'Old Boys' Culture Keeping Women Out of Interventional Cardiology?

Megan Brooks

January 24, 2019

A survey of cardiology fellows-in-training sheds light on why so few women choose interventional cardiology (IC) as a subspecialty and what might entice more of them to enter the field.

The culture of the subspecialty is one negative factor for women, along with inflexible work schedules and radiation exposure, but having a female mentor and a strong passion for IC are key enticements.

Results of the survey were published online January 16 in JACC: Cardiovascular Interventions.

Celina M. Yong

"The landscape of the physician workforce has changed dramatically over the last 3 decades, with significant increases in the proportion of women across numerous medical and surgical subspecialties," Celina M. Yong, MD, Division of Cardiovascular Medicine, Stanford University Medical Center and VA Palo Alto Healthcare, California, told theheart.org | Medscape Cardiology.

"Yet, in cardiology, and specifically interventional cardiology, we persistently remain at the bottom in terms of female representation," she said.

Gender Imbalance

To better understand why that is, Yong and colleagues conducted an online survey — under the direction of the American College of Cardiology (ACC) Women in Cardiology Leadership Council — of current cardiovascular fellows-in-training (FIT).

Of 4250 FIT, 574 completed the survey (10% response rate), with 33% reporting that they anticipated specializing in IC. Men were significantly more likely to choose IC than women (39% vs 17%; odds ratio [OR], 3.98; 95% confidence interval [CI], 2.38 - 6.68; P < .001).

Men were more likely to be married (P = .005) and have children (P = .002), the researchers found. Among married FITs, male IC FITs were more likely to have spouses who do not work outside the home (P = .003).

What was most interesting, said Yong, is that the factors that were viewed as most important in making the decision to pursue an interventional career varied significantly by sex.

Men were more apt to be influenced by positive factors to pursue IC, such as innovation, being seen as an expert, prestige, and finances, whereas women were more likely to be influenced by negative factors, discouraging their pursuit of IC, such as little job flexibility, the demanding nature of IC, radiation exposure, the perception of an "old boys club" culture, lack of female role models, and gender discrimination. Greater interest in another field also was a factor in women's decision not to choose IC.

"Given the numerous factors that uniquely dissuade women from pursuing IC, it is clear that we have a lot of work to do as a profession if we hope to improve the gender imbalances in this field," Yong told theheart.org | Medscape Cardiology.

"This ranges the spectrum from facilitating mentorship, to ensuring that the existing women in the field are visible to trainees through leadership opportunities, to making conscious efforts to change the perception of an old boys club culture, to making gender discrimination unacceptable, to supporting development of technologies that can minimize radiation exposure, to even looking at the structure of our training and work environments to see if changing them can make a career in IC more tenable, for both male and female trainees," said Yong.

The main positive factor influencing a woman's decision to choose IC was having a female mentor or role model in the field, followed by personal interest in IC, opportunity to perform hands-on procedures, the thrill of treating ill patients in critical situations, and the opportunity for immediate gratification.

Passion for the Field

Annapoorna Kini

The finding that the majority (83%) of women cited "passion" as the main reason for choosing IC should not be overlooked, Annapoorna Kini, MD, director of the IC fellowship program, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York City, notes in an editorial.

Despite all the obstacles and negative factors cited for not pursuing a career in IC, "we should remember that there is one thing that will not stop us from doing what we want to do and that is PASSION," writes Kini.

"If one has the passion for the field, pursue it," Kini told theheart.org | Medscape Cardiology. "There will be hurdles at every step. Be humble, have your basics strong (i.e, know your subject), [and know that] steady hard work with good ethics will lead you to path of a successful career."

She said it's also important to "know your limitations," lead a balanced life, and stay healthy.

There is a "great career path" waiting for women in IC, Kini concludes in her editorial, "and the outcome is gratifying and fulfilling. I believe that if you are passionate about IC and love it, you will make it!"

This study was funded by the American College of Cardiology and the Women in Cardiology Section of the ACC. Yong and Kini have disclosed no relevant financial relationships.

JACC Cardiovasc Interv. Published online January 16, 2019. Abstract, Editorial

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