Cardiology is perceived as a demanding specialty with long and inflexible hours, potentially discouraging female residents from pursuing a career in cardiology due to work-life balance concerns.¹ When applying to fellowship, implicit gender bias can emerge during interviews. Female applicants often face disproportionate questions about marital status, childbearing intentions and childcare plans.² These inquiries, though seemingly neutral, can cast doubt on a female candidate's commitment compared to their male counterparts. With fewer female role models, sponsors and mentors in the medical field, female resident applications may likely be viewed as less competitive.

Despite increasing representation of women in medical training, only 10-14% of board-certified and active adult cardiologists are women.³ Representation of women in fellowship has increased,³ however, this growth lags behind women trainee representation in other procedural-based training programs including gastroenterology, pulmonology-critical care and general surgery.³

Once fellowship begins, female cardiologists continue to grapple with a lack of female role models, inadequate support for childbearing and associated responsibilities, and a future with inequity of compensation and advancement³ – all while adjusting to a demanding call schedule during a crucial period that shapes their future careers. Despite many fellows becoming pregnant during fellowship, trainees may feel pressure to take a shorter maternity leave than available.³ Familial responsibilities for women, compared to men, are more likely to limit professional work (38% vs. 29%; p<0.001) and ability to travel for career advancement (46% vs. 41%; p<0.01).³ Male cardiologists are much more likely to have children than women (87% vs. 72%; p<0.001), and, for most men, spouses provide all childcare (57% vs. 13%; p<0.001).²

In addition, women cardiologists are more likely to utilize full- or part-time childcare. Women are more likely to interrupt their training, usually for childbirth, and more likely to be affected by familial responsibilities.³ Notably, in the past two decades, more men have indicated that familial responsibility has negatively impacted their careers – signifying a shift in culture and traditional caregiving roles.³

When choosing a career, differences are noted between selections made by female and male cardiologists of subspecialty and job description, which ultimately contributes to the gender pay gap and subsequent career dissatisfaction. A 2017 survey of >2,000 physicians conducted by the ACC found that female cardiologists were more likely to work in a medical school or university practice, to work part-time or outpatient, and to practice general cardiology or echocardiography.³ Women also spent more time than men doing research and teaching, which is also often paid at a lower rate than clinical careers.³

Gender continues to play a role in leadership and career advancement in the field of cardiology. For example, women, compared to their male colleagues, are less likely to be full professors.⁴ Leadership gaps are especially noted among senior academic faculty, whose networks and experience contribute crucial resources for publication and grant success.⁴ Moreover, clinical trial leadership is predominantly male cardiologists. From 2014-2018, a median of approximately 10% of publications in prominent journals were led by female investigators.⁵ Women are more likely to report lower career advancement and were threefold as likely to experience some form of discrimination.³ While discrimination rates have declined over the past two decades, 65% of women report any discrimination, which increases with time in practice.³

Mentorship for career advancement with women trainees and cardiologists has shown promise in recruitment of a diverse cardiovascular field. Established in 2017, the Penn Women in Cardiology (PWIC) organization at the University of Pennsylvania in Philadelphia, PA, aims to retain and advance women cardiologists. This program provides mentorship to prospective students and residents, leadership development for fellows and early career cardiologists, networking with visiting speakers, and advocacy for increased parental leave and other childbearing responsibilities.¹

Also in 2017, the Duke Cardiovascular Disease fellowship created an initiative to increase fellowship diversity. This included prohibiting applicant photos, ensuring women and underrepresented in medicine (URM) applicants constituted 25% of the interviewee pool, and offering structured mentorship for women and URM fellows.¹ Both of these interventions resulted in higher matriculation of female residents into cardiology.

Organizations such as the ACC have made efforts to establish platforms to support residents, fellows and early career female cardiologists. Several ACC leadership development and mentorship programs foster cardiology interest in women and URM trainees.¹ One example of this continued support is the ACC Women in Cardiology (WIC) member section, wherein women physicians are given an opportunity to network, develop leadership skills and apply for grants to support state-related WIC events.

Mentorship and networking opportunities for women trainees and cardiologists are an important first step towards recruitment of a diverse workforce. However, further support in the arenas of leadership and career advancement, and structural changes with pay equity and anti-bias training throughout the leadership, are needed for improved representation, retainment and advancement of women cardiologists.

This article was authored by Nouran A. Sorour, MD, Department of Cardiology, UMass Memorial Medical Center; Katherine Anais Sadaniantz, MD, Department of Medicine, University of Massachusetts Chan Medical School; and Lara Kovell, MD, FACC, Department of Cardiology, UMass Memorial Medical Center, all in Worcester, MA.

References

1. Balinda IG, Reza N. Diversity, equity, inclusion, and belonging in cardiovascular disease fellowship training. Methodist Debakey Cardiovasc J. 2022;18(3):67-77.
2. Saleem M, Chowdhury M, Aggarwal A, et al. Gender differences in the cardiology fellowship interview experience. JACC Adv. 2024;3(2):doi:10.1016/j.jacadv.2023.100810.
3. Lewis SJ, Mehta LS, Douglas PS, et al. Changes in the professional lives of cardiologists over 2 decades. J Am Coll Cardiol. 2017;69(4):452-462.
4. Altin SE, Parikh PB, Squeri E, et al. Representation of women in cardiology academic faculty ranks. Am J Cardiol. 2023;190:96-97.
5. Van Spall HGC, Lala A, Deering TF, et al. Ending gender inequality in cardiovascular clinical trial leadership: JACC review topic of the week. J Am Coll Cardiol. 2021;77(23):2960-2972.

Clinical Topics: Cardiovascular Care Team

Keywords: Cardiology Magazine, ACC Publications, Parental Leave, Sexism, Leadership, Gender Equity