Resolution of barriers to pursuit of interventional cardiology may improve representation of women
A new study identifies several factors that dissuade female CV fellows-in-training from pursuing interventional cardiology compared with men, including occupational concerns, gender discrimination, job flexibility and overall culture.
The proportion of women across medical specialties has increased in the past decade, with more women than men enrolling in medical school. The number of female trainees has more than doubled in traditionally male-dominated fields like cardiothoracic surgery, urology and neurosurgery, according to background information in the study published in JACC: Cardiovascular Interventions. However, the same rise has not been observed in interventional cardiology, with 2017 estimates showing that only 9% of U.S. interventional cardiology fellows were women.
“This study is the first to examine reasons for selection of [interventional cardiology] as a subspecialty at the exact stage of training during which the decision is made — during general cardiology fellowship,” Celina M. Yong, MD, MBA, MSc, assistant professor and interventional cardiologist at Stanford University Medical Center and Palo Alto VA Medical Center, and colleagues wrote.
Sex differences among CV fellows-in-training
Researchers analyzed survey responses from 574 current CV fellows-in-training who answered questions about their personal and professional decision elements regarding cardiology subspecialty choices. Questions in the survey focused on opportunity, mentorship, lifestyle, interest and occupational health. The survey also collected information such as age, sex, race/ethnicity, marital/child-rearing status, specialization and training status.
Of the fellows-in-training in the study, 33% anticipated that they would specialize in interventional cardiology, with more men showing greater interest than women (39% vs. 17%; OR = 3.98; 95% CI, 2.38-6.68).
Men were more likely to have children (P = .002) and be married (P = .005). Among fellows-in-training who were married, male interventional cardiology fellows-in-training were more likely to have spouses who did not work compared with women who were married (P = .003).
In this study, men were more likely to be influenced by positive traits to pursue interventional cardiology, whereas women were more likely to be negatively influenced against pursuing interventional cardiology.
Among women, some of the attributes leading to a negative influence of pursuing interventional cardiology included little job flexibility (P = .021), greater interest in another field (P = .007), radiation during childbearing (P = .001) and physically demanding nature of the job (P = .005). Other factors included lack of female role models (P = .001), “old boys club” culture (P = .001) and gender discrimination (P = .001).
“Positive drivers that motivate fellows to choose [interventional cardiology] more predominantly influence men, while barriers to entering the field impact women more significantly,” Yong and colleagues wrote. “If we hope to have a workforce that reflects the diversity of our patients and optimizes delivery of care, directly addressing the unique barriers that are cited by women will maximize the impact of our efforts.”
The researchers noted that “there may be changes that can be made to the field to make it more manageable for both sexes, as well as for older interventionalists who may find interventional cardiology schedules untenable.”
Examples cited by the researchers include a transition to shift-based schedules; alternative training tracks to increase options for fellows who do not want to postpone childbearing, those completing research or those who want to pay student loans before entering further subspecialty training; and increased awareness via more meetings and sessions at scientific conferences dedicated to career issues.
In a related editorial, Annapoorna Kini, MD, professor of cardiology at Mount Sinai School of Medicine, wrote: “Women have proven their worth in performing simple to complex procedures. There is a great career path waiting for women in interventional cardiology and the outcome is gratifying and fulfilling. In the future, I can see how women physicians will evolve in terms of their skills, talents, good decision-making and leadership in interventional cardiology. I believe that if you are passionate about [interventional cardiology] and love it, you will make it.” – by Darlene Dobkowski, with additional reporting by Katie Kalvaitis
Disclosures: The study was funded by the American College of Cardiology and the Women in Cardiology Section of the ACC. Yong reports she received support from an American Heart Association Mentored Clinical and Population Research Award. Kini and the other authors report no relevant financial disclosures.