According to a new survey published in EuroIntervention, men state that the long working hours and the need to be on call associated with being an interventional cardiologist are the key reasons why so few women choose the subspecialty. However, female respondents in the survey said that “lack of opportunity” and “radiation” were the main reasons for not choosing to become an interventional cardiologist.
Authors Piera Capranzano (Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy) and others report that the small number of female interventional cardiologists—only 10% of interventional cardiologists are women—“contradicts the fact that throughout Europe, the majority of medical students (nearly 60%) are women”. They therefore conducted a survey, on behalf of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Women Committee, to identify the barriers to women choosing interventional cardiology as a subspecialty.
Capranzano et al sent the survey to members (48,443) of the European Society of Cardiology (ESC) who had expressed an interest in interventional cardiology. Of the 1,787 respondents, 1,085 (60.7%) were women—of whom, 19.6% listed coronary/structural heart disease as their subspecialty (compared with 46.4% of men who responded). The authors report that in the overall cohort, female respondents were more likely to be younger, unmarried and childless than male respondents, adding: “Among invasive-working physicians in the coronary/structural subspecialty, women were less frequently married (p<0.001), less frequently had ≥2 children (p<0.001), and were more frequently younger than 40 years (50.6% vs. 37.6%; p<0.001).”
For both men and women, lack of opportunity was the most common reason for not choosing interventional cardiology as a subspecialty and fears about radiation exposure was the second most common reason. However, in a cohort of 652 men who responded to a question about why women did not choose to become interventional cardiologists, “on-calls” and “long working hours” were most common reasons. Furthermore, of 58 men who gave an open reply to the question, 39.6% claimed that the reason was that working conditions were “too challenging, stressful, demanding, and not suitable” and 32.8% said it was because of the “male-dominated environment” (only 12.8% of women cited environment as the reason in the survey). Other notable open responses included women not being able to handle working under stressful conditions, the “proven tendency of better orientation and coordinate hand orientation in men than women”, and interventional cardiology needing “more adrenaline and testosterone” than women presumably possess.
The authors state that these answers by the male respondents reveal a stereotype of women being “fragile”, unsuited to the demanding work of cath labs, and unable to handle challenging and stressful situations. They add that this stereotype leads to prejudices that “set the basis for an unreasonable preclusion of women from training and inducing a male-dominated interventional environment”. Capranzano et al write that legal quotas have helped to address gender inequality in non-medical professions, but say that they hope such quotas “will never be necessary” in the interventional cardiology environment”. “The latter [ie. introduction of quotas] might be considered a defeat of the intelligence distinctive of our environment with the intention that our sustained efforts will even gender disparity in the field of interventional cardiology, they explain.
Regarding these sustained efforts, the authors outline several ways in which more women could be encouraged to become interventional cardiologists. This includes formal education and training about radiation exposure, particularly during pregnancy, so that women can understand “the actual magnitude of the radiation-related risk and strategies to limit the operator effective dose” and more strategies to promote a balanced participation of women and men in family and working life (ie. so that the burden of family responsibilities does not disproportionally fall to women).
Capranzano et al conclude that their survey “highlights the need to develop new strategies for future training, education, and support of women interventional cardiologists”, which they add is the “main goal” of the EAPCI Women Committee.
The study’s corresponding author Julinda Mehilli (Munich University Clinic, Ludwig-Maximilians University, Munich, Germany), who is the chair of the European Association of Percutaneous EAPC) Women Committee (for more informatiom, see our interview with Mehilli about why the comittee was set up), told Cardiovascular News the idea that interventional cardiology too stressful a job for women or that combining being an interventional cardiologist with a family life is too difficult (for women at least) are “predominate views” among the community. She adds: “Lack of opportunity is a derivate of the archaic perceptions of women’s and men’s roles and leadership abilities. Quotas in interventional cardiology are of less value for changing these perceptions. To achieve gender-equality, other more effective measurements should be implemented—such as development and implementation of the Gender Equality Index as a statistical tool for characterising and measuring progress in gender equality in institutions; changes in social structures related to the organisation of work and family (one example is implementation of parent leave policy on a non-transferable basis etc.); creating supportive networks; and preparing women to become leaders (training, mentoring, coaching etc. )”