Q&A: Award winner breaks ‘barriers for the collective,’ champions equitable pay for women
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According to Rinarani Sanghavi, MD, MBA, champion of gender equity and winner of the 2024 Scrubs & Heels Break the Glass Ceiling Award, pay equity represents “one of the pivotal barriers” in advancing gender equity.
“We all want to be paid equally for equal work,” Sanghavi, a pediatric gastroenterologist and professor of pediatrics at UT Southwestern Medical Center, told Healio.
As the field of gastroenterology has evolved over time, so too has the representation of women. Results of the Association of American Medical Colleges (AAMC) 2022 workforce survey showed that the number of women in gastroenterology grew 219% from 2004 to 2022 — the second highest growth reported among the 20 largest specialties.
Despite this progress, research from Sanghavi and her team demonstrated a difference of up to 50% in Medicare payments between men and women from 2014 to 2019. Sanghavi also cited the 2023 AAMC Faculty Salary Report, which revealed a compensation difference of “close to $40,000” between male and female assistant professors in the U.S.
“It has been well-documented that women gastroenterologists are paid substantially less than their male colleagues and many have justified this gap on ‘difficult to measure’ variables and factors,” Aline Charabaty, MD, clinical director of the Inflammatory Bowel Disease Center at Johns Hopkins Sibley Memorial Hospital and co-founder of Scrubs & Heels, told Healio. “Dr. Sanghavi developed a statistical model to predict what a salary should be based on rank, years in rank, evaluations and work done, which can be used in any division or institution to objectively measure the gender pay gap and subsequently correct it.”
She added, “She also developed programs within her institution and NASPGHAN to enhance the leadership skills of and the consideration of women for leadership positions.”
Notably, Sanghavi reduced the gender pay gap in the division of pediatrics at UT Southwestern Medical Center by half and increased the representation of women division chiefs to 30%.
These accomplishments elevated Sanghavi among those who are “breaking barriers for the collective,” Charabaty said, and deserving of the inaugural Break the Glass Ceiling Award.
In this Healio interview exclusive, Sanghavi expands on gender equity, the role of equitable pay and the impact of Scrubs & Heels in advancing women in gastroenterology.
Healio: What is gender equity and what role does it play in the representation of women?
Sanghavi: Gender equity plays an important role. For the very first time, the AAMC defined gender equity in 2024 and acknowledged that it is an evolving definition. The association says it refers to a state in which people of all genders and gender expressions essentially have equal access to resources, opportunities and participation in academic medicine. We owe it to the future generation of women that are coming along to work toward increased equity, though we are far from it.
According to a study I published with my co-authors in the Journal of Pediatric Gastroenterology and Nutrition in 2021, which looked at the gender of leadership roles in academic pediatric GI programs in North America, about 50% or more were women at the fellowship level. But, as you went to division chief and department chair levels, less than 10% and 20%, respectively, were women. This is a problem because division chiefs and department chairs not only control, influence and inspire the future generation, but they also control the money.
In a separate study that looked at recognition and awards in pediatric gastroenterology, we found another huge equity issue. Between 1987 and 2022, 80% of society awards were given to men and, in fact, two men had received awards twice.
We’ve got a long way to go to achieve equity in the true sense, even though the number of women in gastroenterology is growing.
Healio: How do equitable pay policies advance gender equity?
Sanghavi: Pay equity does play an important role and represents one of the pivotal barriers for advancing gender equity. There are lots of studies that have been published that report women also deal with many other barriers outside of pay equity. Women have to provide more evidence of their competence compared with men, they have to either work less hours or it is suggested they do so by their colleagues after they have children and they often had to suffer from being mistaken for custodial staff or as nurses.
Women have worked just as hard to be here — the pay pendulum has to be in the middle.
Healio: What additional barriers do women face in getting into and staying in gastroenterology?
Sanghavi: For one, women do not have enough sponsors and mentors that we can look up to and who understand. Another is the timing at which most women will apply for and start fellowship, which is when they are getting into childbearing years.
As for staying in GI, I think it is the whole continuum that as fellows there are long hours and it is not conducive to work-life integration. Additionally, the most basic part of GI is scoping, but scopes are made for male hands, so a lot of women do suffer from wrist and hand injuries. Perceptions from women physicians in the U.S. have also shown there are more instances of discrimination and harassment not only from administrators but also from patients.
And lastly, recognition and awards are something people aspire to work toward in their careers. If fewer women get these awards, we don’t have role models we can look up to and aspire to be.
Healio: How can women begin to advocate for themselves in their practices or institutions?
Sanghavi: We need to advocate for ourselves, and we need to advocate for everyone. One way to advocate for yourself is understanding the salary structure: What is your base salary, what is your productivity based on and what is the incentive and bonus structure? Similarly, when you go for your annual evaluation, you should be prepared by understanding baseline salary data and the value you are bringing. Don’t be afraid to negotiate: Everything is on the table and if you do not ask for something, you are never going to get it.
The second part is knowing your opportunities, which include getting involved with committees and societies, serving as a sponsor and being at the tables where decisions are made.
In terms of advocating for all, I would say we need to look at compensation equity, remove bias, lift up the person behind you and nominate women for awards. As women, we have to advance women with us — that is how we really move forward.
Healio: What role does Scrubs & Heels play in helping to advance women?
Sanghavi: Scrubs & Heels is unique and plays many important roles. Throughout the year, its Matrix Mentorship Program for women pairs junior faculty with male and female senior faculty mentors, which is important because this battle for equity needs to be won by men and women working together.
Its annual summit is also phenomenal because it covers a lot of topics that women need to hear and are not taught in medical school. Some of this comes a lot more naturally to our male counterparts, but we need to hear it and be given permission to do it.
I also love Scrubs & Heels because it amplifies the work of women, which is needed to show everybody that we are valued, we are part of this profession and we really play an important role.
References:
- Sanghavi R, et al. J Pediatr Gastroenterol Nutr. 2021;doi:10.1097/MPG.0000000000003320.
- Sanghavi R, et al. J Pediatr Gastroenterol Nutr. 2023;doi:10.1097/MPG.0000000000003863.
- Women are changing the face of medicine in America. https://www.aamc.org/news/women-are-changing-face-medicine-america. Published May 28, 2024. Accessed Aug. 1, 2024.
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