Studies have consistently shown that the vast majority of interventional cardiologists are male—for example, a recent study indicated that only 4.5% of US interventional cardiologists are female.1 Furthermore, Jagsi et al2 recently reported that female cardiologists are paid substantially less than male cardiologists even after adjusting for differences in personal, job, and practice characteristics. This article reviews the steps being taken to ensure that being female is not a barrier to being an interventional cardiologist.
A survey3 by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Women Committee—a working group of female interventional cardiologists that aims to understand gender-related disparities in the field of interventional cardiology to attain gender equality—found that 10% of female cardiologists cite lack of support for family life as a barrier to choosing interventional cardiology as a subspecialty (only 1% of male cardiologists believe their family commitments prevent them from being an interventional cardiologist).
The survey authors Piera Capranzano (Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy) and others note that the “burden of the family responsibilities falls disproportionately to the woman” and that, therefore, strategies are needed to “promote a balanced participation of women and men in family and working life”.
Speaking to Cardiovascular News, the chair of the EAPCI Women Committee, Julinda Mehilli (Munich University Clinic, Ludwig-Maximilians University, Munich, Germany) says, in terms of implementing such strategies, employers need to provide the necessary resources for flexible working hours and childcare facilities for both men and women with children but “governments should provide legal requirements to make these measurements mandatory”.
Shrilla Banerjee (Surrey and Sussex NHS Healthcare Trust, UK), the 2013–2016 Women in Cardiology representative of the British Cardiovascular Society, agrees that greater shared family care between men and women may enable more women to become interventional cardiologists but believes for this to happen, social attitudes need to change. She says: “People tend to accept a woman taking time out of her career or going part-time to look after children but I do not think there are many in the cardiology community who would encourage or even allow a male cardiologist to go part-time. Therefore, we do need to change people’s views.”
Some women also choose not to go into interventional cardiology because they are concerned about the potential hazards—ie. radiation exposure—of working in a cath lab during pregnancy. Capranzano et al explain that a lack awareness of radiation-related hazards “turns into fear” that can preclude women choosing the subspecialty, adding that: “Formal education and training must be implemented for women, especially during pregnancy, to understand the actual magnitude of the radiation-related risk and strategies to limit the operator effective dose.” For Banerjee, again, a change in attitude may be necessary. She reports that most male cardiologists are “forward-thinking” enough to accept that the time that a female colleague may not be able to work in a cath lab because of pregnancy represents “only a small percentage of time” of a 30-year career that they may spend working with their female colleagues. However, she notes that some male cardiologists may resent “having to take on a colleague’s work” if she chooses not to work in the cath lab because of pregnancy. Banerjee adds that while—according to UK employment law—women are not legally obliged to offer to do other roles when they are not able to work in the cath lab, she did extra clinics during her pregnancies. She says: “It was a good experience because I felt useful. As colleagues, we have to get on with each other as we are working towards a common goal. Therefore, if you can do something else when you choose no to work in the cath lab, it will obviously help to win anyone over who feels resentment.”
Both Banerjee and Mehilli advocate established female interventional cardiologists acting as mentors to younger colleagues. Banerjee reports that the British Cardiovascular Society is setting up meetings to enable women to discuss “the challenges that they face in their working lives and how they can overcome them”. Noting that not everyone will be able to attend these meetings (which will be held across the UK), she reports that the society is also creating an email database of mentors so that trainees can email mentors with questions, which may include balancing a family life with a working life. “The mentoring service is not exclusively for women because there are male cardiologists who do not work full time. Therefore, we will try to support anyone who is involved in caring for children or working in a non-traditional fashion,” Banerjee states. Two such mentors are two female cardiologists working in Scotland, who “provide a full-time service and essentially work as one person”. She notes “They will be able to give great advice about how they set up their own timetables and how they cover leave etc.”
Similarly, Mehilli says that established female interventional cardiologists transmitting their experience to younger colleagues is important for combating entrenched gender stereotypes—such as the perception of “women being echocardiographers and men being interventional cardiologists and leaders”. She adds that the EAPCI Women Committee is also establishing a network of mentors to encourage women to choose interventional cardiology as a subspeciality. “One example of this collaboration is our project Percutaneous Treatment of Cardiac Disease in Women book, which is due be published in 2016,” Mehilli notes. Established interventional cardiologists (both male and female), according to Mehilli, could also encourage female cardiologists who are just starting their career to participate in interventional cardiology research projects. “More publicity for existing female interventional cardiologists is needed as well, with a higher proportion of them being invited to speak at conferences or perform live case demonstrations,” she comments.
If more women are to become interventional cardiologists, it is not only attitudes in the cardiology community that need to change as Mehilli believes that the general public need to be made aware that women are just capable as men at delivering good quality interventional care. She says: “A recent publication1 found that while, in the USA, female interventional cardiologists only perform 3% of all percutaneous coronary intervention procedures, the severity of the coronary artery disease they treat and the procedural success rate they achieve are identical to those of their male colleagues.”
To further understand gender disparities in interventional cardiology, Mehilli and her EAPCI Women Committee colleagues are launching a survey to gather information about the working realities in European cath labs. Mehilli explains: “Gathering information and drawing attention about the current situation is needed because the statistics regarding the gender of interventionalists within Europe are lacking.”
- Wang et al. Catheterization and Cardiovascular Interventions 2015. Epub
- Jagsi et al. JACC 2015; Epub
- Capranzano et al. EuroIntervention 2015; Epub