whose husband is also a surgeon, does not have that luxury. “Most women [surgeons] don’t have husbands who stay at home,’’ said Ferrone.

But she said the surgery department at Mass. General has adapted to this new reality; seven of the 15 general surgeons are women. Surgeons at the hospital meet regularly between 6:30 and 7 a.m. and 5 and 8 p.m. — crucial times on the home front — but Ferrone said she is not expected to attend every conference.

“In the past, the schedule at hospitals was very rigid. It was a face-time issue,’’ she said. “Now people understand there needs to be flexibility.’’

Dr. Maureen Connelly, dean for faculty affairs at Harvard Medical School, said the school has adopted programs to help doctors with families advance their careers. They include fellowships of $25,000 to $50,000 a year that allow physicians to hire assistants and spend less time seeing patients so they can focus on publishing research. Harvard is starting to see results, she said. Half of the instructors promoted to assistant professor in the past year were women.

“Over the past 10 years, the role of women in surgery has dramatically changed for the better,’’ said Dr. Jane Mendez, a surgeon at Boston Medical Center. “Most individuals have made the move into the 21st century.’’

Liz Kowalczyk can be reached at kowalczyk@globe.com.
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