Jessica Allegretti, MD, MPH, FACG, on “Being Your Own Best Advocate”
by Jill Gaidos, MD, FACG
Dr. Jessica Allegretti & Dr. Jill Gaidos
I had the opportunity to first meet Dr. Jessica Allegretti at the ACG IBD School in Williamsburg, VA in 2018. I had contacted her several months ago about being interviewed for this series, however, due to COVID, the interview was postponed. We were finally able catch up this summer to complete the interview over the phone.
Dr. Jill Gaidos (JG): For those who don’t know you and aren’t familiar with your work, you are the Associate Director of the Brigham and Women’s Hospital Crohn’s and Colitis Center, the Center’s Director of Clinical Trials and the Director of the Fecal Transplant Program for recurrent Clostridioides difficile at Brigham and Women’s Hospital. What got you interested in fecal microbiota transplantation (FMT) as an area of research?
Dr. Jessica Allegretti (JA): It’s interesting, as with most things, it started with a patient. I was actually in residency. I was already interested in inflammatory bowel disease and was GI fellowship bound and was rotating at the IBD center during an elective. We had a patient who had refractory ulcerative colitis and we were recommending colectomy. And the patient said, “I won’t even meet with the surgeon until you consider this treatment that I’ve been reading about called fecal transplantation.” At the time, I had never heard of it and knew nothing about it. And so, I went on a journey investigating what had been done in the space. And really, at the time, there was almost nothing in IBD, really only small case series in C. difficile. This was before any randomized controlled trials. So unfortunately, we couldn’t offer the patient this therapy at that time. But it really started me thinking about this therapy and the potentials of it. So, when I transitioned to my fellowship at the Brigham, I really had this still in my mind and I wanted to work with whoever was doing work in this area. So, I asked, “Who is doing FMT? I would love to get involved.” The answer was nobody. So, I asked my program leadership and the endoscopy leadership if they would be ok if I started a program at Brigham during my 1st year of fellowship. And they said, “Go for it. Whatever you need support with, we are happy to help.” And so, at the time, C. diff wasn’t a big clinical interest of mine. It really evolved out of my interest in FMT as a potential therapy for IBD and C. diff was the obvious place to start. So, I built it from there, I met with infection control, infectious disease, and the billing department to figure out how to put together this program. We did the first fecal transplant at Brigham the spring of my 1st year of fellowship and it really just sort of took off from there. Naturally, C. diff became a really big focus of my clinical practice and really became this other passion of mine. There was a nice link between my interest in C. diff and IBD and the emergence of microbial therapeutics. So, that’s really where it all started.
JG: You also have a Master’s in Public Health (MPH). Did you do that during fellowship or after you completed fellowship training?
JA: I did that during fellowship. I was really lucky because the Brigham has a big focus on clinical research. As part of my fellowship I was able to do a program called the Program for Clinical Effectiveness at the Harvard School of Public Health which is a summer program that serves as a primer for an MPH with an introduction to statistics and methodology. For those interested, we were able to apply for an MPH through the fellowship program and they select up to 2 people every year to pursue an MPH. I was selected so I was able to build the remaining MPH requirements into my 3 years of fellowship. So, I was very lucky because I really did learn to become self-sufficient from a research standpoint through that experience.
JG: For people who are interested in research and are unable to get a Master’s degree during fellowship, do you think getting a Master’s in Public Health is something they should ask for early in their academic career? Do you think it’s really a game changer having that educational background?
JA: That’s a really good question. I would say, ultimately, no. When you think of everything that an MPH encompasses, there’s a lot of aspects to it. Unless you are really interested in a career in public health, I don’t think that it’s absolutely necessary. I think if you have a focus in clinical research, I do think asking for classes in statistics and being able to understand how to perform your own statistics and to have the vocabulary to be able to communicate effectively with statisticians is important. I remember in residency trying to design studies and not understanding how the analyses are actually performed. It makes it very difficult to design an effective study without having that background and you need to be able to ask the statistician the appropriate questions. Now, I’m lucky that I’m at a point where I don’t have to do all my own statistics anymore, but I can have informed conversations with statisticians about design. So, I do think that is what I would ask for above all else.
JG: Too, understanding the statistical analysis is important for designing the data collection. If you have a spreadsheet with a bunch of words on it and send that to the statistician, they are going to look at you like your crazy.
JA: Absolutely. Understanding how the statistics are done, how to clean the data, how to code the data even so that, again, you are all speaking the same language. I do think that is incredibly helpful. Let’s say you are designing something as simple as a survey study, you need to know how to design the questions in a way so that the output makes sense to a statistician and actually answers the questions you set out to study. I do think those are some of the most important lessons that I took away from the MPH and that is the critical aspect of it.
JG: We were talking, I think it was at the last ACG annual meeting, and you made a comment about how you are now finally being taking seriously for your research. What was it that made you feel you weren’t being taken seriously? And what changed that made you feel you are now finally being taken seriously as a scientist and researcher?
JA: For me, I struggled a bit in the beginning as I was getting started. I started a program when I was a fellow. So, I really felt like from the get-go that I had expertise in an area that no one else in my division, even my hospital, had. But because of my age and because of my junior status, it felt very much like I still I had to “pay my dues” in order to be taken seriously. In training, it’s always assumed you are working underneath someone else. So, I did experience a lot of frustrations in the beginning of my career when I transitioned to an attending as I already truly felt like I was an expert in this space, but because of my age and, in some ways my gender, I really wasn’t being taken seriously or considered a leader. I really felt like I had to advocate for myself and I had to put myself out there in many regards. I had to network as much as I could at meetings to let people know about the work I was doing and what I had done at the Brigham, that I would be happy to give talks, happy to come help set up FMT programs, and share what I knew. I also focused on doing really good work and publishing as much as I could. Really, it was just a lot of hustle. I wanted to be taken seriously and I wanted a seat at the grown-ups table and I really felt like it took a while. My husband even laughs at me when I say this now. He says, “It took a while, Jessica? You’ve only been an attending for 6 years” (laughs). So ultimately, I do think I was able to lift myself up quickly, but I was quite frustrated when I was getting started. Now I have a seat at the table and people consider me a leader in this space. I’m grateful for that because that is where I always wanted to be. I really felt like I had to advocate for myself and put my work out there and really network and meet people like you and many others to explain what I was doing and get my name out there. So, my advice to people when they ask me “How do you get to that place?”. A lot of it is not expecting other people to lift you up. Some people have great people in their corner who do that for them, but in some ways, you still have to be your own best advocate. I found often more senior people don’t want to give talks. I was like, “I’ll fly anywhere, I’ll do anything. If you want me to give a talk, I will be there.” I never said no to those opportunities so I could get my work out there. I think that is really what helped.
JG: Do you feel like you had to do more to advocate for yourself to become recognized as a thought leader in this area than a man 6 years out of fellowship would have had to do?
JA: My answer is always yes. I do think that, even though I work with many amazing women, even my division is equal parts women and men now, I do think that it’s still a male-dominated profession and I am at a disadvantage in that I look like a very young woman. Even still to this day, I still often get the “you’re the doctor?” comments.
I don’t feel like I should have to alter my appearance or try to look older to try to be taken seriously. I feel that the science and the work should speak for itself.
JA: I don’t feel like I should have to alter my appearance or try to look older to try to be taken seriously. I feel that the science and the work should speak for itself. I did feel that in the beginning people were kind of eying me up and down, going “You? This is you?” (Laughing). I wish that the answer was no, but I do think that the answer is yes.
JG: Also, at the last ACG annual meeting, you had co-chaired the Women in GI Luncheon.
JA: Yes, I’m doing it again this year.
JG: You were really excited about the experience you had co-chairing that session. There’s an impression that after training, you don’t need to that type of networking and social connection anymore, but really we need that throughout our careers. What did you get out of that experience as the co-chair organizing and moderating that session?
JA: It’s such a fabulous session and I’m very excited that I’m co-Chairing it again this year with Dr. Jami Kinnucan. I think one of the biggest take-aways is it wasn’t just fellows or women who are about to graduate who attended, it was anyone who was interested in either a career change or looking for that type of networking. And this year, because it’s virtual, it’s open to all woman. For me, the biggest takeaway is that we all have a lot of the same concerns. For women in GI, there’s a lot of fear and uncertainty with regards to navigating careers. How do you balance wanting to have a family and a career and still be taken seriously by your male colleagues. That was a big theme that a lot of women expressed concerns about. How do you choose which path you are going into? Is there a path that will be easier with all of the other aspects that we have to take into consideration? One of the pieces of advice I was trying to share with attendees and also one of the things that I have learned along the way is that some of the best networking I have done was well after fellowship. A lot of the important female colleagues that I have met along the way was while traveling and speaking at meetings like you and Aline (Dr. Aline Charabaty). Really just this huge network of women in IBD, specifically, that I would have never known otherwise. I think as attendings and academics, we have been able to really support each other in ways that I didn’t really know was possible even as a fellow. I think a lot of the more important and supportive relationships were created once I became an attending. I think we as women like to think that other women, especially where you work, will be our best allies but that’s not always the case.
JG: That’s true.
Having allies and advocates at other institutions, for me, has been career-making
JA: There is sometimes a feeling of competition among other women specifically in your division or in your space that can be unfortunate. So, having allies and advocates at other institutions, for me, has been career-making. In the very beginning, when I was trying to get the FMT program going, one of the best things that happened to me was I met a bunch of other women who were doing FMT around the country and they became my network. If I hadn’t met Dr. Colleen Kelly and Dr. Monika Fischer early in my career, I don’t know where I would be right now. And, I didn’t have anyone to turn to within my local space, so that was one of the big talking points that came out of that lunch.
JG: Exactly. Another issue that women face is feeling less respected by the clinic and endoscopy staff as an attending when they stay at the institution where they trained for fellowship. Did you experience that? And, if so, how did you handle that?
JA: It is really interesting. When you are transitioning to attending from a fellow, the staff knows you as a fellow, and sometime garnering respect as the attending can be challenging. I do think that, as women, this is something that we particularly face. For me, I would say that I have been fortunate. Because I was running my own program, even as a fellow, I had sort of earned some of that clout, if you will, as I transitioned, because there was no one else to go to if you wanted an FMT, you had to come to me. I felt like I had a bit of an advantage and why I was quite happy to stay at the Brigham and didn’t have a lot of the same concerns that I know some of my female colleagues have had. For me, the thing that benefited me and the advice I give is, if you treat the endoscopy staff and clinic staff with respect, they will return that respect. I have befriended a lot of the clinic and endoscopy staff and have tried to create a collegial environment. They would never disrespect me because I wouldn’t disrespect them. That has really been helpful. Out of the gate, I always introduce myself if there is someone I don’t know on the endoscopy floor. I say, “Hi, I’m Jessica. I’m the attending today.” It’s easy to get defensive and say, “Well, I’m the attending.” If that is your attitude, people are going to mirror that back to you. So, I think that has helped me along the way. Being on time, showing up, and being responsible, I haven’t had a lot of those issues.
JG: One of the things that you do really well is that you are a physician, a researcher, a scientist, but you are also not afraid to be a woman. You and I have talked about your love of make-up and spending time at Sephora and you have shared a picture of your shoe room on Twitter (available at https://twitter.com/DrJessicaA/status/1233512276361129986/photo/2).
JA: (Laughs) I’m very proud of it!
JG: In this field and in other male-dominated fields, women sometimes feel that they need to be more manly to be taken seriously or respected. Do you ever get push back from that?
I don’t ever want it to be about my appearance but you have to learn this balance between wanting to be yourself and dressing how you can be comfortable – but also shielding yourself from some of the sexist and quite frankly offensive comments that you get day in and day out.
JA: It sort of goes back to the fact that I look like a young woman and I’m also 4’ 10’’. I have very blond hair and I wear hot pink lipstick most days. It’s a balance between wanting to be taken seriously but also wanting to be myself. I actually started really dressing up towards the end of fellowship as I felt that that type of appearance allowed patients to take me more seriously. It really worked and it sort of blossomed from there. I got very into the artistry of make-up which is how I de-stress. That is my creative outlet. Some people paint or write music. My husband is a saxophone player and that is what he does to unwind. For me, doing make-up is how I unwind and how I clear my head. I do think that it is an interesting balance in that I do get a lot of comments whether it’s from colleagues or from patients about my appearance. I don’t ever want it to be about my appearance but you have to learn this balance between wanting to be yourself and dressing how you can be comfortable – but also shielding yourself from some of the sexist and quite frankly offensive comments that you get day in and day out. I do think it is a balance. I think if I didn’t do that, if I didn’t put myself together in a way that I’m comfortable with, I don’t think I would perform in the way that I want to perform because I just wouldn’t feel like myself. We all have the right to dress how we want, to wear as much make-up and to be as feminine or as non-feminine as you want to be. The fact that colleagues feel they can freely comment on your appearance is something I’ve never quite gotten used to though. This never happens to men. One example, I was on service in the hospital about two weeks ago and my fellow, another female, and I and we were about to go see a patient when a female nurse on the floor walked up to us and said, “What are you two children doctors doing here? You are too pretty, you’re too this, you too that” and I was literally like, “What is going on right now?”
JG: (Laughs) That is crazy!
JA: I’m an attending gastroenterologist and this is my fellow and we are about to go see a patient and we are being riddled with critiques about our appearance. It was so off-putting. Even though I do think that sometimes people think they are being complimentary. I don’t put on make-up or dress a certain way because I want people’s comments on it. I do it because that is how I feel my best. It is a bit of a balance. This is something we talked about at the luncheon because you kind of have to have a set series of retorts on how you respond to microaggressions when people say X, Y or Z. I don’t tolerate it.
JG: In that scenario, it’s really important for that fellow to hear how you respond to that and, really, you are supporting her by sticking up for both of you.
JA: Absolutely. This was a senior female nurse and before we walked into the patient’s room, I said to her, “What you just said was extremely offensive and incredibly inappropriate and negates our years and years of combined training.” It was so off putting. She apologized, but we shouldn’t have to deal with that not only from men but from other women.
JG: You are so right!