Re-cherchez la Femme: A Second Look at Women in Gastroenterology in Canada.

We are in an era where the importance of women having access to meaningful roles in medicine and opportunities for advancement is being widely recognized. Therefore, it is with great interest to read the article by Perera et al. (1) in the Journal of the Canadian Association of Gastroenterology on the impact of gender within the gastrointestinal practice. The last time a Canadian-specific assessment was conducted was in 1997, and this article is a long overdue assessment of the landscape.

The current paper details the results of a 2014 survey of CAG members to define the current professional landscape in Canada surrounding equity and gender. The authors noted that women continue to struggle with advancement in their careers related to their gender, ethnicity and marital status. Even though there has been a rise in adult female gastroenterologist representation from 30 to 38%, the study emphasizes that more men attain full professorship and departmental chair roles. Despite the recognition of the physical, organizational, and mental burden of household chores and childcare, there has been minimal effort made for accommodation of women in the workplace. Women continue to shoulder the majority of the responsibilities of family life. The inability to change from full time to part time during childbearing years is yet another disincentive to women entering and remaining in gastroenterology. In addition, residency and fellowships occur during peak reproductive ages for most women. If a woman were to sacrifice her fecundity for ‘future professional gains’, those gains may never be realized in the current environment. This is also true for women who choose not to have children (voluntary childlessness). Burnout is another barrier for women who strive to ‘have it all’. The 2015 ACG Physician Burnout Survey identified women with young children as having higher rates of burnout than those without (2). Women continue to have challenges acquiring grants, accessing technically focused careers and with being encouraged to consider temporary part time work in academia. Part time work is not seen as a side-step in one’s career—it is treated as a step down from pursuit of academia. Mentorship, sponsorship, and encouragement of women to apply to leadership roles, even in partial capacity, are necessary to foster growth of women in our field. The limited representation of women in academic gastroenterology as successfully balancing work with family life is another discouragement for women. After 10 years of practice, a U.S. study in 2008 showed women were more likely to be in part-time, private practice type models with reduced pay (3). This is the reality for many women who may have started off with idealistic career goals in this profession.

Prior studies have shown that female patients prefer female gastroenterologists for assessment and management of gastrointestinal disorders. There is evidence that the desire for a female gastroenterologist is greater among patients in lower socioeconomic status and those with a history of abuse (4). However, in 2018, only 31% of practicing gastroenterologists were female (CMA survey), suggesting that the supply of female gastroenterologists may be insufficient to meet the demands of the population. For the subspecialty of gastroenterology to meet such a need, not only is encouraging enrolment of women into gastroenterology key, but women in training and the early part of their careers must be supported in order to maximize their potential. Advancement that does not require a complete sacrifice of one’s personal or family building goals is key, not only for women but also for men, as revealed in this article. One way to encourage women to remain in practice is to offer various models of part-time work in order to promote continued engagement and forward momentum in the profession and career development; for example, by facilitating part time practice in combination with research, education, administration, innovation, and/or advocacy, all critically important roles in academic medicine. A by-product of such a model is visibility and access to mentors to trainees, which remains an unmet need. Family and personal responsibility ought to be respected and encouraged to sustain personal and professional fulfillment and longevity. For example, conferences and work places, should limit the number of evening hour ‘networking’ sessions. These are just some ways in which we can start to create a career trajectory that respects the importance and supports the integration of work and personal life for both women and men.

To adequately address this persistent equity imbalance, we need our current leadership to be cognizant of the barriers women continue to face, and to encourage and embrace efforts to overcome implicit bias and cultural stereotypes while actively promoting women for positions of leadership. This endeavour requires the support of men in leadership to create the space and opportunity for women to step in. The Canadian Association of Gastroenterology has supported the GIWomenCAN! Initiative, which is gathering data on the current status of women in gastroenterology in Canada, advocating for improved access to opportunities for women in GI in Canada, highlighting the achievements of women gastroenterologists in practice and research, and to provide training to close the leadership gap. We sincerely hope that the next assessment of the state of women in gastroenterology will be more illuminative of not only where we are, but how far we have come.