Amrita Sethi, MD on Promotion, Negotiation and Supporting Women in GI

by Jill Gaidos, MD, FACG

Dr. Amrita Sethi and Dr. Jill Gaidos

After one of her presentations at the ACG Regional Postgraduate Course in Williamsburg, VA, Dr. Sethi and I sat down to talk about her role as an advanced endoscopist and her mission to help support other women in gastroenterology.

Jill Gaidos (JG): Just to introduce you a little, you are the director of Pancreaticobiliary Endoscopy Services and the Director of Experimental Endoscopy at Columbia University. Are these titles that you negotiated at the beginning of your career or are these leadership positions you were promoted into?

Amrita Sethi (AS): That’s a good question. Actually, I’m currently the Director of Interventional Endoscopy. These titles didn’t exist when I first started at Columbia University. When I first got to Columbia, I started as an assistant professor with no additional title. A few years after being there I asked for a raise in my salary.  As a part of negotiating for the raise, I was asked to think of some measurable outcomes such as program development or publications.

One of my interests was, and still is, innovation and developing an animal lab program, so I asked for the title of Director of Experimental Endoscopy with goal of building that program. Then, about 5 years into my career, I was interested in academic and leadership promotion and I simultaneously had an opportunity to negotiate a retention offer. As part of that offer, I was given the title of Director of Pancreaticobiliary Endoscopy Services. That title was actually the idea of my chief of endoscopy at the time, who was really an advocate for me. He recognized that I was already involved in many of the responsibilities that the title encompassed and this was a way to acknowledge and formalize that role.

Most recently, I requested that we change it to Director of Interventional Endoscopy because I felt that was more reflective of my interests and how I envisioned the role. When you’re seeking existing titles or creating new ones, I think it is important that you define them a little bit. That way there can be tangible expectations and ways to measure the value of that title.

JG: I know something that we talked about at the Women in Endoscopy event is negotiating. What pushed you to start negotiating a raise in your salary first and then a new title and more leadership opportunities?

AS: So, initially I had no negotiating skills. I also didn’t really think about asking for a raise or promotion. I’m not sure why, perhaps at the time I didn’t see myself as having done anything special to deserve a raise. I did not really realize my value, which is something that we hear a lot about, until other people would ask me why I hadn’t received a raise or been promoted yet.

JG: You’re just thankful to have a job, right?

AS: Exactly. When I first got my job, my mentor advised me to ask for everything that I would think I was going to want from the beginning because the chances of getting things once you’re there are very difficult. I think that was common advice at the time. So, I had that little bit of support in the beginning which helped with the initial ask but didn’t think much beyond that. Then, I was very lucky to get into the LEAD program. That’s the American Society for Gastrointestinal Endoscopy (ASGE) Leadership Education and Development program that was started by Dr. Colleen Schmidt. That program brought together junior female faculty and fellows with the goal of teaching skills in leadership and career development. We received lectures on how to negotiate by Business School professionals, strategies for team management, and other leadership skills in general. They were great lessons and I learned about things I had never heard of before, particularly regarding strategies in negotiating such as finding ways to balance your priorities with the priorities of the person sitting on the other side of the table. Another great thing about that program was that they really forced us to recognize and define what we saw as our strengths and value.  So, I left feeling empowered to ask…for promotion, for a raise, etc. I remember feeling kind of excited about trying it out.  It didn’t necessarily play out the way it did in my mind, but at least it prompted me to take that step and ask. And it didn’t all happen at once. My academic promotion, for example came later, and I had to persist a little more for that, which I was willing to do when it became more of a priority for me.

Unfortunately, I think traditionally, academic centers don’t make it a point to demonstrate that they value you until you ask them to, in some form, such as looking at another opportunity. It’s unfortunate because, as we heard the other day, women tend to seek external validation more and it doesn’t happen until these moments of negotiation. It’s helpful to understand the culture you work in and find other ways to navigate that and measure your value. The benefit of leadership programs and networking, especially with other women, is that we can help do that for each other.

JG: When you prepared to negotiate for your promotion, did you measure your numbers, including endoscopy volume, clinic patients, etc. prior to meeting with your chief? Is there a way to find out how much revenue you are generating for the hospital? I get the sense that the administration wants to talk numbers and not necessarily about patient outcomes.

AS: The more information you have going into negotiations the better. On the one hand, I just wanted to go in and say, “I’m doing a great job, I’ve started these programs, I bring great value to the program and I deserve the raise,” end of story. Luckily, I had that little bit of training in negotiating that I just described, because I don’t think that pitch would have gotten me very far.  At the end of the day, it’s the numbers that tend to be more important and the value of your effort, as well as the downstream value. It can be eye opening just to discover how hard you’re actually working. We take it for granted sometimes. When you compare your effort to national benchmarks such as those published by the Association of American Medical Colleges, you can see if you are performing up to par, or surpassing those goals, and it gives you more confidence to ask to be compensated accordingly.

JG: How do you find out what to ask for? I mean, did you ask your colleagues how much they were making? I know a lot of people are very tight lipped about that (laughing).

AS: That’s definitely a big problem. There is not a lot of transparency particularly about salaries. I asked my chief of endoscopy, at the time, who importantly wasn’t the person I was negotiating with, so I felt comfortable going to him and getting some advice. I asked female and male colleagues who were in similar positions across the country who had specifically gone through similar negotiation processes. If you have good friends and colleagues who aren’t thinking of it competitively, I think you can get that information. I do think it’s something that we need to be more willing to share as a community. Hopefully, through our societies like the different women’s societies we can set up a space where you don’t have to feel threatened about revealing that information, and don’t have to feel like you’re giving up an edge, perhaps, but really helping empower us all.

One of the points I was taught in the negotiation classes I had attended, was to ask for much more than you think you deserve. It was funny because when I would get advice, particularly from my male colleagues, who would say I was aiming too low and that I should be asking for almost $100,000 more (an exaggeration). I was like, “Are you crazy?!” (laughing). But as they pointed out, what is the worst they are going to do? They are not going to say, “you asked for too much, so we are not going to offer you the job at all,” or “we are going to fire you,” right? They would just say “no.”

I’m still not very comfortable with negotiating but I have been able to help friends as they go through the process. I give them the same advice that I received, and they respond the same way!  For the most part, they have come back and thanked me for pushing them to think that way, because they were successful but may not have done that on their own. So, I think we do have to push ourselves out of our comfort zones and just go for it. The consequences might not be as scary as we imagine. And, of course, it helps to hear what has worked for others.

Author Note

As part of her commitment to support women in the GI field, Dr. Sethi created a non-profit, Women in Endoscopy, and serves as President. You can learn more about its mission at