Women in Interventional Cardiology: ‘If You Love it, You Will Make it!’ Study Identifies Factors Dissuading Female Cardiology Fellows From Pursuing Interventional Cardiology

According to a recent publication in JACC: Cardiovascular Interventions, many factors uniquely dissuade women from pursuing interventional cardiology (IC) compared with men, largely related to the culture of IC as a subspecialty. Targeted resolution of these specific factors may provide the most impact in reducing sex imbalances in the field.

In the last three decades, increased numbers and the proportion of women have visibly changed the landscape of the physician workforce across most medical and surgical specialties. And yet, despite recent targeted national efforts by the professional cardiovascular community, cardiology and interventional cardiology (IC) still persistently rank at the bottom in terms of female representation, with only 13% of general cardiologists and 7% of interventional cardiologists consisting of women. Specifically, only 4.5% of practicing interventional cardiologists are women, and they performed only 3% of total procedures between 2009 and 2013. As of 2017, only 9% of IC fellows in the United States were women. Although prior studies have examined sex differences in the cardiovascular profession, none have examined the specific factors that drive current fellows-in-training to make decisions to pursue IC as a subspecialty at the critical stage when these decisions are made and how these factors may differ by sex. It is unclear why this maldistribution persists. In the light of this matter, the authors sought to determine the factors that influence fellows-in-training (FITs) to pursue a career in interventional cardiology (IC) and how these differ by sex.

An online survey of cardiovascular fellows-in-training (FITs) was conducted under the direction of the American College of Cardiology Women in Cardiology Leadership Council to assess FIT perspectives regarding subspecialty choices. Of 574 respondents, 33% anticipated specializing in IC. Men were more likely to choose IC than women (39% men, 17% women, odds ratio: 3.98 [95% confidence interval: 2.38 to 6.68]; p < 0.001). Men were more likely to be married (p ¼ 0.005) and have children (p ¼ 0.002). Among married FITs, male IC FITs were more likely to have spouses who do not work (p ¼ 0.003). Although men were more likely to be influenced by positive attributes to pursue IC, women were significantly more likely to be influenced negatively against pursuing the field by attributes including greater interest in another field (p ¼ 0.001), little job flexibility (p ¼ 0.02), physically demanding nature of job (p ¼ 0.004), radiation during childbearing (p < 0.001), “old boys’ club” culture (p < 0.001), lack of female role models (p < 0.001), and sex discrimination (p < 0.001).

In response to the findings of the study, primary author Dr. Celina M. Yong, Department of Medicine, Division of Cardiology, Palo Alto Veterans Affairs Hospital stated,“ Even in the modern era of improved representation of women across most other medical specialties, this study provides evidence that IC lags behind. Positive drivers that motivate fellows to choose IC more predominantly influence men, whereas barriers to entering the field impact women more significantly. If we hope to have a workforce that reflects the diversity of our patients and optimizes delivery of care, directly addressing the unique barriers that are cited by women will maximize the impact of our efforts.” Referring to the next step, she added, “Targeted resolution of the specific factors identified may provide the most impact in reducing sex imbalances in the field.”

Speaking from her own experience, Dr. Annapoorna S. Kini, Interventional Director of Structural Heart Program at Mount Sinai Hospital commented, “Women have proved their worth in performing simple to complex procedures. There is a great career path waiting for women in IC, and the outcome is gratifying and fulfilling. In the future, I can see how female physicians will evolve in terms of their skills, talents, good decision making, and leadership in IC. I believe that if you are passionate about IC and love it, you will make it!” Addressing the subject of radiation, she was extremely reassuring, stating, “ I think most women are smart enough to believe that fear of radiation can now be resolved by following radiation safety measures while performing procedures in the catheterization laboratory. Women can now multitask, being mothers, doctors, and wives in order to achieve a work-life balance and deal with the same challenges as our male counterparts. This aspect of our lives will not be that burdensome if we seek family support to help us with our everyday lives. I believe that if you feel that this is the career you want to be exposed to, gain more opportunities, and are extremely confident that you can do it, then what are you waiting for? Professional organizations are now supporting women to pursue this field by having unique meetings to discuss career development and shared experiences. Many female interventionalists who can be considered major role models and mentors succeeded in this field and can be an inspiration to all aspiring women to make it big and have a great impact in this field.”