Reports Air Hot-Button Issues for Cardiologists, Especially Women

Patrice Wendling

January 06, 2017

BOSTON, MA — A new survey shows female cardiologists continue to face obstacles to pregnancy and family life that undercut efforts to attract more women to the male-dominated specialty[1].

Imagine, for example, someone being asked in a job interview whether they intend to have children. Although it's unlikely men would be asked, almost half (43%) of the 501 female respondents said it happened to them.

Moreover, this number was similar between older respondents already through their childbearing years and those younger than 50 years (43% vs 45%; P=0.67), "suggesting that the incidence of this question has not changed over time," lead author Dr Amy A Sarma (Massachusetts General Hospital, Boston) and her colleagues write in the January 3, 2017 issue of the Journal of the American College of Cardiology.

The ACC's Women in Cardiology Council survey comes on the heels of a second survey, the ACC's third decennial 2015 Professional Life Survey (PLS)[2], which offered some reasons for optimism but also showed substantial differences in the personal life choices for men and women in cardiology:

  • Men were more likely than women to be married (89% vs 75%), to have children (87% vs 72%), and to have spouses providing all the childcare (57% vs 13%; P <0.001 for all).

  • Women were more likely than men to practice general clinical cardiology (48% vs 39%) or echocardiography (10% vs 3%) and to work part-time (10% vs 5%; P <0.001 for all).

  • Women were more likely to say family responsibilities had a negative effect on career advancement (37% vs 20%; P <0.001).

"Both of the papers are wake-up calls that we need to pay attention to these issues, that we need to continue to strive for change and make people aware that there are inequities still," coauthor of both papers and chair of the ACC Women in Cardiology Council Dr Claire Duvernoy (VA Ann Arbor Healthcare System, University of Michigan) told heartwire from Medscape.

She said change has come but that cardiology needs to work toward making the field more attractive to women, particularly young women, and family friendly for all groups. The graying cardiology workforce is reason unto itself, with 11%, 15%, and 17% of male and 6%, 8%, and 18% of female respondents to the 1996, 2006, and 2015 Professional Life Surveys aged 60 years or older.

"We're going to have a labor shortage if we don't succeed in drawing more people into this field and if we're excluding half of our population who feels like cardiology's not friendly to them as women," Duvernoy said.

The Pregnant Cardiologist

Among the 501 female physician ACC members to respond to the online survey—reportedly the first to investigate the experience of pregnancy among cardiologists—14% were in training, 30% <7 years out of training, 30% 7 to 20 years out of training, 24% >20 years out of training, and 1% retired.

Most women (76%) reported at least one pregnancy and 19% used assisted reproductive technology (ART) to conceive. This compares with fewer than 2% of ART births among US women in general and likely reflects the decision to delay pregnancy because of education and training, Duvernoy said.

Once pregnant, 40% of female cardiologists experienced a complication (12% <1 miscarriage; 14% preterm delivery or labor; 7% preeclampsia; <1% eclampsia; 4% gestational diabetes). The overall complication rate is on par with other physician groups, "although direct comparisons are challenging," the authors write.

Overstating Radiation Risk, Deterrence

Several studies examining barriers to cardiology have identified concerns about radiation exposure, and the current survey was no different. Specifically, younger cardiologists were significantly more likely to have avoided pregnancy during periods of radiation exposure than those older than 50 years (50% vs 39%; P=0.03).

Despite this concern, however, women were relatively uninformed about whether their department had an official policy on radiation exposure during pregnancy (34% did not know; 32% said it did; 32% said it did not) and underutilized radiation-reduction strategies.

Among the 57% of respondents exposed to radiation during pregnancy, 24% used additional lead coverage, 42% increased their distance from radiation sources, and only 20% used fetal radiation badges, falling far short of the 89% of radiation oncology residents donning such badges in a recent study[3].

The authors were at a loss to explain the underutilization and recommend pregnancy radiation education for both sexes upon entering fellowship, at hire, and at fluoroscopy credentialing, as well as altering practice activities for pregnant cardiologists with radiation concerns.

Duvernoy, who performed cath-lab procedures throughout both of her pregnancies, however, noted that barriers to career advancement may be a bigger sticking point for many women. "I don't think radiation exposure should be overstated as far as deterrent or risk. I think most women who choose to do cardiology understand there is radiation exposure."

She added that while "the survey showed many women did not avail themselves of everything that is available, this may have something to do with not wanting to make waves, especially if you're a junior person or you're in training."

Compulsory Parental Leave, Leveling the Field

The survey found that younger cardiologists have taken significantly longer maternity leaves than their peers older than 50 years (P<0.0001). Nonetheless, 51% of women said they felt pressured to take shorter leaves than available to them; this feeling did not differ by respondent age (P=0.22).

For the 607 pregnancies reported with maternity leave, 15% had a leave of <1 month, 33% of 4 to 8 weeks, 33% of 8 to 12 weeks, 15% of 3 to 6 months and 3% of >6 months.

Partly as a result of the survey data, Duvernoy said the ACC Women in Cardiology section has meetings set with cardiology program and fellowship directors at the upcoming ACC 2017 Scientific Sessions to advocate for more generous parental leave policies (paid leave of 2 months for all cardiologists) and to reduce the stigma of using it.

"You've hit upon an issue I feel very strongly about," she told heartwire . "In looking into research for both this paper and the Professional Life Survey, one of the things that struck me was how much better it is for society as a whole when men take parental leave to an equal degree with women taking maternity leave. And it also struck me how behind and backward the United States is in this respect."

Duvernoy said normalizing parental leave will move the field "in a huge direction forward" but acknowledges "it won't be easy because someone has to do the work." The paper, however, highlights possible solutions such as how to move staff around more flexibly and to take advantage of coverage teams or individuals.

The 30,000-ft View

A total of 2313 cardiologists (42% women) completed the 2015 PLS survey, which was focused on determining whether ACC efforts and ongoing societal changes have helped mitigate the gap between male and female cardiologists over the past 2 decades.

Overall, cardiologists were happy with their work lives: 88% of women and 90% of men reported being moderately to very satisfied in the survey, led by Dr Sandra J Lewis (Northwest Cardiovascular Institute, Portland, OR).

Other bright spots were that women were more likely in 2015 than in 1996 to report being married and having children, and, Duvernoy said, there was a growing trend for men to shoulder more family responsibilities and to acknowledge these responsibilities hindered their ability to do professional work and travel for professional advancement.

Enough Mommy Tracking Already

Changes in the Lives of Cardiologists Over 2 Decades
Source: Journal of the American College of Cardiology. To view a larger image, click here.

Women were significantly less likely than their male peers, however, to report achieving a higher or much higher level of advancement (23% vs 39%; P<0.001). Although the survey did not compare salaries, a recent study reported women were underpaid by an average of $31,749 and that the salary gap between the sexes remained even after adjustment for personal, job, and practice characteristics[4].

The situation is not unique to cardiology, Duvernoy said, but is a deterrent to women entering the field that needs to be recognized and changed through education.

"There is sometimes the perception among division chiefs that women are more of a 'mommy-track' kind of a person and aren't that interested in becoming a full professor or being a division chief because she's trying to raise her kids, and that's unfair to women and should never enter the equation," she added.

Discrimination Differences

Disturbingly, the survey showed that two-thirds of women experience discrimination, nearly three times the rate in men (65% vs 23%) and down only slightly from the 1996 PLS survey (71% vs 21%).

The form this took was strikingly different, however, with women more likely to experience discrimination on the basis of sex (96% vs 8%) and parenting (37% vs 8%) and men more likely to report racial (59% vs 18%) and religious discrimination (22% vs 5%; P <0.001 for all).

Two-thirds (63%) of survey respondents identified as being white, down slightly from 76% in 2006 (data not available in 1996), highlighting the need to bring more minorities into the field.

"We are serving the United States of America, a country of many different ethnic groups, and we need to understand everyone's experiences," Duvernoy observed.

The authors of both papers reported no relevant financial relationships.

Follow Patrice Wendling on Twitter:@pwendl. For more fromtheheart.org, follow us on Twitter and Facebook.

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