by Carolyn Thomas ♥ @HeartSisters
You know there’s trouble in paradise when the Women In Cardiology Leadership Council reports that their group (part of the American College of Cardiology) is “very frustrated and concerned about the lack of growth in the numbers of women pursuing a career in cardiology.”(1) Although women represent over half of medical students, just 10-15 per cent of practicing cardiologists, and 4 per cent of interventional cardiologists (the ones who implanted your stent in the cath lab) are women.
Dr. Celina Yong, one of those rare female interventional cardiologists out there, teaches cardiovascular medicine at Stanford University. She believes that “a gender-lopsided field can affect patient care.”
Cardiologist Dr. Sharonne Hayes, founder of the Mayo Women’s Heart Clinic, described female cardiologists as “walking a tightrope”, which she explained to mean“too feminine to be competent vs. too masculine to be likeable”. In a webinar called “Effecting Change: Professionalism, Bias & Burnout”, presented by the American College of Cardiology’s Women in Cardiology Section, she and her cardiologist colleagues Dr. Jennifer Mieres, and Dr. Laxmi Mehta spoke out on the topics of professionalism, biases, and preventing burnout.
High status jobs, Dr. Hayes noted (like being a cardiologist, for example) are often seen as requiring ‘masculine’ qualities (e.g. calm, decisive, confident) as opposed to ‘feminine’ qualities (e.g. modest, communal, self-effacing) – adding that racial and minority groups are especially affected by this expectation.
“We are dealing with others’ cultural expectations of what and how a woman should ‘be’ and ‘act’ while getting one’s work done.”
The deep roots of gender bias in medicine have been a challenge for a long time everywhere. In their Canadian Journal of Cardiology commentary called The Girls in the Boys’ Club, Drs. Michelle Graham and Catherine Kells (both interventional cardiologists) reflected on their own early career experiences.(8)
As Dr. Kells explained:
” In 1984, it was so rare to have a woman choose cardiology that no one really had any advice to give me. So, I blindly started my training with little to no idea how difficult it would be to balance a career in cardiology with a family life as a wife and mother. The obstacles came in strange places and sometimes from unexpected sources. Nurses, patients, friends, family and colleagues would occasionally make comments like, ‘Women should not be in the cath lab’ or ‘When you have children, you will give up all this nonsense’. My particular favourite was, ‘You marry a wife; you call a doctor’ .”
Dr. Graham, arriving in the profession 10 years later than Dr. Kell, added her own story:
“By the 1990s, a decade later, we had made progress in cardiology, but my experiences unfortunately highlight ongoing issues. When I was an internal medicine resident, most of the attending physicians told me, ‘Don’t do it, you won’t have a job’. To make matters worse, many of my friends said, ‘Don’t do it, you’ll never meet anyone, get married, have a family, have a life …’
“This specialty really was a ‘boys’ club’. By 1996, I was still the only female in my cardiology residency program in the three years I was there. One of the male interventionalists told me that ‘women don’t belong in the cath lab’. However, I think that things would have been much harder for me had I not had the unique mentorship of my program director, Dr. Catherine Kells, to show me that women can have both a successful career in cardiology and a family – but not without pain and effort.”
That’s the historical background from yesterday behind what Dr. Sharonne Hayes is describing about women in cardiology today.
Dr. Hayes acknowledged that, while there’s a lot of self-help advice out there to assist women in coping with pervasive discrimination, “the system is broken, and we need to stop ‘fixing’ women”.
She also talked about what she calls the stereotype identity threat that most female cardiologists have personally experienced on some level.
When you’re aware of a negative stereotype about your group, she explained, your attention is split between the activity at hand and your concerns about being seen stereotypically “which can divert your cognitive resources – the skills that would otherwise be used to help maximize your performance.”
(By the way, I’ve observed that my own cognitive resources evaporate whenever I have tried to squeeze my car into a tight parking spot if a bunch of (male) construction workers happen to be standing nearby watching. Even an experienced parallel parker like me can be reduced to giving up in a sweaty heap before abandoning a perfectly good parking spot in order to avoid critical stares and mocking comments).
Dr. Hayes shared this example of how a stereotype identify threat can work to derail abilities:
“I m getting up in front of the boardroom to do a presentation on women’s heart disease or diversity and inclusion in the workplace. I’m the expert in the room, but I walk into a room filled with white grey-haired male leaders, and I feel“de-skilled”. I am ready, I practiced this – but suddenly I cannot find my words!”
She adds that a similar reaction is common among other negative stereotype identity scenarios, an example being the short kid on the basketball team.
Watch the ACC webinar for more fascinating facts about this dilemma, and also some useful tips for women already working as cardiologists on how to stop feeling like that short kid on the basketball team. . .
1. Lundberg, Gina et al. “Addressing Gender Equity in Cardiology”, American Journal of Medicine, Commentary, 2020 Elsevier Inc. doi.org/10.1016/j.amjmed.2020.05.016
2. Mehta LS et al. “Current Demographic Status of Cardiologists in the United States”. JAMA Cardiol. 2019 Oct 1;4(10):1029-1033. doi:10.1001/jamacardio.2019.3247.
3. Maxwell, Y. “Discrimination Still Runs Rampant for Women in Cardiology”. TCTMD, April 2, 2016.
4. Celina M. Yong et al. “Sex Differences in the Pursuit of Interventional Cardiology as a Subspecialty Among Cardiovascular Fellows-in-Training”. J Am Coll Cardiol Cardiovasc Interv. 2019 Jan. 12 (3) 219–228
Patient–physician gender concordance and increased mortality among female heart attack patients.” Proceedings of the National Academy of Sciences 115.34 (2018): 8569-8574.
6. The free webinar,“Effecting Change: Professionalism, Bias & Burnout”, presented by the American College of Cardiology’s Women in Cardiology Section. Speakers included cardiologists Dr. Sharonne Hayes, Dr. Jennifer Mieres, and Dr. Laxmi Mehta on the topics of professionalism, biases, and preventing burnout. October 29, 2020
7. Journal of Women’s Health. http://doi.org/10.1089/jwh.2016.6044 Volume: 26 Issue 5: May 1, 2017. 413-419Speaker Introductions at Internal Medicine Grand Rounds: Forms of Address Reveal Gender Bias”,
8. MM Graham, CM Kells. “The Girls in the Boys’ Club: Reflections from Canadian Women in Cardiology.” Can J Cardiol 2005;21(13):1163-1164.
Q: How can cardiology be more welcoming to women in the profession?
NOTE FROM CAROLYN: I wrote about the cardiology gender gap (but from a patient’s perspective) in my book, “A Woman’s Guide to Living with Heart Disease“ , published by Johns Hopkins University Press in 2017. You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher (use their code HTWN to save 30% off the list price).
–Women in Cardiology: “Underrepresented, Underestimated, and Undervalued“: (Four papers in the journal JAMA Cardiology tackle the issues affecting women who are thinking about joining or who have already joined the male-dominated field); article published in TCTMD.