“You have to be careful in the cath lab, don’t want to be pregnant and have to be pulled out.”
Words of advice from a mentor when expressing my desire to go into cardiology.
“I just assumed you wouldn’t be having children with your career path.”
Discussion with my family regarding my plans for the future.
“You’ll match cardiology because you’re female and pretty.”
Encouragement from a peer.
It is well known and documented that there is a sex discrepancy in cardiology, with women accounting for only 21% of general cardiovascular fellows in training (2). There remains a question as to why. Is it because women are less qualified than men to be cardiologist so are simply not selected? I’d like to think that’s not the case in modern times. Rather, my theory is that women simply are not applying cardiology. Would you if you had the conversations I did?
The truth is there are many factors driving women away from cardiology and its advance fellowships. In studies assessing why women are less likely to pursue interventional fellowship, it was found that women reported concerns about decreased flexibility, physical demands, radiation exposure during childbearing years, “old boys club” culture, and sex discrimination (1). They were concerned about interference with family life and challenges of having children during fellowship (3), a reflection of societal gender roles. As a trainee, these were the negative reasons I also heard. As matter of fact, I heard more of the reasons not to than the reasons to pursue. Cardiology is a diverse and passionate field that studies both anatomy and physiology of not just the cardiac system, but also the vascular, pulmonary, endocrine, and neural. But that’s not what people wanted to talk about when I expressed interest in cardiology.
Perhaps part of my experience was due to my lack of exposure to female cardiologists. This is not unique to my program. Women in cardiology are inadequately represented in terms of role models. In a survey of 20 barriers to pursing advanced fellowship, lack of female role models was the 6th most reported (1). This was more than sexual discrimination, plans to have children within 5 years, or extension of training (1). It is unsurprising that female trainees report lacking female role models considering only 19.3% of cardiovascular fellowship program directors are women (2). With so few women pursuing cardiology, it is no surprise that cardiology leadership also has a scarcity of female physicians.
In addition to antiquated societal norms and underrepresentation, some women feel discouraged due to harassment and discrimination based on their sex. I know I certainly had that experience. While overt sexism is less common in today’s society, micro aggressions still persist and discourage women from pursing cardiology. In a survey of female interventionalists, 74% of women reported the perception that being female would make training more difficult, if not preclude it all together (4). Perhaps one of the more common microaggressions occurs in the cath lab. There is the lack of proper radiation training and use of unisex (male) shielding (4). By not adequately protecting women in the cath lab, the belief that women are unsafe in the cath lab is perpetuated and lends to the perception women of childbearing age should not be pursing cardiology. This perception persists despite evidence that pregnancy is safe in the cath lab with proper precautions (4).
We are all in agreement that gender disparities exist. But what are we going to do about it? I call for a re-branding of cardiology, particularly for female trainees. Mentors need to encourage and strengthen, not advise against as I was. Trainees to need to be accurately educated on the demands and benefits of pursuing a career in cardiology. Peers need to elevate and seek female partnership in projects. Maybe then women will feel encouraged to apply and welcome in the field. Maybe then we will stop having gender disparities to write about.
1) Yong C, Abnousi F, Rzesszut A, et al. Sex Differences in the Pursuit of Interventional Cardiology as a Subspecialty Among Cardiovascular Fellows-in-Training. JACC: Cardiovascular Interventions. 2019; 12(3): 219-228.
2) Thakker R, Abu Jazar D, Elbadawi A, et al. Sex and Education Background of Cardiovascular Disease Trainees and Program Directors in the United States. J Am Heart Assoc. 2022; 11:e027039.
3) Douglas P, Rzeszut A, Merz C, et al. Career Preferences and Perceptions of Cardiology Among US Internal Medicine Trainees. JAMA Cardiol. 2018; 3(8): 682-691.
4) Grines C, Voeltz M, Dupont A, et al. A Paucity of Female Interventional Cardiologists: What are the Issues and How Can We Increase Recruitment and Retention of Women? Journal of the American Heart Association. 2021; 10(5): https://doi.org/10.1161/JAHA.120.019431.