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Report: Workplace improvements needed for childbearing cardiologists
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Maternity leave, radiation exposure and breast-feeding accommodations were among the issues raised by a survey of cardiologists on family planning matters.
A report on the survey from the American College of Cardiology Women in Cardiology Leadership Council concluded that, “Given that most female cardiologists are pregnant at some point during their careers, particularly during the vulnerable periods of training and early career, improving the experience of pregnancy and early parenthood for all cardiologists may secure the best possible candidates to the field of cardiology.”
The council sent a voluntary online anonymous survey to 5,005 email addresses of female physician members of the ACC, and received 501 responses (41% aged 30-40 years; 64% white).
Among respondents, 76% had experienced at least one pregnancy and 45% of those who had never been pregnant said they hoped to be in the future.
Most pregnancies occurred during cardiology fellowship or early career, and 43% of respondents reported they had been asked in at least one interview whether they intended to have children. The question was asked more often to women in practice than women in training (45% vs. 33%; P = .051), and those older than 50 years reported having been asked it as often as those younger than 50 years (43% vs. 45%; P = .67), “suggesting that the incidence of this question has not changed over time,” Amy A. Sarma, MD, MHS, from the department of cardiology at Massachusetts General Hospital, and colleagues wrote. “The prevalence of this question raises important questions as to why interviewers so commonly inquire about family planning and whether it influences women’s choices regarding positions.”
Assistive technologies
Of those reporting at least one pregnancy, 19% used assistive reproductive technologies, much higher than the 2% rate in the general population; it was more common in those younger than 50 years than in those older than 50 years (24% vs. 9%; P = .001). This could reflect a high level of infertility due to delayed childbearing or career characteristics, or a higher level of use because of increased awareness of and access to treatments, Sarma and colleagues wrote.
Of those who had been pregnant, 40% reported a pregnancy-related complication, including 12% with at least one miscarriage, according to the authors.
Although 47% of respondents reported trying to avoid pregnancy during periods of radiation exposure, 57% reported being exposed to radiation while pregnant. Those younger than 50 years were more likely to have avoided pregnancy during periods of radiation exposure than those older than 50 years (50% vs. 39%; P = .03).
Maternity leave
Women younger than 50 years had longer maternity leaves than women older than 50 years (P < .0001), but 51% of respondents reported feeling pressure to take a shorter maternity leave than that available. This response did not differ by age (P = .22) but was more common for women in training than women in practice (60% vs. 50%; P = .04), Sarma and colleagues wrote.
Although 92% of cardiologists who gave birth initiated breast-feeding, only 46% continued it beyond 6 months. “In light of these findings, it is not surprising that only 32% of women reported that they did not experience barriers to breast-feeding,” the authors wrote.
Only 10% of respondents reported that their career did not influence their family planning, and 58% of those who chose not to become pregnant stated their career was a factor in that decision.
“Strategies to improve the experience of pregnancy among female cardiologists are likely to improve the experience of most women in cardiology and, in doing so, will hopefully attract more women to the field,” Sarma and colleagues wrote. “Thus, further research into optimal strategies to improve the experience of pregnancy among cardiologists is warranted.” – by Erik Swain
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Pamela S. Douglas, MD
One finding that struck me was the prevalence of pregnancy complications and the widespread need for assistive reproductive technology among women in cardiology. I was also struck by how the system does not encourage female cardiologists seeking to have children, especially with 43% of women being asked during job interviews ill-advised questions about their intent to have children. I was also struck by how incredibly common it is for women in cardiology not to use appropriate technologies for radiation reduction and monitoring when pregnant, in contrast with radiation oncologists. Also of interest was that a lot of women who had babies did not know what their organization’s maternity or paternity leave policies are. Although each of these items is small in isolation, in aggregate it appears that our profession does not do an optimal job in supporting women cardiologists in having and raising families, a normal aspect of human life.
This is the first time that questions about pregnancy in cardiologists have been asked, so we don’t have a benchmark or pathway to help improve the situation. The ACC’s Professional Life Survey conducted every 10 years has asked what proportion of female cardiologists have children, and that has increased from 63% in 1996 to 72% in 2015. That’s better, but it’s still a high percentage without children. There is something about our profession that either selects for women who don’t want to have children, or makes it prohibitively difficult.
The ACC has recently convened a diversity task force whose goal is to make sure we are able to recruit and retain all available talent in cardiology. Right now, internal medicine residents are about 45% to 50% female, and cardiology fellowships are about 20% female, which means there’s a significant sex-specific difference in those choosing the cardiology profession. The ACC task force will address that gap and make recommendations to ensure that we are welcoming to all, and that our profession benefits from a diversity of backgrounds, experiences and perspectives. As one example, in the 2015 ACC Professional Life Survey, 65% of female respondents reported experiencing discrimination. That’s a legitimate deterrent for female internal medicine residents to choose cardiology, and a point of dissatisfaction for women already in the profession. It’s something we need to fix.
Having data like these help us to better understand the experiences of women in cardiology and can go a long way toward helping us make the profession a welcoming workplace for both men and women.
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