Culture of interventional cardiology drives women away

A survey of cardiovascular fellows-in-training (FIT) offered insight into why women at that career stage are less likely to pursue interventional cardiology—a subspecialty that ranks among the lowest in all of medicine in terms of female representation.

Female FITs were more strongly influenced than men by negative factors pushing them away from interventional cardiology (IC), including little job flexibility, the physically demanding nature of the job, an “old boys’ club” culture, sex discrimination and the lack of female role models in the field. Men, on the other hand, were more positively influenced by factors like innovation in the field, prestige, the likelihood of being employed after training and financial advantages.

“Positive drivers that motivate fellows to choose IC more predominantly influence men, whereas barriers to entering the field impact women more significantly,” Celina M. Yong, MD, MBA, MSc, with the department of medicine at Stanford University, and co-authors wrote in JACC: Cardiovascular Interventions. “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.”

These findings were pulled from a survey of 574 cardiovascular FITs conducted in 2017. Thirty-nine percent of male respondents said they were likely to choose interventional cardiology compared to 17 percent of women. Lower interest in IC among women wasn’t surprising, considering recent analyses have shown a low representation of women in the field as well as inequities in compensation and discrimination.

“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. … As of 2017, only 9% of IC fellows in the United States were women,” Yong and colleagues wrote.

The survey also revealed that men who were interested in interventional cardiology—despite being at the same career stage—were more likely to be married, have children and have a nonworking spouse. However, many FITs of both sexes indicated they wanted to have children in the future, suggesting women who pursue IC “are generally postponing childbearing.” Two-thirds of survey respondents were between 30 and 34 years old.

“Given that the age at which women often pursue IC training extends into the age range during which reproductive risks significantly increase (medically termed ‘advanced maternal age’), this may make the selection of an IC career more difficult for women,” the authors wrote.

Yong and colleagues said alternative training schedules which allow for research or clinical work for a year or two between a general cardiology fellowship and an interventional fellowship might provide more options for women who don’t wish to postpone having children or who want to prioritize research work before further subspecialty training.

Free-text responses to the survey also indicated some women were concerned about radiation in the cath lab, including how it might affect childbearing and how wearing heavy lead shields to guard against radiation could be physically demanding or cause back problems. But Yong et al. pointed out the increased use of weightless lead and the emergence of robotic PCI could alleviate one of those problems. Also, current data and consensus statements suggest that with proper protection, there isn’t an increased risk to the fetus of a pregnant woman in the cath lab.

The survey had a 10 percent response rate, which is typical of survey research, but the authors acknowledged that is still a limitation because it might not have captured the perspectives of all FITs.

“Although the investigators used sophisticated principal-component analysis with varimax rotation to assess positive and negative attributes, it is not clear how valid that approach would be for assessing and ranking positive and especially negative factors considering the small sample size,” Annapoorna Kini, MD, with Mount Sinai Hospital and Icahn School of Medicine at Mount Sinain in New York, wrote in a related editorial.

Still, Kini said the study provided “unique insights” into what dissuades women from pursuing interventional cardiology, which can be used to develop new strategies for supporting women interventionalists and reducing the sex imbalance in the subspecialty.

Above all, Kini took an encouraging tone. She wrote that professional organizations are now taking note of the disparity and working to improve it, and noted there are many female physicians with successful careers who can serve as role models and mentors.

“Despite all the obstacles and negative factors we read about pursuing IC for women, we should remember that there is one thing that will not stop us from doing what we want to do, and that is passion,” Kini wrote. “If we are passionate about seeing patients feel better after complex procedures, passionate about the new cutting-edge technology and procedures we can offer to our patients, passionate about the idea that women can equally work with men and be as good if not better, then we should not be afraid to pursue a satisfying career in this subspecialty of cardiology.”