From the Journals

The ongoing issue of gender disparities in interventional cardiology



As gender disparities persist in interventional cardiology, a new survey is shedding light on what is keeping women away from the field.

With women representing only 9% of interventional cardiologists in the United States as of 2017, researchers under the direction of the American College of Cardiology Women in Cardiology Leadership Council sought to asses the perspectives of fellows-in-training (FIT) regarding the factors influencing their cardiology subspecialty decisions.

A total of 574 FIT completed the survey, with 190 respondents anticipating pursuit of a career in interventional cardiology. The results of the survey were published online in JACC: Cardiovascular Interventions. According to the report, unlike other studies that looked at gender disparities in interventional cardiology that focused on the training (residency) or later (practicing cardiologists), this is the first to look at the time when the decision is made during general cardiology fellowship.

The goal of the survey was “to try to understand in the current realm of our millennials who are studying and are in fellowship and in training and in the trenches, what is dissuading them to be in the subspecialty of interventional cardiology,” Roxana Mehran, MD, Icahn School of Medicine at Mount Sinai, New York, and coauthor of the study, said in an interview.

Lead author Celina Yong, MD, and her colleagues wrote in their report on the survey that women “were more likely to express interest in all other cardiovascular specialties (general/clinical cardiology, advanced imaging, heart failure/transplant, adult congenital, and other), with the exception of electrophysiology (13% women vs. 87% men, P = .001).”

Researchers analyzed the 504 remaining survey responses after excluding those considering electrophysiology to get a better understanding about the influencing factors related to the decision to pursue interventional cardiology.

“Logistic regression of all demographic characteristics revealed that male sex was the most significant predictor of a career choice in interventional cardiology [odds ratio, 3.98; P less than 0.001],” the authors noted.

All respondents who intended to pursue a career in interventional cardiology had a list of 15 options to select the reasons for choosing this path. The top five, in descending order, were the opportunity to pursue hands-on procedures, personal interest in the specialty subject area, the opportunity for immediate gratification or sense of accomplishment, the thrill of treating ill patients in critical situations, and having mentors or role models the respondent identified with.

“When disaggregated by gender, there were six attributes that were significantly different between men and women in terms of reasons for pursuing” interventional cardiology, the authors stated. “Men were more likely to be driven by innovation in the field, importance of being an expert, likelihood of employment after completion of training, financial advantages, and prestige. Women were more likely to be driven by having a female mentor or role model.”

For those not pursuing a career in interventional cardiology, the top five reasons, in descending order, were an uncontrollable or unpredictable lifestyle, concern over long work hours and poor work/life balance, greater interest in another field, a desire for different type of patient contact, and wanting to have children in the next 5 years.

“There were seven attributes identified that negatively influenced IC choice differently by sex,” noted Dr. Yong, of VA Palo Alto (Calif.) Medical Center, and her colleagues. “Women were more likely to be negatively influenced by all seven of these factors compared to men (in descending order)”:

1) Greater interest in another field.

2) Little flexibility in job prospects/opportunities over a lifetime.

3) Physically demanding nature of job (e.g., wearing heavy lead).

4) Radiation exposure concerns during childbearing.

5) “Old boys club” culture.

6) Lack of female role models.

7) Gender discrimination or harassment.

Dr. Mehran said that despite some limitations, the survey results were not surprising.

“Unfortunately, surveys are very subjective,” she said. Also, one can question how biased some of these questions are. “But nonetheless, I think the result is very similar to what we had expected and have been talking about.”

She noted that the subspecialty of interventional cardiology needs to be more family friendly.

“I think we are going to lose a lot of good men also who are not choosing interventional cardiology,” she said. “There is no question that we have to think about how we can enhance and improve and pave the way for men and women, but mostly women because there are hardly any women and that’s important. The family friendly environment is very, very important in interventional cardiology.”

The patriarchal culture is another area that needs to be addressed, she said.

“I feel that, hopefully, that’s a perception and not much of a reality,” Dr. Mehran said, though she did note that there are plenty of examples where female doctors do not get shown the same level of respect their male counterparts do. She noted, for example, at scientific meetings, when a woman is on a panel and speaking, audience members can be seen tuning out, using it as opportunity to look at phones. Sometimes the women on the panels are not even referred to as “doctor.”

“I think we have to have a standard that those kinds of things will not be tolerated, that people will be called out if they didn’t do the extra work to find the best women for those important panels and leadership roles. There has to be a code of conduct that is equal and gender neutral,” she said, adding: “I think we are trying to work very hard to equalize the playing field but we have to come up with solutions.”

To that end, Dr. Mehran created a not-for-profit organization, Women As One, to tackle these gender disparities.

“We are really looking for solutions,” she said. “We will hold several think tanks with key opinion leaders, men and women, to come up with how best can academic organizations make sure that there is gender equality, good representation, and no discrimination on the basis of sex. ... We have to come up with solutions. Otherwise we just keep showing the same statistics over and over again and its not improving.”

SOURCE: JACC: Cardiovasc Interven. 2019 Jan; doi: 10.1016/j.jcin.2018.09.036

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