1. The erasure of gender
Fiona Webster, Kathleen Rice, Jennifer Christian, Natashia Seemann, Nancy Baxter, Carol-Anne Moulton, Tulin Cil
University of Toronto, Canada

2. We do not have any conflict of interest to declare

3. Women in US Academic Medicine Report 2011-2012
Over the last decade, the number of women in surgery has steadily increased. In the US, women now make up 48% of medical students and 24% of surgical residents1. Despite this rise in the overall proportion of women surgeons, women are not well represented in academic surgery positions, and are particularly underrepresented in higher ranking leadership roles1. For example, women make up 25% of assistant professors, 17% of associate professors and only 9% of full professors in academic surgery positions in the United States1. Only 5% of all Chairs of Surgery, the most powerful position at any one center, are women1
Women in US Academic Medicine Report

4. Aim
Our team sought to understand this imbalance in female representation within academic surgery leadership by examining women surgeons’ accounts of their own experiences as women in surgery

5. Results

6. “You know, if you look at actual just straight-up promotion… [some senior women] have been passed over for every major promotion, not just here but at other institutions.
(Focus group participant 5)
The conversation we engaged in during the focus group was candid and the women participants shared a series of accounts from their lives during medical training and practice that ranged from overt harassment and bullying to feeling pressured to having to adopt certain rigid roles in relation to their male mentors.

7. However, in one-on-one interviews, participants consistently maintained that that gender had not informed, touched or influenced their professional careers in any way.

8. Disavowal Distancing Contradictions
We have grouped our findings to describe three types of discursive strategies that participants used to construct gender as a more or less irrelevant concept in their careers. We have categorized these themes as: 1) disavowal of gender inequity; 2) distancing from gender discrimination; and 3) contradictions about gender.

9. Our findings support a growing body of evidence that indicates people –especially women- are often unwilling to identify as victims of discrimination or inequity. This may be especially true in our population of successful academic surgeons.

10. This tendency has been documented across a range of elite professions, including law, academia, and IT. These strategies have the discursive effect of making incidents of discrimination or inequity seem like isolated events that are contingent on individual factors and thereby dissociated from larger social and structural issues.

11. Women surgeons argued that because men are not allowed to exercise authoritarian forms of power at work, the profession of surgery must therefore be gender equitable. Conceptualizing gender power in this overt way, however, may prevent women from being aware of how gender is lived and negotiated in more subtle ways.

12. Conclusions
As overt acts of discrimination become less acceptable in mainstream society, discrimination does not necessarily disappear but rather manifests itself in ambiguous and covert forms. This has the effect of rendering gender issues difficult to identify and address.
An irony of our study is that through disavowing and distancing themselves from gender discrimination, these women ultimately exposed the degree to which these issues continue to be pervasive in surgery. It is encouraging to find that overt discrimination is unacceptable and rare in surgery today, and that women surgeons identify marked improvement from decades past. However, discrimination does seem to persist in subtle yet significant ways. Women surgeons’ ability to both identify and resist discrimination were hobbled by narratives of individualism, gender equality, and normative ideas of gender difference.