Welcome to AHGE Endo Hangout with GI Fellows, Breaking the Glass Ceiling. We have attendees joining us from all over the world tonight, and the American Society for Gastrointestinal Endoscopy greatly appreciates your participation. My name is Ali Vergara, and I will be the facilitator for this presentation. Before we get started, there are a few housekeeping items. We want this presentation to be interactive, so you are encouraged to submit your questions at any time online by using the question box in the GoToWebinar panel on the right-hand side of your screen. If you do not see the GoToWebinar panel, please click the white arrow in the orange box located on the right-hand side of your screen. Please note that this presentation is being recorded and will be posted in the Fellows Corner section on GILeap, AHGE's online learning management platform, within a week. Now it is my pleasure to introduce our two moderators, Dr. Lauren Feld and Dr. Lauren Rabinowitz, who will help facilitate the incoming questions. I will now hand the presentation over to them. Thank you to ASG for hosting this webinar, to our panelists for their dedication to fellow education, and to all of you for joining. I am a second-year fellow at the University of Washington, and I'm pleased to be co-moderating with Lauren Rabinowitz, who I first met over a shared research project around our interest in gender equity in gastroenterology. Thank you. I'm Lauren Rabinowitz. I'm a third-year fellow at Mount Sinai in New York City, and a co-founder of the Mount Sinai Women in Gastroenterology Research Group. I'm thrilled to be co-moderating with Lauren tonight, and also to be helping to facilitate passing questions along to our wonderful panelists. One of our panelists tonight, Dr. Colleen Schmidt, is president of the multi-specialty Galen Medical Group in Chattanooga, Tennessee. She is past president of ASGE, where she developed the ASGE Leadership, Education, and Development Lead Program for Women. She is currently the vice president for the GI Quality Improvement Consortium, GI Quick Registry, a collaboration between ASGE and ACG. Dr. Ashley Faux is a professor of medicine at Case Western Reserve University School of Medicine. She is an advanced therapeutic endoscopist, and is on the faculty at University Hospitals Cleveland Medical Center, and serves as the director of endoscopy at the Cleveland VA MC. She is a counselor on the ASGE Governing Board. Dr. Jennifer Moranke is an associate professor of medicine and director of endoscopy at Penn State Hershey Medical Center, where her practice focuses on interventional endoscopy. Her main clinical interests are pancreatic obiliary and luminal malignancies, and her research has included work on pancreatic cyst depletion, endoscopy education, and endoscopic suturing. She is currently on the ASGE Educational Curriculum Council, and director of the LEAD Program for 2021. Dr. Brooke Glessing is an advanced endoscopist, director of endoscopy at University Hospitals Cleveland Medical Center, and medical director of the Digestive Health Institute at University Hospitals Ahuja Medical Center. She has been involved with ASGE on various committees, and is a graduate of the ASGE Leadership Education and Development Program for Women. Dr. Amitabh Chak is the current secretary-elect of ASGE. He is one of the advanced endoscopists at Case Western Reserve University. He served in various positions with ASGE and the GIE Journal, and currently he is the director of Advanced Technology and Innovation Center of Excellence at UH Cleveland Medical Center. Thanks, Lauren and Lauren. Once again, welcome to this next section of Endo Hangouts. This is specially designed by ASGE for fellows, and it requires fellows to be involved both as moderators, as Lauren and Lauren will help us, but for those of you who are attending, we welcome your questions for this panelist that we've designed specially for this session. There's going to be a lot of discussion, and hopefully some new ideas and new recognition will come out of it. So without further ado, I'm going to hand the controls over to Dr. Ashley Foe, one of my colleagues and current ASGE counselor. Ashley, take it away. Thanks, Amitabh. I want to welcome all the fellows. I'm so glad you all could join us tonight. I think you're really going to enjoy this. We've really enjoyed putting it together, so we're going to start off with a fun, entertaining, although somewhat depressing video produced, directed, acted in by our own Brooke Glessing. I think you'll find this very entertaining, and we'll start with questions after. Morning, Lauren. Hey, Dr. Glessing. What are you doing out today? Are you going to be able to work? Yeah, I think so. That's what I usually wear. I understand you are here to see Dr. Glessing today, you are going to just love her. She smells so pretty, and she's so beautiful. What I'm going to do now is I'm going to... Hey, Dr. Glessing. Hi, Dr. Shapiro. Hi, Brooke. Hi, Mr. Smith. How are you? I'm good. How are you? Good. I'm Dr. Glessing. I'll be doing the procedure today. Okay. It's nice to meet you. You're Dr. O'Connor, is that correct? Yes. Okay. I just wanted to go over this procedure and talk about what we're doing, why we're doing it, what the risks are, and then if you have any questions at the end, you can certainly ask me anything that you have before we proceed, okay? Okay. Okay. Do you have any other questions for me before we get going? Well, no. I see the doctor just walked in, so maybe I'll ask him some questions. Hello, Mr. Smith. My name is Dr. Motiv. I'm the GI fellow. I'm going to be actually joining Dr. Glessing. She's the attendant who's going to do the procedure for you today. I'm only like a trainee and a fellow, but she is the actual attendant doing the procedure. You're the doctor? Yeah. I'm actually Dr. Glessing. Oh, I'm sorry. I didn't understand that. You just seem too young and too pretty, and I didn't think you were the doctor. I thought you were the nurse. Have you done any of these before? You just look so young. Do you feel confident and your colleagues feel you're confident? We're going to get going in just a few minutes, okay? Okay. Okay. Thank you. All right, Mr. Smith. My name is May. I'm the nurse. I'm going to be the one to the room. I'm sure you're going to love Dr. Glessing. She's so nice. She's always smiling, very bubbly. We all love her here, and she's so pretty, too. I mean, she's kind of young. She's a woman. I mean, I can trust her to get this done. Yeah, yeah, yeah, definitely. Yeah, I would. Okay. All right, let's get you in. Okay, guys, so that's it for the EGD. Let's go ahead and get set up for the colonoscopy. Hey, Brooke, do you want another 50 and two? Yeah. Are the vitals okay? Yeah, yeah. Okay, yeah, let's go ahead and get another round of meds. Okay. All right, Brooke, would you like to set up for the colonoscopy while I go take this away? Sure, sure. Sure, I can do that. Oh, hey, Brooke. Thanks for letting me join your procedures today. Oh, hey, Tim. How's it going? Good. You look so cute today. Have you lost weight? Oh, yeah, thank you. So what's going on with the company? Madam, have you checked out our new device, the polyp resection device? What do you think? No, I'm going to be using it next week, I think. Okay. Let me get you some videos from Dr. Raja at King Planet. He does it really well. Maybe you'll learn something from those. So, Dr. Glassing, thank you so much for making and sharing this fabulous video. One of the things that comes up in multiple of the contexts that are represented in the video itself is sort of that, like, difficulty setting boundaries when somebody either assumes that you're, you know, not the physician, or that even if they recognize you are the physician, that you can't possibly be the attending. We were wondering, could you just sort of share your go-to methods of setting boundaries without being perceived as hostile or difficult or, you know, somebody who can't take a joke? Oh, yeah, no, absolutely. So, you know, what's interesting is that when I was making this video, it was obviously, you know, scenarios that were based on true events, but even during the making of this video, I found myself at times completely at loss for how to respond to these scenarios that I had already made up. And so I would actually love to hear what everyone else has as strategies for how to, you know, manage these types of situations and the, you know, the correct response. But I will say it really does vary for me on a day-to-day basis, depending on really my mood and what else is going on. And I'm sad to say that I wish I had a better strategy consistently, but, and I definitely am able to, I mean, vendors. So vendors, I am super easy. It's very easy for me to immediately tell them that, you know, my name is Dr. Glessing, that I think I have earned the right to be called Dr. Glessing. I also am very quick to tell them if I don't feel like, you know, we are being respectful to each other that, you know, they, they no longer need to come and join me for procedures. So that's pretty easy with my nursing staff and my techs and even the fellows. I think one of the things that is so important and one of the things that I'm so grateful for is that I work at a place where I have that people are very aware of this, I would say. And so in order to, I think kind of engaging the entire organization and the culture of your group to really support the idea of gender equality, I think is really important. And so I oftentimes will kind of even tell my staff, I'm like, Hey, I, I totally am okay if you call me Brooke when we're alone or, you know, not in front of patients, but it's very important when we were in front of patients for you to address me as Dr. Glessing. And, you know, I think even just awareness is important. So I will say after I made this video with my staff, they have all been very aware of, you know, but you are bubbly and you are smiling, you do smile and you are pretty. I'm like, thank you very much. That's very nice. But that has nothing to do with my abilities as a doctor and my qualifications and in front of patients, especially, you know, you know, either say nothing or something, you know, to the, to, to really speak to my qualifications as a physician. And I think that that helps them set the tone for the patients, right? If you, if the patients see that the staff around you are respecting you and treating you as equal. I think that that then sets a tone for, for the patients. I will say that with patients, that is my, my weakness. So, you know, with older patients are really cute. Sometimes I just kind of let it go. You know, if they're a little bit more hostile than I will be, I will kind of get into my deeper voice and a little bit less smiley persona. And, you know, my, you know, my stance of being, you know, stronger to try to make myself seem a little bit more, I don't know. I don't know. Panelists, do you have any, that's, that's kind of what I've been trying to do for, for, for boundaries. But I will say patients are the hardest because I want, I don't want to alienate them and I do want them to respect me, but I also don't want to. And the thing that I find myself getting into as far as traps is sometimes, you know, Oh, you look so young. I'm older than I look. I age really well. There was a cartoon that I, I think I've actually even said this. Oh, my hands are really small. I don't shake like an old man. I mean, there's so many things that I say, and I hate that I do that sometimes because I'm trying to justify me being a female. And that's, that has absolutely, I think the wrong approach. And so I think trying to really. Sorry. So Colleen, how do you deal with patients when, when they don't recognize you as a. Position or treat you differently or, or don't even want a woman. What would you do then? Or ask you. Thank you, Brooke. The answers were really thoughtful. I think very honest and. We share those experiences. I think all of us do. I'm from the South and in the South, we are taught to be friendly, but happily also to be very respectful. Unfortunately, I took that with me when I trained in Boston and called my patients, what we often call each other in the South, which is sweetie. And when I was an intern, my third year resident came down on me so hard. She said, you never call a patient, sweetie. You always address them respectfully. Mr. Smith, Ms. Jones. And that stayed with me for the rest of my career. And I think it's for me, a slippery slope. To go down the path then of, of calling a patient by their first name. And in return, they call me Dr. Schmidt. There is the occasional patient. And like, I, I think Brooke implied, I think sometimes. It is I'm, I'm in charge, not you, Dr. Schmidt. Colleen or being passive aggressive. Often I think they are just trying to be friendly and warm, but I refer to them by their last name. And like, like Brooke, slow the tempo of the conversation down in a very intentional. Serious way to ensure that we are connected at the professional level. I'm here to take care of you as a physician. Use the white space and discuss their symptoms. And we, and I just asked them a question about why they're there. There's a lot of material in that video that, you know, You can spend each thing talking about, but. How do you, Ashley or Jennifer, how do you deal with. I mean, fellows going by who. Call the male physicians by doctor and don't call you. I mean, fellows are different from. Because there are trainees. Do you let that slide or do you. Oh, I I've noticed now that I am older. That they all call me by my last name. I wonder. You know, when I was a freshman. I don't really tend to have that problem. I think when you're a junior, you know, I know Brooke started. With us and. Well, you weren't, you weren't a fellow. So I was a fellow. So it's harder when you be your fellow and you move on to an attending and the fellows knew you as a fellow. So I was a fellow. So maybe there was a little bit of people calling me Ashley. And I think. In my first couple of years that happened and it kind of a little bit bugged me and then they stopped doing it. And then it kind of made me feel. Older because they weren't doing it. So, you know, It goes in waves a little, but I don't really have issues with the fellows. I, I would say the video really represented well. That it. Can be nurses in front of patients. And. Reps and. And patients. And, you know, I sort of echo what Colleen and Brooke said it sort of depends upon the patient and the day and. You know, what's been going on and sort of. Why they're doing it. Yeah. The patient wants to control the whole. Everything, but then there's the other ones who just can't pronounce my last name or they, you know, they see my badge. And so I. Jennifer. Yeah. I have found. That modeling the behavior that I would like from others has been somewhat effective. I, for example, I always refer to the fellows by their title. So, you know, Dr. Thomas or, you know, Dr. Thomas or Dr. Thomas. When we're working. And I'm speaking with the nurses. I always refer to the fellows. You know, by their title. And also when I started. As a director of endoscopy, there was a, a. An anesthesiologist counterpart. And everyone referred to her uniformly. Everyone referred, referred to her by her first name. To the point that I didn't, I didn't feel like I was in the making. I have always referred to her when we're in meetings. Most of the time. She's not even there. I always refer to her by her title. And I think that that has. Helped because the leadership team. In endoscopy refers to me as Dr. And then that sort of trickles down to, to, to the nurses. And then their interactions with patients is, has a little bit of a different tone. And so I think that it takes time, but that has been effective for me. I agree with everyone else in that the patients are the hardest. To, to correct. And the only opening that I see is sometimes though, like call me Jen. Sometimes even people will call me Jenny. And they'll say like, it's okay that I call you that. Right. And it's like, well, at work, people call me Dr. But when we're out of work, you can call me Jen, you know? And so that has also, you know, and I do it with a smile, right? So I'm friendly, try to be warm. But when you don't have that opening, I just let it slide because invariably most of the people who are there, who are there to see me are having something scary, something potentially bad. Doom going on. And if they need to have a little bit of control of the situation, I'm kind of okay with that. I don't know if that moves the ball forward or not, but. Well, I really appreciated what you said about leading by example and sort of making sure that you're addressing the fellows by their, by their professional title. We had one attending at our institution who would consistently address fellows by their first name, which is fine for the male fellows. Cause if you tell a patient, this is Brian, he'll be doing your scope today. Then they say, great. And if you say, this is Lauren, she'll be doing your scope today. And they're like, you know, are you qualified? Is this okay? And so one, one of the female fellows, one of my colleagues pointed it out. And since he's completely rectified behavior. So I think it really does show that sort of like standing up for yourself can sort of help. You know, bring positive change for other people that you're that you're working with. I did want to mention that for all of the attendees, there are many of you, I'm thrilled that you've all joined us. You can feel free to put questions in the chat box and we'll Lauren and I will pass those along to our panel. So feel free to type in questions that you want to ask specifically. But while we are waiting for, for attendee questions, I'll direct it back to the panel to say, you know, we've talked about sort of ally type behavior. And I'm wondering, you know, in the video, there was the fellow who was sort of addressed more as the, as the physician. And so what are some behaviors that you've witnessed from sort of ally people helping to, you know, step up or address bias that they witnessed? So maybe Dr. Foe, if you could talk about sort of how you've seen that been, you know, good allies be involved. Well, you know, I don't really, I would say the major issues that I have are patients and sometimes other colleagues, but by and large I have to say, you know, we do have a lot of women in our institution who are faculty and, you know, I do see the fellows introducing themselves to the men by their first name and they don't wear a white coat and the patients don't bat an eye and it blows my mind. I just, because I always put my white coat on and I, you know, so I might not be the best person to answer that. I, you know, I I feel generally pretty lucky. I feel, though this stuff happens all the time and I think I can, I mean, I can relate to every single one of those. I don't know that I've ever had a nurse saying, you know, you'll love Dr. Faux, she's so pretty, but Brooke is better looking than I am, but, you know, I'm not sure. I mean maybe I miss some of that, but in general I feel, you know, I feel pretty lucky that I've been able to and I think I would just say, you know, what Colleen had said before, which is the way you carry yourself and, you know, you're confident, you show that you're in control and I think patients respond to that and I think other people respond to that, so I feel like it's sort of a little bit, you know, my mother was a physician and so I sort of learned from her and she's kind of a sort of a badass, I would say, in general. She, you know, liked to control the OR even though she was the anesthesiologist sort of thing and so I think I got that from her and so I think it is really important the way you carry yourself and you exude confidence even if you're not confident, right, and I think that I've generally been pretty lucky and again also I have a group of men who I work with who are the most respectful, never cross boundaries, don't, you know, call me by my, you know, my title around other people and so I just think I've been lucky in that way, so maybe I'll pass the mic to someone else. Well, sorry, go ahead. No, no, go ahead. Go ahead, Lauren. Lauren, go ahead. I was just gonna say sort of as a follow-up to that, one of the questions coming into the chat is, it seems like actually several of our fellow participants tonight feel that perhaps nurses treat them differently, perhaps less respectfully in the endoscopy suite and actually can cause patient safety issues and, you know, is that something that you've experienced now that you're sort of more senior? Maybe, Dr. Schmidt, you can take this question and do you have any recommendations as a young female trainee who wants very much to be incredibly respectful of nursing colleagues? How do you sort of navigate that relationship? I think that this is a particularly easy place for us to be confused. We, like surgeons, are in procedures working in very intimate settings. Really, that is, I think the intensity of it is sometimes heightened by what we do and we feel that bond with the staff that are in the room with us. We are on mission and we're on mission together, but when the patient is asleep, we do have exchanges that are meant, I think, to both increase that sense of camaraderie, but at the same time, there still need to be boundaries to that. And just two things. One, I'm very careful that the conversation in that procedure stays at a professional level. We may talk about other things, maybe the newest movie or our newest recipe, that sort of thing, but at the same time, their eyes are on the screen with me looking for polyps and if the conversation goes sideways or they're distracted by something else, that's that's kind of the call to arms. Let's get our attention back to what we're doing and they know that I mean. Let's get focused on the patient and that allows everyone to understand again who's in charge of the team. So I don't mean to be controlling about it. It doesn't happen very often, but I do think you have to keep the conversation in those intimate procedures at a professional, cordial level. I'm not trying to preach to anybody. What we do is a lot of fun and it lends itself to team-based care. The other area where I think it's a very important is sometimes we're all kind of moving into the patient at the same time. Brooke enjoyed that in her procedure. You've got fellows coming in, you've got staff coming in, or you may walk in where staff are preparing a patient, but the staff know that when I enter into a conversation with the patient, everything else goes into the background and that's the way it should be. The patient needs to be able to hear me. This needs to be a one-on-one conversation that we're having. We're talking about risky procedures and literally if there's too many people in the room, sometimes people will step out. That conveys to the patient that this is the person in charge. Let us step back and let you have that conversation with her. At the same time, we still really enjoy working together because we all know that that's the intent. I think that is what Jennifer pointed out. That is a learned behavior. Sometimes it's a big culture change, but it's one over time that I think will serve your patients well and serves the discipline well and serves to actually help us develop a better team and refocus. Can I just make a comment, Colleen, on that theme? I think that has been the most challenging thing for me as director of endoscopy at the VA. I think as a woman, there are mostly women nurses and so as you become friends with them, because us women, we're just chattier than men are. We talk about, I'll come home and I can get a roofer, an electrician. I get recommendations from my nurses. They feel like you and they are on the same level until suddenly it's patient care and I have to be in charge and something's happening. Then you turn into the bitch, the B word, because you're trying to, things have changed and I am in charge. Yes, I am going to tell you, I'm going to ask you to do something and it's kind of, I think it's very challenging and I think women have a harder time because of that female thing where the women, you know, you talk about your kids at work or you talk about your dog that's, you know, whatever. I think that at least I'm that way. I'm sort of, you know, you spend a lot of your time at work and you sort of end up sort of being friends with the nurses but then it's hard to, it's hard, that's a really hard balance and I've struggled with it and, you know, for 16 years now so it's really challenging. I think it'll be a challenge for all of us on this call from now to the end of our careers but you know there's some things you can even do physically. You're in the procedure, things are going on around you, just think about when you settle yourself into your stance on both feet and kind of relook at the screen and say okay everybody eyes on the screen. It doesn't need to be harsh or commanding even, just let's refocus. At the same time I like to go out with some of my nurses after work to get nachos and that sort of thing but that's different, that's letting your hair down. It's not the same in the procedure room or in front of the patients and I think they're smart, they're smart women. I think they can get that and if you have to you can have a very explicit conversation with them and I think they'll get that too. You know I was gonna say just to kind of echo what you guys are saying, so I also struggle as director of endoscopy with this but I do think that just being really assertive and talking to people as you see the behavior happening, you know, pulling people aside as appropriate, you know, not talking to them in front of an entire group or entire room but I think again that's about just creating this culture in your workplace of respect and so same with to answer the question that Lauren had brought up a little bit ago about fellows feeling like they weren't being respected. I mean it's really hard I think as a trainee to go to your staff, the staff that will say I have been doing this longer than you have been born, right? You know you get that a lot too, like I know more about GI than you will ever know. I mean comments like that I know were said to me when I was a fellow and so it's sometimes hard to advocate for yourself when you are a trainee but I think if you have a mentor or some other ally, you know, as a staff that can also kind of just say you know we are all on the same team, we're all doing what's best for the patient care and we all have to be in this together, we have to respect each other in front of the patient because really you know the patient needs to feel confidence in their team. I think that that's really important and I think addressing it as immediate to the issue as you can I think is really important and I super struggle with this boundaries in the room because I'm super chatty and like I feel like everyone probably thinks that they know my life like and so I do think that I struggle with this a lot what Colleen and Ashley were saying about you know I also like to go out for drinks before COVID and all that with my team and I also personally feel like in the long run and I could be wrong about this because I am on the younger side but I do feel like when I have been able to interact with my team outside of work it actually makes for a stronger partnership at work because we kind of see each other also as human beings and people that have lives and it's able to and sometimes I will even say okay guys like I'm talking to you with my director hat on which I know sounds kind of stupid but or you know like we're in the room and I'm like just like Colleen was saying you guys okay now we really need to focus or you know all eyes on the screen or whatever and I think that just being very vocal about it is also important so that way it doesn't get pent up and all of a sudden it comes out as something more aggressive than it needs to be. So you're on the pretty and young side right Brooke? No you know what I was so I was creating this video and I would say I totally agree with what Ashley said we are very fortunate we have a lot of women in leadership and all of you know all of our immediate colleagues are so respectful but there's this one surgeon that I absolutely love work with him all the time but to me he is like a classic like older white surgeon and when I was talking about what we were doing and this micro you know talk about microaggressions he was totally like well that doesn't really happen right and then he's like what's an example so I said something about how well you know like people say you know I can't be a doctor because I'm so pretty and or young I'm too young he's like but you are pretty and young like what's wrong with saying that I don't I don't know what the problem is I don't get it you know I was like oh so you know it is around us and I think a lot of the problem is that we don't recognize it you know it's on it that's why it's called unconscious bias because we just do it without recognizing what the implications are what that the meaning behind those statements are so keep those questions coming Lyle can you give Jennifer the control and then she can launch into the questions what won't save the last 20 to 30 minutes for more questions there's a lot of material in there but we also want to give Jennifer a chance to go through some of her content and then we'll see how far as you guys know who've been to these endo hangout they don't always end but we'll keep them going great thanks Amitabh so I am segueing into a little bit of information about on ramps off ramps kind of foot on the gas foot off the gas in terms of overall career and I get a lot of my data from articles in the Harvard Business Review and most of the data that we're going to be talking about tonight is from the business world but I think that it does apply to the medical field as well because we're highly educated you know advanced degrees really qualified women but large numbers are of highly qualified women are leaving the workforce there is a brain drain and there's also a phenomenon in the sandwich generation where you have highly skilled really experienced women between the ages of 40 to 55 who leave work to care for family members and nearly 60% of highly qualified women describe their careers as nonlinear interestingly of MBA holders one in three white women does not have a full-time job compared to one in twenty white men so this is there's definitely women leaving the workforce in higher numbers and we'd expect so about the of the women who do leave you know full-time work those who off-ramp do it for a short period of time on average only 2.7 years and then 40% of them will go back at some point and find full-time jobs a little less than a quarter of them will go back and work part-time less than 10% will become self-employed and then there's 30% of off-rampers who don't return to the workforce now there is some data in terms of doctors related to this and of those who rejoin 70% site enjoyment and satisfaction as the as the main reason to return this data is interesting because it shows a top five reasons women leave the fast lane the fast lane and the top five reasons men leave and family time is the is kind of the number one reason about a quarter of people want to earn a degree or explore other training less than 20% feel that work is not enjoyable or satisfying some move about less than 20% move and then 16% are changing careers conversely the top five reasons men leave the main reason is to change careers similarly to women they're earning a degree or developing other training more men find work to not be enjoyable or satisfying and then they're not interested in the field anymore and compared to 44% in women family time only accounts for 12% of the reasons why men leave the fast lane this data is from a huge women in the workforce survey that's been conducted by McKinsey and company in partnership with lean in org and this survey has been going on since 2015 and has included over 600 companies and about 250,000 respondents in 2020 they focused their their efforts on how the COVID-19 pandemic is affecting the workforce but this slide was kind of interesting to me so mothers are three times more likely to be responsible for most of the household labor but more than 70% of fathers think that they're splitting it equally whereas you know only 44% of mothers feel the same way and so in in the mother is here they're doing for either most of the work or all of the work in over 50% of households at least for mothers perspectives in terms of COVID-19 mothers are more likely to consider scaling back you know reducing work hours switching to a less demanding job potentially taking a leave of absence moving from a full-time role to a part-time role or even 7% are considering leaving the workforce altogether now this timeout or time away this off-ramp comes at a penalty right so if you look at the salary of those who spend no time out if they're out for less than a year their earning power is decreased by 11% but if they're out for three years or more their earning power is decreased by over over 37% right so these are huge issues that I think it's important for us all to be aware of when we're considering these these changes and negotiating these things even with our own partners about who's gonna do what or for how long I think having this information helps empower us to make good decisions for ourselves and our families so let me go back here what can be done so in medicine I think this is slow to evolve the business world is way ahead of us but make some more flexibility in the day-to-day work and find ways to make the work that we do more sustainable have flexibility in the career arc right so in in the business world we can unbundle projects and tasks but could we also do that in medicine could we unbundle some of the work associated with providing care could we activate physicians as needed how do we eliminate the stigma of stepping down or going part-time or taking time off or stepping back how do we take steps to minimize gender bias and you know we're going through some of that today and avoid burning bridges so the connections that you make the context that the context that you make the relationships that you build be careful not to burn those bridges because they may be your a way to re-enter the workforce continue to nurture your ambition and work actively with your own mentors to develop a path back so those are just a couple of tips and insights about women in the workforce so can I take the prerogative of before Colleen of asking the panel questions that did any of you consider taking time off for family and a corollary to that question is when choosing either when you made your decision to choose GI which is a procedural field and requires a fair amount of intensity and even more number you decided to choose interventional endoscopy was that a challenge or did you struggle with that decision either because of families or other things pulling you in different directions how did you choose that career or how did you handle that what would things Jennifer was talking about I'll start because I did it twice when I was a so I've been married for 41 years when I was a third-year resident we decided to have our first child and I wanted to go into GI they had just started doing this very neat procedure called ERCP and I wanted to do it at Duke so I went to my department chair and who knows this was my first negotiation and I said I would like to do GI but I'd like to take your off and job share with this other resident and then go do a GI fellowship at Duke and he supported me a hundred percent never thought twice about it I just that's what I wanted to do and I explained my reason and he got behind me and really paved the way for that to happen the second time out I took was when I was on faculty and doing outcomes research we decided to have our second child and I really just didn't have enough patient contact and we wanted to move closer to our family so that's exactly what I did I took another year out to to do that Clint and I my husband and I looked at all of our options including going back to Boston, moving to Chattanooga, and a lot of other places, but it's a very crooked circular path. I think, as Jennifer pointed out, if it had been longer, I'm not sure the path back in would have been quite as easy, but I knew how long I wanted to take out, and I knew what I wanted to do next. Maybe that helped, and I negotiated both of those and thought through them with my partner. Can I ask a follow-up question of how you negotiated your way back into the workforce and what joining again was like? I never missed a beat. I think the interval years provided great fodder for stories that we share with our staff, with our family, and hopefully in the future with my grandchildren. I don't want folks to overthink it. Just think about what you want next and what you want to envision as your career, not your next job, and this is meant to be a bridge to that. If your time out is just, I can't do this anymore, that's a different thought process, but I think in both of these occasions, the first time was, I know what I want to do. Can you help me get there? The second time was, this is not what I thought it was going to be. I want to do something else. What is it? Here it is. Let's work in that direction. I hope that helps. Ashley, Brooke, Jennifer, Ashley, did you ever consider not? I had a mother who was one of five women in her medical school class, and so she was my role model. She would make comments like, why do women think they should be treated differently than men? She was very much old school. She was a bit alarmed when I got pregnant with my interneer. She did not get excited like my friends did. She was like, ooh, interesting move. I never really thought, because my mom worked full-time until she retired, overnight call in the hospitals and came home and cooked us gourmet meals. That's just been my role model. I did think, though, about when my husband and I were both looking for jobs at the same time. He's a physician, and he works at a hospital in Cleveland that's not flexible. You're there, and you're there all the time. He works really, really hard. I think that you can think about what job you're looking at. I worked at the VA, mostly. There are a lot of women there, and the hours are very limited. We made it so that one of us could be flexible. Now, I do have to remember when I would get annoyed that I was always the one who had to deal with the kids if something happened because my husband couldn't. Remember, that's why I signed up for this job. I didn't really think take time off, although I'm thinking about it now. I'm thinking four days a week sounds really good. I think COVID has given me a new perspective. When I was working about 70 percent, I was like, okay, this is kind of reasonable. My kids are both in college, and they certainly didn't like me getting home early. The one who was stuck at home when COVID hit was annoyed that I was getting home early during COVID time. One thing to remember, and Colleen, you talked about a little bit, your life is phases. You'll have the before kids, you'll have the kids when they're little, then you'll have the kids when they go to college. You can change your career as you have more time to do things. One follow-up question, and just a follow-up question that's coming through. It sounds like, Dr. Schmidt, what you were saying is that you had an idea of how you wanted to achieve what you wanted to achieve. It also sounds like you had a program director or leadership that supported you in doing that. I just wondered if you could talk a little bit about what to do if you brought an idea like that forward and didn't get the support that you had gotten. Do you think your course would have been different, or how might you have handled it in that case? Honestly, I think I would have adapted. I would have gone to a different GI fellowship. I would have been very surprised if I'd been told no, so surprised that I'm not sure I would have accepted that, really. Then I would have gone to talk to other people and test that. Was it a reasonable thought process, logical goal? I was asking, and I'm still working. It wasn't like I was going to take a complete year off, which is not an unreasonable request, by the way, but I already had a plan. I was a bit surprised that he was so fully supportive of it, back when this was 1989. Don't date yourself. Brooke and Jennifer, one of the hardest things, and this is also true for ASGE, is as people go through their fellowship, especially women, ones who are interested in going into endoscopy or interventional endoscopy, more and more and more of them drop off as they go through their fellowships. Were you committed to interventional endoscopy? Did you ever think of not doing it, or was it a challenge to go into intervention? For me, interventional endoscopy is why I went into GI. I had a light bulb moment as a medical student rotating through a cancer center, and I saw my patient undergo an EUSFNA ERCP, and I was going to be an oncologist. I saw that, and that was it for me, and that is still my favorite thing to do. That's my favorite thing to do, and so for me, it was always interventional or bust, and I think because I had that, that was my true north. I knew it from very early on. All those decisions became very easy for me, but I also had advantages that a lot of women don't have. I had a significant other that was very supportive, that he doesn't require a lot of maintenance. He's good when I'm gone, or if I'm not, I'm coming home. I'm not. He's totally independent. He doesn't need me. Is this a dog or your spouse? I'm sorry. He was mobile. He would go where I wanted to go for fellowship. He had input, and then the other advantage is, and I recognize that this is a huge advantage for me, but he's a stay-at-home dad, and I came from a very traditional. I'm one of five kids. My mom stayed at home, and so I'm used to having a very, you know, somebody's-at-home, very stable environment, and I wanted that for my kids, and my husband provides that for us because the truth is that if it were up to me, it would not be stable. It wouldn't be stable if everybody was counting on me. So, yes, I actually went into GI because I fell in love with the liver, and then it was pretty quickly during my general GI fellowship that I just absolutely fell in love with therapeutic endoscopy, and then from that point forward, it was just like Jen. It was, you know, that or bust, so, and you know, and I also, my advantage maybe was that I was single and didn't have anything connecting me or tying me down to anything, and so I felt very fortunate when I was going through the fellowship process and going through even trying to find my first job. I mean, Cleveland, why not, you know? I mean, it's just me, so once I, I just, I think it's so important to like what you do, and I fell in love with therapeutic endoscopy, and that's from that point forward I did that, but I just want to back up, and I just want to say one thing because I had a really good training history, and so I don't want this to sound like I didn't, but I did have a mentor. I had many mentors, but one of the mentors that I had when I was a resident, I was married at the time, and I was thinking about family planning, and I was advised strongly to not have kids at that time because it was not going to do well. I was, the timing of it was not going to work for applying to GI fellowship, and I mean, and that was, that was making so many assumptions, like I wanted a baby, and boom, I would have one, like, you know, at the time, though, like, you know, you think a lot. At the time, you think all these decisions are so important, and they're going to change your entire career and your future, and we didn't talk about on roads and off ramps and all that stuff at the time, and so I didn't pursue it, and I mean, now, like, I'm divorced, and I'm glad that I guess maybe that, I don't know, but that really changed, that might have changed my life a lot, and I, you know, and now I don't think any of us would advise, you know, you have to live your life, and you have to do what's important to you, and so that's something that I wish, you know, I don't know. I'm very happy with my life, so who knows, this is the life that I have, but that was very pivotal at the time, you know, 15 years ago, so in any case. Helene, can you give us some safe words of advice? So, the, we were talking just a minute ago about what would I have done if things had not worked out the way I thought they would, and I think that that actually would probably be the next opportunity I would have had for negotiation, even though I didn't know it at the time, so when Amitabh approached me about being part of the panel, we thought about case presentations, so I have two. One is a fellow who is doing an advanced year, and she wants to go into private practice. The second one, if we get to that, and it's fine if we don't, wants to have an academic career, but to take a big step back from this, I'll reiterate that I think as you embark on your career, you need to have some idea of what's important to you and what you want your life to look like, because at the end of it, you want it to be a life that you enjoy professionally and personally, so an exercise that we go through in some of the leadership programs is for you to look at all of the different value sets that surround you in the universe and really think about what's important to you, so what identifies you in terms of decision-making, and for this woman, she identifies these freedom, autonomy, some might say, making a difference, so making a difference in patients' lives, her sense of well-being, and then personal development, and then you go through, I would recommend an exercise of, as you look at a job, be it in private practice or in academia, of really creating your own personal inventory and then a professional inventory, and what I mean by personal inventory is you and your partner sit down and you articulate, it may be very general, it doesn't have to be, you know, down in the weeds, what your priorities are for what your life is going to look like, and for this person, this woman, she wanted to join a quality group, a group with a good reputation, someone she knew she could trust her patients with, she wants to start a family, doesn't know when or how, but she knows she wants one, and she wants eventual financial independence. Now, her professional inventory is that she is well-trained, she believes she actually does have some specific talents, she is interested in participating in governance in the group, so she, what kind of groups would allow that to happen, and her own personal work approach is one towards a team-based approach, she's not one that likes to be isolated or work alone. Her long-term goal is full partnership in a group, so she responds to an ad for a large group practice, and I want to turn it back to Lauren and Lauren and see if there are any questions that might come up from any of the attendees, maybe some of you are looking at similar experiences, and if there are any questions that come to mind. So, Dr. Schmidt, can you talk a little bit about, like, when you're negotiating and when you're thinking about all of these values, is there something very fundamentally different about being a woman negotiating versus a man negotiating? There are books written about how women negotiate as compared to men, or rather, how we might not negotiate. There are some that I will recommend to you, I know that there are millions of self-help books, but there are some that I think can really make a difference in any number of attributes that you need to bring to that kind of conversation. So, this is going to be a good segue to maybe one of my other slides, but let's just talk generally about negotiation and then specifically about women. We can derail this at any time, Lauren and Lauren, but one of the first things that you want to understand is that the only expectation when you sit down, let's say it is about this kind of job, is that you are going to negotiate, not what you're going to negotiate, but they are prepared for you to negotiate. The person on the other side of that Zoom interview or on the other side of the restaurant table knows that you're going to negotiate. There are going to be things that you just don't agree on in terms of where you're going to end up in your contract or your employment agreement, but long term, and this goes for any negotiation, I think, whether it be with a payer or with a hospital or with your division chief or with this large group, is the goals are mutual. Everybody wants a win-win. They want you to succeed and you want to bring success to the group. Really, one of the fundamental reasons to negotiate is that both sides of the table have clear expectations of the other party, and in the long run, you are leaving behind a relationship of some kind, and if you're moving forward, you're creating a partnership and a relationship, so you want to cultivate the positive aspects of that discussion, and by way of doing that, I mean you always want to end and start a conversation or an email or a letter with thank you for this opportunity. I appreciate the opportunity to review this. Make sure that in the end, you're negotiating with the person that can do the deal, and if you're not, if they're not that person, then you need to get follow-up in writing from the person that is. This goes for private practice or academia. You can imagine you're having this wonderful discussion and they're promising you the world and come to find out they didn't have the world to promise you, even though their intentions may have been good. When you receive an offer, doesn't matter if it's by email or verbal or over the telephone or by Zoom, thank the individual for the opportunity and want to take some time out to review that. If they press you, just thank them again and say you'd like to take some time to review the details because negotiation is often about the package. If you get obsessed with each detail, you're going to feel like you're losing part of the time, and in fact, what you're negotiating is the entire agreement, so take the time to understand what parts of that are important to you, where you're willing to give and take, what your priorities are, and then in the end, again, this goes for everyone. Negotiation has to be done with integrity. You want never to negotiate for the sake of negotiating, but really to have a conversation about what's important to you, and then document and summarize all conversations, so if they don't send it to you, just write a summary email soon afterwards. Thank you for our discussion yesterday. Here's my understanding of what we agreed upon. Now, with regard to women, there is a number of traps we can fall into, but rather than telling you the don'ts, let me tell you what I think are the do's. Think about your negotiation for this job as in the context of your entire career. Now, in private practice, the truism is you don't want to change. You want to find a private practice that you can be married to and stay married to for the rest of your career because it's all about building a referral base and relationships. My impression of academia is that it might be a little bit different. It might be necessary to move to another institution or even city in order to get that next promotion, but I'll leave that to the academicians to think and talk with you about, but you are talking about the trajectory of your life, not just about this next job, so there may be some trade-offs there that are going to be a better fit for your life where it is. Let's say you do have a young child. You need Monday afternoons off to take your kid to karate. Truth. Your husband is a musician. He has rehearsals on Thursday night. That's the deal breaker. You got to be out of there by four o'clock to pick up the kids. Whatever that is, think about the entire situation of your life and your professional goals. Use every opportunity you can to ask questions. If you're in private practice, look at MGMA standards for payments. Talk to other people in the town. Call the medical society. Ask the staff what are these folks like. You know the nurses know better than anybody what someone is really like in a professional setting. Understand what your real needs are as you look through that list and the offer that's been made to you. Prioritize, though, and then think about where you could make some gifts back in trade-offs. One of our assets is that we do tend to use our radar. We see what's going on in the room. We're not laser focused on a certain sentence, and that can stand our benefit. We understand those cues that are going on around us, and we tend to negotiate communally. We do a better job of negotiating for our kids, for our spouse, or for our dogs than we do for ourselves. That can be used to your advantage as well, so that compassionate curiosity can be turned to your advantage. Figure out what your ask is. Practice it. Don't just practice it, but think about even if it's just with your partner or your best friend or your colleague, what every potential objection could be, and think about what your response is going to be to that. Practice making the ask. Feel like you can stop and let the other person talk. Use the white space of the conversation and leave the extra information and emotion and words out. Let them jump in to fill in the silence. That can be very telling and really be very informative to you. What you're negotiating, the most important thing I think you have is your time, the time of your life. It's not anything you'll ever get back. For folks in academia, just like folks in private practice, most of the time that's measured in 10 half days a week. If your expectations are to be providing a certain amount of patient care, there's going to be some bleed over into the afternoon, and the afternoon will bleed over into the evening. If you use an electronic health record, you know the temptation is just to take that home. Set boundaries for yourself and understand what it is to finish your day. I need to practice more of what I preach for that, but time is the most important thing that you'll ever negotiate. Maybe I can stop there, Lauren and Lauren. That's great. Lauren, any questions coming up or can we? Yeah, we have a question that asked about how to recommend refining a specific skill set that sort of will set someone apart. So we have a fellow who's saying that they're not necessarily interested in doing a fellowship after General GI, but they are a bit worried about sort of the job market and if and how to sort of present themselves as a desirable candidate in that negotiation. Does anyone have any recommendations on that? Amitabh, you're good with this if you want to speak. You know, we've had a number of women who have done General GI, not done fellowship, and sort of felt it out a little bit when they were at their job what the needs are. So one of our faculty went in to sort of take care of cystic fibrosis patients and sort of differentiate that way. Another one spent two months learning esophageal motility and pH and now she sort of runs the esophageal, you know, clinic and things at the VA. Now she was at the University as well. So you can potentially, if you know where you want to be, sort of try to figure out what they might want and, you know, you can oftentimes, especially if they really want that, they'll send you to do, you know, a couple months of training somewhere. So you could certainly, maybe sometimes, because during fellowship it's you know, it's a quick three years. You may not be able to figure it out before you go somewhere. I think it's not unreasonable to, you know, sort of take a little time to figure that out but that's just one opinion. I'm curious here. I mean, I would say that if you don't particularly have a super interest in a niche, I would not say that you do because you know that where you're interviewing really needs someone that is, you know, into motility or into nutrition or really interested in IBS. Like, I would say be really true to what you want to do and to not market yourself for the job. Market who you are and the right job will become available. Yeah, I would also kind of say follow what your interests are, right? So if you like to do endoscopy, don't want to do a fourth year of advanced endoscopy but like scoping and are, you know, consider yourself good at it, then cultivate some endoscopic niches. You know, become the person who is more comfortable taking out larger polyps or you know, those interested in Barrett's ablation or some of those other endoscopic skills. If you like motility, you like reading motility studies, you know, then certainly focus your time on, you know, marketing yourself as your group's motility expert. It's a time when if you determine early enough in your three years that you want to focus on something, most programs will help you curate your experience to help support you in that venture. And you might want to environmentally scan and see where there's some real deficits, especially if you have a certain community that you're interested in. For example, in our community, there's one person that does pelvic floor and I mean, I'm from a small southeastern city but there are a lot of people with pelvic floor dysfunction. Can I ask a question of the, of Colleen and the panelists? Is that okay? Go ahead. I just, I was curious Colleen for, and everyone else, for negotiation because I have an idea in my head what I tell people and it's probably wrong and I'm just curious what you think. So nowadays when you're interviewing for jobs, you know, it's never just one and done. I mean, it could be one and then you could be done with each other but the majority of times it's an interview and then a follow-up conversation or interview and so it's actually multiple interviews and when you start the negotiating process, you know, do you start it right from the get-go or do you save that and to your point Colleen with the right people but for like the second round? So I mean, I always kind of taught that the first interview is you're both getting to know each other and is it the right fit and is it going to be the right culture and the right job and then if it is and you both like kind of like courting each other and then if it is and you go to that second round, that's when you start bringing particular negotiations to the table but is that, is that right? Is that wrong? What do you guys think? I absolutely agree with you. The, and what you may be asking Brooke is when do you bring up the vulgar subject of money? All the time, money, you know, extra. Yeah, I think the the first interview is exactly as you suggested. This is, this is the Gestalt interview. This is, is this the kind of person and kind of practice I might want to fit with for the rest of my life? Ashley or Jennifer, you may have a different perspective from academia but that's the point you're rechecking the reputation of the group in the city and you know, calling your aunt Susan that may be an anesthesiologist there to find out what the reputation is and I save the details for the second visit and it doesn't matter which side I would be on on that Zoom call but being usually on the hiring side, we save that for the second discussion. There's no reason to go down that road if, if you know that it's not going to be somebody you want to stay with for the rest of your career. Yeah, I would agree with that. I, I only really have experience or insight into negotiating in the world of academia and I came across some negotiation tips recently and it was really like, you know, don't get hung up on a certain amount of money or negotiating for time off that you will never use or, or certain things. Negotiate for things that will put you in a position to achieve your goals for the next five years, right? So, and I think that sometimes when you're fresh out of fellowship, it's hard to even like really determine what you want to do in five years like, you know, but as you, you know, as you start working and you sort of see like, well, where would I like to be and what would I like to be doing? I think that that, that was like, wow, that's great because when you set yourself up for somebody who's going to advocate for you for something or put you in a position where you're going to be exposed to X, Y, and Z, or allow you to do outreach somewhere where you're trying to cultivate a practice, like all those types of things, if you can negotiate for, for those stepping stones or building blocks, I thought that that would, that was kind of good advice. And Colleen, you might be able to speak to that. The other thing is that there's an information imbalance in a lot of these interactions and negotiations. And it really takes effort to help find out as much about the group or the practice or the institution as possible to figure out what is available to you. What do they need? You know, do they need, you're interested in, you know, being a quality officer, you know, that's your thing. Well, do they need that? What is their system in place? Who's currently in it? What are the dynamics? Is somebody leaving? You know, things like that, you know, and so that's an information imbalance that is sometimes hard to balance out. But you may be able to ask the right questions or sit down with the right people. When you're having these interviews, it's important to have meetings with some of the other groups, some of the other disciplines that are working closely with GI and who you're going to be interacting with, because they can often give you a lot of insight beyond what you're being told within your group. That's really helpful. Thank you. And I wanted to follow up on sort of, as Dr. Schmidt said, the vulgar subject of money, because as we know, it's one of the giant disparities that persists in GI that female gastroenterologists are paid less when you control for a variety of factors. And in my very short medical career thus far, I've already seen two instances where women applying to a job realized that they were being offered less than a man at the same level. So two residents from my residency applied for hospitalist positions for the year after their residency. And the male resident was offered several thousand dollars more per year. And they only knew because they were dating and sort of compared their packages. And both very qualified residents with no other differences, fresh out of training. And so I'm wondering, sort of one of the suggestions that's often given is to ask, you know, to be increased transparency and ask, you know, what, you know, ask male colleagues what they're making their ask, you know, male junior faculty, what, you know, what their salaries are. But like putting that advice into practice feels incredibly uncomfortable to me. And so I'm wondering, is that something that anyone has done? How would you put that into? How would you sort of practice that? Or if you think that's a terrible idea, what are other strategies to sort of minimize that, that pay disparity? You know, um, there's not a lot of transparency anywhere that I know of. I know that where my husband works, you are forbidden to tell people what you make, like, is my understanding. I had a friend and her husband who both got were interviewing for jobs and practice in internal medicine. And I mean, they even said to her, well, you know, we don't need to pay as much because we know how much your husband makes. I mean, so I don't, you know, I don't know, maybe Colleen's the most business savvy of all of us here for sure. Because the other three of us, we're just, you know, I don't know. We're sheep at an academic center. But um, you know, you try not to get hung up on it, because, you know, you do make a fair amount of money, and you'll be comfortable. But it is kind of galling, if you find out that, you know, people who are doing the same amount of work are making more money. So it is hard. I don't know, you know, you have your moments, but I don't know, Colleen, I would, I don't know, unless Jen. Okay, I think there's not a lot of transparency, at least in academia, I would say, in fact, I got called by one of the women who's at another hospital in the Midwest, and trying to get salary information, because she was frustrated. And she was asking me all these questions. I'm like, I don't really know what other people make on the floor. It's so hard, because it's not just salary based on, like RVUs and productivity, it's salary based on, if you're a professor, associate or assistant, it's how much teaching time do you have? How much research grants do you have? It's so complicated, that there's always a way that someone can explain why you're making less money than someone else, in my experience. I think some of the academic centers actually are really making efforts to improve transparency. I'm sure there's some of the ones that that we've researched to prepare talks like this. So I don't have any skin in that game in terms of promoting one over another. But I do think that there are some good sites you can go to, to understand what general questions you need to ask. And I can't emphasize this enough, especially for for young women going into academics, you cannot possibly make enough phone calls and ask enough questions. Because of these, these very important insights that Brooks just described, there are so many moving parts in that kind of job. It's very difficult to understand what benchmark you're trying to compare yourself with. So I think you have to not only know what you want and understand your worth, but be able to ask very open ended general questions to the person that you're interviewing or negotiating with about how they created this offer. Ask very specific questions about the points and how they what their basis of comparison is. But I wouldn't do that from the context of just pure ignorance. I would ask as many mentors and colleagues as you possibly can. And it's possible that you would need to divide that into those different buckets. What is this, what is this? I imagine when you go into an academic position, you may have some seed money, some seed grants, but it's very unlikely coming out of fellowship that you're going to have that, you know, great big ball in the sky of being independently funded. That's one of the things that you're working toward. So you have to break down those first several pieces and talk to different people at different institutions. If you're interviewing at one of those where they are transparent, you can go to their website and find out how they measure that. In private practice, there are two things you need. One is your proforma. They need to be able to present you with a proforma. This is after the, this is after the second interview. This is getting to the third one. This is when you are actually starting down that path of negotiation. And they need to be able to provide you with data to support each of the elements in your proforma. So what are the inputs? Now some of that overlaps with an academic position. If they're expecting you to develop, to generate a certain number of RVUs, what does that look like in real life? Does that mean you're doing 10 colonoscopies five days a week or two ERCPs a week? What does that mean? What happens when the revenue per RVU gets dialed down, which can happen with big important procedures that are very time-consuming? How do they offset that for their faculty? In private practice, the other thing you need is a contract. You may be told this is a contract for a group. It's a take it or leave it contract. This is the same contract for everyone. Everything is negotiable and contracts can be amended. Then have that reviewed with an attorney. I'll just leave it with those two things. If anybody has any specific questions, glad to talk with you. Can I just make a comment? I was just going to say one final question, but go ahead and make your comment and let's get one final question. In academics, it's important to discuss what your FTE will be. Of the 10 half-day sessions, how many of those sessions are you expected to be doing clinical duties? That's what your RVUs are going to be based on as well as potential bonuses based on that clinical FTE. If you're a full-time employee, but you see patients in the clinic and do endoscopies in eight of those 10 sessions, then you're a 0.88. You can negotiate for time. One of Colleen's key points about negotiation was time, negotiating for time. That's what we do in academics. You negotiate your clinical FTE down based on other duties you have. If you have research funding, you can buy some time that way. If you have other administrative duties, you can buy time that way. My first job, I was a 0.99 FTE unbeknownst to me for many years and got lots of flack about my RVUs up against that 0.99 despite me being scheduled for six or seven sessions a week. It was impossible to reach. Let's get one final question from the fellows and then wrap it up. First of all, thank you all so much for your insight and your advice and your wisdom. Just looking at the attendees tonight, I'm really thrilled to see that there are some male fellows who have tuned in as well, but I would say that the overwhelming majority of this group audience and panelists has been women. I actually wondered if we could hear from each one of the panelists what we can do as women in gastroenterology to continue to encourage allyship from our male colleagues. Dr. Faux, maybe we could start with you. I think we've discussed some of these things about being respectful to everyone around you and leading by example. I think it's also helpful. The men can, if you have leaders in your group who are not doing their job, maybe those are the people to go to because people behave based on a top-down phenomenon. I think we really see that where if the people above you don't behave in the right way, it's very hard. Everybody else falls in line that way. I think it's important, like Brooke was saying, if something happens, you probably got to nip it in the bud right there. I think it's interesting that she was saying as she made this video how it made people realize little things. We've already had many discussions about how it's very different being a woman and men don't get it. I think pulling people aside probably when it happens and not making a big deal of it, but making them understand because I think you can see there are little things. One little thing once in a while, you may be able to tolerate that, but over time, it does get tiring and you're going to be doing this for a long time. It does start wearing away a little bit, so I think making people realize that because I think people don't. Obviously, we've already all discussed that the men around us don't really get it, so maybe we should all get a copy of Brooke's video and show it because it really brings out all those points. It's going to go viral on YouTube. I think recognizing our allies and acknowledging them and appreciating them, like, hey, thanks for sticking up for me, or hey, thanks for redirecting that person for me, or hey, thanks for nominating me for this, or all those things. I think as a woman in medicine, I try to be an ally for my co-women in medicine. I think just being aware of that, like Amitabh is a hashtag he for she, and we appreciate that. There's lots of them out there, and so I think trying to cultivate that sort of culture is one of the things that we can do. Thanks. Thanks to the moderators, the fellows, and especially the panel. This is terrific. Thank you all for joining us for this Fellows Hangout. The next one is March 5th, I believe, although we passed the slide, and it's part two. There we go. Luminal EUF, we had a part one, and then we didn't get very far into all of our videos, so this will be a little more traditional of an ENDO Hangout with more videos, and so we hope you can join us for that one. Thank you. Go ahead, Ellie. Sorry. Nope, that's okay. In closing, thank you to our panelists, Dr. Schmidt, Dr. Faux, Dr. Maranke, Dr. Glessing, and Dr. Chuck, and our GI fellow moderators, Dr. Feld and Dr. Rabinowitz, for this excellent presentation, and thank you all for your participation tonight. We hope this information has been useful to you and your practice. This concludes our presentation.

Breaking the Glass Ceiling

ASGE

gender bias

gastroenterology

panel discussion

workplace boundaries

inclusive environment

women leaving workforce

challenges in medical field

career choices

negotiation

gender disparities