Addressing the Gender Gap

Siddharth WayangankarMy perspective on this topic is limited and should be viewed by readers with this in mind given my experiences in the workplace as a male professional.

Female interventional cardiologists represent a mere 4% of total operators (3% of the annual PCI volume), according to a recent study. Because the field is an offshoot of internal medicine—traditionally favored equally by both genders—this begs the question: what is the root cause of this discrepancy? The customary excuse is that interventional cardiology is a procedural field. However, this may not be valid since similar specialties like surgery and orthopedics have actually seen an increasing proportion of female residents each year. To this end, in 2009 women accounted for 21.3% of US surgeons.

While the proportion of applicants to US medical schools who were women decreased by 10% over the past decade, that of women applying to internal medicine residency has remained constant over the last 5 years. I call this the “pseudo-stabilization phenomenon” because I believe that the majority of women interested in pursuing procedural specialties have removed themselves from the prospective interventional cardiology pool by choosing fields like surgery, orthopedics, and urology. The consistent increase in the proportion of women within these specialties may be an indication of the same.

Additionally, female internal medicine trainees have many other nonprocedural career options such as primary care, endocrinology, infectious disease, hematology, oncology, and rheumatology. Each of these medicine subspecialties continues to recruit > 50% women with each enrollment cycle, and those percentages are on the rise. However, although American Board of Internal Medicine (ABIM) data show a mild increase in proportion of female cardiology fellows from 17% in 2005 to 21% in 2013, Electronic Residency Application Service data from 2011 show that out of the 8,265 female internal medicine residents, only 3% applied to cardiology fellowships. Further, interventional cardiology has to compete with other high-paying subspecialties like general cardiology, heart failure, and electrophysiology. For example, ABIM data over the last decade reveals that proportion of women in electrophysiology was 50% more than that of interventional cardiology.

Interventional cardiology is associated with not only greater physical stress compared with other cardiology fields but also entails working on an inflexible, inconsistent, and unpredictable schedule. Training is grueling, and many programs have transitioned to a 2-year curriculum in order to accommodate structural and peripheral topics. Additionally, the professional expectations of trainees and physicians are usually out of sync with their desired work-life balance. Most cardiology fellows are in their early 30s, and hence a protracted fellowship thereafter might be perceived by women as a hurdle to starting or raising a family. In fact, a recent survey showed that 70% of the female cardiologists in Arizona perceived their cardiology training as a barrier to pregnancy.  

To encourage more women to be a part of the interventional cardiology community, I think there needs to be a grassroots effort. Adequate and early career guidance may help them plan their academic and personal objectives more effectively. Secondly, encouraging women interested in cardiology to enroll in a 6-year combined bachelor’s degree and MD program and then to pursue the ABIM’s newly initiated competency-based pilot “Internal Medicine-Cardiology” program may help significantly shorten training time. Also, consideration should be made in the future to formulate a combined general/interventional cardiology program in order to further shorten the total training period.  

Another significant issue—regardless of gender—is radiation safety, especially the lack of comprehensive knowledge among trainees regarding risk. According to SCAI’s Women in Innovations (WIN) initiative, there are no data demonstrating a significant increased risk to the fetus of pregnant operator in the cardiac catheterization laboratory. Even so, the interventional community needs to evaluate, encourage, and invest in technological innovations like robot-assisted PCI that might help temper the radiation skepticism among trainees.

Ultimately, bridging the gender gap will result from excellent mentoring. Programs specifically geared toward women—like WIN and the American College of Cardiology’s Women in Cardiology Section—can encourage budding female physicians to share gender-specific issues and help mold their careers in the best possible way.