Women in cardiology—are we a rare species? Current data show that 50% of medical students are women, with a similar ratio applying to internal medicine residency. However, this number precipitously drops in cardiology, with 12% of women choosing cardiology as a career. Of these, only 10% of women elect to specialize in procedural fields (1), making the disparity in numbers real and palpable. The most commonly cited deterrents to a cardiology career for women are impairments to family planning, poor work/life balance, and perceived radiation risks (2–4). To address such challenges, cardiology fellows Drs. Gina Mentzer and Christina Salazar created a women cardiology fellows group at The Ohio State University Wexner Medical Center (OSUWMC). Expanding on the success of this group, Dr. Alexa Meara and I (N.M.O.) cofounded a women fellowship leadership group for female fellows across all internal medicine specialties at OSUWMC. With structured agendas and reading materials, these 1-h monthly forums offer a safe and confidential setting to discuss hurdles and promote career development. In our experience, both groups have substantially enriched our fellowship experience in fostering friendships and forging collaborations. Through this paper, we attempt to highlight the challenges and opportunities of the current landscape and share the resources that we found helpful during our training. Women Cardiologists Are Less Likely To Be Married Or Have Children Compared With Men Research suggests that 71% of women cardiologists were married (compared with 90% of men), and 63% of women cardiologists had children (compared with 88% of men) (5). As training fellows, it helps to keep these numbers in perspective, and to determine personal goals early on. There will never be a perfect time to settle down or have a child. Current Society for Cardiovascular Angiography and Interventions recommendations state that pregnant physicians should not be precluded from participating in the laboratory (6). It is heartening to know that radiation in the laboratory does not affect pregnancy outcomes. Therefore, child planning during fellowship is worth contemplation. Although maternity leave may postpone training, having children early offers the benefit of avoiding high-risk pregnancies and the ensuing complications (7). Women Cardiologists Earn Less Than Their Male Counterparts Data from 2014 indicate differences in annual salary, with women and men earning $309,000 and $356,000, respectively. An average difference of approximately $50,000 is striking, and women must learn to champion for themselves and each other (8). We should learn to advocate for ourselves as early as fellowship. It is well known that women are less likely to negotiate when offered job contracts. Fellowship is a good time to formulate our priorities before we step out into the real world. Although flexibility with work hours may matter to some of us, a full-time position with pari passu, or equal, salary may be important to others. Reviewing contracts with our spouses or other advisers, including men, is insightful. We should seek their advice to get a reasonable income for our equivalent services. Few Women Are In Academic Positions, With Fewer Women Being Full Professors The current statistics suggest that fewer women reach top academic positions compared with men. Currently, 19% of men and 5% of women are full professors. Meanwhile, there are equal number of men and women at the instructor level (1). Whether this reflects women having inadequate credentials or being less likely to apply for promotions is not known. A good piece of advice we have received is to update our résumé every month. Every small step, whether it is giving grand rounds or mentoring a resident, should be included. As women, we need to be proactive starting at a fellowship stage to make a conscious effort to apply for promotions, if we harbor academic aspirations. Learn To Sit At The “Table”: Make Your Voice Heard Sheryl Sandberg’s astute observation in the business industry is applicable to our field (9). In our experiences, the most successful female fellows and cardiologists are those who sit at the table and voice their opinion during conferences. We all agree that women are wired differently—we bring a diverse view to the forefront, which can improve the quality of the discussion and the decisions reached. Because we are a rare entity in this field, making our voice heard is paradoxically easier. The Journey Gets Long: Build A Support Network As we advance in our training, we find ourselves surrounded with fewer female colleagues at every stage. Therefore, the role of a professional support system must be underscored. Women in cardiology face a unique set of challenges, which are best identified by our own flock. Issues like being single, marriage conflicts because of long hours, or having a child with perceived radiation risks in the laboratory are natural fears. These fears are often not voiced to avoid appearing weak. Through our groups, we have discussed such issues in a private, nonjudgmental setting. This has bolstered our personal relationships and helped us emerge as stronger women cardiologists. Work/Life Balance: Acknowledging Your Personal Pillars Of Strength As women in medicine, most of us are blessed with a robust support system comprised of friends, family, and faith. An understanding support system is integral to our happiness, which directly translates to workplace success. A recent study on National Institutes of Health K08 and K23 grant awardees reported that women with these grants were likely to spend an average of 8.5 h/week more than men on domestic activities (10). We believe that these study findings are eye-opening. Although we cannot change everything, it is sometimes necessary to seek out help to avoid burnout. Acquaint Yourself With The Available Resources Success requires strategy. Diversify your mentorship and know the singular resources available to female fellows. Both the American Heart Association and American College of Cardiology have Women in Cardiology Councils, which are tailored toward networking, mentoring, and career advancement. The American Heart Association also offers the annual Women in Cardiology Trainee Award for Excellence, which provides workshops and a forum to meet other successful women trainees. As previous recipients of this award, we have found this event to be a fantastic resource that is ripe with opportunities. Both groups also have leadership roles available for fellows-in-training at the local and national levels. If you plan to attend these conferences, schedule your travels with these programs in mind. In addition, our groups have successfully secured intramural professional development grants for the last 4 years. We have utilized the grant funding for instruction on leadership and effective communication. Collaborate: Multitasking Is Our Innate Talent Collaboration increases your networks and span of reach. Sometimes, as women, we may miss the networking opportunities that occur at the golf course or football games. Therefore, we have to be visible and willing to participate in research and clinical initiatives. Studies suggest that women are better at multitasking and men are better at focusing (11). We should harness this multitasking ability to engage in teamwork, and improve our productivity. Build The Pipeline, Be The Change That You Want To See In The World Having encountered the struggles, and having been blessed with strong mentorship, it is fulfilling to counsel incoming medical students and residents. Our suggestion is that cardiology offers the complete spectrum from an outpatient experience to an inpatient intensive approach and from a career in basic science to a completely clinical career. As long as there is passion, this field offers flexibility and versatility with lifestyle choices. As women fellows, we serve as role models in many ways to young physicians. It always makes our day when a resident sends us a note or runs into us in the corridor and announces that she will apply for cardiology. Our Vision: One Day There Will No Longer Be Women Cardiologists, Just Cardiologists This sex gap will shrink and hopefully disappear. It will require dedicated efforts from men and women to bring this to fruition. As beneficiaries of the current system, we are thrilled and honored to train as cardiology fellows. Through such outlets, we hope that incoming residents make a choice in cardiology, independent of their sex. RESPONSE: A Rare Species, Armed With Vision and Leadership Skills Sandra Lewis MD [email protected]; Northwest Cardio Vascular Institute, Portland, Oregon This work in Ohio by our young colleagues, presented here by Drs. Oza and Breathett, is to be lauded and duplicated. We may be a rare species, but with such vision and leadership, we are not endangered. This year heralds the 10th anniversary of the Women in Cardiology (WIC) Section of the American College of Cardiology (ACC). When I began my cardiology fellowship at Stanford University in 1980, 4 out of 8 fellows were women. In a tongue-in-cheek manner, we called ourselves the “Fellowettes.” After all 4 of us gave birth during fellowship, a famous or infamous faculty meeting concluded that Stanford could no longer take further women as fellows. The overt message was clear: motherhood and cardiology were incompatible. Some 25 years later, supporting women who are both cardiologists and mothers is one of the many goals of ACC’s WIC Council. There was an identified need to lead, support, and mentor women in cardiology. Our goal was to meet that need, while providing a support network where such issues could be explored safely and creatively. Through strong leadership, the Council was 1 of the 2 groups to launch a “section” in the ACC. To succeed in the mission, the WIC section has identified at least 1 section representative in each state. The issues—highlighted eloquently by Oza and Breathett—are reflected in the mission of the WIC section: · •To enhance the careers of women cardiologists through the creation of professional development, mentoring, and networking programs, and through the promotion of leadership opportunities within the ACC; · •To enhance the appeal of cardiology for women residents by recommending changes in training programs and by promoting effective, efficient, and diverse career opportunities; and · •To encourage young women in high school, college, and medical school to pursue a career in cardiology through the creation of mentoring programs and preceptorships. In 1998, and again in 2008, the ACC has surveyed members to understand the differences between men and women in cardiology. These ACC Professional Life Surveys highlight differences and similarities for women and men in cardiology (1,2). For example, men and women both reported a high level of satisfaction with family life, but women were less satisfied with their work as cardiologists (88% vs. 92%) and with their level of financial compensation (1). As we prepare to repeat the survey for the third time, our women fellows are identifying many of the same challenges, and I would contend failures, in cardiology leadership that we faced a generation ago. Although our Ohio fellows identify opportunities for women during their fellowship and early career, we all share in the responsibility of meeting these challenges. Senior leadership, both men and women, must work together to acknowledge and understand the ongoing barriers and the potential gains of bringing more women into the field of cardiology if we wish to actualize the vision of the fellows: “one day there will no longer be women cardiologists, just cardiologists.” Source
