Cardiology Awards Continue to Favor Male, White Recipients

Professional societies in cardiology are more likely to award men and white individuals than they are women and minority groups, to an extent that’s disproportionate from the field’s demographics, according to an analysis of data that span from 2000 to 2021.

Ample evidence has previously made the case that disparities exist in cardiology when it comes to publishing, leadership positions, work/life balance, and wages.

Kinza Iqbal, MBBS (Dow University of Health Sciences, Karachi, Pakistan), lead investigator of the new report, said that on this backdrop what they found was “not very surprising, but disheartening.”

The study, published online Monday in the Journal of the American College of Cardiology, looked at honors given between 2000 and 2021 by seven different professional societies: American College of Cardiology (ACC), American Heart Association (AHA), American Society of Echocardiography (ASE), Society for Cardiovascular Angiography and Interventions (SCAI), Heart Rhythm Society (HRS), European Society of Cardiology (ESC), and Canadian Cardiovascular Society (CCS).

Over the two-decade period, more than three-quarters of award recipients were white and a similar proportion were male. “We thought that this is a strong message that might resonate with the societies and with the women in cardiology,” Iqbal told TCTMD, noting that there have been “promising” increases in diversity in recent years.

Still, even when members of the underrepresented groups are recognized, they tend to be well-known names or people active on social media, she pointed out. “There are a lot of hidden jewels within the cardiovascular team that don’t get the recognition.”

Senior author Martha Gulati, MD (Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA), in an interview with TCTMD, said that though there has been some awareness among her professional peers of the disparities in this area, these “certainly hadn’t been quantified.” She continued: “We felt [that] taking a picture, essentially, of what’s going on is just helpful for our community—to know this and to have numbers. One thing I can always say about cardiology is we’re data-driven.”

Their goal “wasn’t to criticize our national societies, but to bring to their attention [what] they might not realize,” Gulati added.

There are a lot of hidden jewels within the cardiovascular team that don’t get the recognition. Kinza Iqbal

Iqbal and colleagues identified awardees using each society’s website, collecting information on gender, race/ethnicity, and academic degree. Additionally, they used facial appearance, name, and/or country of origin to assign race/ethnicity.

There were 173 unique awards, of which 94 were given by the AHA, 27 by the HRS, 17 by the ACC, 16 by the CCS, eight by the ASE, seven by the ESC, and four by SCAI. There were 3,044 recipients, including 2,830 unique awardees.

Overall, 75.3% of those honored were white. Nearly one in five (18.9%) were Asian, with 4.5% being Hispanic/Latino and 1.4% Black. There were changes over time: at the study’s outset, in 2000, fully 92.3% of recipients were white, decreasing to 62.8% in 2021 (P < 0.001). Each of the three racial/ethnic minority groups saw gains over the two decades.

The racial/ethnic imbalance was greater for late- versus early-career awards. For instance, 36.7% of early-career awardees were Asian, dropping to 15.0% in later-career awards. This “indicates a leaky pipeline,” the authors note. “Several factors, including implicit bias, may be responsible for preventing underrepresented groups from ascending the academic ladder and receiving senior awards like ‘lifetime achievement awards.’”

To look at gender, the researchers excluded female-specific honors, such that 169 awards remained. Men accounted for 76.2% of the recipients and women for 23.8% in the US, Europe, and Canada combined. The situation as particularly acute in Canada, where only 12.3% of awardees were female; in the US and Europe, the rates were 25.1% and 25.7%, respectively.

Yet there were some positive sex-related shifts: in 2000, just 7.7% of awardees were female, but by 2021, the proportion had risen to 31.2% (P < 0.05). For perspective, 34% of AHA members and 35.7% of ESC members were female in 2021.

With awards honoring leadership, though, women were particularly underrecognized at 18.1%. “Tying male gender with leadership attributes puts women at a disadvantage; a paradigm shift is required to accept women as capable leaders in cardiology,” the paper notes.

The gender breakdown of receiving an award also varied by degree. Among those with a PhD, nearly half (48.2%) were women. But among recipients with an MD or both an MD and PhD, just 15.3% and 17.5% were women, respectively.

Notably, awards named after men were less likely than noneponymous awards to be given to women (10.9% vs 23.2%; P< 0.01). “Male-eponymous awards can deter women applicants and give a subtle hint to selection committees to favor men as winners, creating an implicit bias,” Iqbal et al observe.

‘Be More Proactive’

Looking at these patterns, said Gulati, allows for a better understanding of why up-and-coming cardiologists don’t always complete their career trajectory or get the opportunities they deserve. “Awards can raise your profile nationally and internationally. It helps your work get known,” she commented, adding that this recognition factors into getting promoted to more-senior roles.

Both Gulati and Iqbal suggested ways to improve diversity among those honored.

For cardiologists, it’s important to nominate colleagues who fall outside what’s been the typical awardee demographic, so “that they’re at least considered, that their names are rising in these committees,” Gulati urged. “Until the world’s the place we want it to be, we’ve got to be more proactive about thinking of people of diverse backgrounds and women for awards, and we have to do the work to get them [noticed].”

Applicants, meanwhile, should be encouraged to put themselves out there, said Iqbal. “A lot of times women shy away from seeking out applications or letters of recommendation. That should change.”

And finally, Gulati said, efforts should be made to ensure that selection committees for awards or other leadership roles are more representative of what the diverse cardiology community looks like. These groups can benefit from training on how to recognize and address implicit bias, she added. “We need the award committees to be thinking: who are we giving the awards to? What message are we sending?”

Another to tackle are eponymous awards, which Gulati suggested could be replaced by others named specifically for what they honor, like research or leadership. The paper suggests other steps professional societies can take, including standardized selection criteria, inclusive award descriptions, and collection of applicant and awardee demographic information as a way to monitor progress.

Iqbal stressed, however, that the takeaway from their results should not be tokenism.

“We don’t want to send out this message that we should recognize women just because they are women or racial minorities just because they are racial minorities,” she said. “We want them to be recognized because they are contributing”—sometimes doing so in outsized ways by helping to address health inequities by serving in underserved areas.