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First Person

An EM Career Marked by Ingrained Gender Bias

Edwardsen, Elizabeth A. MD

doi: 10.1097/01.EEM.0000604604.06886.e4
First Person

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It started early in my career. I was a resident in internal medicine, but found a better fit in emergency medicine. I enjoyed the problem-solving, quick pace, and variety. I completed four of the five years of clinical emergency practice required, and then asked an administrator at my university hospital for a letter of recommendation for the board certification process. He said he had no idea what I was talking about.

I was baffled. I knew he was helping a male medical school classmate through this same process. His letter was a required part of the application. This administrator, however, was known for making gender-biased statements like, “Women should not be in medicine.”

He also had less knowledge of my work because of my hospital position, but all my training had been done at his institution, and plenty of administrators could attest to my abilities. He was essentially refusing to write the letter. I then asked an administrator in internal medicine, my specialty of training and board certification, but no action was taken on my behalf.

I was unable to sit for the emergency medicine boards. My inability to demonstrate “appropriate” credentialing greatly affected my career mobility to other institutions and communities, my credibility for my chosen practice setting, and future leadership in my career of choice.

Nonetheless, I spent 23 years as an emergency physician at this university medical center and an affiliated hospital, and I was recruited by a new chairwoman to be faculty for the new emergency medicine residency program.

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Energy Drain

Women confront hurdles throughout their personal and professional lives that are unknown to their male colleagues. Viewed singly in a vacuum, many demeaning and undermining events can seem insignificant or merely slights. But over a lifetime, the additional toll and energy drain for women struggling to excel and succeed is monumental. When women behave the same as men, those actions may lead to opportunities but are also likely to lead to victimization.

As emergency medicine became more established, my position (without board certification) became more tenuous. Some said they didn't want to hear my perspective, sometimes I was ordered to stop an email dialogue, and once I was admonished like a child by an administrator, who said the workplace equivalent of “wait till your father gets home.” These interactions were staggering to me as a senior physician with extensive communication skills.

As an established and respected senior physician, I believed I could advocate for patients, staff, and my unit to improve operations, but a negative paper trail about me started appearing. It was just not credible that I, an exemplary student and employee until age 50, suddenly became a problem at work.

A meeting once was scheduled by hospital administrators to discuss interdepartmental issues that had been ignored for years. The administrative team had avoided transparency, open discussions, meetings, and even emails, so I was excited for the opportunity to offer new perspectives and improved processes.

As the discussion evolved and practice variabilities were aired, one administrator burst out of his chair and yelled, “I don't have to take this!” He stormed from the room, but returned less than a minute later and yelled at me, “You can leave this job if you don't like it!” He left again. A second administrator, a friend of the first, left to comfort him, and then he returned and told me I had to apologize. “Why are you always a problem?” another administrator asked and then he left too.

These four male administrators were clinging to their tribal comfort zone and shunning me as a female outsider. Not one appeared interested in improved situational awareness or conflict resolution. I was informed two months later that my position was not being renewed. Subsequently, the majority of my unit staff sought alternate positions.

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A False Choice

The male culture and patriarchy often create a false choice between a perceived functional male team and a disruptive woman. The true choice is an inclusive, improved culture with policies and procedures to address bias, harassment, and discrimination.

Recent years have been a powerful watershed period for addressing sexual harassment in the workplace, but gender bias is still experienced by women in the workplace with career-limiting and even, as in my case, career-ending consequences. Society can no longer normalize or justify through ignorance the clear gender bias, harassment, and discrimination in the workplace.

Efforts toward empowerment have surged forward while recognizing devastating and pervasive victimization. Many injustices and immoralities are simply “awful but lawful,” according to our legal system, and a culture change is needed. I hope sharing my story will lead to thoughtful exploration of this issue and maintain momentum toward justice for all.

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Dr. Edwardsenrecently retired as an associate professor of emergency medicine after serving as the medical director for an adult emergency department at a university hospital. She has published several chapters and numerous articles on intimate partner violence, patient and physician communication, empathy, and sexual assault. She also initiated a domestic violence curriculum at the medical school where she taught. Her book, Elusive Equity, Empathy, and Empowerment: One Woman's Journey through the Challenges of Gender Bias in the Early Twenty-First Century, is available athttps://www.pandorabangelmd.com.

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