Y-ECCO Interview corner: Jane Andrews

Jane Andrews at ECCO'17, Barcelona © ECCO

Professor Andrews, we are delighted you could join us today. You are well known in the IBD world and have lectured widely. Can you share your journey with us today and start off by telling us how you chose gastroenterology and IBD as a specialty? We would love to hear your story.
I am flattered, thank you for inviting me to be interviewed. My story is one with detours, as all the interesting ones are. I actually initially went into general internal medicine training. In Australia you do 3 years of advanced general medicine training, either 3 years of general medicine or three different specialities. My first selection was to do a year of gastroenterology. I had already done quite a lot of haematology, oncology, cardiology and ICU. I was missing gastroenterology, so I thought I should do it. But actually, once I got into gastroenterology I enjoyed it so much and had some really lovely mentors who inspired me to continue in the field. One of the great mentors, with whom I’m still in touch, told me back then that I was pretty good at IBD and I should pursue it as a career, and got me in touch with someone to spend a year of IBD with. So, it was sort of decided for me. I did a year’s IBD fellowship in Oxford.

I came back from Oxford with my leg in plaster, having been run over by a bus whilst riding a bike, and was also pregnant with my first child. I had my first child in Australia and then I took 12–13 weeks off, and finished my gastroenterology/internal medicine training. Because of having been in the UK and having been pregnant, I was too big to scope, so I still didn’t have my ticket for colonoscopy. I then embarked on a PhD in Adelaide. At the time, I did the PhD for lifestyle reasons, because of the flexibility of the hours, compared with clinical hours, with a young child. My husband is an anaesthetist, so matching up both careers, and after-hours commitments, was a challenge. I did a motility-based PhD because there was guaranteed funding at the time. That led me to a good area where I have good functional skills with IBS and general GI as well as IBD.

Jane Andrews at ECCO'16, Amsterdam © ECCO

 In Australia at that time, I was one of the few women doing gastroenterology. I didn’t really realise this until I finished training, and then all of a sudden, I realised that in South Australia, where I was, I was only the second female gastroenterologist out of a pool of about 60 gastroenterologists in the state. So, by default, I was referred all the young people with IBD, particularly if they had perianal disease or if they wanted to talk about pregnancy and sexual health. That’s where that research interest grew out of, inspired by the patients, and it went on from there. 

The training systems are different in different countries and continents. What’s it like in Australia?
It’s fairly long, too, not so dissimilar from the UK. I did a 5-year undergraduate medical degree, but now they are all 6 years. If one does post-graduate studies, then it’s a minimum of 7 years. For internal medicine the minimum is 3 years before the barrier exam, and 3 years after. I then did a PhD, and since I went part time because of having two further children whilst doing the PhD, it took 5 instead of 3 years. I had my qualifications as a gastroenterologist by the time I was 32, but I didn’t finish my PhD till I was 37, and I didn’t get what I would consider a proper job that I wanted to do until I was in my 40s. I wanted a job in an area I’m interested in, where I could work part time and be able to look after three young kids and align my circumstances with my husband’s, who was a paediatric anaesthetist with multiple oncalls.

Trying to juggle everything meant that I was unable to take up jobs that were too far away from home or involved too many hospital hours. So, I actually did a lot of private work in those days, which involved two sessions of clinics a week at a public hospital, and my private practice built up to be a lot of IBD, which gradually displaced everything else. A colleague of mine at another hospital went on sabbatical, and he nominated to his hospital that I should be his backfill. When my colleague returned from his sabbatical, I had obviously done a good job, so the department decided they wanted to keep me and crafted a job that was less than full time. The hospital that I really wanted to work at then approached me with an IBD position which was permanent, and I started off as less than full time and built up to the full-time job that I’ve been doing for many years now.

Jane Andrews at ECCO'17, Barcelona © ECCO

It’s lovely that you got your dream job, and clearly the PhD time was an important period in your career for several reasons. Do you think every gastroenterology trainee should do a PhD to be able to get their dream job? 
I think it really depends on what job someone dreams of. I don’t think it’s necessary to have a PhD in order to become a good gastroenterologist. I do think that everybody should do some research though, because I think it teaches you to ask questions, be cynical, look at the evidence and think of more than one explanation. What you see is not all there is. It’s also important for people to train in different units, because if you stay in the same hospital and always work with the same system, you can think that this is the only way.

I think if you want to be part of education in the future and want to change medicine for more than one patient and one doctor, then you do need to do a PhD, otherwise you can’t supervise research graduates, which is what really allows a person to multiply their outputs and influence, and to mentor and inspire young people. That’s what keeps my job interesting now, it’s the young people who I work with. The clinical environment can get repetitive sometimes and only lasts for the 20–40 minutes you’re spending with one patient. So if there’s something you’re doing well, wouldn’t it be nice for you to teach those skills to 20 people who then have that ripple out effect. It carries on the legacy of how systems work better or the teachings of better ways of doing things. 

How did you build your research network during and after your PhD?
It’s been fairly organic. The best advice I could give, is to be genuinely interested in what you’re doing. My work since my PhD has been in a totally different direction than my PhD. I learnt some really good things from my PhD but I wasn’t passionate about what I was doing. The stuff I’ve done since, about quality outcomes and care models in IBD, that is something I’m really passionate about. If you’re really interested in something and you make it happen, other people catch that interest, or the people who already have that passion come to you and ask to be part of your projects. It’s a mixture of leading from the front and also being prepared to talk to people, and not always thinking what can I get out of it. No one is able to do all the ideas they come up with, so it’s really good to talk to other people and let them even take an idea. Things won’t get done unless someone actually does it, and if you have three things already queuing up, you won’t be able to do them all. So, there’s a great benefit with regards to generosity in discussions with people who have a genuine interest, and collaborations. It’s much better to be open than to be paranoid. Working with people makes it more fun for me. 

How did you juggle all this together with your family? Can someone be perfect in every area?
You probably have to ask this question to my children. No one can be perfect in every area. You’ve got to admit that being a working mother, you’re always going to feel guilty, and you’re always going to feel that you’re not doing anything well. Once you get over that, you can realise that you’re doing some things reasonably, otherwise people wouldn’t ask you back.

I didn’t work full time till after my youngest was about 8 years old. I used to go to the school and read books to the children and do the tuck shops and go on excursions etc., certainly not a lot, but I spread my work as 0.6–0.7 over the five working days, so I could take my kids to school and could often pick them up. So, I could do all my work in a 6-hour window in the middle of the day. Of course, that led to career disruption. If I had been the typical male bread-winner, I might now have 400 publications rather than 150–160, but does that matter? At the end of the day, I’m still married to my first husband, the kids are happy, one of them is doing medicine and two are doing science degrees and we all talk together and have fun as a family. 

Jane Andrews at ECCO'17, Barcelona © ECCO

Jane Andrews at ECCO'16, Amsterdam © ECCO

Did your and your husband’s careers have the same trajectories?
To have a tier 1 career, when you look at the people who are really in that top tier, most are on second or third marriages, or when you talk to people, you do realise that something’s got to give. There are some untold circumstances and sadnesses, so I think tier 2 is quite comfortable for me. When the children were younger, my husband was working many more hours than me, had a proper consultant job before I had one and took up more senior roles within the department. Now, as the children have got older and my research network has grown, I do more business travel than my husband does, more publishing and public speaking. There has to be give and take in any relationship. We haven’t always done it perfectly, but no one does. The people who say they have got it perfect hide behind the wallpaper. We all know from interviewing our patients that once you shut that clinic door and ask what’s really going on, there’s a very different story.

We don’t do our young female colleagues any favours by pretending that it’s all easy, or that it was magic, or that our families and marriages are all perfect, because that’s not really the case.

What would you advise both female and male Y-ECCOs? How can people strike that balance, and become successful?
I don’t think you cannot compromise your career at some point. It is difficult to accept it, as it’s a bit of a hit to your own ego, and it’s a struggle within your relationship when you see other colleagues at work going ahead of you who have less good CVs to that point. But you have to think, at the end of the day, if everything stopped now, if I got a serious illness, what would I most regret not doing? Is it being a professor at 35, or is it being a good mum or dad?

We have to realise that just because we might have to put a career break on now, that does not mean that we cannot get going later. We should all be kind to each other. We should accept that different ways work for different people. People can be really cruel, which can stem from jealousy or wanting to get ahead or wanting someone to “toughen up”, but we all have to realise that at the end of the day what matters to some might not be as important to others, and we should all support each other. 

What are the things you like about ECCO?
I was introduced to ECCO when I was in Oxford, and a lot of the people who are opinion leaders in IBD worked in Oxford at the time. Since the first introduction, which led to other avenues and collaborations on projects, I have been attending ECCO: I went to its 3rd or 4th meeting in Hamburg and have been attending ever since. I have had the honour of being asked to be part of the programme for the last 2 years, which I was delighted about. There are some lovely people who are part of my research consortium and professional network whom I’ve met at ECCO. The organisation really connects people with the same interests from around the world, and it’s great having those links.

Jane Andrews at ECCO'17, Barcelona © ECCO

I wish I had more writing space to include everything we talked about, Professor Andrews, and to share more of your fantastic thoughts with ECCO. Thank you ever so much for talking to me. Perhaps I can quote some of your pearls of wisdom at a later date, and I hope to see you again at the next ECCO Congress.

Please contact the ECCO Office (This email address is being protected from spambots. You need JavaScript enabled to view it.) and tweet your ideas @Y_ECCO_IBD for other people you’d like us to interview and the questions you’d like us to ask.