Healthcare in Crisis: How Are We Best Heard?

I have become a keeper of stories. And as I navigate the murky waters of the culture of orthopaedic Surgery, I have become conflicted. I sit between generations of women and I am experiencing a crisis of my identity in terms of my volume. My burning question these days is, “Do I let myself be drawn into conflict by anyone other than my teenage daughters?”

My mother turned 80 this week. She is a force of nature. I was brought up with accountability to the nth degree. There was no shirking a chore or a task. There was no avoiding conflict. Disagreement meant conversation. Cooler heads prevailing was not a thing in my family. We called each other out, had intellectual showdowns, did not hold back, and then moved on with mostly love and a ton of humor. Shying away from a challenge was just not instilled in me.

The next generation of women and underrepresented minorities coming behind me in orthopaedic surgery do not yet have a paved way to follow. The way has been eased. But only slightly. And I worry that the culture of collaborative cool-headed veneer may not be preparing them to be heard. Or perhaps I am dead wrong. Maybe this shift will arm them to be far more effective than I can imagine.

My daughters' generation is skilled in reconciliation. They hold things in that I think are better out. In some, their strengths harken back to my grandmother. Kill them with kindness. Catch more bees with honey. I know they believe that revenge is a dish best-served cold. But once in a while, they let the fight out. And when they do I can’t keep up.

It took me many years to learn that fiery behavior from women is both revered and repellant. Sometimes the only way to be heard is by raising my voice, And sometimes the best way to be ignored is by raising my voice. Either way, I have come to accept my own inability to accept the status quo in the culture of surgical culture. I am seeking to understand the most effective way to communicate the need I feel for change. Although my upbringing is with high volume, I can shape-shift into many forms. At the end of the day, I am a pragmatist. And my cause is alienating to many, no matter which volume I choose to use.

I do not pretend to have answers. In 2023, conflict is afoot but change has not arrived. There are well-known men who serve as faculty who continue to sexually harass their trainees in plain sight. Retaliation is alive and well, even among the leaders seeking change, and the hypocrisy is astounding. Orthopaedic societies have improved diversity on the boards of directors but the percentage of women and underrepresented minorities in our presidential lines is not at all reflective of the membership. And most sickening are the stories of young physicians hired as orthopaedic surgeons by hospitals and organizations who create and allow for toxicity that detracts from morale, access to care, quality of care, and patient safety. Our newest graduates are at the mercy of some systems that can only be challenged by our senior leaders. New surgeons are gaslit and taken advantage of in new and creative ways, and they are grossly underprepared to stick up for themselves and their patients.

This crisis of culture is real. Surgeons cannot perform with compassion and excellence when we are distracted by bad behavior that has become normalized. And our community is divided, often over semantics. I do not know whether to be soft or loud, veneered or fiery, confrontational or cool-headed. But one thing is clear. If we all disengage, the quagmire that is healthcare in 2023 will divide us and disable us from all that we need to give good care to our patients.

I implore you, my community of women and underrepresented minorities in orthopaedics (and our allies). Can we please stick together? There are too few of us to survive factions. There is too much at stake. If we continue to divide we will move backward. The next generation deserves a trail that is blazed.