Women in Interventional Cardiology

Interventional cardiology requires extensive training, has unpredictable and long work hours, is physically and mentally demanding, and requires cognitive, technical, and leadership skills. For those that follow the calling, the rewards are immeasurable, improving and saving lives. I do not often think of myself as a minority, but as a female interventional cardiologist, and one of the few women in a leadership position within the field, I am a minority. This position comes with great responsibility—to broadcast the female workforce shortage and highlight the positive impact that women have on our profession and patients. The truth is in the numbers. Little progress has been made with respect to increasing representation of women in interventional cardiology in the past decade. The American Board of Internal Medicine tracks board certification and fellow workforce data annually. Although women still comprise about half of residents completing internal medicine, <40% pursue fellowship training. The number of women pursing cardiology fellowship, the applicant pool for interventional, has been stagnant at 22% since 2007. During this time, however, several fields have had a marked increase in female fellows. In endocrinology, for example, 75% of fellows are women, and >50% of trainees in rheumatology, infectious disease, palliative care, and geriatrics are women. Among cardiology subspecialties, heart failure has the highest percentage of women at 35%. At a glance, it appears that women are choosing specialties with more predicable schedules or that require more compassion, but this may also reflect the mindset of individuals that choose internal medicine. The primary message from these statistics is that we need to reach women at an earlier stage in life, as young as high school but no later than medical school, to expose them to cardiology. My story is similar to many I have heard from my interventional colleagues. I was destined for a surgical residency until one of my medical attendings directed me toward interventional cardiology. So what are the statistics for interventional cardiology? The number of accredited positions for training in interventional cardiology has steadily increased from 169 in 2006 to 292 in 2014. Women have comprised 4% to 10% of fellows in that time period with no increase in the proportion of women since 2009. Doing the math, in 2014, there were 26 female trainees among the 143 US training programs. I am 1 of 6 female program directors and have first-hand experience with the difficulty in recruiting female fellows. At my own institution, I have served as a positive role model and repeatedly encouraged talented women to pursue interventional training to no avail. Every year I receive >130 applications for our 4 positions and, most years, the number of female applicants can be counted on one hand. Despite an effort to interview qualified female candidates, we have only trained 2 women in the past 5 years, or 10%. Most fellows, even those who derive great satisfaction from the cath laboratory, cite the night hours and work–life balance as reasons for not choosing intervention. A study of sex, role models, and specialty choices among graduates of US medical school found that in residencies where women were substantially under-represented, such as neurosurgery, orthopedics, and general surgery, there was no association between exposure to a female department chair or with the proportion of female full-time faculty and specialty choice. Rather, female students were more likely to enter programs with a higher proportion of female residents. This suggests that role models close in age are more relatable and that current female trainees and recent graduates should be engaged in the effort to attract more women into the field. After interventional fellowship, differences exist in the practice patterns of women and men. As a high-volume operator at an academic medical center, I was initially surprised by the findings of an analysis from the National Cardiovascular Data Registry of percutaneous coronary intervention. Among ≈2.5 million percutaneous coronary interventions performed at 1431 hospitals between 2009 and 2013, only 4.5% of operators were women and they performed 3% of procedures. Reflecting back to the statistics in fellowship, the fact that only 36% of hospitals had at least 1 female operator is really not surprising. The study also found that female operators performed a lower median number of percutaneous coronary interventions per year, 48 compared with 69. This difference and the overall low procedural numbers for all operators require further assessment. Perhaps, the difference is because of the younger age of female operators influencing scheduled laboratory time or referrals, the type of practices women chose, less than full-time employment status or career interruptions, or the potential that percutaneous coronary interventions are being performed at Veterans Administration hospitals that are not captured in NCDR. Equally disturbing as the low procedural numbers is the fact that after adjustment for the amount and type of work performed, women in cardiology are compensated significantly less than men. Although (Circ Cardiovasc Interv. 2016;9:e004323. DOI: 10.1161/CIRCINTERVENTIONS.116.004323.) © 2016 American Heart Association, Inc.