Women making gains in medicine but still underrepresented in cardiology

Mentors for women interested in cardiology could help draw more women into the field and help provide support for trainees.

Fewer women in medicine are choosing a career in cardiology, but some of the professional organizations are focusing on ways to attract them to the field.

Women now account for almost half of all medical students, yet women remain a minority group in cardiology, according to several studies. Mentoring and flexible schedules could persuade women to enter the field of cardiology, some suggest.

The U.K. experience

In 2005, the journal Heart published a report by Timmis et al. about women’s experiences in the field of cardiology in the United Kingdom. The researchers found that women outnumbered men in medical school; however, they were underrepresented in cardiology. Only 16.8% of trainees and 7.4% of consultants were women, they wrote. In 2004, the British Cardiac Society (BCS) created a working group to determine if male dominance was detrimental or cause for concern.

Although one study reported that cardiology was the most common specialty chosen by women, other data found that only 17% of cardiology trainees nationwide were women, according to the report. In London, only 8% of trainees were women. The researchers found no evidence of gender discrimination.

The working group found that women were “turned off” by cardiology, the researchers wrote. One reason could be that women witness the long hours associated with cardiology that are not family friendly. The researchers recommended improving flexible training opportunities to attract more women into the field.

There is also interest among women cardiology trainees in part-time consulting work after their training is completed, according to a questionnaire the women completed.

Almost half of the questionnaire respondents reported gender bias on the job, according to the report. However, the researchers found no evidence of gender bias during recruitment to training programs. They also theorized that career prospects for women would improve as more women become consultants in the field.

Women in training and consulting involved in the questionnaire said they would recommend a career in cardiology to another woman contemplating it.

“This led the working group to conclude that despite the gender-related difficulties that many of the respondents reported, it is clear that a career in cardiology can be as fulfilling for women as for men,” Timmis and colleagues wrote.

U.S. statistics

In an accompanying editorial about women in cardiology in the United States, Nanette K. Wenger, MD, professor of medicine in the division of cardiology at Emory University, found that the percentage of women graduating from medical schools in this country increased from 8% to 44% in the past 30 years, and the percentage of female physicians increased from 8% to 25%. Sixty percent of female physicians were younger than 45 in 2001, and 25% were younger than 35.

However, there is still a challenge to increase the number of women in cardiology, Wenger wrote in her editorial.

In 2000, the Association of American Medical Colleges found that women were underrepresented in leadership roles in academia: 11% of women were professors, 19% were associate professors, 50% were assistant professors, 18% were instructors and 2.4% were at other ranks. Nine women were deans, 54 were senior associate deans, 233 were associate deans and 208 were assistant deans, according to Wenger’s editorial.

In 2003, the American College of Cardiology reported that 6% of its fellows were women, but 14% of the affiliates-in-training were women.

The American Board of Internal Medicine reported an increase in women in cardiology from 13% between 1994 and 1995 to 18% between 2002 and 2003. Of these women, 79% were clinical cardiologists, 31% were echocardiographers, 18% were invasive cardiologists, 13% were involved in research, 10% were interventional cardiologists, 9% were electrophysiologists and 4% to 5% were nuclear or transplant cardiologists, according to Wenger. Compared with men, women were more likely to focus on clinical cardiology, echocardiology, transplant cardiology or research.

The American Board of Internal Medicine survey also found that 71% of the women were married compared with 90% of men; 63% had children compared with 88% of men. Thirty percent of women interrupted training and 46% interrupted practice for more than a month, mostly due to pregnancy or childbirth. Twenty percent of men interrupted training, and 13% interrupted practice. Eight percent of women had all childcare provided by a spouse, compared with 50% of men, according to Wenger. In addition, 44% percent of women altered training or practice to minimize occupational radiation risk, and 23% chose a career path that minimized radiation exposure. Seventeen percent of men altered their practice or training to minimize radiation exposure, and 8% chose a career that provided minimized exposure.

Groups take action

The American Heart Association established its Women in Cardiology Committee in 1993 to positively affect the number of women choosing cardiology as a career and to assist in the professional development of these women.

In 1994, the ACC organized its own Women in Cardiology Committee as an ad hoc committee, which then became a standing committee in 1998. Committee goals included increasing recruitment of women into cardiology.

In addition, Women in Thoracic Surgery is a nonprofit organization with 65 members whose goals include mentoring young women and providing the public with information about heart disease in women.

In 2005, both the AHA and the ACC appointed female presidents, Alice Jacobs, MD, and Pamela S. Douglas, MD, respectively.

Wenger said that recruiting women into medicine has been accomplished because half of all medical students are now women; however, she asks what the next steps are to encourage women to focus on cardiology; the environment should be exciting and welcoming for women.

One major finding in the British report included a desire for role models. Women in the workplace would benefit from other women as mentors, the researchers wrote. Women mentors could encourage other women to enter and stay in cardiology training programs, as well as provide independent support and advice to the trainees.

Women working in the field also found that mentors were key.

Marian C. Limacher

“I suspect that having role models provides reassurance that this is a place that a woman can have a productive career and a life outside the hospital as well,” Marian C. Limacher, MD, a professor of medicine at the University of Florida, Gainesville, said.

Limacher, however, said that good role models in general could help women in cardiology. Her role models were men.

“I had excellent role models who never made me feel that I would be treated any differently than my male colleagues,” Limacher said. “That has always been my experience, both in Houston where I trained and in my years at [the University of] Florida.”

The British report added that almost all of the questionnaire respondents were adamant that they would recommend cardiology as a career to other women. Limacher said women working in cardiology in the United States advised the same thing.

“Do it,” she said. “This is fun and fulfilling.”

Wendy Post, MD, associate professor of medicine and epidemiology in the division of cardiology at Johns Hopkins University also advised women to work in the field that most interests them.

“Do what you want to do. You want to be excited, and there are so many paths in cardiology,” she said. – by Lauren Riley

For more information:

• Timmis AD, English KM. Women in cardiology: a UK perspective. Heart. 2005;91:273-274.
• Wenger NK. Women in cardiology: a US perspective. Heart. 2005;91:277-279.