Women in CV fellowships on the rise; not so among other underrepresented groups
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Key takeaways:
- The proportion of women in cardiology fellowships improved significantly since 2008.
- Representation of Black and Hispanic individuals was unchanged since 2012, but trends in recent years show improvement.
Representation of women in CV fellowships has significantly improved in the past decade, whereas Black and Hispanic representation remained stagnant, but recent trends may indicate improvement on the horizon, researchers reported.
“Both male and female internal medicine residents are deterred from a cardiology career by perceptions of adverse job conditions, lack of diversity and negative impacts on family life,” Sarah C. Snow, MD, fellow with advanced training in cardiology at Duke University School of Medicine, and colleagues wrote. “To determine the impact of recent efforts to create a more diverse cardiology workforce, we examined changes in the representation of women and underrepresented in medicine individuals in CVD and CV subspecialty fellowships over time.”
Image: Adobe Stock
Using publicly available data from the Accreditation Council for Graduate Medical Education, Snow and colleagues evaluated data from 2008 to 2022 for all residents, internal medicine residents, general surgery residents and fellows in CVD and CV subspecialty fellowships.
Data regarding sex, race and ethnicity were manually extracted and Mann-Kendall tests were used to determine trends over time.
The results were published in JAMA Cardiology.
Representation of women in CV fellowships
From 2008 to 2022, the proportion of women trainees increased from 40.5% to 46.8% in all residencies (P < .001), 27.4% to 45.2% in general surgery (P < .001) and 36.7% to 43.8% in internal medicine (P < .001).
The proportion of women among CVD trainees increased from 17.6% in 2008 to 25.5% in 2022 (P = .001) and increased from 6.3% in 2008 to 20.1% in 2022 among interventional cardiology fellows (P = .002).
In addition, from 2008 to 2022, the proportion of women among general surgery trainees increased from 27.4% to 45.2% (P < .001), according to the study.
Among the CV subspecialties, women had the highest representation in adult congenital heart disease (41.2%) and HF (35.6%), which remined stable through 2022.
“Although the increases in women trainees were significant, providing hope for continued improvement, they lag well behind the percentages of women trainees in all residencies, internal medicine and general surgery that are now above 40%,” the researchers wrote. “The increase in women trainees in interventional cardiology provides hope that efforts to mitigate some of these barriers are being successful. Interestingly, women interventional cardiology trainees identified barriers to selecting electrophysiology lack of women role models, perceived ‘old boys club’ nature and gender discrimination, suggesting that these barriers in electrophysiology, rather than additional training duration or procedure complexity, require continued attention.”
Black and Hispanic representation
The proportion of Black and Hispanic trainees in internal medicine increased from 8.6% (P < .001) while increases in general surgery were not statistically significant (9.7% to 16.1%; P = .35). There were also important increases in the percentages of Black and Hispanic trainees in CVD (from 8.3% in 2012; P = .09) and interventional cardiology (3.8% to 13.4%; P = .12).
Additionally, the proportion of all residents, general surgery, internal medicine and CVD trainees who were Black or Hispanic were similar in 2012 — when such data were made available — between 8.3% and 9.7%.
From 2012 to 2022, the proportion of Black or Hispanic representation increased to 15.2% for all residencies and increased to 15.6% in internal medicine (P for all < .001).
Although the researchers observed no significant change in Black or Hispanic representation in general surgery (P = .35), CVD (P = .09) or interventional cardiology (P = .12) from 2012 to 2022, they reported a recent positive trend in all three categories.
Moreover, trainees in adults congenital heart disease, HF and electrophysiology had the lowest proportion of Black or Hispanic representation in 2022, which did not significantly change over time.
“Representation of underrepresented in medicine individuals is low across all residencies, especially among Black men and in comparison with percentages of these groups in the U.S. population,” the researchers wrote. “Concerted efforts by professional societies and program leadership, as well as accessibility to role models, have likely contributed to these positive changes for women and underrepresented in medicine (individuals). ... Cardiology must learn from internal medicine and procedural specialties with admirable progress, like general surgery, where holistic review by programs and longitudinal mentoring during medical school have been the most effective interventions to increase women and [underrepresented in medicine] representation.”
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