Number of Women Cardiologists Doubles, But Still Much Room for Improvement

December 16, 2008

December 16, 2008 (Providence, Rhode Island) — Although the number of women doctors in US cardiology has almost doubled in the past 10 years, a new survey reveals that more than two-thirds of female cardiologists continue to report discrimination, mostly on the basis of gender or parenting responsibilities [1].

The good news is that . . . both men and women cardiologists are hugely satisfied with their job--over 90% love what they do.

"We've made great strides and a lot of progress, but we still want to make more," Dr Athena Poppas (Brown University, Providence, RI), lead author and chair of the ACC Women in Cardiology Council, which commissioned the research, told heartwire . Poppas and colleagues report the results of the survey in the December 16, 2008 issue of the Journal of the American College of Cardiology.

"The good news is that as well as the number of female practicing cardiologists almost doubling, both men and women cardiologists are hugely satisfied with their job--over 90% love what they do," Poppas added. But there is still much to achieve. "We need to find ways to reduce discrimination, establish greater flexibility in work hours, and expand opportunities for mentorship to better meet the needs of women and men as they plan their careers in cardiology."

Greater Flexibility Is the Key

Poppas explained that the new survey was hosted online between September 2005 and January 2006 and was almost identical to a Women in Cardiology Section of the ACC questionnaire that was sent out in 1996, so the researchers were able to directly compare the results a decade apart. The 2006 survey was emailed to all 1901 female ACC members and an age-matched sample of 2360 male members. At the close of data collection, 1110 individuals had completed the questionnaire: 667 (60%) women and 443 (40%) men.

The survey did not include fellows in training, but other data show that the percentage of women entering the subspecialty of cardiology increased significantly, from 10% in 1996 to 18% in 2004, Poppas explained. And the number of practicing female cardiologists in the US increased from 5% in 1996 to 8% in 2006, according to ACC membership files. Still, says Poppas, this is not good enough.

"Almost 50% of people graduating from medical school are women, and 42% of those going into internal medicine are women, but not as many are choosing the next step of cardiology," she explains. Other medical specialties that are viewed as just as demanding, in terms of time, as cardiology--such as surgery or pulmonary/critical care--fare better in attracting female doctors, she notes. For example, around 25% of pulmonary/critical-care trainees are women.

To keep good people in cardiology . . . we are going to need to establish greater flexibility in work hours.

"When we looked at the reasons behind this, there were a couple of things that came out," she continues. "First is the need for flexibility, for both men and women. Men are starting to want the same things as women, with many doctors striving for a better work-life balance."

Only around 80% of cardiologists work full-time, according to the survey, which Poppas says is "kind of amazing." This is a reduction of 6% in the number of women and a 13% reduction in the number of men working full-time from 1996.

An even more dramatic increase appears to be the number of men who are not practicing medicine or have "other" arrangements, increasing from 1% in 1996 to 12% currently. Men may be retiring early or working in administrative roles, says Poppas.

"To keep good people in cardiology--both men and women--we are going to need to establish greater flexibility inwork hours. This is an issue that needs to be addressed institutionally and on a personal level as well," she stresses.

No Change in Number of Women Married, Having Kids

The second reason that women don't seem to be choosing cardiology is interlinked with the first, says Poppas, and that is that they are still experiencing discrimination. Interestingly, women report that the type of discrimination has shifted over the past 10 years; they experience less gender discrimination now, but more discrimination on the basis of parenting responsibilities.

Women don't have a stay-at-home spouse so they have to prioritize family more than men.

The new survey shows that only 73% of women cardiologists are married, and a smaller fraction have children (66%), compared with 91% of male cardiologists who are married and 92% who have children.

These discrepancies in marital status and choices in childrearing remain unchanged over the past decade, Poppas notes, pointing out that choices in childcare arrangements also remain quite different among male and female cardiologists.

In the 2006 survey, for example, more male cardiologists than ever--66%--had a stay-at-home spouse providing childcare. "Women don't have a stay-at-home spouse so they have to prioritize family more than men," she says.

"The perception is that cardiology is more demanding, and the hours less easy to control than other areas of medicine. Cardiology involves life-threatening emergencies, so you're not always sure you'll be home for dinner or make it to the school play," says Poppas.

Cardiologist Dr Melissa Walton-Shirley (TJ Samson Community Hospital, Glasgow, KY), moderator of forum and a wife and mother herself, agrees. She told heartwire : "I've been in private practice for 17 years. Even though I find cardiology enormously fulfilling, my children and husband are my life, and from a professional standpoint, it has often left me with the feeling that it wasn't the best climate for child rearing.

"In order to maintain an adequate balance, it requires having a good significant other, a second backup situation for everything, and a very understanding family. It's sobering when you finally realize the magnitude of the sacrifice required," she adds.

Pregnancy and Maternity Leave: Unique Impediments for Women

Poppas and her colleagues say one of the inherently unique impediments for working women in the US is the burden of pregnancy and maternity leave. Between 1996 and 2006, there appears to have been an increase in medical institutions with family-leave policies in place, yet still nearly half of respondents reported that either their institution had no official policies in place or they were not aware of its details.

You're not always sure you'll be home for dinner or make it to the school play.

Only a minority of female cardiologists were familiar and satisfied with their administrative family-leave policy, and this has not changed substantially in the past 10 years. At the same time, fewer women interrupted their training or their practice for pregnancy--approximately one-third of the 66% of women with children did not take more than one month of additional leave, the survey found.

"Whether this reflects more liberal recommendations for continuing to work during pregnancy or, as other investigators have suggested, a greater degree of guilt or overt or subtle pressure not to burden one's colleagues is unknown," the researchers say.

Women are also less likely than men to pursue careers in interventional cardiology due, in part, to concerns about radiation exposure and pregnancy risks. One in four women in the new survey reported selecting tracks toreduce their radiation risk.

Women Face Racial and Religious Discrimination Too

The survey illustrates that men face discrimination too, generally on the basis of race or religion. This may be linked to the increasing percentage of international medical graduates in US medical residencies (42%) and cardiology fellowships (32%), the researchers suggest.

But females also face discrimination on the basis of race or religion, creating a kind of "double-whammy" for women, said Poppas.

The number of women who have experienced discrimination of one kind or another "remains inexcusably high," at 69%, Poppas and colleagues conclude.

"For the culture to change, institutions must first acknowledge the pervasive impediments for women and improve their support for women throughout their careers [and] . . . set an example of not tolerating any type of discrimination. With regard to childrearing, it will take changes in both the workplace and in society in general," they note. "Finally, women must be both actively recruited and encouraged by mentors to pursue leadership roles."

Walton-Shirley says: "If I had to advise a young female physician with regard to this very difficult issue, I'd recommend she join a large group and preferably work in an environment where hospitalists can cover night and weekend duties short of interventional responsibilities. Make certain that your partners understand that your goals include being both a good parent and a good physician.

"It's also inherently discriminatory when I describe this as a difficult situation for females only," Walton-Shirley adds. "I know plenty of male cardiologists who could have been much more attentive fathers if they had only been given the time."

Good Mentors Are Vital

Poppas says the progress that has been made in the past decade has been fostered by the ACC, supporting and helping to establish the Women in Cardiology group to promote leadership among women.

The group has promoted a virtual mentoring program that has been invaluable for women, she says, noting that good mentors are vital for both sexes. Also, at meetings, a scheme has been initiated whereby female medical students and residents shadow some of the female fellows and attendings who are at the conference.

  1. Poppas A, Cummings J, Dorbala S, et al. Survey results: a decade of change in professional life in cardiology. A 2008 report of the ACC Women in Cardiology Council. J Am Coll Cardiol 2008; 52:2215-2226.


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