For anyone undergoing a gastrointestinal procedure, the face you want to see as you emerge from the anaesthetic haze is that of Associate Professor (Assoc Prof) Payal Saxena.
Assoc Prof Saxena is a gastroenterologist who specialises in interventional endoscopy. She is also Australia’s leading expert in Peroral Endoscopic Myotomy (POEM). POEM is a new endoscopic treatment to treat swallowing disorders.
On the medical playing field, gastroenterology is one of the most competitive internal medicine specialties, vying with cardiology for the greatest number of enrolments. In the Australian gastroenterologist community, around 20 percent of doctors are female. In the global community of interventional gastroenterology, less than one percent are women.
Becoming a successful gastroenterologist takes extremely hard work, empathy, self-motivation, and plenty of smarts. Spend five minutes with Payal Saxena and it’s instantly clear she has all four.
Disrupting the field of interventional gastroenterology
Payal Saxena grew up in Sydney’s west to Indian parents who raised her to be independent and strong. Her formidable educational credentials include a Bachelor of Electrical Engineering (Honours) and a Master of Biomedical Engineering from the University of New South Wales followed by Bachelor of Medicine, Bachelor of Surgery (Honours) at Flinders University. Payal completed her internship at Flinders Medical School in Adelaide, Basic Physician training at St Vincent’s Hospital, and Advanced Physician training, specialising in gastroenterology, at Concord and Bankstown Hospitals.
Two and a half years at the world-renowned Johns Hopkins Hospital came next, where Payal accomplished an Advanced Interventional Endoscopy and Research Fellowship. She graduated as a physician of the Royal College of Physicians in 2011.
Today, Assoc Prof Saxena holds positions at the Royal Prince Alfred Hospital, Chris O’Brien Lifehouse, Sydney University and the Institute of Academic Surgery. She does post-graduate teaching, co-founded the Women in Gastroenterology Network Asia-Pacific (WIGNAP), and remains passionate about research and mentoring young gastroenterologists.
Saltire Capital Partners recently met with Assoc Prof Saxena to explore her thoughts on diversity in her field, women in leadership, and her role in disrupting the field of interventional gastroenterology.
When did you decide to become a gastroenterologist, and was your career path intentional?
My interest in gastroenterology was sparked during training. It’s an interesting specialty because it deals with all sorts of diseases in the entire gastrointestinal tract. I see all kinds of people and enjoy helping people feel better by doing procedures that diagnose, relieve, and treat symptoms, as well as giving healthy people peace of mind after an endoscopy. My career path was intentional. I always had clear goals and achieved them with hard work.
The gender gap in medicine is no secret. Did that enter your thinking when deciding to pursue a career in medicine?
I wasn’t aware of the gender gap for a long time. My parents raised me as a child, not as a girl child or a boy child. The gender gap became more obvious at university, but I still didn’t see it as a major barrier to achieving my career goals. Engineering was my first degree and in a lecture hall of 250 students, I was sometimes one of only three girls. Medicine was different, with many more women in the classes.
Why do you think there are so few female interventional gastroenterologists?
I believe a few reasons drive this: interventional gastroenterology is the most surgical of all the gastroenterology sub-specialties. It involves performing many procedures, which can be high risk, long in duration, or which expose you to radiation from under a lead apron. Sometimes I’ll perform 15-20 endoscopies in a day. The days are long, which can make it challenging for women to balance work and life if they also have child care responsibilities. Also, there aren’t many female role models or mentors in the field.
Have you had career moments when your leadership skills helped overcome challenges presented by the gender gap?
Perhaps, fortunately, I noticed the gender gap more in retrospect than I did at the time. For example, while I was at Johns Hopkins Hospital, several senior Australian endoscopists told me my research wasn’t something I should pursue because it wasn’t likely I’d be successful, that there was no place for my type of work and that I was wasting my time with my research and pursuit of new interventional procedures.
I used to tell my friends how sweet those old gastroenterologists were for offering me the advice that my career choice wasn’t a good one, and what a shame it was that I was going to do what I wanted to do anyway.
Medical device industry reps often met with trainees to discuss devices or invite us to interventional endoscopy events and meetings. On occasion some reps would ignore me, so I’d interrupt their conversations with male colleagues to express my interest. Perhaps they assumed a female wouldn’t be interested in joining interventional endoscopy meetings.
At Johns Hopkins, I learned new endoscopy techniques that I wanted to practice in Australia because the new procedures required no surgery and delivered superior patient outcomes. That was met with heavy resistance in certain areas. Several senior clinicians, who had nothing to do with my specialty, shared negative opinions on my work because they didn’t like the new ideas. I felt my gender was a problem for some people because I didn’t see male colleagues in the same situation experiencing the same challenges.
How did you manage resistance to bringing new endoscopy techniques to Australia?
Initially there were some confrontations with senior male doctors who didn’t want me to introduce new procedures or to secure the equipment and devices to perform them. I made it through those tough meetings because I had an excellent mentor and Director of Endoscopy who always backed me, and a supportive Head of Department, both of whom helped me realise I wasn’t alone. I was also completely supported by surgeons and have been appointed as the academic lead for interventional endoscopy at the Institute of Academic Surgery. Ultimately, escalating to the medical administration was pivotal in breaking down the barriers of conflict and settling the tension.
There were times when it was hard for me to continue but it never changed my goal of introducing new techniques to improve patient outcomes. I could see the way I was treated was based on fear of the unknown and an old-school unwillingness to progress.
Additionally, medical device company’s such as Boston Scientific, Erbe, Olympus, Fuji, Device Technologies, Cook Medical and Endotherapeutics have been instrumental in supporting me with the introduction of new techniques and therapies in the evolving field of interventional endoscopy.
How has mentoring helped your career?
Mentoring was valuable in shaping my career and navigating conflict, although it started late for me. When I arrived at Johns Hopkins in my early 30s, I was told I needed to pick a mentor. I’d not experienced that kind of mentorship in Australia and remember thinking what’s a mentor? Johns Hopkins was a great environment for mentoring and role models, with the world’s leading interventional endoscopists under one roof. There were eight doctors, and half were women, which is highly unusual. There’s no doubt that effective leadership and mentoring plays a critical role in the career success of both genders.
An early piece of mentoring advice was to strive to become a thought leader; someone who other people call for advice.
Do you mentor younger gastroenterologists?
Yes. I’m passionate about helping young doctors realise their career goals and firmly believe that diverse opinions improve the leadership and performance of organisations in any industry. I’m a co-founder of the Women in Gastroenterology Network Asia-Pacific (WIGNAP) with female gastroenterologists across Asia-Pacific. Since 2014, WIGNAP has provided a professional networking platform for female gastroenterologists in this region, to develop training opportunities and mentor trainees. In my practice, we run a Fellowship program and take Advanced Endoscopy trainees every year, who want to do interventional gastroenterology. We help them learn these unique procedures, assist with research and publications, offer career advice, and make introductions to our networks to help create ongoing support for clinical procedures.
I love helping young doctors create a career path instead of watching them wait for one to unfold.
What advice would you give your younger self?
I had three big weapons that I would use all over again. First, I was oblivious to the gender tension around me. I’m glad I was oblivious because if I’d paid attention to it, it would have doused my confidence and I wouldn’t have progressed. Second, I wasn’t shy to push for everything I wanted, including applying for Fellowships and so on. I was supported in how I approached my career, but no one told me what to do either. Finally, I was independent at a very young age and that independence helped me pursue my career goals later on in life, without any fear.
What advice do you have for young gastroenterologists?
I guide young gastroenterologists on how important it is to define a career goal instead of waiting for opportunities to fall into your lap. I encourage young doctors to give 100 percent to what they do and become exceptional so that others want to hire them. Be wary of listening to self-talk that starts with “I can’t” and focus on defining what you want and how to get it. Don’t take shortcuts, cut corners, or worry about the “what ifs”. Carefully consider doors that open along the way. Sometimes the opportunistic doors won’t lead you where you want to go, even though it seems like an easy option at the time. If you experience forms of workplace harassment or bullying, escalate immediately. Communicate with senior management through the formal channels in your workplace. It’s important to be honest, and open when you experience something you know is wrong.
What are some highlights of your career?
There are many small daily highlights from meeting patients and working with my great team. One bigger highlight was co-founding the Women in Gastroenterology Network Asia-Pacific (WIGNAP) to help nurture young women in this field and promote the value of diversity in gastroenterology. Another proud moment was performing live case studies and presentations at a Prague Endoscopy Conference in 2020, which featured only female gastroenterologists and interventional endoscopists on the invited faculty.
For more information about Assoc Prof Payal Saxena visit her website. If you’re experiencing workplace challenges, please know you’re not alone. Safe Work Australia offers resources for you to get help.