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‘Why not me?’ – Bringing women into view of the advanced endoscopy suite
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In this guest commentary, Amrita Sethi, MD, and Uzma Siddiqui, MD, leaders of Women in Endoscopy (WIE), address the recent Twitter-storm over the low number of women matched in advanced endoscopy fellowships for the upcoming year. Tyler Berzin, MD, FASGE, pointed out that only nine of the 70 matched fellowships would be occupied by women in 2019, for a rate of just 12.9%.
While the Twitter discussion that followed highlighted a number of important issues, what stood out the most was that this was the first time we were discussing data demonstrating the abysmal numbers of women in advanced endoscopy in an open forum.
Congratulations to all who matched in advanced endoscopy this year. Some important data for @ASGEendoscopy in 2019: I count 70 matched fellowship applicants, 9 women (12.8%). I can't find any specialty match with lower %. Can anyone name one? We must do better.@WomeninEndo pic.twitter.com/Rom0o9R5KT
— Tyler Berzin MD, FASGE (@tberzin) July 16, 2019
In years past, we all talked amongst ourselves – especially the women – that there weren’t many women in our field, but Berzin took notice, brought this harsh reality to light, and then took it to Twitter. Questions that naturally arise are whether this number is higher or lower than past years? Why are the rates so low (ie, barriers)? What needs to happen to make it better? We need more information.
According to the Association of American Medical Colleges, about 30% of gastroenterology fellows are women. While this is still not at the level of equal representation, it is more than double that of women in advanced endoscopy.
Possible hurdles
When the question regarding existing perceptions about why women might avoid advanced endoscopy as their focus, common responses included issues such as radiation exposure, work-life balance, and high-risk patient scenarios.
It is known that interventionalists may be asked to do extra call, face less flexible schedules, care for sicker patients and perform riskier procedures. These nuances may make work responsibilities seem more daunting and possibly contribute to making the field of advanced endoscopy less attractive to female applicants.
However, it is important for trainees to recognize that if there are successful women in the field who have already navigated these issues and who can serve as guides to achieving their own interests and goals and, in fact, dispell some of the misperceptions that hinder them. Female GI trainees (and all trainees in medicine) should approach their interests in the field with the goal in mind, without thinking too far ahead to what it ‘might’ mean for their lifestyle. Once they pinpoint their ideal focus, they need to explore positive avenues in which they can make that happen.
Trainees may only see existing paths, which are full of these obstacles. However, they can look to mentors to help create new opportunities and forge new pathways that are less laden with these barriers.
Maybe more discussion and transparency about our field will attract more women to enter it. This does require a female trainee to actively seek mentorship and assess their own endoscopy skills and mental fortitude for the job, but there are many positive aspects that can be highlighted.
With experience, confidence in one’s own technical skill exponentially rises as does the satisfaction of having significant impact on patients’ lives. Being able to provide patients with innovative care that prevents them from undergoing invasive surgeries and subsequent morbidity, is one of the most rewarding aspects of advanced endoscopy and worth the early hardships that can be encountered along the way.
WIE and other women’s groups are working to conduct more relevant surveys among women in gastroenterology to see if these perceptions still penetrate into the newest generation of GIs, but the biggest change is already underway.
Women taking center stage
Despite the discouraging number of women in this year’s advanced endscopy match, more women are moving into positions of visibility such as directors of advanced endoscopy programs, invited speakers at conferences, key opinion leaders working with industry and more. Until recently, there have only been a few well-recognized female interventional endoscopists. However, change is under way.
The more that female trainees see senior level women performing in positions of leadership at universities and hospitals, speaking at meetings, publishing papers, working with industry, the more it will inspire the next generation.
One of our goals with WIE is to help promote women into these positions where they do become more recognized as leaders in their own institutions and practices. By being visible in that space, they can then serve as mentors and inspiration for incoming trainees with whom they work.
WIE is trying to create opportunities for women to get involved, whether it’s working with industry, serving as faculty for events, or building leadership skills. Ideally, WIE hopes to create a network of mentors on a global level so they might be easily identified by trainees for insight and support. Additionally, WIE strives to build observer opportunities during which time trainees can see firsthand how women in therapeutic endoscopy work. This could lead to a better understanding of the field and hopefully inspire others to pursue it.
Global perspective
WIE is an international organization and realizes that these are similar conversations and issues that are occurring around the world. If anything, we in the U.S. may actually have more women in advanced endoscopy, but this is data that we need to understand.
As with the U.S., the core issues likely center around lack of mentorship and visibility of success.
As a whole, whenever you include everyone from different genders, ethnicities, areas of the country and world into a discussion, you get more opinions and a broader perspective. In the end, you also provide patients a much better level of care and advance the field of gastroenterology as a whole.
Gratitude
We would be remiss not to thank the mentors and the women who are already out there inspiring and those who have recruited other women trainees into the field.
We also need to thank the men in the field who are calling out this issue and helping to support women fellows in their own institutions and practices, as exemplified by Berzin. This all contributes to the process of change.
We clearly can’t do this alone and need everyone’s support to make advanced endoscopy more accessible to women. It’s very important that all the similar advocacy groups work together. Our numbers are small across the board, so we need to be a provide a collaborative approach when thinking of ways we can solve this problem.
Now more than ever, people across many professions are interested in the advancement of women, including in interventional endoscopy, and we should capitalize on this extra exposure and seize this opportunity.
For more information: Amrita Sethi, MD, serves as Director of Interventional Endoscopy and Associate Professor of Medicine at Columbia University Medical Center and is the founder and president of WIE. She can be reached at as3614@cumc.columbia.edu. Uzma Siddiqui, MD, serves as Associate Director of the Center for Endoscopic Research and Therapeutics (CERT), Director of Advanced Endoscopy Training and Endoscopic Ultrasound and Associate Professor of Medicine at the University of Chicago. She can be reached at usiddiqui@bsd.uchicago.edu. For more information on Women in Interventional Endoscopy, visit www.womeninendo.org.