Encouraging diversity to build a stronger surgical workforce

Panelists at a session Wednesday morning explored the topic of parity in surgery.

“Women are affected by gender bias at every stage of their career,” according to Caprice C. Greenberg, MD, MPH, FACS, professor, Morgridge Distinguished Chair in Health Services Research, vice-chair of research, department of surgery, divisions of surgical oncology and of general surgery, University of Wisconsin-Madison.

Women surgeons earn less than men, are treated more harshly when something goes wrong, and are less likely to get promoted to full professor or to chair of departments of surgery, Dr. Greenberg said. As a consequence of unequal treatment, women are less likely to finish surgical residency and more likely to suffer from burnout, she added.

Disparities in pay and promotion are at least partly attributable to the fact that women are less likely to receive National Institutes of Health funding for their research. Furthermore, Dr. Greenberg noted that traditionally “female-type work,” such as teaching and nursing, are undervalued in society. Similarly, a study comparing payment for obstetrical procedures versus urological operations showed that payment was lower for the former than the latter, she said.

To address these issues, “leadership must not just ‘talk the talk,’ but has to ‘walk the walk,’” Dr. Greenberg said. “Pay and resource equity are critical to the climate in an institution.” To improve payment equity, institutions should “set performance metrics and report on them,” and be transparent about their compensation policies, she added.

“This is not just a women’s issue. It’s everybody’s issue,” said Dr. Greenberg, adding that multifaceted diversity improves performance, and equity and inclusion are vital to sustain departments of surgery.

Sherry M. Wren, MD, FACS, FCS(ECSA), professor and vice-chair, professional development and diversity, department of surgery, Stanford University, Palo Alto, CA; honorary professor, Barts and the London School of Medicine, Queen Mary University of London, U.K.; director, clinical surgery, Palo Alto Veterans Health Care System; director, global surgery, and faculty fellow, Center for Innovation and Global Health, Stanford University, described the strides that academic institutions are making.

According to Dr. Wren, the University of California, San Diego, recently began conducting a “periodic measurement of campus climate combined with strategic interventions focused on improving institutional faculty behavior.” Since then, the number of complaints of disruptive behavior has diminished. “Once you have knowledge, you can drive change,” she said.

The keys to faculty development, Dr. Wren said, are encouraging mentorship and sponsorship, instituting family-friendly policies, addressing dysfunctional faculty, and providing leadership opportunities. “Have an open call and applications for positions within the department, and make sure opportunities are spread out,” she said.

“Actively address issues that are impediments to retention and promotion,” added Dr. Wren, including lack of pay parity, lack of equity in departmental support, lack of understanding of promotion and compensation metrics, lack of visibility in the department, and lack of inclusion.

“Women are less likely to be included in informal and formal social gatherings, less likely to be included in collaborative research, less likely to have mentors and sponsors, and less likely to be given advice about navigating the workplace,” Dr. Wren said.

Specific recruitment strategies that she recommended include being cognizant of one’s own unconscious biases in the process of evaluating new staff and faculty. “Pay attention to thoughts that drive your opinions, and be open to contradictory evidence and opinions,” Dr. Wren said. Actively seek candidates who contribute to diversity and excellence, and conduct structured interviews that use set criteria and objective measures to assess candidates.

Siri Chilazi, MBA, MPP, research fellow, women and public policy program, Harvard Kennedy School, Cambridge, MA, described how other professions work to achieve parity. “Companies spend a lot of time and money on diversity training, and it doesn’t work,” Ms. Chilazi said. The reason it is ineffecive is because many of these programs are designed to “fix” the company. “This is about fixing individuals” and their behaviors that stem from their unconscious biases, she said.

“Even if you know you have an unconscious bias, it’s very difficult to change,” said Ms. Chilazi, adding that the concept of behavioral design, which tells us how the mind works, is now being applied to help employers address their unconscious biases.

To diminish the likelihood of these biases affecting the recruitment and hiring processes, Ms. Chilazi said human resources departments are now sending blinded resumes to hiring managers, where names, dates, and other identifying information is removed. They also are conducting structured interviews and asking hiring personnel to state which candidate answered the questions best. Companies are also asking candidates to perform “work sample tests,” so that employers can objectively observe whether potential new hires have the skills and knowledge to do the job.

To retain employees, Ms. Chilazi recommended “microsponsorship,” which involves offering small acts of everyday support, such as pointing out when a colleague is interrupted while speaking and publicly noting when an employee has done a good job. When these acts occur regularly, they can change the work culture, she said.

The session concluded with a question-and-answer session. Barbara Lee Bass, MD, FACS, Immediate Past-President, American College of Surgeons (ACS); Herbert Chen, MD, FACS, chairman, department of surgery, professor of surgery and biomedical engineering, Fay Fletcher Kerner Endowed Chair, surgeon-in-chief, University of Alabama-Birmingham (UAB) Hospital and Health System, and senior advisor, UAB Comprehensive Cancer Center, who has studied diversity in surgery; and ACS President Ronald V. Maier, MD, FACS, FRCSEd(Hon), FCSHK(Hon), joined the other panelists.