Female Cardiologists Less Likely Than Male Colleagues to Be Full Professors

A national study found that the differences between men and women could not be explained by known factors that influence academic rank.

Female Cardiologists Less Likely Than Male Colleagues to Be Full Professors

In academic medicine, full professorship is one of the major rewards that individuals can receive for their work. But a new study suggests that in the field of cardiology, women are less likely than men to hold that prestigious title despite having similar career experiences and other achievements that typically lead to increased academic rank.  

Although several recent studies have shown the effect of the gender gap on wages in clinical practice, and on satisfaction and perceived pressures at work, the question of equality across genders in academic medicine environments has not been well studied, noted the study’s lead author Daniel M. Blumenthal, MD, MBA (Massachusetts General Hospital, Boston, MA), in an interview with TCTMD.

Using data from a contemporary, cross-sectional database of US physicians, Blumenthal and colleagues examined faculty rank differences between 3,180 male and 630 female cardiologists affiliated with 109 medical schools in the United States. Subjects were either assistant, associate, or full professors.

Even after adjusting for factors known to influence academic rank and promotion such as years of experience, number of publications (total, and first- and last-author papers), affiliation with a medical school ranked highly in research, NIH funding, Medicare revenue, and procedural subspecialties, female cardiologists were 37% less likely than male peers to be full professors.

“This gap is not explained by things that we traditionally associate with academic success,” Blumenthal said, adding that the findings are consistent with previous studies looking more broadly across varied medical specialties.

“This paper perhaps provides an additional piece of evidence that we have persistent sex differences in how women are rewarded for their work relative to men,” he told TCTMD.

Preliminary data from the study were presented as a poster last year at the American College of Cardiology annual meeting, and the full data were published online in the February 7, 2017 issue of Circulation.

Good News for Interventional Cardiologists

While the results do not shed light on what is driving the gender gap in academic medicine, Blumenthal said some known issues that may be responsible include non-work-related duties, including family obligations, that typically fall to women more than men, leaving them with less time to devote to their academic careers. Other factors may be difficulty finding effective mentorship and less early-career funding.

One subspecialty for whom there was good news in the study, however, is interventional cardiologists.

“After adjustment for many factors, being an interventional cardiologist was associated with an increase in the likelihood of being a full professor,” Blumenthal noted, saying it was “unexpected” and the reasons behind it are unclear. “I think additional work is needed to try to understand why people in procedural specialties are more likely to advance academically than people in non-procedural cardiology subspecialties,” he said.

Other findings from the study were that, compared with men, women faculty were younger, had fewer total publications, and were less likely to have conducted a registered clinical trial, although they were equally likely to have NIH funding. Women also were more likely than men to be assistant professors (60.2% vs 46.8%; P < 0.001), but similarly likely to be associate professors (24.0% vs 22.6%; P = 0.47).

Due to the dearth of information regarding gender differences in academic medicine, Blumenthal and colleagues say studies “focused on the experiences of women in academic cardiology would be extremely helpful for understanding the particular forces that influence career advancement.” Furthermore, they suggest that if sex disparities in promotion in academic cardiology do exist, they are likely multifactorial, with different root causes, which may require disparate approaches to address them.

Understanding and Mitigating Bias

“Given that women comprise nearly half of medical school matriculates, in the face of the current and projected cardiology workforce shortage, with more than half of current cardiologists over 55 years of age, identifying barriers for women’s career advancement in academic cardiology is critical to attract women to the cardiology workforce,” write Molly Carnes, MD, MS (University of Wisconsin‒Madison, Madison, WI) and C. Noel Bairey Merz, MD (Cedars-Sinai Heart Institute, Los Angeles, CA), in an accompanying editorial.

Calling the study “methodologically sound and compelling,” Carnes and Bairey Merz say it should stimulate more research “with the goal of ensuring that academic cardiology has the ability to foster the career of each individual cardiologist—regardless of their gender—to their full potential to contribute to a vibrant future of research, teaching, and clinical care.”

Importantly, as society’s understanding of how to mitigate unwanted effects of gender stereotypes is growing, the editorialists say, institutions should pay attention to seemingly small things such as the language used in their hiring and performance-reward practices.

“For example, rather than indicating that an institution is searching for ‘a strong, charismatic leader,’ specific information such as ‘a physician- scientist who has led a federally funded research program for over 10 years and participated in the profession at a national level’ would reduce reinforcement of implicit male leader role congruity,” Carnes and Bairey Merz suggest. They also encourage institutions to ensure that hiring and promotion committees value credentials first before evaluating individual applicants.

Another important consideration may be behavioral reinforcement. In one recent study led by Carnes, a 2.5-hour workshop on gender bias was found to increase awareness of personal biases, make individuals more inclined to take action to promote gender equity, and create a more positive work environment.

  • Blumenthal DM, Olenski AR, Yeh RW, et al. Sex differences in faculty rank among academic cardiologists in the United States. Circulation. 2017;135:506-517.

  • Carnes M, Bairey Merz CN. Women are less likely than men to be full professors in cardiology: why does this happen and how can we fix it? Circulation. 2017;135:518-520.

  • Blumenthal reports no relevant conflicts of interest.
  • Carnes reports grants from the National Institutes of Health for research on reducing stereotype-based bias in academic medicine, science, and engineering.
  • Bairey Merz reports support from the Barbra Streisand Women’s Cardiovascular Research and Education Program, the Erika Glazer Women’s Heart Health Project, and the Linda Joy Pollin Women’s Heart Health Program.