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bias, me too: bias, me tooIt began with a short-lived post on a closed Facebook page for female physicians about a year ago. The post revealed one of Toronto's worst-kept secrets, that Marko Duic, MD, then the chief of emergency medicine at Southlake Regional Health Centre in Toronto, had hired no female EPs during his tenure there or before that at Toronto's St. Joseph's Health Centre, a period of 16 years. The post attracted considerable attention before it was taken down, according to The Globe and Mail, the Canadian newspaper that published an article about Dr. Duic on Dec. 16. That newspaper article led Southlake to start an independent review of ED hiring and prompted Dr. Duic to resign on Jan. 31 before the assessment was complete. When Dr. Duic took over each ED, he created a floating schedule giving emergency physicians more choice and control. (http://bit.ly/2T9kZUF.) Doctors were asked to come in early and perhaps stay late when volume was high, and they were asked to check vital signs in the waiting room. This decreased waits and resulted in the hospitals collecting Ministry of Health performance bonuses that, according to The Globe and Mail, amounted to $2.5 million in 2017-2018. He describes himself as an emergency patient flow advisor on his LinkedIn page. The spotlight on Dr. Duic's hiring practices came after eight female physicians decided to demand a change. After considerable discussion, they informally surveyed 28 similar emergency departments in Ontario or nearby, finding that 34 percent of the emergency physicians in those departments were women while Southlake had no female EPs among its 31 doctors. They asked Danny Kastner, a Toronto attorney, to file a complaint and request an independent investigation into Dr. Duic's actions in March 2018. A copy of that complaint was given to Emergency Medicine News by an anonymous source. Fear of Being Blackballed Mr. Kastner said his clients do not want their identities revealed because they feared the power that Dr. Duic still wields. Even when promised anonymity, they said they were afraid they would be blackballed in the emergency medicine community. Mr. Kastner's March 9, 2018, letter, however, noted that Dr. Duic appeared to have hired only male physicians in his role first as the chief of emergency medicine at St. Joseph's (2002-2011) and then at Southlake (2011-2019). They wrote that the leaders of Southlake Regional Health Centre, the University of Toronto Royal College, and its faculty of medicine and program directors have oversight responsibility for Dr. Duic and the trainee programs for which he has responsibility. “...Dr. Duic appears to have engaged in a deliberate and long-standing practice of refusing to hire or work with women physicians. The institutions at which Dr. Duic has worked, including Southlake and U of T [University of Toronto], appear to have tolerated this,” the women wrote. They asked Southlake and the University of Toronto to coordinate an independent investigation to determine if their concerns were valid, to remove Dr. Duic from hiring processes in the interim, and to suspend all university rotations at Southlake until the investigation was completed and a nondiscriminatory learning environment was assured.Table: Informal Survey of 29 Canadian EDsThe letter alludes to several accounts of Dr. Duic refusing to hire women in his department. “Almost immediately after Dr. Duic ceased his role in hiring, the number of women in the Emergency Department increased dramatically. Since 2016 a total of 13 women have been hired, taking the Emergency Department from nearly all male to roughly 30 percent female in less than two years,” according to the letter. ‘No Evidence’ According to The Globe and Mail article, both institutions responded to Mr. Kastner that they had conducted internal investigations that did not find evidence of discrimination. (Dec. 16, 2018; https://tgam.ca/2Xhhjzx.) The institutions first told Mr. Kastner and his clients that they saw no need for an independent investigation and that their internal investigation was sufficient. Southlake's chief of staff, Steven Beatty, MD, wrote Mr. Kastner in April 2018 to say “the only evidence that Southlake has engaged in discriminating practices is the absence of female emergency physicians currently providing care in the emergency department at Southlake,” according to The Globe and Mail. He said other types of diversity, such as sexual orientation, race, and age, should be considered. The Globe and Mail reported that Dr. Beatty provided data that showed that Dr. Duic supervised 25 male and no female trainees from April 2011 to April 2015. An open letter and petition from the group Canadian Women in Medicine noted that the internal investigation consisted of “reviewing years of evaluations from trainees who completed rotations at the St. Joseph's and Southlake emergency departments for any suggestion of gender discrimination or equity issue.” Trevor Young, MD, the dean of the faculty of medicine, said the lack of specific complaints from Dr. Duic's trainees about sexism raised no equity concerns about the clinical learning environment at the Southlake Emergency Department. (http://bit.ly/2SdqZHy.) The women's group took issue with those findings drawn from teaching evaluations by the 25 men Dr. Duic supervised at that time. They called the investigation incomplete, and asked: “How can this reasonably be considered a sensitive test for gender discrimination in the department?” Once The Globe and Mail reporter started investigating the claims this past October, Southlake hired a female emergency physician as well as an outside firm to conduct an independent investigation. Mr. Kastner said he was told the investigation is ongoing, and hopes its results will be made public. Petition Posted Canadian Women in Medicine's petition about the issue has recorded at least 450 signatures so far. (https://canadianwim.ca/.) Setareh Ziai, MD, the president of the organization, said Dr. Duic was also reported to have resisted supervising female medical students and residents. “Canadian Women in Medicine has heard [this] from many members of our organization, who themselves were aware of Dr. Duic's reputation or rotated as trainees through one of the emergency departments where Dr. Duic was chief,” she said. “[W]e are disappointed with the University of Toronto's inaction on this issue. This conduct is completely unacceptable and unethical. He continues in his clinical role as an emergency physician and maintains his faculty appointment at the University of Toronto. This means that he continues to teach medical trainees who are sent to rotate through his department.” Dr. Ziai said CWIM also has strong concerns about the clinical learning environment in the Southlake ED. “We don't see that an all-male environment where there is an ongoing investigation into a leader's misogyny can reasonably provide an equitable learning experience for female trainees. We are also concerned about the messages that male trainees may be receiving in this ‘learning’ environment,” she wrote to EMN in an email. A spokesperson for the faculty of medicine at the University of Toronto wrote to EMN in an email that the faculty has contractual agreements with its hospitals, each of which is an independent organization governed by its own board. “The University has no approval authority over hospital hiring decisions, nor does it comment on personnel matters,” she wrote. A spokeswoman for Southlake did not respond to a query from EMN about this article. Dr. Duic responded to EMN's request for an interview with an email that stated: “I made the decision [to] step down as Chief of the Emergency Department as of January 31, 2019. My sole focus now is my full-time clinical duties, supporting hospital leadership and my emergency colleagues. Working as the Chief of Emergency Medicine at Southlake Hospital was one of the most rewarding experiences of my professional career. I worked with an outstanding team, and am proud of our collective accomplishments. The positive changes we made together were considerable and established a legacy of innovation and efficiency, resulting in some of the best waiting times in the Province of Ontario. The key to our success has been our intense and unwavering commitment to the people we serve: our patients and the community.” He did not respond to questions about his hiring or educational practices. Ms. SoRellehas been a medical and science writer for more than 40 years, previously at the University of Texas MD Anderson Cancer Center, the Houston Chronicle, and Baylor College of Medicine. She has received more than 60 awards, including the Texas Human Rights Foundation Award. She has been a contributor to EMN for more than 20 years.

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