Female Cardiologists and Interventionalists Rare, Isolated in Australia and New Zealand

A first-of-its-kind snapshot of gender diversity in cardiology to be undertaken in Australia and New Zealand shows that the imbalance in male and female practitioners seen in the United States is also a reality Down Under.

The gap is particularly stark within interventional cardiology, investigators led by Sonya Burgess, MBCHB (University of New South Wales, Sydney, Australia), conclude.

In a finding unique to this the region, however, the vast majority of public hospitals actually have no female operators on staff. “Female interventional cardiologists were rare and practicing in isolation,” the authors note.

“We know gender disparity is an issue,” senior author Sarah Zaman, MBBS, PhD (Monash Cardiovascular Research Centre, Melbourne, Australia), told TCTMD. “We go to international conferences like TCT and we look around the year the hall, and usually it’s just myself and one or two other female colleagues. We wanted to collect the data in Australia and New Zealand, because that’s never been done before.”

Burgess et al obtained the total number and gender breakdown of physicians practicing between 2015 and 2017 from the Australian Health Practitioner Regulation Agency, the Medical Council of New Zealand, and the Royal College of Physicians. Out of a total of 121,211 practicing doctors in Australia and New Zealand during this period, 42% were female. Among specialists, however, women represented scarcely one-third of physicians across disciplines and just 15% of practicing cardiologists were female. The situation worsened for interventional cardiology, where women made up just 4.8%. Of cath lab directors in Australia and New Zealand, just 3.4% were female.

Those numbers echo data published in 2016 by the Society for Cardiovascular Angiography and Intervention (SCAI)’s Women in Innovations (WIN) group, which found that women account for 4.5% of US interventional cardiologists and have lower PCI case volumes than their male counterparts. That study also found that 41% of women worked at a US institution where they were the only female interventional cardiologist.

Here, the Australia/New Zealand data paint an even bleaker picture. According to Burgess, Zaman, and colleagues, 89% of female interventional cardiologists practice at hospitals where they are the sole female operator. These lone interventionalists are further isolated by geography: three out of Australia’s eight states, for example, have no female interventional cardiologists.

“The low numbers of female interventional cardiologists overall and their relative isolation has the potential to impact on recruitment, collegial support, mentoring, and research,” the authors write. What’s more, the gender gap is “unlikely to narrow in the near future,” since cardiology training programs surveyed during this period included 23% women, while interventional fellowships had just 9%.

In a further sobering detail, Burgess et al note that the gender pay gap, documented elsewhere in cardiology and in medicine more generally, is alive and well in Australia and New Zealand, where the average annual taxable income in 2015-2016 for female cardiologists was AUD $266,805—slightly more than half of their male counterparts’ income of AUD$ 484,086.

Work to Be Done

Zaman hopes that having data in hand will serve to support other work being done, particularly by women in cardiology groups like SCAI WIN and Women as One and spur additional research into underlying causes for the disparities. She hopes that male cardiologists will also be galvanized by the data and appreciate that they, too, have a role to play.

Everyone should care about diversity in the workforce and having an inclusive culture in the workforce. Sarah Zaman

“I’m hoping that male cardiologists and leaders in cardiology will also read this and think a little bit about what they can do as directors of cath labs or cardiology departments to help enact change,” she said. As it is now, she estimates, 95% of the people sharing or tweeting the paper since its publication in the Journal of the American College of Cardiology earlier this week have been female.

“I feel like men think it’s not their problem, so they are less inclined to talk about it, or tweet it, or bring it up in meetings and discussions,” Zaman said. “I think a lot of male cardiologists doesn’t see it as an issue. They have that unconscious bias that women self-exclude from this profession.” The commonly cited explanations are that women shy away from the on-call hours or the physical demands of the job. These may play a role, says Zaman, but that needs to be properly studied and “doesn’t fully account for the severe gender disparity that we’re seeing.”

The authors conclude that interventional cardiology and cardiology more generally has likely lost potential leaders and innovators by failing to encourage more women into the profession who could then serve as role models for trainees. There’s also evidence to suggest that women doctors are typically more aware of differences in coronary artery disease symptoms and treatment between men and women and that female physicians do more to advocate for the inclusion of women in clinical trials. Moreover, some research suggests that a better balance of male and female clinicians leads to better CVD outcomes in women. 

For all those reasons, men should be as invested in change as their female colleagues, Zaman said. “I think if men care about their patients and their female patients especially, then addressing the gender gap has been shown to be a powerful way to improve heart health. Everyone should care about diversity in the work force and having an inclusive culture in the workforce.”