More female trainees, but still not enough women in cardiology

Women remain underrepresented in cardiology despite a growing pipeline of female medical students and internal medicine resident physicians, according to a Sept. 11 report in JAMA Cardiology.

Laxmi S. Mehta, MD, of Ohio State University, and colleagues pulled data from the Association of American Medical Colleges, American Medical Association and American Board of Internal Medicine to stratify and assess the demographics of medical students, resident physicians, fellows and practicing cardiologists between 2006 and 2016. The team said in JAMA that racial and ethnic diversity is increasing within the U.S. general population, but that same improvement hasn’t been mirrored in medicine.

“Sex and racial/ethnic diversity in medicine provides opportunities for diverse mentorship along all stages of career pathway and stimulates research on diversity and health inequities,” Mehta and co-authors wrote. “However, there is a dearth of demographic data characterizing the current cardiology workforce.”

The researchers’ data revealed that, despite a 42.6% prevalence of female internal medicine resident physicians, women are still underrepresented in adult general cardiology fellowships, comprising just 21.5% of the pool. They’re also underrepresented in procedural subspecialty fellowships, including interventional cardiology (9.8%) and electrophysiology (13.7%).

The percentage of female adult cardiologists increased just slightly between 2006 and 2016—from 8.9% to 12.6%—but Mehta et al. said it isn’t all bad news. Trends showed an increase in female pediatric cardiology fellows throughout the decade (from 40.4% in 2006 to 50.5% in 2016), and women physicians actually made up a disproportionately higher number of pediatric residency positions (72.9%). Additionally, the rising prevalence of female pediatric cardiology fellows translated to a subsequent increase in the percentage of female pediatric cardiologists, from 27.1% to 34%.

As for other underrepresented minorities (URMs), Mehta and colleagues reported prevalence in adult and pediatric cardiology fellowships started low (11.1%) and remained low through follow-up (12.4%). Underrepresented minorities comprised just 8% of practicing adult and pediatric cardiologists.

The authors did note one exception in URM representation—Asian students and physicians. While Asian individuals make up just 5.2% of the U.S. general population they’re not considered underrepresented in the medical community because they account for 22.1% of U.S. medical school graduates, 38.1% of internal medicine resident physicians, 40.4% of adult cardiology fellows, 19.9% of adult cardiologists, 22.6% of pediatric resident physicians, 28% of pediatric cardiology fellows and 20.1% of pediatric cardiologists.

Mehta and co-authors warned, however, that that doesn’t make Asian physicians unimportant in the diversity conversation.

“As the cardiology field works toward greater URM diversity, the overall success of Asian individuals should not penalize or delegitimize diversity initiatives for Asian physicians,” they wrote. “Despite Asian individuals constituting a non-underrepresented minority group, they remain a minority in leadership within medicine.”

The authors said some barriers to better female representation in medicine are trainees’ perceptions of a negative culture within cardiology and the perceived attractiveness of other fields like surgery and obstetrics. Today’s trainees value work-life balance and flexibility in their careers, and the medical field is just now learning to adapt.

“Efforts to improve the culture, increase mentorship and promote work-life balance may help attract a more diverse group of individuals to pursue training in cardiology,” Mehta et al. said. “Further research is needed regarding potential solutions that may be effective in reducing barriers to diversity and improving the climate for diversity in the cardiology workforce.”