More Women Internists, but Numbers in Subspecialties Drop

Marcia Frellick

September 23, 2019

The number of women physicians who chose internal medicine (IM) residencies grew from 30.2% in 1991 to 42.4% in 2017, but for subspecialty fellowships, the trend was in the opposite direction, a study has found.

Anna T. Stone, MD, with the Department of Cardiology at St. Vincent Hospital and Heart Center in Indianapolis, Indiana, and colleagues found that in 1991, of the 7986 residents in subspecialty fellowships, 33.3% were women, but the number dropped to 23.6% of the 19,868 subspecialty fellows in 2016.

Their findings were published online September 23 in a research letter in JAMA Internal Medicine.

The researchers tracked gender differences over a quarter century in nine IM subspecialties: cardiovascular disease, endocrinology, gastroenterology, geriatric medicine, hematology and oncology, infectious disease, nephrology, pulmonary disease and critical care, and rheumatology.

The increase in the number of women internists follows the increase in the number of women in medical school in general. In 2017, for the first time, women in medical school outnumbered men, making up 50.7% of the student population, as reported by Medscape Medical News.

But the large gender gaps in subspecialties were striking.

In 2016, cardiology had the lowest percentage of women, though the percentage had more than doubled, from 10.1% in 1991 to 21.3% in 2016.

Table. Change in Percentage of Women in Nine Subspecialty Fellowships

Subspecialty Women in 1991 (%) Women in 2016 (%)
Cardiovascular disease 10.1 21.3
Endocrinology 40.6 71.3
Gastroenterology 10.7 34.0
Geriatrics 46.4 67.9
Hematology/oncology 26.0 42.9
Infectious disease 39.3 54.6
Nephrology 23.9 34.4
Pulmonary disease/critical care   16.2   32.6
Rheumatology 40.1 60.2

Coauthor Mary Norine Walsh, MD, medical director of heart failure and cardiac transplantation at St. Vincent Heart Center in Indianapolis, Indiana, told Medscape Medical News, "It's pretty clear from surveys in internal medicine that women more often than men never even considered cardiology."

Medscape reported last year on an American College of Cardiology (ACC) study that found that 62.6% of female trainees had never considered a cardiology career, as compared with 37% of their male counterparts.

She said IM surveys have shown that women prioritize long-term patient relationships and family time over financial goals and that many women see the field of cardiology as not being family friendly.

"We as a specialty need to hear that," she said. "Money isn't the only thing that matters."

She added, however, that obstetrics and gynecology, in which the number of women is higher, has a very high call burden as well, "so it's not all about the influence of overnight responsibilities," she said.

Walsh, past president of the ACC, said the ACC has been addressing low numbers of women in part through its Women in Cardiology Section's Visiting Professor Program. In that program, a female expert in a given field of cardiology comes and gives grand rounds at an institution where there may be fewer women faculty in cardiology.

"Exposure really does translate," she said. "For many trainees, you ask why they selected their specialty, and it often comes down to experience with one individual or a pivotal moment in training," she said.

Growth Rates for Other Subspecialties

The article compares the increase in the number of women in other specialties during more than 2 decades.

Compared with cardiology, the percentage of women in endocrinology grew 0.96% per year faster.

"The percentages of women in gastroenterology, geriatric medicine, rheumatology, and hematology and oncology increased at a rate close to 0.5% per year faster and infectious disease and nephrology increased at a rate close to 0.3% per year faster," the authors write.

Walsh said she sees hopeful signs in her specialty. Male and female cardiologists are taking to social media to show their junior colleagues that family and cardiology can be a rewarding mix, she said.

Also, data that were collected after the study was submitted show that after the years of flat trends in female fellows' interest in cardiology, the percentage of female fellows in the subspecialty grew from 21% to 23%.

"We may have started to move the needle a little bit," she said.

The researchers used enrollment data from the ACGME Residents and Fellows by Sex and Specialty, 2017, which was included in a report published annually by the Accreditation Council for Graduate Medical Education.

The authors have disclosed no relevant financial relationships.

JAMA Intern Med. Pubished online September 23, 2019. Abstract

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