Women in cardiology encouraged to ‘lead from where you stand’
While the percentage of men and women graduating medical school is becoming more and more and more similar, cardiology is still a male-dominated field.
“I didn't initially feel the downside of being a woman in cardiology and it wasn't until I got a job that I started to realize some of the differences in negotiating, the path that you're encouraged to take,” Hanna Gaggin, MD, MPH, FACC, cardiologist at Massachusetts General Hospital, assistant professor of medicine at Harvard Medical School and a Cardiology Today Next Gen Innovator, told Cardiology Today. “For example, I was kind of encouraged to take a lower salary when I was beginning, but it was my male mentor, who is a cardiologist, who told me to take a higher salary.”
Although steps are being taken to encourage women to take active leadership roles in the field, many of those positions still lack a female presence.
“When I look around to leadership positions, you don’t see many women who are professors,” Gaggin said. “You see a lot of assistant professors and fewer associate professors, but if you start to look at full professors, you just don’t see as many women.”
According to Gaggin, changes can be made over time by encouraging women and training them in leadership positions and negotiating skills. Additionally, she said, changes can be made to archaic promotional tracks, which may have been set up decades ago when the field was predominantly men.
“I think, especially in my division, and department, there’s a lot of encouragement of women groups, whether it’s women in medicine, women in cardiology, where there is a lot of mentorship that’s happening. That’s kind of the beginning of how things are going to improve.”
C. Noel Bairey Merz, MD, FACC, FAHA, told Cardiology Today that there are further steps to be taken in order to bring about gender equality in cardiology.
“Progress will be made when institutions, society, and men recognize the need to reduce and eliminate gender-related bias and conflation of gender and status by implementing evidence-based approaches, in order to optimize productivity, revenue and well-being of all,” Bairey Merz, director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai Heart Institute and Cardiology Today Editorial Board Member, said.
Finding a voice
Women in medicine need to amplify one another, find their “posse,” request coaches and sponsors and craft their own legacy statements, according to an expert speaking during an AMA webinar in honor of Women in Medicine Month.
“Lead from where you stand, whether it be pediatricians addressing vaccination or emergency medicine physicians talking about disaster preparedness in a hurricane. Speak about the health impact of an issue,” Vineet Arora, MD, MAPP, from the University of Chicago said during the webinar. “Use your voice to promote medical truth. ... Celebrate the medical heroes among us.”
Arora kicked off the webinar by asking, where are the women in medicine who are leading? Though roughly half of applicants to medical school are women, only one in five women make full professor and just 16% rise to the level of dean of a medical school, she explained. This “leaky pipeline” fails women in medicine at that level, but that does not mean women in medicine are invisible or not leading. One-third of associate deans are women, but we do not hear about them, Arora said. Citing Julie K. Silver, MD, Arora discussed how even in medical press or lay press covering medicine, women are still missing.
Silver went on to show that women are underrepresented in benchmark areas of academia such as award recipients of medical societies. The American Academy of Dermatology, Arora said, touts nearly half of practicing physicians as being women as well as faculty, yet one of their prestigious awards has only been given to women 8.3% of the time. In invitations to grand rounds, women are less likely to give those at other institutions and are less likely to be named visiting professors, Arora showed.
Arora attributed at least some of this to a discomfort among women – even women physicians – with self-promotion. In many cases, a physician must be sponsored for recognition like grand rounds and association awards and, in many cases, the best way to get that sponsorship is to ask for it.
“Many of us can find mentors in our workspace. It’s harder to find coaches and sponsors,” she said. “A coach is short-term interaction to help with targeted feedback and problem-solving. ... You need a sponsor to ... use their influence in their field to support their mentee to gain visibility.”
Coaches can help women work through job negotiations and sponsors can put names forward for Grand Rounds or society awards.
And once there, once recognized by an institution, women must also recognize the passive ways their roles can be minimized, Arora said. Specifically, she showed data in which women are introduced as “doctor” less often than their male peers. Though women introducers were on parity between the sexes, men introducing women called them doctor only 50% of the time while they did so for men being introduced 72% of the time.
“This could be a more subtle form of bias and you might think it’s not much,” Arora said. But it adds to the image of a doctor as a man. “Women are not perceived of not only as doctors but as leaders. ... We will see bias and we need to stand up in defense of our colleagues.”
Maternal, internal discrimination
Arora showed that this is compounded by “maternal discrimination” in the workplace where four out of five physician women reported discrimination and one-third reported discrimination based on being a mother. Pay discordance, consideration for promotion, disrespect by support staff and exclusion from administrative decisions were all heavily impacted by maternal discrimination, she showed. Additionally, women who reported maternal discrimination had 74% higher rate of burnout.
Lastly, Arora pointed to internal threats to women’s success – stereotype threat, the likeability penalty and imposter syndrome as well as women not supporting one another through Queen Bee syndrome – can further reinforce the lack of visible women leadership in medicine.
She cited medical school observation data where men scored 1.5 levels higher than women, which is equivalent to 4 months of additional training. The only correlation being the difference in sex, leading the researchers to hypothesize that this could be due to stereotype threat. Other research looking at critiques of medical residents’ performance showed mixed messages to women addressing their levels of confidence, assertiveness and aggressiveness.
Even the women quoted in her presentation, Arora said, often responded to her with statements playing down their leadership roles, yet they all very much lead from where they stand.
“The truth is that we are and we have to accept that and fight the internal voice in our head and go out and lead,” Arora said. “We all have to overcome this to lead.”
Amplification of women voices
She suggested women take on a role of amplification for one another. If each woman consistently gives credit to other women for the strides they’ve made, the research they’ve done or the stance they’ve taken, that amplification will be heard and cuts off the chance for someone else to take the credit. Instead, women are often seen to be each other’s worst enemies, with women bullies directing much of their antagonism toward other women.
“We have enough battles to fight that we have to work together and here’s this genius strategy we can operate on,” Arora said. “It’s important we step out from hiding and say, ‘I’m here and I’m ready to lead.’”
And, to do so, Arora says to women in medicine: “Find your posse.”
She belongs to Physician Moms, a Facebook group for physicians who are also mothers, and she said, “Social media has made it easier to find your posse.” These women along with those in the workplace and women in societies can act as a sounding board for physicians, allowing for confirmation and amplification of women in medicine.
Each woman in medicine should craft her own legacy statement, stand by it and find her support system to make it happen, Arora concluded. In this, you should create your image as a leader and set the goals that you want to achieve.
“This legacy statement centers you to think about what’s your compelling future and inspires you to change your present,” she said. “Think about your legacy because you are writing it every day.”
Healio.com has covered women in medicine for decades in various forms and these themes recur time and again. See the articles below for how things have changed and how women in medicine continue to fight similar battles to their predecessors. – by Katrina Altersitz and Dave Quaile
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