Women cardiologists report maternity leave disparities, high pregnancy complication rates
More than half of women cardiologists report pregnancy had an adverse career impact, with most respondents describing troubling or potentially illegal practices, including extra service requirements or a salary decrease, survey data show.
The survey of more than 300 women cardiologists, which the researchers described as the first survey to examine experiences and policies specific to pregnancy and maternity leave in cardiology, also revealed significant health concerns, including 36.5% of women experiencing pregnancy complications, a rate that is much higher than the general population.
“As a former chief of cardiology, I can say that it is very hard to hire women,” Martha Gulati, MD, MS, FACC, FAHA, president-elect of the American Society for Preventive Cardiology, told Healio. “Sometimes, the biggest reasons were related to these issues around pregnancy and maternity leave. I wanted to know more about why it is hard to hire and retain women cardiologists and if this is why our numbers are not growing in cardiology. If these are problems women are facing in practice, it should be no surprise we lose women at different points in their career.”
Assessing survey data
The researchers analyzed survey data from 323 women cardiologists who responded to questions about their experiences while pregnant and on maternity leave, sent through the American College of Cardiology Women in Cardiology section e-mail list management software; Women As One also sent the survey to its membership. The anonymous survey sought to examine the impact of pregnancy and motherhood on women cardiologists in the workplace. There were 16 questions and two open sections for comments. Attorney co-authors analyzed each free-text entry to determine whether the respondent indicated employer actions that were potentially in violation of the Family and Medical Leave Act (FMLA) of 1993 and/or antidiscrimination laws.
Among respondents, 48.3% reported working in academic settings when pregnant. Most pregnancies occurred less than 5 years before taking the survey.
Among respondents who had been pregnant as a practicing cardiologist, 37.2% reported requirements for an extra service or call before maternity leave. Of those who performed extra service or call, 17.5% were placed on bedrest before delivery, compared with 7.4% who did not perform extra service or call (P = .005).
“We need to rethink this and say, ‘Is this a good idea?’” Gulati told Healio. “This idea that, because you have taken maternity leave, somehow you must ‘pay back’ that time. We need to get rid of that thought practice. I do not mean to imply that we should just throw the burden on other people. But let’s not think of it as ‘coverage.’ Should we hire locums for coverage for those months of maternity leave? Let’s think about that as a policy.”
During the year of pregnancy, 41.2% experienced a salary decrease; only 7.4% had their relative value units prorated for time on maternity leave; 23.2% had no paid maternity leave.
Self-reported pregnancy complications occurred in 36.5% of respondents and those with complications had a 60% greater chance of reporting that pregnancy adversely affected their career compared with those without complications. Nearly three-fourths of respondents reported experiences that legal scholars deemed troubling or possibly illegal, according to the researchers.
“What we don’t always realize is how much we accept in medicine — going with the flow — a lawyer would look at and say that these are troubling and potentially illegal practices,” Gulati told Healio.
More than half of survey respondents reported that pregnancy adversely impacted their career; comments indicated 42.4% reported experiencing external pressures and even “outright discrimination” that negatively impacted their careers. One survey respondent described being told her promotion was delayed due to pregnancy.
Gulati said she hoped that data could be helpful for effecting change, particularly for private practice cardiologists.
“We hear these stories in our community, but it is good for us to quantify it,” Gulati said. “In academic institutions, we are more protected under FMLA and Title IX; however, in private practice, which is where most cardiologists are, there are different issues they are dealing with. Quantifying these data in this way will be helpful for our community as we try to create a level playing field and create a community that is welcoming to men and women.”
‘Egregious’ violation of policies
In a related editorial, Cardiology Today Editorial Board Member Laxmi S. Mehta, MD, FACC, FAHA, FNLA, a professor of medicine and the Sarah Ross Soter Endowed Chair in Women’s Cardiovascular Health at the Ohio State University Wexner Medical Center, and colleagues wrote the data reveal an “egregious violation of policies” that have important policy implications.
“These findings reveal restrictive maternity leave data in a profession that has historically and currently continues to have a diversity problem,” Mehta and colleagues wrote. “These findings implore us to systematically analyze institutional policies and leadership competencies. Furthermore, this is an opportunity for professional science organizations to sanction health policy and professionalism documents that can provide employers and institutions guidance regarding best practices on professionalism and promoting clinician well-being. Leadership that condones these restrictive policies or even promotes them through ignorance and inaction needs to be held accountable.”
Reference:
Mehta LS, et al. J Am Coll Cardiol. 2022;doi:10.1016/j.jacc.2021.12.035.
For more information:
Martha Gulati, MD, MS, FACC, FAHA, can be reached at martha.gulati@gmail.com; Twitter: @drmarthagulati.
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