Rising concern about gender and racial equity has gripped our nation and the world. In 2017, the American College of Cardiology (ACC) championed this cause by forming the Taskforce on Diversity and Inclusion. This group, led by Pamela Douglas, MD, MACC, and Kim Williams, MD, MACC, developed the ACC's Diversity and Inclusion Strategy, which was recently approved by the Board of Trustees. Adult and pediatric cardiologists share goals of inclusion as a means of providing the best care for a diverse population; however, strategies to achieve these goals are dissimilar because pediatric and adult medicine differs greatly by patient and provider demography and by the pipeline of primary care residents. So what is the status of diversity within pediatric cardiology? And what strategies would provide a balanced workforce?

We will address gender balance first, since there is more data. The present workforce of board certified pediatric cardiologists is 66% male and 34% female.¹ However, women have entered the field in increasing numbers over several decades, representing 40% of pediatric cardiology fellows in 2001 and 49% in 2016. The most recent group taking the subspecialty board examination is 51.4% female.¹ There are likely to be several reasons for the shift in gender balance, but one strong factor is a seismic shift in the pipeline of medical students and pediatric residents, such that the first-time examinees for general pediatric certification are 74.5% female.^1,2 Those of us who meet with pediatric intern candidates have become accustomed to seeing a brave lone male candidate in a room filled with women. Ironically, we need to reach down to the undergraduate level to show young men that there are interesting technologies and appealing work styles within the field of congenital heart disease, thereby enticing them down the path of pediatrics to cardiology.

Although gender balance is moving toward parity, it is important to also address factors associated with professional success. Only 20% of the ACC's Adult Congenital and Pediatric Cardiology (ACPC) section members are women.³ This is significantly lower than the approximately one-third of board-certified pediatric cardiologists who are women,¹ indicating possible barriers to participation in ACC activities, such as balancing childcare with Scientific Session attendance or committee participation. Financial necessity may also be a factor. The 2018 Doximity Physician Compensation Report indicated that women pediatric cardiologists were paid $249,000 per year on average, which is 15% less than men.⁴

How might we encourage more gender diversity in the section? The average age of ACPC members is 60 years and only 8.2% are between the ages of 31-40 years.³ Since recent graduates are gender balanced, an obvious strategy for increasing the gender diversity of the section is to recruit and retain young members. What measures would encourage young women to join the ACC, attend the Scientific Session and become section members? For early career women, lack of resources for childcare, breastfeeding and other family-friendly resources becomes a significant barrier for attendance at national meetings.^5-7 Added costs of caring for a child at meetings also present a barrier; therefore, ACC might contemplate stipends or other resources to encourage participation. Curriculum content should include a recurring forum for specific topics related to planning and negotiating family leave, part-time employment, career tracks and negotiating part-time grant funding. These steps should enhance academic recognition, improve financial parity and decrease burnout.

Cultural and racial diversity within the field of pediatric cardiology is undocumented but providers are clearly not matched to the population of children we serve. This disproportion within pediatrics is worsening due to an expansion in minority birth rate. The 2015 US Census estimates show that as of 2016, minority newborns outnumber non-Hispanic whites.⁸ Extrapolating from AAMG workforce data, Stoddard projected that by the year 2025 there would be 12.1 African American pediatricians and 9.2 Hispanic pediatricians/100,000 children, while non-Hispanic white pediatricians number 54.2/100,000 children.⁹ We must urgently explore all measures to reach down to the high school and college level encourage minority students, facilitating their progress through the pipeline. This will require careful tracking and assessment of best strategies.

In summary, we are far from our goal of achieving a cultural match between pediatric cardiologists and our patient population and it will require intensive effort to reverse the current trend. Conversely, there is excellent gender balance among the younger generation of pediatric cardiologists. In order to maintain this gender balance, we will need to attract men into the pediatric pipeline. We also must focus on the younger group of pediatric cardiologists as a strategy for increasing the gender diversity within our organization.

These early-career pediatric cardiologists enrich our field and our ACPC section, bringing with it more gender balance, fresh insights and new attitudes about work-life balance. It is important that we facilitate their participation in the ACC by providing resources for their professional development and family-friendly conferences, thereby promoting the best outcome for our patients with congenital heart disease and childhood cardiovascular disorders.

References

1. American Board of Pediatrics 2018 Workforce Database. Accessed March 3, 2018. https://www.abp.org/content/workforce.
2. Association of American Medical Colleges News. "More Women Than Men Enrolled in U.S. Medical Schools in 2017." News release, December 18, 2017. AAMC News. Accessed February 7, 2018. https://news.aamc.org/press-releases/article/applicant-enrollment-2017/.
3. American College of Cardiology 2018 database, personal communication, February 25, 2018.
4. Doximity 2018 Physician Compensation Report. Accessed March 3, 2018. https://blog.doximity.com/articles/doximity-2018-physician-compensation-report.
5. Mason MA. The Baby Penalty. The Chronical of Higher Education. Accessed February 21, 2018. https://www.chronicle.com/article/The-Baby-Penalty/140813.
6. Calisi RM. Opinion: how to tackle the childcare-conference conundrum. Proc Natl Acad Sci USA 2018;115:2845-9.
7. Bos AL, Sweet-Cushman J, Schneider MC. Family-friendly academic conferences: a missing link to fix the "leaky pipeline"? Polit Groups Identities 2017.
8. Kohn D It's official: Minority babies are the majority among the nation's infants, but only just. Pew Research Center. Accessed March 3, 2018. http://www.pewresearch.org/fact-tank/2016/06/23/its-official-minority-babies-are-the-majority-among-the-nations-infants-but-only-just/.
9. Stoddard JJ, Back MR, Brotherton SE. The respective racial and ethnic diversity of US pediatricians and American children. Pediatrics 2000;105:27-31.

Keywords: Pediatrics, Heart Defects, Congenital, Child, Infant, Newborn, Birth Rate, Physicians, Employment, Workplace, Cultural Diversity, Civil Rights

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