Exactly. Thank you. All right, so we're going to get started. I know everybody's antsy to leave, maybe. So I was asked to give a talk on women in GI, which I thought was kind of a nice thing to throw in there. Doug, good job. I am the chair of the ASG Women's Committee, which started about two years ago. Karen Woods was on the task force and is on the Women's Committee. She helped when we were trying to come up with a strategic plan for the Women's Committee and always has valuable insight. So Karen, please chime in. So we know that there are more women enrolling in medical school than men since 2019. And women compose 51% of medical students. And over the past 11 years, women in GI has increased from 11% to 19%. So we're still a minority, but there are more of us now. The 2020 Physician Specialty Data Report, 30% of GI fellows were women, which is lower than across all the ACGME specialties, which is about 46%. So there's still GIs attracting fewer women than other specialties. So why is it important, and why do we care, and why are we trying to get more women into GI? Because, well, it's the right thing to do, right? We're 50% of the population is women, so there's no reason why we can't have more women in GI. Because women are, half our patients are women, unless you work at the VA like me, where it's a little bit less. But anyway, there's a value to having women for a multitude of reasons, right? But diversity of experiences, values, and perspectives, this may produce a more intelligent and thoughtful approach to development, problem solving, and innovation. And of course, there's a diversity of humans. We get a greater sense of belonging, connectedness, satisfaction amongst employees and staff when there are people on the nursing side, and the secretarial side, and also on the physician side. And we know that we can also deliver higher quality delivery of health care services to all patients and better patient experience. You guys know that there are women who only want women endoscopists, or women doctors, right? So I think it's really important. So what's the benefit of diversity in the workplace? So there's been a lot of new data coming out, right? These companies that are super successful, the ones that have been most successful are led by women, right? So this is sort of from Harvard Business Review, 19% higher innovation revenues. Hey, I got that word Harvard in once. I'm really behind Doug, so I got to do a little bit more, but we'll work on that. 35% performance advantage over those that are homogeneous, and 36% more profitable. So this is a business thing. This is a little different than medicine, but you get the point. So let's talk about pay equity. So we know that women are paid less than men, right? There's that time that women have to work before they will ever, that men will work before women will equal that salary. Women physicians earned almost $110,000 less than men physicians, an estimated $2 million over a 40-year career. Isn't that just disgusting? So how can we narrow this gap? So we can enhance the salary data with regards to transparency. So in Canada, they do this. University of California has some transparency data for their employees. So it puts pressure on an organization, right? It aids in your negotiation. So this is something that the Women's Committee is trying to do. We would like to get together a database, and not only of just women and their salaries. We want to get together a database that's like, their salary, what their other benefits are, but also by region, type of practice, so that you guys, when you're going to negotiate, could look at this data and say, huh. But also have the men's data, right? Because we need to know what they're getting as well. So we can see, maybe, huh, we should be able to negotiate for more. Or, oh, I see that maternity leave, paternity leave, whatever, all these sorts of things. I mean, I think it could be useful for men and for women. There's just no transparency. I mean, I know my husband works at the Cleveland Clinic. You are not allowed to tell anybody your salary. It is seriously a big, fat no-no. I don't know what it is in Harvard. Oh, I said Harvard again. What's Harvard? Are you allowed to tell your salaries? Yeah. So it's very interesting, right? So we thought that it would be really useful to have this database. And we're still working on trying to get something together like this to help you guys to negotiate salaries and see where people are at. So we also need to engage our allies, male sponsorship and mentorship. These benefits are seen in other industries. And also to facilitate equitable promotion, which I'll be talking about after this. So the Women's Committee put out this statement, which I wonder if people saw. I don't know exactly how it was disseminated. But this is supporting pay equity. And it's just one of the position statements. There's another one coming out that I'll talk about about family leave. But basically saying that this disparity needs to go away. And we're going to make efforts like this database amongst other things to try and work towards that. So as a man, why should I care? So unequal pay breeds a toxic environment. And I think the faculty who are in this can sort of attest to this. We're all here working. And then new fellows come in. And they're getting paid more than we are. It does kind of, yeah, you're getting paid a lot. But it's kind of annoying. I'm a full professor. I've been doing it for 19 years. First year out of fellowship, non-advanced endoscopist getting paid more than I am. So in the workplace, it can cause issues. So if you're, as a woman, working as hard as a man but getting paid less, I mean, that is just not a good environment to be in. So it's not about the money. We make a lot of money. But it's feeling like, are you being undervalued that you're getting paid less? So that's a problem. And you don't want to be in that environment, male or female. 16% of male doctors are married to female doctors. So does my husband want me to make less than the men in my department? I mean, you know, I don't think so. And the other interesting thing, and Jen and I were talking about this. And I cannot find data on this. But I know my friend who's an OB-GYN in Boston and Jen who's in pediatrics. As more women moved into the field, all salaries came down. That's what you have to be aware of. The feminization of salaries for medicine is the way to start caring for all of us. So that's why you really should care, men, OK? So when you become in a position of power, I mean, it's just interesting. So I cannot find the data on it. If anybody can find it, I would love to have it. Because I feel like this could inspire the men more than anything, besides a toxic work environment. But I thought that's kind of interesting. OK, so another big issue is family leave. So this was a position statement that was just approved by the governing board talking about paid leave policies for all genders after birth, adoption, or fostering a child, as well as care of a family member after a qualifying event. And there is really interesting data about the benefits of at least 12 weeks of paid leave. And in Finland, interestingly, there's a great paper by Lauren Feld and Amy Oksentenko in a recent Red Journal, where in Finland, they give you the month before you deliver and a year after. And they've shown that there are fewer complications and health issues in those women compared to those who do the three months or two months like we do in the United States. So that's pretty interesting. It is a challenging situation in trying to have your partners covering for you and things like that. But people have to realize that we want women in medicine, but women have to have the babies, right? And I think those of you who have wives who are physicians can appreciate this. I mean, it's a challenging time. And when I was a fellow and I had my kids, I took all my call up front. I did extra service. I mean, I did all this stuff to make it I didn't even cause a ripple. That was sort of what we did, right? You took all your extra stuff because you didn't want to burden your co-fellows. But really, in reality, that's probably not what you really should have to do. And in a practice, it was very interesting when I was presenting this to the board, there were comments like, we didn't know what to do. We had a woman who got pregnant, and then she had a baby, and we didn't know what to do with her bonus because she didn't make her RVU benchmarks. And I was like, so you didn't give the woman who had the baby a bonus? That's just, you have to adjust the RVUs, right? So there's a lot of things that go into it. And it is complicated, but we sort of need to make this accommodation at some point, right? Because it's not easy having a baby. It's not easy having a newborn and pumping at work. And it doesn't seem like it's a big thing, but carrying that damn bag in, and you're trying to find refrigeration, and you're waiting for the pump room. I mean, it's a thing. So I think that now that we have more women in, I think there's more of an impetus to do things differently and not make the women make up for being absent, right? So there was some concern, certainly, in trying to figure out how to keep things equitable. But I sort of made the comment, because there was a comment about someone that they thought was sort of abusing this system of getting all this time. It's like, you know, there are bad male partners too, right? It's not like, you know, there are other ways to abuse a system, and men have figured this out too. So, you know, you can't say, you can't point to the woman who keeps getting pregnant as sort of, you know, she's trying to take advantage of the system. So in any case, this was passed and approved by the board. And we are planning to produce some white papers around both family leave and pay equity in the coming year. So other challenges for women in GI, and see, Doug is all over this ergonomics thing. I think it's a big problem for women because everything was sort of built around male hands, right? And so some companies, I feel like a lot of the scope companies sort of are talking it like they want to make things, but I don't really actually think their heart's in it. I had my hand molded once. I mean, you know, nothing ever happened. So I think it's something you really need to think about, and Doug was saying that in Canada they have a very interesting way of teaching ergonomics and colonoscopy, and it's something to think about early in your career because once you're my age, I told Doug, there's no way I'm changing how I hold the scope. I just can't, you know, it's like too much for me. But we actually have a great course coming up. It's Women Teaching Women, and it's in November, and Amandeep Shergill, who has gotten a master's in ergonomics is going to be there, and we're gonna do a whole thing on ergonomics, like all the things you need to think about, like, you know, screen height and height of the bed and mats and whatever else, and have sort of like an ergonomics timeout. So I think that will be really a good thing to do. We're also gonna develop a white paper on that as well. So it's not a female thing for sure, but I think, you know, times have changed since when I was a fellow. We are just cramming more procedures in. We're doing way more than we used to, and so these repetitive use injuries are definitely gonna happen, and you wanna try to really minimize that so you can work longer. Because I'm really, you know, I was talking to Karen, I just feel like I sort of hit the 50s and I'm sort of falling apart. So it's really, like, I know you're young now and you just don't even get it, and I totally get that you don't get it, because I don't, you know, I started having arthritis, I'm like, oh, this is what patients are talking about. You know, I mean, it's really, and then if you take like a MedDRAW dose pack and you wake up the first morning, you're like, oh my God, this is how I used to feel, you know, and then the day later, you're back to where you were. But so it's really, you know, a big issue, and you guys need to think about it so you can work, you know, till you're 60 or whatever. In the surgical literature, women do tend to experience more musculoskeletal and occupational-related injuries. So, you know, really think about it. There's also this issue with advanced endoscopy. There are fewer women in advanced endoscopy, and there's sort of this concern. It's during the peak childbearing years, the radiation safety, is that a concern? I would say that, you know, I get it, but the radiation is really low. I mean, if you have, you know, drapes on the, lead drapes on the head of the floral unit, on the table, you're wearing your thyroid shield and everything, the radiation doses are really, really low. You know, I get the issue, but I think that it's something that can be managed, and so we need to sort of get that out there if we want women doing advanced endoscopy. So, with regards to promotion, when I became, when I was promoted to professor, I was immediately asked to be on the promotions and tenure committee, because we're trying to get as many women as we can, and when you're a full professor, you can vote on all the people that come up, whereas if you're lower, you can't always vote. So, I'm pretty involved with that now, and I'll give a talk on promotion, because I've sort of been doing this for five years and have a pretty good sense of what you guys should start thinking about. I don't think that I really did, but open leadership positions need to be widely publicized so that it's not just a small group focused people and maybe excludes women. We need to provide grants to support women's career advancement. And the ASGE has a diversity grant now that they started. I think Jen Christie had started that on the Diversity Committee. And some people do one-on-one external coaching. There's coaches that you can pay to help you in your career. And there are people who enthusiastically support that. We have a coaching program within the residency program that I think was started at Harvard. I said that again. At Harvard. So I didn't go to Harvard, but I know people who went to Harvard. And I live in Cleveland, which is an awesome city. And I was going to put that on my lead slide, but Jen said not to do that. We also have the Women's SIG. So I would encourage the women, if you want to meet some people who are full professors, and I'll talk about that in my promotion talk, who may be able to write you letters, you might want to get involved with the Women's SIG. You can talk about women's issues and shopping, of course, which is my favorite conversation. Again, there's this Women Teaching Women Retooling Your Toolbox. So the concept of this course is, you know, it was funny. I was talking to Lakeisha Mayo, who's my liaison, who's awesome. She's not here today. And I was saying, you know, we should do a course where women are teaching women, because sometimes women are, they feel intimidated. Like, they're going to go up to Doug Rex and be like, hey, show me how to do a palpectomy. I mean, I think women are intimidated. And Lakeisha was like, what? Really? And I said, yeah. So we sort of did a quick poll, and people thought that was a good idea. So we're bringing some really awesome women together who are going to teach you things. Like, you finished fellowship, but you never got to try the cryo balloon, or Ovesco, or whatever. And you want to sort of learn how to do these things that maybe were developed after you finished your fellowship. And so, and then, like I said, Amandeep is the guru of ergonomics, so she's going to do a lot with that. Other things that the ASG is doing for women in GI, if you all don't know who Colleen Schmidt is, but when she was president, she started this LEAD program. It's a leadership, education, and development program. It's an awesome program. It's 20 to 30, I think it's up to 30 women a year. And there are these great workshops with great speakers that aren't necessarily GI doctor speakers, but other speakers about all kinds of issues that women deal with. And they meet twice a year and meet at DDW, and the classes are really cohesive, and it's a really great thing. It's for women one to five years out of practice. So if you're interested in doing some sort of leadership role, private practice, academics, whatever, it's a really great program. And I think people have really, really loved it. And the ASG Women's SIG is just exploding. Ferga Gleason, I think, is the one who started it, or maybe probably in Chahal, I can't recall, in 2019. And it's a great way to network. We meet at DDW every year. And they've been doing, Ferga's really done a ton of stuff with workshops online. I think with COVID, everybody's gotten used to the Zoom platform, and they'll have Zoom meetings just to chat about a topic pretty regularly. So this is a really busy slide. I don't know if you can see it very well. But there are a lot of things going on in a lot of the GI societies, as well as Amrita Sethi started something called Women in Endoscopy, which they have some courses, webinars, and meet at DDW. And that's really great. AGA and ACG have long histories of women's committees and a lot of things that they're active. AGA has a women's luncheon at DDW, which I went to years ago. There's also something called the GWC, the Gastroenterology Women's Coalition, which has been percolating along for many, many years. But I think probably now that there are more women, it's multi-society. It's ASLD, AGA, DD, ASG, and NASPGAN. NASPGAN, I was getting to that. Seriously, there were about 300 people on the room last year. Which is bigger than it's been, right? Because I was actually a liaison forever ago, and it wasn't much of a thing. But it's turning into a bigger thing. So I think looking at all this that there is, ASG didn't want to just do the same thing. But I think we all need to support all of this, right? And I am a big proponent of women promoting other women. I do not like it when we're not in competition with each other, right? So that's really, really important. And I'll talk about that in my promotion talk, too. But this is for the guys, allyship, how to be an ally. And I talked to Joe Elmanzer, who apparently did a great talk at LEAD last year. But I got his slides, and some of these are his. But I didn't totally get what he was saying. So I'm doing my own thing. So allyship is a strategic mechanism to promote equity in the workplace. Allies will endeavor to have systemic improvement in workplace policies, practice, and culture. Senior leaders have to cultivate this. If you're at a place where the senior leadership doesn't cultivate this sort of culture, it's just not going to work. And I have been super lucky at my institution. I have never had an issue with my male colleagues helping me out, no inappropriate comments, nothing like that. But it's a top-down thing. If the guy at the top is behaving that way or lets that happen, it's just not going to work. And I know a lot of my colleagues who've been at places that, honestly, I just don't know how they would possibly work there. So I feel very, very lucky. I'm also in a program that I had multiple female co-fellows back in the early 2000s. And I've always had faculty that are women. So we all have each other. We're sharing. Not that my male colleagues won't cover my call. But sometimes with women, it's a little easier. They can kind of a little bit relate to you. But I've been, again, very lucky. You need to read, listen, and watch, stay alert to these inequities and disparities. Own your privilege. I don't think men realize, like, you've probably never had a rep tell you good job when you deploy a stent. Just little stupid stuff, right? Or that the rep calls you by your first name, but they call the male doctor's doctor. It's like these little things. Patients, I give them a pass, especially the vets. They'll be like, OK, sweetie, honey, can I get a blanket? Can I get a straw? But how many of you women have a patient ask you for a blanket or a straw or a drink? Men? Oh, stop. You guys are full of shit. Anyway, so I'm just saying that it's not big things, but it's these micro, it's these little things that, over time, gets a bit tiresome. Be a sponsor or a mentor. You guys are in junior positions. You'll be starting junior positions, and you'll feel like you have no power. Like Joe Almunzer, he's fully promoted. He's the chair. He doesn't care. So he is all out there getting women on documents, making sure that there's a certain number of women in courses. I did a course with a guy from Pittsburgh who I love, and we put our faculty together. And his was all-male, and mine was half-female, half-male. And he was like, oh, god, mine looks like Sausage Fest 2018. But you may be getting together research groups, right? Think about having women at the table, because we did this really cool workshop at DDW that nobody attended, because it was Friday before DDW. But it was so interesting how women and men think so differently. And they bring different things to the table. I mean, it's truly, it was such an aha moment for me about just how men and women communicate differently. And so I think having women at the table is really, really important. So I think, as men, I think this is something you need to start off early in your career in doing and making sure that you have women around you. So what will be your legacy? And again, in my opinion, the success of those I've mentored is a reflection of me, right? So that is the culture that I grew up in. Amitabh Chak was my mentor. Other mentors, Gerard Eisenberg, Richard Wong, Mike Sivak, I mean, they all worked to help me. And so I saw myself move up. I was on, you know, Gary Falk was the first person to put me on an ASG committee. What? Right, right, true. Put me on an ASG committee and then for the past 20 years, that's what I've been doing. And, you know, Steve Edmundowitz came to give a talk and I was doing an ERCP, I was the advanced fellow. And, you know, he came in and we were chatting and he gave me his card. He's like, anything, you know, if you need me to help you out. I mean, you know, you guys can be those people. And those people, we all look up to. And their, will be remembered, their legacy is based on how their mentees have performed. So it's really important to me. And I, like I said, women, we need to stick together. It's not that I don't help the men out, but I do proportionately help out the women. So these are just a few of my people that I've gotten, you know, every time I'm gonna do a course and I wanna, you know, try and help the women out, I really, you know, try to get these people involved, get them on ASG committees, get them on, you know, whatever that I can to help them out. So, you know, at the end of my life, I wanna have a slide with a gazillion people on it. At the end of my career to feel like I've kind of really done what I was supposed to do. People helped me out. It wasn't women necessarily, but shout out to Karen Woods, who was on the board. And I was a chair of training, I think at the time. And she was on an FDA committee on an FDA panel and got me on the FDA panel, which is kind of cool. I'm still on it, although I don't know that we haven't met in forever, right? You know, Colleen Schmidt, I mean, these are people from all around. So, you know, I'm gonna give a little talk on networking and promotion, you know, start networking now. Pete, you know, Anita Afzali, who's this person here, who was at Ohio State, came up to me. I was president of the Ohio GI Society. And she came right up to me and she's like, hi, I'm Anita and I really like to be involved. And she was just, you know, put it right out there. And then I got her on one of the, I mean, I'm not responsible for her rise to greatness, but I got her on the Ohio GI Society, I mean, it helps with promotion, on the Ohio GI Society board. And then I was doing a Midwest ACG talk thing, got her on a talk there. So, you know, just remember, there's all these people who can help you out. You just have to reach out and be a little more aggressive. Be like a man, be aggressive. So for women, demand your worth, right? Recognize that you are getting paid less and hopefully you can figure out ways to work around that. Be true to yourself, do what feels right for you, not just because the men are doing it, right? We're just different beings, we have different needs. Grab opportunities, but do a good job. So if you asked to give a talk, you gotta be super solid, ready, prepared. Like Doug was saying, you know, get someone to see your talk, see what they think, give you advice. John Salzman's like a crazy person about this stuff. Like he wants all the fonts to be the same. He's like editing his fellow's fonts and their, you know, everything. And he would give me advice about saying too many ums, which I know I do, but. So, but you gotta do a good job because you want them to invite you back. So you gotta get that ball rolling and keep it rolling. Support the women around you, both genders, throughout your career. You know, women, we are not in competition with each other. Help each other out, right? And again, attend these network opportunities, the Women's SIG, DDW offerings for women. There are gonna be more and more of those. And I'll talk a little bit about promotion, but you need to start thinking about that, as Doug said, at the beginning of your job. Also, as you're looking for a job, look at the faculty and your colleagues. Is there diversity there? Talk to other women. See, do they feel supported? Do they feel valued? Try to understand the culture of the women. I was talking to some other women before about this. You know, we had a woman who came in, her husband was an NFL orthopedic, you know, like the orthopedic surgeons to the Browns, they have to be like NFL certified or whatever. And his wife was a GI doctor, and she wanted no call, la da da, you know, all this stuff. And, you know, we were like six of us in the division, and we're thinking, we're like, wait, we took call, we take call. So you have to be a little careful as women to figure out what the culture is and what the other people are doing, and maybe think about that as you're negotiating, because you don't want to be the woman who comes in, because you negotiated really well, and you have no call, and all the other women have call. You know what I mean? So it's a little, it's sort of a changing time, I just be a little bit careful, because all of us were like, that's crap, right? We take call. But, you know, we have to change our mindset a little bit, I think. I mean, not that we shouldn't take call, but, you know, you get it, right? You know, it's funny, because people are talking about time for pumping, and I'm thinking, like, I didn't have time for pumping. I just like, I would just leave and go and run back, and, you know, but I think these things are important, so I'm trying to change my mindset. Because my mom was a physician, so she was one of five women in her medical school class, and she was appalled that I was pregnant in my intern year. She thought that was the worst idea ever, and that women shouldn't be getting special treatment and whatever. So that's where I come from. So I feel like I've moved a fair amount here, but my mom is like a, you know, women should not get special treatment. So, a little different time. Thank you. See, look at Cleveland. Beautiful.

women in gastrointestinal medicine

representation of women

medical school enrollment

gender diversity in GI

gender pay gap in medicine

gender equity in the workplace