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Interventional Cardiology: Few Women Pursue This Gratifying Career
Being accepted. That was my biggest concern as I embarked upon my career as an interventional cardiologist. I was confident that I could do the work, but I was less sure of how or if patients and colleagues would accept a woman in a male-dominated profession.
Being a woman in the subspecialty of interventional cardiology makes me part of a relatively exclusive group. Within the United States, only 18% of cardiologists are women. That percentage drops significantly when looking at the interventional cardiology profession, where women account for only 5.9% of physicians within the subspecialty, according to the Society for Cardiovascular Angiography and Interventions’ Women in Innovations (WIN) group.
As I progressed into my career, being accepted wasn’t as big of an obstacle as I expected. Patients freely accepted me as their physician and were happy that someone was working to help them resolve their health issues. As for my colleagues, the fact that I am a woman was rarely an issue, and they readily accepted me.
Remaining Hurdles
Cindy L. Grines
However, there were still other obstacles necessary for me to overcome. For instance, you don’t see many female physicians in the cardiac cath lab, and there are many good reasons for that. Being an interventional cardiologist is tremendously demanding in terms of the physical and emotional toll it takes on physicians. Plus, being on call to perform procedures disrupts any sort of work/life balance that physicians strive to achieve. These demands apply to all interventional cardiologists, whether they are male or female.
Women, however, have additional concerns than their male counterparts, such as motherhood for the women who choose to have children. Most women are 32 or 33 years old when they land their first job in the profession after years of formal education and training. During those prime childbearing years, female physicians often feel forced to choose between starting a family and pursuing their careers. Some opt to postpone starting their families, while others choose a different medical career. Timing, it seems, is a factor that drives some women away from careers in interventional cardiology.
Additionally, the effects of chronic radiation exposure from fluoroscopy during procedures is another major concern for women who may be pregnant and fear the potential exposure of their fetus to radiation. This is a legitimate concern, but there are effective measures to prevent exposure, such as using lead aprons, sleeves and other protective gear. I continued performing procedures through both of my pregnancies, taking special precautions to shield my abdomen from radiation exposure. As is standard, I wore a radiation dosimeter on my waistband, and it indicated that my exposure remained at safe levels during my pregnancies.
Although the lead aprons and other shielding are important, they are heavy, awkward and fatiguing. The shielding adds to the physical demands of being an interventional cardiologist. The constant need to bend over patients during procedures while standing is not only fatiguing, but can also lead to chronic orthopedic neck and back injuries among interventional cardiologists. The increased incidence of these injuries within the profession has been well documented in numerous medical journals.
Technological Advancements
Fortunately, new innovations are being introduced into the cath lab that reduce radiation exposure and the physical demand of the profession. One such innovation is vascular robotic systems for PCI procedures, a technology that I use in my practice. Robotic-assisted systems, such as CorPath (Corindus Vascular Robotics), allow physicians to perform procedures from behind a control console, or “cockpit,” instead of being next to the patient during the procedure. The cockpit contains displays to visualize the procedure, and digital controls for the physician to control the movement of the interventional devices by bedside-mounted robotic arm.
There are multiple benefits to using a robotic-assisted system. The systems allow for sub-millimeter movements to place stents and balloons, and can advance or retract guidewires with movements as small as a millimeter. The increased precision is a welcomed addition in all PCI procedures, whether performed by men or women, and is especially beneficial in situations when blood vessel branches have particularly sharp angles or when there is a tight stenosis.
Additionally, I’ve found that performing PCI procedures from the cockpit also reduces the physical fatigue from standing and leaning over the patient during the procedure. The cockpit’s radiation shielding eliminates the need for physicians to wear the heavy and cumbersome lead aprons used in traditional PCI procedures to protect themselves from radiation exposure. Also, the cockpit’s placement itself provides radiation protection, since it is positioned several feet away from the patient and the fluoroscopy unit.
For women, the introduction of robotic-assisted technology eliminates the concerns about radiation exposure that can affect pregnancy, and the systems reduce the physical demands of the profession that are obstacles for both men and women.
Cindy L. Grines, MD, at the control console of a vascular robotic system for PCI procedures. According to Grines, robotic-assisted PCI helps to increase the precision of stent and balloon placement while reducing physical fatigue and exposure to radiation.
Photo courtesy of Corindus
How and Why
Considering all of the challenges for a woman to become an interventional cardiologist, many may wonder why I chose to pursue the profession. For me, the decision was simple and driven by my passion for the profession. After spending so many years in school and training, I knew I had to put my skills to use doing something that I love, and that love was — and is — interventional cardiology.
For women who are considering a career in interventional cardiology, all of the challenges that I’ve mentioned so far can be overcome, and I’m proof of that. The biggest challenge that an interventional cardiologist will encounter — whether they are male or female — will be achieving some type of work/life balance. In this profession, physicians are often on call to perform procedures, which certainly disrupts family life. But these disruptions can be managed. It’s important to be selective about where you work. The workplace must be supportive of your efforts to balance your personal and professional needs, such as equally distributing on-call duties and allowing for personal time away from the practice. Also, having a supportive family —whether a spouse or an extended family — certainly helps with attaining a work/life balance.
Today, after more than 2 decades in the profession, I still find my work tremendously gratifying. The impact I am able to have on my patients and their families’ lives is inspiring. As I look ahead at my career and what’s to come in this field, I am excited about the prospect of how new procedures and technology can advance the effectiveness of what we do to help our patients.