Alberta Health Services deleted a key recommendation that called for an independent investigator to review incidents of discrimination from a report on the experience of women in medical leadership, says a physician who was an adviser on the study.
Carrie Kollias said the edited report released by the provincial health agency also deleted narratives from female physicians about instances of discrimination and harassment that they faced while working in provincial facilities.
“Keep in mind that this report was initially requested under the premise of giving women a voice," Dr. Kollias, an orthopaedic surgeon and one of the nine female physicians on an advisory group contributing to the project, wrote in an e-mail to Alberta Health Services (AHS) and released to The Globe and Mail.
“To see the original report rewritten is particularly offensive and duplicitous.”
Alberta Health Services, the provincewide health authority, launched a working group in 2017 to review the experience of women in medical leadership. Women are underrepresented in medical leadership in Alberta: They account for 37 per cent of all physicians employed by AHS but hold only 26 per cent of the 891 physician leadership roles, including positions such as medical directors and associate medical directors for different zones in the province.
The project was led by Vanessa Maclean, an Edmonton physician who collected data through an online survey of AHS physician leaders, focus groups and interviews with physician leaders.
An advisory group, including Dr. Kollias, participated and provided input for the review.
Dr. Maclean submitted a 113-page draft to AHS in February, 2018. The draft included a recommendation for a third-party ombudsperson who could assess and advise on incidents of discrimination and harassment.
The original report also detailed stories from female physicians about their treatment within the health authority, Dr. Kollias said. Dr. Maclean declined to comment and directed questions to AHS.
But the public report, which was posted online 11 months later, on a Friday before Christmas, left those stories out, as well as the recommendation for the ombudsperson.
Instead of an ombudsperson, AHS announced the creation of an associate chief medical officer responsible for physician health, diversity and wellness within the organization.
Dr. Kollias, who was working in Alberta when she participated in the advisory group but now lives in Australia, argued that an ombudsperson would provide a level of accountability that can’t come from within AHS.
“It’s not in their best interest to raise issues and investigate many times or to implement sanctions because it makes a headache for themselves,” she said.
She wrote Francois Belanger, the chief medical officer for AHS, in March to object to the edits, describing the removal of the recommendation for an ombudsperson her greatest disappointment.
“I have observed AHS leadership either not willing or not able to implement appropriate disciplinary actions, especially when there is a personal or professional relationship involved between leadership and the problematic doctor or employee,” Dr. Kollias wrote. “It is thus easier to turn a blind eye and pretend it didn’t happen.”
Dr. Kollias also argued that the report plays down the concerns of women who were interviewed about their experiences.
Verna Yiu, chief executive and president of AHS, defended the changes to the report and said it was edited to focus on recommendations.
She said the new associate chief medical officer role is the second-ranking position within AHS’ medical leadership, just below that of chief medical officer.
“This position is really going to be providing, in our mind, a safe and secure confidential venue for individual physicians where they can go to for advice, support, navigation for issues, whether it be related to gender equity or not, or even broader diversity in general,” she said in an interview.
If AHS does not adequately address physicians’ concerns about the workplace, Dr. Yiu said organizations such as the College of Physicians and Surgeons of Alberta and the Alberta Medical Association are available.
Alberta Health Minister Tyler Shandro was not available for an interview, but in an e-mailed statement said the review was a good initiative that other provinces could learn from. The statement did not address the changes to the report.
“Women are now the majority of our medical-school graduates in Canada and we need to make sure the path to leadership roles is open to them. This report alone won’t fix all the barriers female physician leaders encounter, but it’s a step forward.”
The Opposition New Democrats, who were in government at the time, did not respond to requests for comment.
Alison Clarke, a family doctor who is president of the Alberta Medical Association, said she feels the publicly released report accurately reflects challenges to women in medical leadership.
“It looks at all the aspects of not only identifying people, bringing them up, but then supporting them when they’re there and ensuring that everybody who wants to get to that level has an opportunity to get there.”
The report concludes with reflections from Dr. Belanger. In it, he wrote, “the experience of female physician leaders in AHS is different than their male counterparts. However, this does not universally imply that it is worse.”
Mamta Gautam, an Ottawa psychiatrist who runs courses for women in medical leadership, encouraged AHS leadership three years ago to look at problems within the organization after a number of women expressed concerns in her workshops.
Dr. Gautam applauded AHS for conducting the review, saying the findings are “not inaccurate.” Still, she said it also raised many unanswered questions about the difficult experiences of women.
“My hope is that [AHS] will be interested in looking at these issues some more.”
In North America, women are underrepresented in leadership roles throughout medicine, though they now account for half or more of students graduating from medical schools. A study published in the Journal of the American Medical Association in January found that 82.6 per cent of presidential leadership positions of major medical societies between 2008 and 2017 were held by men.