- Email: [email protected]
Women in cardiology practice in a “man's world”
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MODEL
Hellenic Society of Cardiology (2017) xx, 1e2
Available online at www.sciencedirect.com
ScienceDirect journal homepage: http://www.journals.elsevier.com/ hellenic-journal-of-cardiology/
PRESIDENT’S PAGE
Women in cardiology practice in a “man’s world” In a so-called “man’s world,” it can sometimes be challenging for a woman to manage a medical career, considering the great number of obstacles she has to face and overcome at her workplace. Although the number of female physicians in high-demanded specialties, such as surgery, internal medicine, and cardiology, is increasing, the gap persists. Nowadays, women occupy about 30% of US physician positions and 50% of the students entering Medical Schools in the US, with a similar ratio applying to internal medicine residency. Nonetheless, this number is reduced in cardiology as it remains a male-dominated specialty. The absence of sex diversity in the workforce is surprising, with current data indicating that only 12% of female physicians choose a career in cardiology. This percentage drops further in subspecialties such as interventional cardiology and electrophysiology, dashing our hopes that this number might increase in the future.1e3 It seems that women are more likely to function as clinical cardiologists (79%) and echocardiographers (31%) than interventional cardiologists (10%), electrophysiologists (9%), or transplant cardiologists (4-5%), and surprisingly, only 13% of them are in research.4 Female cardiologists face many challenges that discourage them from pursuing this specialty and more interventional careers. The most commonly reported barriers are failure in family planning, poor workelife balance in a field in which on-call duties can be frequent and demanding, gender discrimination, and radiation risks.1,2 It is impressive that women cardiologists are less likely to be married or have children compared to men. They pursue their career and deal with family later. Indeed, only 71% get married (compared with 90% of men) and 63% have children (compared with 88% of men).2 It can be inferred that family responsibilities prevent women cardiologists’ effort to pursue a professional career in medicine, and thus, they postpone having children because of the demanding/competitive nature of this specialty. Although a Peer review under responsibility of Hellenic Society of Cardiology.
fellowship does not last forever, it still continues to pose a significant deterrent for many female medical residents who decide to wait until they are no longer on call every other night before even thinking about becoming pregnant.3,5 The problem of radiation is not insignificant. Nevertheless, the Society for Cardiovascular Angiography and Interventions (SCAI) announced that radiation in the laboratory does not affect pregnancy outcomes. Thus, it becomes evident that pregnant physicians should not be excluded from participating in the laboratory.2 It can be argued that female cardiologists make less money than their male colleagues because of their underrepresentation in higher paying procedural subspecialties. Their inability to participate in full-time schedules may also reflect their failure to negotiate as combatively as men.2,3 Although women are well represented in early career stages, only few of them become full professors (5%) compared with men (19%), suggesting a paucity of women in academic cardiology. The sex bias may play a role in that. The less obvious barrier is the absence of strong female role models that can guide and provide leadership aspirations.2,6 To further understand gender disparity in the academic community, Moss-Racusin et al. performed an experiment that revealed the preference of science faculty members to hire a male student to work in their laboratory compared to an equally qualified female one. It is noteworthy that they evaluated the male applicant as more competent, and they were also willing to offer a higher starting salary and a greater amount of career mentoring.6,7 In 2014, Boehm et al. to compared publication performance in the field of cardiology between men and women, and they reported higher success of female than male physicians. Nevertheless, only 25% of conference abstracts were submitted by women, indicating their underrepresentation to top leadership positions.6 In 1996, and again in 2006, the American College of Cardiology (ACC) conducted two Professional Life Surveys to investigate differences and similarities between female
http://dx.doi.org/10.1016/j.hjc.2017.05.011 1109-9666/ª 2017 Hellenic Society of Cardiology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Tsioufis C, Women in cardiology practice in a “man’s world”, Hellenic Society of Cardiology (2017), http://dx.doi.org/10.1016/j.hjc.2017.05.011
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MODEL
2 and male cardiologists. These surveys revealed that women are less likely to be married or have children, practice interventional cardiology, and pursue career development and higher salaries.1 These observations have been discussed on multiple occasions during the past decades. The American Heart Association (AHA), the American College of Cardiology (ACC), and the European Society of Cardiology (ESC) have women in their Cardiology Councils, which were charged to enhance the professional advancement of women cardiologists and positively impact the number of female physicians choosing this specialty as a career. Their goal is to promote successful clinical and research careers among female physicians.2,4 In addition, the AHA also offers the annual Women in Cardiology Trainee Award for Excellence and has multiple programs to help recruit female physicians into cardiology, e.g., online mentorship programs, visiting female professor programs, and networking opportunities at scientific meetings. However, the exact impact of these efforts is unknown yet.2,3 It is crucial to demonstrate the possibility of cardiology as a career choice to female college students and internal medicine trainees early during their education/training. It becomes evident that they should also be informed of the broad range of possible career options within cardiology.5 It is noteworthy that there are studies suggesting that male and female physicians may show differences in practicing medicine8; it has been reported that female physicians may be more likely to adhere to clinical guidelines, provide preventive care, use more patient-centered communication, show high performance in standardized examinations, and provide more psychosocial counseling to their patients than their male peers. To date, there is no evidence indicating whether these differences may affect patient outcome. A recent cross-sectional study examining US nationally representative data9 of hospitalized Medicare elderly beneficiaries investigated the potential difference in patient outcomes according to the gender of their internist. In a total of 1,583,028 hospitalizations of patients of age 80.2 years, the 1-month rate of readmission and mortality was lower in those treated by a women internist, after adjustments for several cofounders, including clinical characteristics of the patients, length of stay, medication treatment, physicians’ characteristics (age and years of practicing medicine), and primary medical condition of the patients at admission. Accordingly, patients cared for by female physicians had lower 30-day mortality than those treated by male physicians (10.82% vs. 11.49%; P < .001; number needed to treat [NNT] to prevent 1 death, 149). However, additional adjustment for physician’s characteristics showed a limited effect on the aforementioned results (female physicians, 11.07% vs. male physicians, 11.49%; P < .001; NNT, 233).10 The landscape is slowly changing for women, and in some cases, it would seem that maximizing opportunities is a matter of personality rather than gender. However, women are still perceived differently as most of the times it seems difficult to balance career and family responsibilities in a “man’s world.” Nowadays, as job promotion and
President’s page recognition is based on achievements, excellence, and team work, female physicians should have the same opportunities irrespective of their gender. In the field of patient outcomes, understanding exactly why the previously mentioned differences in care quality and practice patterns exist may provide valuable insights into improving the quality of care for all patients, irrespective of who provides their care. All female physicians need to perceive the internal and external deterrents that prevent them from setting higher professional targets and work on overcoming them. Many women cardiologists have proved that they can indeed have it alldfamily, career, academic cardiology, and even leisure timedand that with great effort on their part, they can all be balanced well. Therefore, collaboration from life partners, efficient time management, and setting appropriate expectations is required.3
References 1. Jagsi R, Biga C, Poppas A, et al. Work activities and compensation of male and female cardiologists. J Am Coll Cardiol. 2016;67(5):529e541. 2. Oza NM, Breathett K. Women in cardiology: fellows’ perspective. J Am Coll Cardiol. 2015;65(9):951e953. 3. Sanghavi M. Women in cardiology: introspection into the underrepresentation. Circ Cardiovasc Qual Outcomes. 2014;7(1): 188e190. 4. Wenger NK. Women in cardiology: the US experience. Heart. 2005;91(3):277e279. 5. Warnes CA, Fedson SE, Foster E, et al. Working group 2: How to encourage more women to choose a career in cardiology. J Am Coll Cardiol. 2004;44(2):238e241. 6. Weismann CG, Colson ER, Shapiro ED. Letter to the Editor in response to “publication performance of women compared to men in German cardiology” by Boehm et al. (2014). Int J Cardiol. 2015;182:227e228. 7. Moss-Racusin CA, Dovidio JF, Brescoll VL, Graham MJ, Handelsman J. Science faculty’s subtle gender biases favor male students. Proc Natl Acad Sci U S A. 2012;109(41): 16474e16479. 8. Baumha ¨kel M, Mu ¨hm M. Influence of gender of phy¨ller U, Bo sicians and patients on guideline-recommended treatment of chronic heart failure in a cross-sectional study. Eur J Heart Fail. 2009;11(3):299e303. 9. Tsugawa Y, Jena AB, Figueroa JF, Orav J, Blumenthal M. Comparison of hospital mortality and readmission rates for medicare patients treated by male vs women physicians. JAMA Intern Med. 2017 Feb 1;177(2):206e213. 10. Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication: ameta-analytic review. JAMA. 2002;288(6): 756e764.
Costas Tsioufis, Associate Professor of Cardiology, President of Hellenic Society of Cardiology, Medical School, National and Kapodistrian University of Athens, Greece E-mail address: [email protected] 24 May 2017
Please cite this article in press as: Tsioufis C, Women in cardiology practice in a “man’s world”, Hellenic Society of Cardiology (2017), http://dx.doi.org/10.1016/j.hjc.2017.05.011
MODEL
Hellenic Society of Cardiology (2017) xx, 1e2
Available online at www.sciencedirect.com
ScienceDirect journal homepage: http://www.journals.elsevier.com/ hellenic-journal-of-cardiology/
PRESIDENT’S PAGE
Women in cardiology practice in a “man’s world” In a so-called “man’s world,” it can sometimes be challenging for a woman to manage a medical career, considering the great number of obstacles she has to face and overcome at her workplace. Although the number of female physicians in high-demanded specialties, such as surgery, internal medicine, and cardiology, is increasing, the gap persists. Nowadays, women occupy about 30% of US physician positions and 50% of the students entering Medical Schools in the US, with a similar ratio applying to internal medicine residency. Nonetheless, this number is reduced in cardiology as it remains a male-dominated specialty. The absence of sex diversity in the workforce is surprising, with current data indicating that only 12% of female physicians choose a career in cardiology. This percentage drops further in subspecialties such as interventional cardiology and electrophysiology, dashing our hopes that this number might increase in the future.1e3 It seems that women are more likely to function as clinical cardiologists (79%) and echocardiographers (31%) than interventional cardiologists (10%), electrophysiologists (9%), or transplant cardiologists (4-5%), and surprisingly, only 13% of them are in research.4 Female cardiologists face many challenges that discourage them from pursuing this specialty and more interventional careers. The most commonly reported barriers are failure in family planning, poor workelife balance in a field in which on-call duties can be frequent and demanding, gender discrimination, and radiation risks.1,2 It is impressive that women cardiologists are less likely to be married or have children compared to men. They pursue their career and deal with family later. Indeed, only 71% get married (compared with 90% of men) and 63% have children (compared with 88% of men).2 It can be inferred that family responsibilities prevent women cardiologists’ effort to pursue a professional career in medicine, and thus, they postpone having children because of the demanding/competitive nature of this specialty. Although a Peer review under responsibility of Hellenic Society of Cardiology.
fellowship does not last forever, it still continues to pose a significant deterrent for many female medical residents who decide to wait until they are no longer on call every other night before even thinking about becoming pregnant.3,5 The problem of radiation is not insignificant. Nevertheless, the Society for Cardiovascular Angiography and Interventions (SCAI) announced that radiation in the laboratory does not affect pregnancy outcomes. Thus, it becomes evident that pregnant physicians should not be excluded from participating in the laboratory.2 It can be argued that female cardiologists make less money than their male colleagues because of their underrepresentation in higher paying procedural subspecialties. Their inability to participate in full-time schedules may also reflect their failure to negotiate as combatively as men.2,3 Although women are well represented in early career stages, only few of them become full professors (5%) compared with men (19%), suggesting a paucity of women in academic cardiology. The sex bias may play a role in that. The less obvious barrier is the absence of strong female role models that can guide and provide leadership aspirations.2,6 To further understand gender disparity in the academic community, Moss-Racusin et al. performed an experiment that revealed the preference of science faculty members to hire a male student to work in their laboratory compared to an equally qualified female one. It is noteworthy that they evaluated the male applicant as more competent, and they were also willing to offer a higher starting salary and a greater amount of career mentoring.6,7 In 2014, Boehm et al. to compared publication performance in the field of cardiology between men and women, and they reported higher success of female than male physicians. Nevertheless, only 25% of conference abstracts were submitted by women, indicating their underrepresentation to top leadership positions.6 In 1996, and again in 2006, the American College of Cardiology (ACC) conducted two Professional Life Surveys to investigate differences and similarities between female
http://dx.doi.org/10.1016/j.hjc.2017.05.011 1109-9666/ª 2017 Hellenic Society of Cardiology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Tsioufis C, Women in cardiology practice in a “man’s world”, Hellenic Society of Cardiology (2017), http://dx.doi.org/10.1016/j.hjc.2017.05.011
+
MODEL
2 and male cardiologists. These surveys revealed that women are less likely to be married or have children, practice interventional cardiology, and pursue career development and higher salaries.1 These observations have been discussed on multiple occasions during the past decades. The American Heart Association (AHA), the American College of Cardiology (ACC), and the European Society of Cardiology (ESC) have women in their Cardiology Councils, which were charged to enhance the professional advancement of women cardiologists and positively impact the number of female physicians choosing this specialty as a career. Their goal is to promote successful clinical and research careers among female physicians.2,4 In addition, the AHA also offers the annual Women in Cardiology Trainee Award for Excellence and has multiple programs to help recruit female physicians into cardiology, e.g., online mentorship programs, visiting female professor programs, and networking opportunities at scientific meetings. However, the exact impact of these efforts is unknown yet.2,3 It is crucial to demonstrate the possibility of cardiology as a career choice to female college students and internal medicine trainees early during their education/training. It becomes evident that they should also be informed of the broad range of possible career options within cardiology.5 It is noteworthy that there are studies suggesting that male and female physicians may show differences in practicing medicine8; it has been reported that female physicians may be more likely to adhere to clinical guidelines, provide preventive care, use more patient-centered communication, show high performance in standardized examinations, and provide more psychosocial counseling to their patients than their male peers. To date, there is no evidence indicating whether these differences may affect patient outcome. A recent cross-sectional study examining US nationally representative data9 of hospitalized Medicare elderly beneficiaries investigated the potential difference in patient outcomes according to the gender of their internist. In a total of 1,583,028 hospitalizations of patients of age 80.2 years, the 1-month rate of readmission and mortality was lower in those treated by a women internist, after adjustments for several cofounders, including clinical characteristics of the patients, length of stay, medication treatment, physicians’ characteristics (age and years of practicing medicine), and primary medical condition of the patients at admission. Accordingly, patients cared for by female physicians had lower 30-day mortality than those treated by male physicians (10.82% vs. 11.49%; P < .001; number needed to treat [NNT] to prevent 1 death, 149). However, additional adjustment for physician’s characteristics showed a limited effect on the aforementioned results (female physicians, 11.07% vs. male physicians, 11.49%; P < .001; NNT, 233).10 The landscape is slowly changing for women, and in some cases, it would seem that maximizing opportunities is a matter of personality rather than gender. However, women are still perceived differently as most of the times it seems difficult to balance career and family responsibilities in a “man’s world.” Nowadays, as job promotion and
President’s page recognition is based on achievements, excellence, and team work, female physicians should have the same opportunities irrespective of their gender. In the field of patient outcomes, understanding exactly why the previously mentioned differences in care quality and practice patterns exist may provide valuable insights into improving the quality of care for all patients, irrespective of who provides their care. All female physicians need to perceive the internal and external deterrents that prevent them from setting higher professional targets and work on overcoming them. Many women cardiologists have proved that they can indeed have it alldfamily, career, academic cardiology, and even leisure timedand that with great effort on their part, they can all be balanced well. Therefore, collaboration from life partners, efficient time management, and setting appropriate expectations is required.3
References 1. Jagsi R, Biga C, Poppas A, et al. Work activities and compensation of male and female cardiologists. J Am Coll Cardiol. 2016;67(5):529e541. 2. Oza NM, Breathett K. Women in cardiology: fellows’ perspective. J Am Coll Cardiol. 2015;65(9):951e953. 3. Sanghavi M. Women in cardiology: introspection into the underrepresentation. Circ Cardiovasc Qual Outcomes. 2014;7(1): 188e190. 4. Wenger NK. Women in cardiology: the US experience. Heart. 2005;91(3):277e279. 5. Warnes CA, Fedson SE, Foster E, et al. Working group 2: How to encourage more women to choose a career in cardiology. J Am Coll Cardiol. 2004;44(2):238e241. 6. Weismann CG, Colson ER, Shapiro ED. Letter to the Editor in response to “publication performance of women compared to men in German cardiology” by Boehm et al. (2014). Int J Cardiol. 2015;182:227e228. 7. Moss-Racusin CA, Dovidio JF, Brescoll VL, Graham MJ, Handelsman J. Science faculty’s subtle gender biases favor male students. Proc Natl Acad Sci U S A. 2012;109(41): 16474e16479. 8. Baumha ¨kel M, Mu ¨hm M. Influence of gender of phy¨ller U, Bo sicians and patients on guideline-recommended treatment of chronic heart failure in a cross-sectional study. Eur J Heart Fail. 2009;11(3):299e303. 9. Tsugawa Y, Jena AB, Figueroa JF, Orav J, Blumenthal M. Comparison of hospital mortality and readmission rates for medicare patients treated by male vs women physicians. JAMA Intern Med. 2017 Feb 1;177(2):206e213. 10. Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication: ameta-analytic review. JAMA. 2002;288(6): 756e764.
Costas Tsioufis, Associate Professor of Cardiology, President of Hellenic Society of Cardiology, Medical School, National and Kapodistrian University of Athens, Greece E-mail address: [email protected] 24 May 2017
Please cite this article in press as: Tsioufis C, Women in cardiology practice in a “man’s world”, Hellenic Society of Cardiology (2017), http://dx.doi.org/10.1016/j.hjc.2017.05.011