Why Aren’t There More Female Cardiologists?

Bongeka Zuma (left), a medical student interested in cardiology, meeting with Fatima Rodriguez, MD, MPH.

We know that slightly more than half of medical students in the United States are women, as are about half of internal medicine residents. But, as assistant professor of cardiovascular medicine Fatima Rodriguez, MD, MPH, says, “Something happens at the critical transition when people are deciding what specialty fellowship to do.”

Joshua Knowles, MD, PhD, assistant professor of cardiovascular medicine, who directs the general cardiology fellowship program, knows what those numbers look like at Stanford. “Over the last few years, of 450 applications for fellowship we’ve received per year in cardiology, only 20% to 25% have been women,” he says. “The deficit in general cardiology only grows in subspecialties like interventional cardiology and electrophysiology, where only 10% of people doing fellowships are women.”

Celina Yong, MD, MBA, MSc, assistant professor of cardiovascular medicine, became aware abruptly of how few female colleagues she had in interventional cardiology: “I remember going to one of our big national conferences when I was a trainee and sitting in a 1,000-person auditorium, listening to a great lecture that I was passionate about. When I looked around, I realized that I was the only female physician in the room.”

What to Do About Women Not Choosing Cardiology

Work-life balance was the number one concern of internal medicine trainees who responded to a survey, published in the Aug. 2018 issue of JAMA Cardiology, about career preferences and cardiology perceptions. Recognizing the need for a committed and diverse workforce, several professional cardiology societies have undertaken studies and published articles addressing the issue. Negative perceptions of cardiology, such as adverse job conditions and interference with family life, often lead women to pursue other subspecialties.

Yong has taken a research approach to increasing the number of women in cardiology. “To better understand the barriers for women and to overcome misperceptions,” she says, “I’ve focused on collecting and analyzing firsthand data on these issues, with hopes that we can use a data-driven approach to enable large-scale institutional change to happen.” Writing in the Journal of the American College of Cardiology, she proposed three recommendations: “changing professional expectations to accommodate young families, providing resources for young mothers in the catheterization lab, and equalizing opportunities for promotion. My hope in putting those ideas forth in publication form, and backing them up with actual data, was to get more wheels turning across the country.”

What Stanford Is Doing

Knowles mentions several efforts to increase the numbers of women in the fellowship program. “We invite as many talented women as we can. We pair them with leaders in the field so that they can see others like them who have made it. And our fellows and faculty established a Women in Cardiology interest group to stimulate interactions outside the office.”

Women in medicine at Stanford do not face the wage inequity often mentioned elsewhere as a drawback to choosing certain specialties. In the Department of Medicine, a thoughtful and logical approach to salaries eliminates inequity. Cathy Garzio, vice chair and director of finance and administration for the department, describes the plan: “In fiscal 2017, we introduced our compensation plan using a methodology where we pay people based on their medical specialty, their rank—assistant or associate or full professor—and their years at that rank. We are super transparent about our methodology and our principles.”

Celina Yong, MD, MBA, MSc, in the catheterization lab at the Palo Alto Veterans Administration Hospital.

What Young Female Faculty Are Doing

Both Rodriguez and Yong feel called to contribute their ideas and efforts to increase the number of women in cardiology. Rodriguez believes one way is through mentorship: “We need to focus upstream—in medical school and residency—to try to attract talented women to cardiology. Many of us make it a point to mentor women interested in careers in cardiology, because one of the reasons they are not choosing cardiology is because they don’t see a lot of role models in this field.”

Yong sees potential in the recently-funded Stanford Advancement of Women in Medicine program. The goal, she says, “is to develop an evidence base for actionable interventions that will improve the representation of women in all specialties and at the highest levels of leadership. By developing a foundation of research to better understand the infrastructure, policy, and cultural barriers to gender equity throughout medicine, we hope to translate those findings into interventions with maximum measurable impact.”

It is clear that two of Stanford’s young female cardiologists will try to reverse the trend of their specialty losing so much talent. With luck, their efforts will encourage women in other specialties to do the same.