What a human rights complaint by Alberta's only female cardiovascular surgeon says about sexism in surgery
'This is the only way change will get effected,' says Dr. Teresa Kieser
For more than three decades, Dr. Teresa Kieser has served patients at the Foothills Medical Centre in Calgary as Alberta's only female cardiovascular surgeon. She's been recognized globally for her work and had several medical and research papers published.
But as her career nears its end, Kieser wants Canadians to think about a different part of her journey: the gender-based discrimination she alleges she faced during her 34 years in the position.
"I just thought, 'I cannot just fade into the sunset having gone through all this, without bringing the light of day onto it,'" she told The Current's Matt Galloway.
Last month, Kieser filed a complaint with the Alberta Human Rights Commission against her employer, Alberta Health Services (AHS). She claimed she faced a lack of respect and complaints about her operating speed — all because of her gender.
"This has gone on for a long time, and … I just [ignored] it and took the high road. Because as a woman in a male-dominated field, you don't want to rock the boat," she said. "You're so happy to be doing what you're doing, and you make it this far."
So this human rights complaint, Kieser said, is to "shed light on the conscious and unconscious bias toward women in the workplace."
In an email to The Current, AHS said it cannot comment on specific complaints due to privacy concerns, but said it is "committed to creating safe and secure workplaces for all physicians, staff, patients and families. Any form of harassment or violence is not tolerated."
"AHS recognizes the opportunity to better support our women physicians, women physician leaders and our entire physician workforce. Any instances of inappropriate behaviour are considered thoroughly and confidentially, and we take appropriate action to ensure our people are safe and protected," the AHS said.
One incident she outlines in her 11-page complaint happened in November 2020. A male colleague raised questions about her judgment, clinical decision-making and technical abilities related to two patient cases.
An external investigation soon followed. As a result, Kieser was forbidden from performing surgeries for more than a year as the investigation was conducted.
According to Kieser's complaint, an external reviewer informed AHS that a five-year data analysis of her work would be required to compare it with the work of other surgeons in her group. The complaint alleges that AHS did not undertake the review and that eventually a settlement was reached, the terms of which were not disclosed.
Kieser described the whole ordeal as "inhuman" and said those days were some of the darkest of her life.
"Taking away somebody's ability to give is the worst thing one can do," she said. "But the people who really suffered were the patients I could not help and the student cardiac surgeons I could not reach."
This is the only way change will get effected — if the light of day is shed on the inequalities that women suffer to get to where they are.-Dr. Teresa Kieser
Kieser's case is not unique in medicine. Last year, Dr. Irene Cybulsky, the former head of cardiac surgery at Hamilton Health Sciences, won a gender discrimination case against the hospital network after the Human Rights Tribunal of Ontario found that gender bias had played a role in her ousting from that post.
According to a Canadian Medical Association survey of female physicians and medical students at the 2020 Canadian Women in Medicine Conference, 77 per cent of respondents said they had experienced gender inequity in their training or practice setting.
Kieser said she feels now is the right time for her to go public with her complaints.
"It's hard enough to do heart surgery — never mind trying to watch your back and [see if] somebody is going to attack what you've done," she said.
"This is the only way change will get effected: if the light of day is shed on the inequalities that women suffer to get to where they are."
According to the CMA, more than half of all first-year medical students in Canada in 2017/18 were female. Yet surgery is still a male-dominated field; Kieser remains Alberta's only female cardiovascular surgeon 34 years after entering the field.
Part of it comes down to the assumptions people make about surgeons, according to Dr. Nancy Baxter, a surgeon who heads Melbourne University's School of Population and Global Health.
"When people think about a surgeon, they generally think about a man," she said. "So they think about qualities that are more so-called masculine.
"Surgeons are people who get things done, who are decisive, who can be abrasive," she said, "versus what people generally think of as feminine, which is team-building, collegial, collaborative. That type of thing."
Dr. Marisa Louridas, a surgeon at St. Michael's Hospital in Toronto, says she has experienced this first-hand.
"As a junior surgeon, when I reflect on it, I'm still not seen as a surgeon," she said. "When I walk into a room, they assume that I'm a nurse or another part of the health-care team — and that assumption is very, very strong."
Because of these assumptions, there's a tendency to question a female surgeon's results, Baxter said, no matter how experienced or talented she is.
"When you do well, it's luck. When something happens and there's a mistake or a patient does poorly, then it's your fault," she said. "Whereas with men, it's kind of the opposite. When they do well, that's their skill. And when something happens, then that's bad luck."
Misogyny is very common … and I think it just comes out, particularly, in surgery, which is a specialty where women are still not the norm.-Dr. Nancy Baxter
This way of thinking has its roots in medical school and occupational segregation, said Baxter.
"When [you're] in medical school … you kind of rely on your preceptors, your mentors to kind of steer you to the specialty that's most likely to be suitable to you — in terms of your skills, your abilities and your personality," she said.
"Because women aren't seen as surgeons, women kind of get steered toward non-surgical specialties."
Although she's only been in practice for a few years, Louridas said she's seen the impact occupational segregation has had on up-and-coming female surgeons — but also the effect female surgeons, like herself, can have on countering those assumptions.
"I have medical students come to my operating room … and afterward, send me emails saying, 'It's so helpful to see a female in surgery who's having a family and still doing this job,'" she said.
"It just speaks to that: There's this hidden curriculum … steering these medical students away before they've stepped foot in the hospital."
The old boys' club
Encouraging more women to become surgeons is only part of the solution, Baxter said.
"Sexism is deeply pervasive in society," she said. "Misogyny is very common … and I think it just comes out, particularly, in surgery, which is a specialty where women are still not the norm."
One of the ways it may come out is through crude comments about female surgeons.
Plastic surgeon Dr. Darby Little, a resident at the University of Toronto, told The Current that once, while she was in an operating room with fellow residents and trainees, the men began ranking the best-looking female surgeons.
"In retrospect, I think what was so concerning about this experience was, as a first-year medical student, I wasn't surprised, I wasn't offended," she said. "I had almost expected or anticipated this behaviour."
I think we need to change the culture of surgery so that we have more male allies, and men are just not willing to participate when something like that has happened.- Dr. Nancy Baxter
Louridas said it hurts to hear stories like Little's — but it's also not surprising.
"Unfortunately, I've been in operating rooms, too — and I think most people have — where the conversation is not appropriate, especially where they're referring to one gender or the other," she said.
Kieser said surgery is still an old boys' club and, as a result, there's an "awful lot of unconscious bias" in the field.
"I think some of these men that sort of talk this way, they don't realize it's offensive — because their father did it, their father's father did it," she said. "This is what we're fighting."
According to Baxter, part of that fight involves encouraging men to speak up when they see or hear discrimination in the operating room.
In the operating room where Darby Little was, she said, there were likely some junior male students. "Many of them may not have wanted to participate in that," she said.
"I think we need to change the culture of surgery so that we have more male allies, and men are just not willing to participate when something like that has happened."
Otherwise, Baxter said, female surgeons will continue experiencing what Kieser and Little went through.
"You can have all the women in surgery that you want. But until the bro culture changes, I don't think anything's going to change," she said.
Written by Mouhamad Rachini. Produced by Samira Mohyeddin.