From the AGA Journals

Women in GI: Career-spanning strategies to overcome gender bias

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The real work is just beginning

Gastroenterology is a male-dominated field; women represent only 18% of current practicing gastroenterologists. Fortunately more women are entering medicine, including our field of gastroenterology, with current statistics showing that 39% of fellows are women. There have been historical barriers to women’s entry into the gastroenterology field, but thanks to the efforts of great female leaders in gastroenterology and men who are allies of women in our field, we have seen some of these barriers start to weaken. However, there is much work yet to be done. In fact, many would argue our work is just beginning.

Dr. Laura Raffals is a gastroenterologist at the Mayo Clinic, Rochester, Minn.

Dr. Laura Raffals

Bernica and colleagues present a thought-provoking piece outlining opportunities for women to navigate their careers and overcome obstacles so that they can achieve professional and personal fulfillment. Spanning the entirety of a women’s career, these suggestions highlight the importance of seeking out other women for mentorship and sponsorship and taking advantage of resources available through the various national societies. In addition to seeking out women for support throughout our careers, we should not overlook the opportunity to seek out our men colleagues who are ready to serve as our allies. In a male-dominated field, our “he-for-she” colleagues are often our greatest allies and sponsors.

Hopefully we will all learn something from Bernica and colleagues’ important piece and continue to sponsor and encourage women to practice this great field so that someday our workforce will look more like the patients we are caring for.

Laura E. Raffals, MD, is with the department of gastroenterology and hepatology at Mayo Clinic, Rochester, Minn. She has no conflicts of interest.



The gender gap in gastroenterology persists – currently, women constitute 39% of fellows, but only 22% of senior AGA members and less than 18% of all practicing gastroenterologists – and it has gained even greater significance within the “current historical moment” of the COVID pandemic and growing cognizance of systemic sexism and racism, according to experts.

During the pandemic, women have been more likely to stay home to care for ill family members and children affected by school closures, which increases their already disproportionate share of unpaid work, wrote Jessica Bernica, MD, of Baylor College of Medicine in Houston with her associates in Techniques and Innovations in Gastrointestinal Endoscopy. They noted that, according to one study, this “holds true for female physicians, who despite their more privileged positions, also experience higher demands at home, impacting their ability to contribute to teaching, service, and research.”

At the same time, the pandemic has brought into focus which jobs are “truly essential” – and that they are “overwhelmingly [held] by women and people of color, who are often underpaid and undervalued,” the experts wrote. The growing focus on systemic racism has also increased awareness of the chronic gender discrimination faced by female minorities, as well as by women in general, they added. In the field of gastroenterology, inherent gender bias – both systemic and self-directed – can bar women from advancing beginning as early as medical school.

To help address these issues, the experts outlined key opportunities for change as women navigate professional “forks in the road” throughout their careers.

Throughout their careers

During medical school and residency, women can specifically request gastroenterology rotations (“ideally with both inpatient and outpatient exposure”), attend society conferences, participate in research themselves, and join a research track or serve as chief medical resident. When applying for gastroenterology fellowships, they can prioritize programs with female faculty, which were recently found to be more likely to hire female fellows.

During fellowship, women can avail themselves of female mentors, who can help them strategize about ways to address gender bias, connect with GI groups and societies, and learn endoscopy techniques, including “unique approaches ... [that] overcome the challenges of standard scope sizes and accessibility.” At the institutional level, opportunities to affect positive changes for women trainees include “formal education on the benefits of hands-on learning and encouraging explicit and open communication between parties regarding invitation to, comfort with, and type of physical contact prior to a case.”

After fellowship, early-career gastroenterologists should scrutinize contracts for details on pay and research support, and they should ideally join a practice that either already has many women physicians on staff, or that ensures salary transparency and has “parental leave policies that are compatible with [applicants’] personal and professional goals.” But the experts advocated caution about part-time positions, which may purport to offer more flexibility but turn into full-time work for part-time pay and can preclude participation in practice management.

The experts recommended midcareer female gastroenterologists call out their own achievements rather than waiting for recognition, “actively seek promotion and tenure,” negotiate their salaries (as men tend to do routinely), and think twice before accepting professional roles that are uncompensated or do not clearly promote career advancement.

Senior gastroenterologists have unique opportunities to spearhead changes in institutional policies and practices, according to the experts. Specific examples include “explicitly stating [in job listings] that salary is negotiable, creating transparent written compensation plans, and conducting audits of job offers” to help mitigate any inequities in pay or hiring practices. In addition, senior women gastroenterologists can mentor individual women in the field, implement formal trainings on implicit bias, ensure that their practice or department tracks the gender of gastroenterologists who join, leave, or are promoted.

The experts did not report receiving funding for the work. They reported having no conflicts of interest.

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