IN BRIEF Dr. Behrens recounts the many steps and challenges she faced in breaking gender barriers during the 1980s. She was elected the first woman president (now referred to as chair) of the FSMB in 1989. This is the third in a series of articles observing the FSMB's 100th Anniversary in 2012.
They were on the dais. All sitting side by side behind a long table. The Federation of State Medical Boards Board of Directors. Most of them close to or beyond retirement age. All of them white and all of them male.
It was the early 1980s. I was a surgeon, a few years into my practice, already vice chair of the Wisconsin Medical Examining Board, attending my first Federation meeting — and a woman.
I remember looking at this staid line up on stage and I realized that total male control of the FSMB would have to change in the very near future.
What I could not foresee was that I would find it necessary to take on a major role in bringing women to the leadership of the Federation of State Medical Boards.
Let's put the early 1980s into perspective. The women's movement of the 1960s and 1970s was starting to have an impact. The inclusion of minorities and previously excluded groups was getting a lot of press, and a few pioneering women were finding themselves in positions and places of authority unknown to women just a decade earlier. About 11 percent of practicing physicians were women. While there were still no laws in place to help guarantee equality as there are today, the entire country was aware of the need for nondiscrimination.
At that meeting most of the women who were state board members got together one afternoon for snacks. There were about seven of us.
Committee Member
The Wisconsin Medical Examining Board (MEB) members had supported me to be nominated for the Federation's Long Range Planning Committee. I was the only woman on the slate of candidates for office and committee membership. At that time, there were always two candidates nominated for each committee position and office. The Federation president (now the president is called the chair) began introducing the nominees and offering some personal information or anecdote about each candidate. When he came to me, he could not pronounce my name, and only said that I was from Wisconsin. (Not an auspicious introduction to an election.)
But I had talked to many people at the meeting. I had written a letter to each board introducing myself. (This was in the days before email or texting, of course.) My loyal supporters on the Wisconsin MEB had networked for me.
And when the election was over, I was the first woman on a Federation committee. I was elated.
Board of Directors
After I became chair of the Wisconsin Medical Examining Board, the board members again supported me in 1985, this time as a candidate for the Federation Board of Directors. So, with the help of the many people I had come to know on boards throughout the country, my candidacy was again successful, and I became the first woman on the Federation Board of Directors. I was enthused, involved in Wisconsin and nationally, and enjoying every minute of it.
Vice President
In 1987, my board supported me for vice president of the FSMB. At that time, there were always two candidates for vice president, and traditionally, the winning candidate was the only person nominated for president-elect the following year and was elected to that position by acclamation.
To be recommended for this position was truly an honor, but before allowing my name to be submitted, I had to be sure this was the right decision for the Federation and for me. Should I win, this would be an intense three-year commitment. I had serious discussions about it with several people, including the two women physicians in highly visible medical leadership roles at that time. They were Dr. Edithe Levit, who was then the first woman president and CEO of the National Board of Medical Examiners, and Dr. Nancy Dickey, who had recently been the first woman elected to the American Medical Association (AMA) Board of Trustees, and who would become the first woman president of the AMA about a decade later in 1997. I am very grateful for the advice I received from both of them. In summary, they both told me “If you know you can do the job, go for it.” I took this and everything else into consideration in making my decision.
The Nominating Committee did place me on the slate as one of the two candidates for Federation vice president.
When the votes were counted, I had won the vice presidency. What a grand day that was for me. And there were so many people, both men and women, who were happy along with me.
And Then Things Changed
During those years, my interests and attentions were drawn to the many issues facing the Federation and the state boards. I was really not focusing on the internal politics of the Federation.
But the Nominating Committee decided that they would not nominate me for president-elect. A “technicality” in the bylaws supposedly disqualified me. It seems that the committee had misread my resume and assumed that I had left the Wisconsin board at a time that made me ineligible to run for the office. This was a moot point because I rejoined the Wisconsin board about a year later.
Instead of dwelling on the committee's confusion or being perplexed by its action, I decided to approach the matter in a more constructive way.
There were more important questions to consider. The first one was: Is there some way I would harm the Federation if I were president? And, was there a valid reason why I should not be FSMB president?
After contemplation, and private discussions with a few knowledgeable people, it became clear to me that the answer to these questions was “no.”
After the candidate list was published and people on other boards became aware of what had happened, there were phone calls from all over the country. I never realized how many friends I had in the Federation.
Uniformly, the statements were: “How could they do this to you?” “How can I help you?” “How can my board help you?” I was overwhelmed by the support and encouragement I received from so many people.
Also, both men and women on numerous state boards were thinking deeply about what had occurred and were very concerned about its implications. This concern arose because the organization was starting to become a major player nationally and the last thing it needed was a reputation of discrimination.
My Decision
I analyzed and contemplated my options. It was evident that I had two possible routes to follow:
Quietly withdraw.
Start preparations for a write-in campaign.
So the next questions to consider were: if I pursued a write-in campaign, was winning a realistic goal? What really were my chances? If I lost, what had I accomplished? Was it worth it? I had to consider both the winning and losing scenarios, and what the fallout of each would be for the Federation.
There had been a few unsuccessful write-in campaigns in Federation history. But there was a difference between those campaigns and what this one would be. Here there was an obvious irregularity in how the nomination process had been handled. This write-in campaign would be a referendum on fair play within the Federation. Did the membership want an organization which was still run by the techniques of “an old boys' club” (I don't care for that term, but there is none other that fits), or did they want decisions to be made in a more equitable way?
After all, just being represented in the recent elections was progress for women. At one of the Federation meetings I had spoken with a woman public member. She had applied for an appointive position on a Federation committee in the 1970s. She had been told that as a woman or as a public member she was not eligible to hold office or serve on a Federation committee.
I am not a feminist. I was not one of the protesting, bra-burning, activist women who threw themselves into the controversy of equal rights for women during that era of our nation's growth. During the years that feminist protests were grabbing the headlines, I was busy studying to reach my goal of becoming a physician and surgeon, since at that time there were few spots for women in medical schools.
But in this situation, I began to realize that I must stand up for the principles of equality for women and other minorities. I did not complete my general surgery residency and fellowship by being a shrinking violet. Surgery at that time was still very much a man's field. It was tough for a woman in surgery training then. I have never taken the easy way out of demanding situations. So, if a write-in campaign was the best course of action, I would follow it.
If I did pursue a write-in campaign, I wanted it done in a dignified, honorable, gracious manner. I would not be involved in any underhanded attacks or innuendo.
So, after much thought, deliberation and analysis, I decided that a write-in campaign was my only feasible option, for several reasons:
First, if not challenged, similar tactics could be used again in the future against any qualified candidate.
Second, because it had happened to me, I was the only one who could tackle this injustice effectively. I firmly believed that this issue had to be addressed openly.
Third, I wanted another woman or other minority to be able to take on leadership in the Federation without having to go through similar circumstances.
Fourth, I trusted the members of the Federation to work this out for what was best for the Federation. Fifth, if I lost, it would still make it uncomfortable for the decision makers to do such a thing again.
Sixth and most importantly, if there was not an effort to correct what the nominating committee had done, the reputation of discrimination would follow the Federation for years to come. This would mean that the Federation would lack some of the integrity it needed to accomplish its mission in the national arena.
How Does One Create a Successful Write-In Campaign?
Wanting to do it, and being able to do it successfully, are two very different things.
The first step? I knew that I would need some knowledgeable advice. A friend who is very astute on political situations gave me much encouragement, information on what to expect from various people, and how best to prepare. Another lifelong friend was/is a national expert on parliamentary procedure — wrote the book, so to speak. We looked at the parliamentary challenges from every angle. My fellow Wisconsin board members were there for me every minute with a positive attitude, backing and suggestions.
I carefully drafted a letter to each state board and delegate of the Federation Annual Meeting. I had brochures which outlined my qualifications. I went to the Annual Meeting with a good understanding of the parliamentary issues that could arise, along with an awareness of other possible scenarios, and plans for how each could best be handled. My campaign was based on my merits in being able to lead the Federation and that there was no technicality that should keep me from holding the office.
The Annual Meeting was a whirlwind. Several of the senior and longtime Federation members, some members of the Board of Directors and other men in leadership positions were more supportive than I could have imagined. It soon became evident that each one, on his own or working with small groups, had taken on a project to help my campaign. For example, several were doing detailed analysis of the Federation's bylaws. Others were thinking through the election process itself and wanted to make sure that it was fair in every way for each candidate. Some made it their project to network for me with the delegates. One was concerned that people might not know how to spell my name, so he had “Write-in Behrens for President-Elect” pens made for everyone. I did not ask for all this. These men voluntarily gave me their help and assistance. There were a few women who were Federation members at that time and they were as helpful as they could be also.
While it was an important issue for the members to address, this election overshadowed some of the chief functions of the Federation's Annual Meeting. The valuable time between lectures and at meals was not being used to discuss Federation policies and individual state board problems or to review the excellent lectures. Instead, the election turned into the main topic of conversation. Much to my distress, I found that untrue rumors seemed to start in the ether and take on a life of their own. Despite my best intentions to have a dignified and gracious campaign, there were times when I had no control over what was being said. These effects I regret.
And, yes, when the votes were counted, I won the election for president-elect of the Federation of State Medical Boards.
My years as president-elect and president were busy and rewarding. It was a privilege and an honor to be able to serve the Federation in these offices. It was like having a second full-time job, as there was so much going on in the FSMB at that time.
The FSMB Becomes the Go-to Organization
While the Federation had been in existence since 1912 and while it had some influence in its earlier years, it was during the time I was active in the Federation that it became a go-to organization on the national stage. Our policies and activities caught the attention of all groups and agencies interested in licensure and regulation.
The Federation Board Action Data Bank had recently gone online and was at the cutting edge of using computers to store data and communicate with the states. Computer use was still primitive. There were only 1,000 hosts on the Internet in 1984. But the Federation developed the system and policy to start using computers to obtain and disseminate organized data about disciplined physicians with the state boards. There were challenges however. For example, with very little protection against computer hacking, some boards were very hesitant to use computers to transfer their data. But in addition to a top-of-the-line mainframe computer, the Federation also had one of the first effective firewalls. Also, to protect each day's data, a copy of the computer tape had to be hand-carried to a secure location off-site each evening. Few other agencies or organizations at that time were using computers as effectively or as safely as the FSMB.
The Elements of a Modern State Medical and Osteopathic Board was a landmark document and was adopted during my term as president. It was requested by the U.S. Department of Health and Human Services as a blueprint for the structure and function of a modern state medical board. It was consistent with the Federation policy document, A Guide to the Essentials of a Modern Medical Practice Act. It reflected the relevant characteristics of effective medical boards, and became an indispensable document for anyone interested in the regulation of medical practice.
The Federation was the main advisor as the government developed its policy for use of a National Practitioner Data Bank.
There were many serious discussions starting on a variety of subjects, including impaired physicians and their rehabilitation, prescribing of narcotics, mandating of continuing medical education, and having uniformity in licensing for foreign medical graduates.
The groundwork for the United States Medical Licensing Examination (USMLE) was finalized during my term as president and the papers were signed making it a reality. Also that year the National Board of Medical Examiners celebrated its 75th anniversary, and I was privileged to pay tribute to it during the FSMB's Annual Meeting. That speech was published in the Federation Bulletin, January 1991, Vol. 78, Number 1.
With all these things going on, there was a need for expanding the Federation office, and this was also accomplished.
In other words, those years laid the foundation for what the Federation has now become. I am proud to be associated with these developments in a small way. Also, I thoroughly enjoyed working with then Executive Vice President Dr. Bryant Galusha (that position is now called the president and CEO). His many skills served the Federation well during these years.
Looking Back
So, would I do it again — take on a write-in campaign to stand up for principles I believe in? Absolutely.
Am I glad I stood my ground? Of course.
Given the world as it is today, it is difficult to envision how problematic the circumstances of that election were and how many people realized that the credibility of the FSMB depended on how this event was handled. It was not a fight that I could have won on my own.
Today, it is not unusual to have a woman or a member of a minority group (and in the Federation, that includes public members and foreign medical graduates) in various leadership positions in the FSMB.
I have the privilege of knowing the six capable women who have served the Federation as president or chair since my tenure. I admit that I smile at the knowledge that the paths to their leadership roles were made a bit easier because of the stand I took a little over 20 years ago. The Federation also elected the first public member, foreign medical graduate and African American presidents within 10 years after my term. There had been a Hispanic president in 1984 and an osteopath in 1988. In other words, all of these so-called “glass ceilings” have been broken in the FSMB, and all this occurred before the position name was changed from president to chair in 2003.
There are currently 70 member boards in the Federation. Women serve as the executive director for 37 of the 70 boards. And women comprise approximately 40 percent of the 540-plus members serving on these state boards.
We women of 2012 are descendants of women who were not allowed to vote. We know the saga of women's suffrage and we are grateful for it, but it is thought-provoking for us to realize that the struggle for the vote for women lasted 70 years.
Today women have the luxury of being able to take most of our participation for granted, be it in government positions, organizational leadership roles or in any institution. There are still some instances that require women to stand up against social and historical norms that need to be modified. When each bias is recognized, much effort and energy has to be invested to try to bring about the needed changes.
The years have passed and I have been involved in other challenging situations, a variety of organizations and other leadership roles. It has truly become a different world for women.
Am I glad that the world has changed?
I can't imagine going back to the world as it used to be.
About the Author
↵Dr. Behrens is a retired surgeon in Wisconsin and past president of the FSMB.
