Digital Extra

By FELICE J. FREYER
Journal-Bulletin Medical Writer

On the bookshelf in her corner office at Harvard Community Health Plan of New England, Esther Emard keeps a small Minnie Mouse doll dressed in a candy-striper's uniform.

It was a gift from her mother, to remind Emard where she got her start in health care -- as a 14-year-old hospital volunteer in a red-and-white striped jumper.

But lately the little figure seems to have taken on an extra burden of symbolism. A symbol of how far Emard has come; how far, indeed, that women have come.

Last month, Emard, 43, was appointed president of the 94,000-member HMO, making her the first woman to lead the organization and the highest-ranking woman in Rhode Island's health care industry.

She stands at the vanguard of women's gradual ascent in the ranks of an industry that they have long dominated in numbers but not in power.

For generations, health care has been a women's business -- as long as that business was comforting and nursing patients, drawing blood, giving injections, emptying bed pans. When it came to deciding what work would be done, who would do it and how it would be done; when it came to moving money and earning lots of it -- that was primarily the job of a small group of men at the top.

Today it's starting to change. Women continue to dominate the lower-paying ranks in health care, and men continue to control the corner offices. But women are moving into the mid-level supervisory and decision-making roles, and a few, like Emard, make it to the top. Indeed, there may be more women in powerful positions in health care than in any other major industry.

Although no statewide statistics are available, a glance at figures from a couple of key institutions gives a picture of what's happening.

At Harvard Health's Rhode Island division, two-thirds of the people in supervisory or managerial positions are women. One-third of the physicians are women, as are 61 percent of pharmacists and 85 percent of nurse clinicians.

At Lifespan, the Providence-based health care network founded by Miriam and Rhode Island Hospitals, 74 percent of employees are women. Of those who hold positions of "director" or higher, 32 percent are women.

But the roles of women vary from division to division. At Lifespan's home health agency, VNA of Rhode Island, for example, women clearly are calling the shots: 92 percent of employees are women, 90 percent of middle management are women and two of the three senior managers (including the president) are women.

When Barbara Schepps enrolled in medical school in the mid-1960s, she was one of 10 women in a class of 110. When she started her specialty training in radiology, she was the only woman in her class.

Today, women are a minority in Schepps' own practice group, Rhode Island Medical Imaging, and they are a minority (21 percent) of doctors in Rhode Island. Even so, Schepps is president of her group, and she is also president of the Rhode Island Medical Society, the second woman elected by her peers to that post.

And when Schepps's daughter enrolled in medical school recently, her class was about evenly divided between men and women, a typical situation these days.

"It's come a long way," says Schepps, 54.

Clearly it did so only through the strenuous efforts of pioneers like her. Schepps is convinced that medical schools used to have quotas limiting the number of women they would admit. Those who got in were treated roughly. When teaching doctors made rounds, they would ask each trainee a question. But if the trainee was a woman, Schepps recalls, they would keep asking her questions until they cornered her with one she couldn't answer.

Schepps succeeded by the force of her own personality: "I'm driven. I'm a dog with a bone. I'm tenacious."

Practicing medicine, Schepps said, "is one of the most gratifying things you can do with your life."

But as opportunities start to open for women, she cautions, it's important for women not to expect special treatment. "If you want to be treated equally and fairly, you have to be able to do the job that anyone else who has that job does. You can't ask for exceptions because you are a woman. That's where women sometimes get a bad rap. . . . They forget that men are fathers and men have responsibilities also."

Sandra Coletta was attracted to health care for the same reason many women are: "I wanted to make a difference." But she's not talented in scientific matters, so she took an atypical path into the industry. She's an accountant who has risen to the position of senior vice president for managed care at Lifespan. She handles all the contracts with health insurance companies and HMOs, making her one of the few women who is up to her elbows in the financial side of health care.

"I used to go to hospital association finance meetings, and I'd be the only woman there," she recalls. "I never really sensed any negative reaction. Internally, it felt a little awkward, as it always does when you're the only one of something.

"I am first a mother and a female, and I have not tried to mask that. It's not sex discrimination to talk about the NCAA playoffs, but not something I'm comfortable talking about."

Coletta, 37, does not recall facing any sex discrimination, or any doubts about her competence. "I had the philosophy of not seeing it. . . . I don't know if it was a question of attitude or just naivete. " Or maybe it's a matter of confidence: "If you doubt yourself, others will doubt you."

Coletta balances her career with the job of raising three children, ages 11, 8 and 5, with her husband, who owns several service stations. As an executive, she has the flexibility to keep up with their needs -- and a nanny to fill the gaps. "I attend all the field trips, go to all the plays. I adjust my schedule. . . . My secretary has my calendar and the children's calendar on her system."

Rachael Arruda occupies one of the lower rungs of the health care ladder, but she's been given a chance to climb, and she's thrilled at her prospects.

Arruda, 36, started in 1991 earning $7.25 an hour as a part-time phlebotomist -- a person who draws blood -- at Kent County Memorial Hospital. At the time, she wanted to return to the work force after having two children, and taking the phlebotomist training course at the Community College of Rhode Island was a fast way to acquire a skill.

Arruda did well at CCRI and decided to keep taking courses toward a nursing degree. She'd been unsuccessful in a brief stint at nursing school after high school, but now, it seemed, she was older and more motivated.

And, best of all, she won a LINC (Ladders in Nursing Careers) scholarship through the Hospital Association of Rhode Island. The LINC program started in 1994 with a grant from the Robert Wood Johnson Foundation. Entry-level and mid-level employees at participating institutions get full tuition reimbursement, their employers' promise of flexible hours to accommodate class schedules, and counseling and tutoring help. In return, each LINC participant pledges to keep working for their employer 18 months for each year they spend in LINC.

Arruda expects to graduate in May with an associate's degree in nursing from CCRI. Then she can take her nursing qualifying exam, and if she passes, she expects to get a job as a nurse at Kent County.

Because her children are only 9 and 10 years old, Arruda plans to continue working part time, but will be earning considerably more money. And doing something she loves.

As the Minnie Mouse doll suggests, Esther Emard's route of entry into health care was a traditional one: She became a nurse.

A native of Fall River, Mass., who describes herself as "180-proof Portuguese," Emard attended the University of Rhode Island's nursing program and became a staff nurse at Morton Hospital in Taunton, Mass. Mother of a little girl, she worked part time at first, as did most of her colleagues who were also mothers.

But there was a difference: Emard's husband, Richard, an industrial engineer, worked part time sometimes so that Esther could work full time. They alternated that way until their daughter was in middle school; he even stayed home for a year and a half.

Meanwhile, Emard rose through the ranks at Morton Hospital to become associate director of nursing. Wanting to learn more about managed care, she took a job at the Rhode Island Group Health Association, administering its Warwick health center. When Harvard Health acquired RIGHA, Emard was asked to take over the duties of vice president of operations.

She doesn't remember any overt discrimination, but she has this observation: "I find that being a woman, you need to more immediately demonstrate that you're very competent -- within the first 15 minutes."

Today, as the new president, she strives for an open, inclusive management style. Her door is always open. The plaque outside it bears her name only, no title. She does her best to learn the name of every employee. Emard doesn't see this as uniquely female, but rather the approach of any good manager.

Emard stresses another important aspect of her ascent: It was not merely that she was very good at her job, but also that her employer actively encourages women to succeed.

When Emard was appointed president, Manuel M. Ferris, president and chief executive office of the parent company, Harvard Pilgrim Health Care, gave her an important charge:

"I want you," she recalls him saying, "to be a role model for women."

More Women in R.I. history