Editor’s Note: This is part two of Dr. Bensen’s reflection on her challenging path to ACEP leadership. Part one appeared in the April 2018 issue.

In 1982, when ACEP was 14 years old, after five tries, I became the first woman elected to the ACEP Board of Directors. Until then, ACEP had been a man’s world. Administrative assistant Kathy Syke sent me the same letter she sent to all Board members to ask us to wear suits and ties to the Board meeting because our pictures would be taken. Back then, Board members might show up in jeans, shorts, or even bathing suits. In red ink, she added a smiley face and a handwritten note exempting me from the request.

I showed up in my gray flannel skirt, blue blazer, white blouse, and pearls (standard casual business attire of the day). Right before the picture, I stopped the photographer to get a Board vote on the two gaudy ties I pulled from my pocket. That Board picture shows us all smiling broadly and me in my pearls.

Chipping Away at Bias

Some gender bias was just situational blindness easily overcome by humor, casual conversation, or Board discussion, like the notorious men’s room story captured on ACEP’s anniversary film. Some bias was deliberate, insidious, cruel, and never-ending, a painful story for another day.

I was counseled not to knit at Board meetings. Knitting kept me focused and always made me feel that I accomplished something, even during the least productive meetings. So I bought my first computer and, without the benefit of the internet, social media, or Google, often finished my Board-assigned tasks prior to leaving the meeting. It was several years before even staff members had computers. I later discovered that my actions were threatening because everyone assumed I was taking copious minutes. Amazing how big some imaginations can be.

At the Board meetings, Kathy and I were the only two women in attendance, and she was there to take notes. At the staff level, department heads who attended Board meetings were initially men. I was blessed with a phenomenal mentor-husband but had no female mentors on the Board. As usual, back then my very capable ACEP mentor was the secretary. She who controls the minutes controls the world.

My physician mentors were in the shadows. Initially, Ellen H. Taliaferro, MD, FACEP, and I would meet at ACEP meetings. Then, we were joined by Carol Rivers, MD. However, these were the days when the guys would make jokes about “conspiracies” if three women were talking together, regardless of who they were or the topic of conversation. When Marsha Ford, MD, FACEP, completed our foursome, we began to meet, separate from ACEP, for a week every few years. We were each allotted a day during which we laid out our issues, concerns, questions, and ideas for the group to ponder. Phone calls and shared adjacent rooms at the Scientific Assembly filled the gaps between retreats.

Board meetings presented a challenge. Respected at home, as one of the four boarded emergency physicians in the state, and accustomed to taking action on my own, I did not understand why my comments and suggestions were summarily dismissed or ignored. It always threw me for a loop when, later in the meeting, my idea would be presented by one of the men, discussed, and often unanimously approved.

I lived in a world that was not female-friendly, so I learned to beat the system by being creative. When my local bank would not lend me money without the signature of my husband, Kork, I took the papers home for “him” to sign over the weekend because “he was on the tugboat when the bank was open Monday through Friday.” Since my tubal ligation permit required my husband’s signature while the vasectomy form did not require mine, I asked the physician to step out of the room to let us discuss it. Kork and I winked at each other as I signed the paper twice, once with my name and once with his.

I quickly adapted to the Board norm and made sure that my ideas were well implanted in the mind of at least one colleague before I brought them up at the Board. During an ACEP meeting on a beach at the Del in San Diego, the “girls” and I crafted talking points for my solution to the loss of members to splinter groups. We planned the structure of what we called sections, discussed strategy, and debated which Board member would become my messenger. Then in casual conversations, I carefully planted seeds of the idea with selected staff, Board, and non-Board members; the rest is history.

All three men elected with me in 1982 were ultimately elected Treasurer and Vice President. Two went on to become ACEP Presidents. I failed to recognize at the time that there was a series of glass ceilings. I cracked the first when I agreed to run for the Board. With the help of Ellen, Elizabeth Fields, MD, and Vera Morkovin, MD, it finally broke. I ran for Treasurer my last three years on the Board, but, it wasn’t until Ellen became the first woman treasurer in 1986 that ACEP had its first female officer. Although she was elected Vice President the next year, she could not break that last glass ceiling. She never became President Elect or President, a fate shared by Charlotte Yeh, MD, FACEP, who became Treasurer (1991), then Vice President, but never President.

In 1991, Nancy Auer, MD, FACEP, was elected to the Board. And in 1997, she became ACEP’s first woman President. The ACEP Board had taken another step toward gender neutrality. ACEP has had five female Presidents since.

In those early years, a group of us celebrated a Boston Tea Party whenever ACEP went to Boston. The Tea Party was a special dinner to honor first Nancy Auer and then the women ACEP officers who followed her. For 50 years, ACEP has grown and evolved. We no longer ignore the lack of a woman on the Board. We now wonder why there aren’t more (there are currently five).

Looking Ahead

Today, when so many women have served on the Board and as officers, some members wonder if bias still exists in ACEP. It does; differences will always generate bias.

Each of us brings a unique perspective to our specialty. ACEP needs to be the place where every emergency physician has a voice and an opportunity. To succeed, ACEP will have to seek out, listen to, and hear individuals who, though qualified to lead, chose not to, those who can join but don’t, those who should stay in the college but leave, and those we have excluded but need to include.

We need to be more aware of problems and solutions beyond our limited individual viewpoints. We need to search for emergency physicians we don’t know, listen to new ideas, broaden our horizon, and return to ACEP with a different outlook. Fifty years from now, ACEP will be glad we did. Now, as in 1982, I ask you not to vote for someone because they are ______, but don’t vote against them because they are _______. You fill in the blanks.

Dr. Bensen is president of Medical Education Programs in Buffalo Junction, Virginia.