I did not expect the tears. My emotions took me by surprise as I watched my friend Dr. Kristy Weber ascend the podium to became the first woman to serve as President of the American Academy of Orthopaedic Surgery (AAOS).
This was an incredible moment. For years my enlightened orthopaedic sisters and brothers have worked to transform this field into a more diverse and inclusive profession. I too have been committed to this cause my entire career, serving as a member of the AAOS nominating committee that put Dr. Weber in the Presidential line, and as past chair of both the AAOS Diversity Advisory Board and the AAOS Women’s Health Issues Board. While so many have worked so hard over so many years, this moment when a woman became our Academy leader resonated most deeply with me. Yes, our profession can commit to diversity. Yes, we can recognize that a medical specialty which is 94 percent male does not represent the patients we serve. Yes, we can work towards a place where all children regardless of their gender, race, ethnicity or sexual orientation can strive to reach their God-given potential — including those who want to become orthopaedic surgeons.
I listened with pride as Dr. Weber gave a kick-ass speech. She spoke boldly, with just the right balance of respect for the current majority (white and male Academy fellows) while acknowledging that the status quo is no longer acceptable. Dr. Weber shared the results of a 2018 survey of 5,600 AAOS members which showed that 50 percent of respondents reported experiencing discrimination and bullying. Even more troubling, more than 50 percent of the women who responded reported experiencing sexual harassment in their role as orthopaedic surgeons. As President Weber stated, “This is not acceptable.” No, it is not.
Let us pause and contemplate this data. I know a lot of male orthopaedic surgeons and have worked side by side with my male partners for years, trusting them to care for my patients when I am away and to operate on me and my family. Honestly, I don’t know any one of them who believes that treating people unfairly is right. I have personally observed medicine to be a profession of noble people who possess strong moral compasses. So who is doing all this discrimination, bullying and sexual harassment?
The answer is we all are. Each of us has bias, both conscious and unconscious. Bias is part of the human condition. Research shows that each of us categorizes individuals within seconds of meeting them as warm vs. cold, and competent vs. incompetent (1). Without actually knowing a person, we have a perception of who they are. The least favorable impression is an individual who is both cold and incompetent; the most favorable, the one all leaders want, is to be seen as both warm and competent. This immediate categorization disadvantages women leaders.
Our initial impression of a woman leader is that she is competent but cold. Experts explain this disconnect stems from stereotypes created by our unconscious brain. Leaders are tough and decisive; women are nurturing and kind (our mothers). Yet for a woman to be a leader and make difficult decisions, she must be tough. If she is tough she cannot be nice. If a woman leader is nice, she is seen as weak — which means she cannot be competent. Irrespective of political views, think of Hillary Clinton, Angela Merkel and Margaret Thatcher compared to Bill Clinton, Ronald Reagan and John F. Kennedy. In my opinion, these women are seen as competent and cold while the men are viewed as competent and warm. As Shankar Vedantam stated so well, “American women are trapped in a paradox that is deeply embedded in our culture.”
All women leaders I know have experienced this paradox. It is real. A brief personal story illustrates how this works. A few years ago I checked into the radiology department as a patient. At the time I was Chair of the Orthopaedic Department at Mayo Clinic Florida. As I waited in my patient gown, the young radiology technician called for “Mrs. O’Connor” and I followed her into the exam room. Once inside the room, she paused and told me she would be right back. She returned with one of the older technicians. After they completed my studies, the young technician turned to me and addressed me (for the first time) as Dr. O’Connor. She went on to say that when she realized who I was, she went to get the second technician to help her, but then added that I was “really quite nice.”
This young woman could not reconcile that I as (a female) Chair could be nice (i.e., competent and warm). While she had never met me, she immediately concluded that I was competent and cold. I believe she simply could not imagine that I could lead all those male partners of mine without being a demanding person. Her unconscious bias influenced her behavior towards me as a patient. Imagine how our biases impact our behaviors towards women in leadership and patients who don’t look like us.
For the record, President Kristy Weber is both competent and warm. She has been my friend and colleague for years. In fact, all the women leaders I know are warm and caring people, as are the vast majority of the male leaders. In orthopaedics, as in medicine and society, we must continue to evolve so that we see every person as a fellow human worthy of our consideration and respect. Our patients, our children and ourselves deserve no less. Then the bullying, discrimination and sexual harassment will stop. We are so much better than that.
- Cuddy, Amy J.C., Peter Glick, and Anna Beninger. "The Dynamics of Warmth and Competence Judgments, and Their Outcomes in Organizations." Research in Organizational Behavior 31 (2011): 73–98.
Dr. Mary I. O’Connor is Director of the Center for Musculoskeletal Care at Yale School of Medicine and Yale New Haven Health and Professor of Orthopaedics and Rehabilitation at Yale School of Medicine. She is Chair of Movement is Life, a multi-stakeholder coalition committed to the elimination of musculoskeletal health disparities. She asks you to see The Power Of Shared Vision in High Performance Teams. As a member of The Perry Foundation Board of Directors and host of both Perry Initiative workshops and Nth Dimensions students, Dr. O’Connor has encouraged and mentored dozens of young women to pursue orthopaedics. Dr. O'Connor can be reached on LinkedIn or at firstname.lastname@example.org. Follow her on Twitter @MaryOConnorMD.
Illustration by Jennifer Bogartz