January 9, 2023
By Kamil Evy Bantol, Drexel University College of Medicine

If you have gone through the medical education and residency application process, one of the biggest selling points of each program is their dedication to diversity and inclusion — diversity not just in their patient population, but also in recruiting a class that is diverse in age, sex, race/ethnicity and life experiences. Looking at medical school class profiles show that this initiative has mostly been successful. Drexel University College of Medicine’s most recent matriculating class (the class of 2026), for example, boasts a group comprising 59% female students. This is reflected nationally, with women comprising over half of entering medical students, recent medical graduates and active trainees in the United States.

Unfortunately, this diversity has not been felt in all areas in medicine. In cardiology, women comprise only 18% of fellows, less than 15% of practicing general cardiologists, and less than 5% of interventional cardiologists.¹ This is a stark difference to the patients they serve, with recent estimates indicating that more than 50% of women in the United States above 40 years old suffer from cardiovascular disease.² It is also the leading cause of death in women, contributing to one in every five female deaths.³ With research indicating that patient outcomes improve when there is diversity in the health care workforce, various organizations emphasize the need for more diversity in recruiting physicians and cardiologists.⁴

Why do these disparities in cardiology exist?

Cardiology is touted as one of the most competitive fellowships within internal medicine. According to the 2022 fellowship match data from the National Resident Match Program, cardiology had an 87% match rate for U.S. medical graduates and a 69% overall match rate.⁵ This difficulty in obtaining a fellowship in and of itself poses a large barrier to many applicants.

However, scores and one’s curriculum vitae are only one piece of the puzzle. Cardiology is often viewed by many residents as a field with poor work-life balance. Call schedules as attendings tend to be more grueling than other specialties — particularly within interventional cardiology, which requires prompt patient care 24/7. This difficult lifestyle is reflected in a 2017 survey of cardiologists.⁶ Compared to men, women cardiologists were less likely to be married or have children. Having a family further played a role in their career, with women reporting that childbirth and family responsibilities hindered their professional work or career advancement. They also were three times more likely to experience discrimination, particularly sex and parenting discrimination. Additionally, given that women comprise less than 50% of cardiology physicians, the lack of mentorship was cited as one of the barriers women experience in the field.

What are some current initiatives to close this gap in cardiology?

Work is currently underway to achieve gender equity within cardiology. Current efforts include the Women in Cardiology section of the American College of Cardiology which aims to promote women leadership in the field and provide networking/mentorship opportunities through local chapters nationwide. A local chapter here in Philadelphia is the Penn Women in Cardiology group, which has hosted webinars and speed networking events in the past to pair fellows with women faculty and foster their networking and career negotiation skills.⁷ Advocacy is also a core mission of the group. They have advocated to decrease work-related barriers by supporting efforts to create lactation spaces at hospitals and expansion of parental leave policies. Of course, these changes only scratch the surface of what is needed to support women in medicine who have an interest in cardiology. However, my hope is that with great effort, we can eliminate such gaps in medicine. I realize that changes in the field can be frustrating and slow, but I also believe that it is important: Our patients need it and deserve it.

Sources/Resources:

1. Burgess S, Shaw E, Zaman S. Women in Cardiology. Circulation 2019;139(8):1001-1002. DOI: 10.1161/CIRCULATIONAHA.118.037835
2. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022;145(8):e153-e639. (In eng). DOI: 10.1161/cir.0000000000001052
3. Centers for Disease Control and Prevention, National Center for Health Statistics. About Multiple Cause of Death, 1999-2020. Centers for Disease Control and Prevention
4. Capers Qt, Johnson A, Berlacher K, Douglas PS. The Urgent and Ongoing Need for Diversity, Inclusion, and Equity in the Cardiology Workforce in the United States. Journal of the American Heart Association 2021;10(6):e018893-e018893. (In eng). DOI: 10.1161/JAHA.120.018893
5. National Resident Matching Program. Fellowship Match Data & Reports. National Resident Matching Program. (https://www.nrmp.org/match-data-analytics/fellowship-data-reports/)
6. Lewis Sandra J, Mehta Laxmi S, Douglas Pamela S, et al. Changes in the Professional Lives of Cardiologists Over 2 Decades. Journal of the American College of Cardiology 2017;69(4):452-462. DOI: 10.1016/j.jacc.2016.11.027
7. Penn Medicine News. Penn Women in Cardiology: Breaking barriers and building support for female representation in cardiovascular medicine. (https://www.pennmedicine.org/news/news-blog/2020/september/penn-women-in-cardiology)