Female Interventionalists Remain a Rarity in the United States

Women make up less than 5% of practicing interventional cardiologists in the United States and tend to have a lower PCI case volume than their male counterparts, according to a registry study published online August 10, 2015, ahead of print in Catheterization and Cardiovascular Interventions. Even so, in-hospital mortality rates are similarly low for patients treated by high- and low-volume female operators.

The findings were originally presented at the 2014 Transcatheter Cardiovascular Therapeutics symposium in Washington, DC.

Tracy Y. Wang, MD, MHS, MSc, of the Duke Clinical Research Institute (Durham, NC), and colleagues culled data from the National Cardiovascular Data Registry CathPCI registry on 2,465,685 consecutive PCIs performed at 1,431 US institutions from July 2009 through June 2013.

Female operators accounted for 4.5% (n = 412) of the 9,179 interventionalists and performed only 3% of the procedures. In addition, 41% of the women worked at an institution where they were the only female interventional cardiologist.

Over the study period, the percentage of PCI procedures performed by women that were on-call (vs daytime) rose modestly from 14.1% to 16.8%. Although women performed fewer procedures annually than men (median 48 vs 69; P < .001), they treated a higher proportion of cases involving STEMI or cardiogenic shock (20.3% vs 17.1%; P < .001). Overall procedural success of female operators was high and comparable to that of male operators, with 93% of patients achieving TIMI 3 flow with residual stenosis < 25% after PCI.

In-hospital mortality was 1.8% among patients treated by female operators—specifically 2.18% for those with ACS and 0.46% for elective cases. Procedural volume of female operators did not impact in-hospital mortality (1.95% for those performing < 50 cases/year vs 1.75% for those performing ≥ 50 cases/year; P = .119). This finding was upheld after multivariate adjustment (P = .76).

Acting on the Gender Gap

“Our study provides evidence that although the volume of female interventionalists has grown in the past 4 years, female interventionalists remain uncommon in the US,” the study authors write. “We need to identify effective measures that might broaden the appeal of this specialty to female candidates.”

Although obstacles like “disparities in compensation or promotion” could discourage women from joining the field, less tangible factors may also contribute, they say. “Our study reveals that many women operate in relative isolation with few opportunities for networking and mentorship with other female interventionalists within the same practice,” the authors write. “Lifestyle has also been cited as a potential reason for the limited appeal of this specialty to female candidates.”

In an email interview with TCTMD, Dr. Wang said the motivation behind the study was to gather hard evidence to aid in advising fellows about career choices. “We know so little about female interventional cardiologists,” she said.

“The dearth of female mentors and role models in this domain will perpetuate the trend of underrepresentation in this field,” Dr. Wang commented. “Female patients may prefer a female proceduralist, so their physician selection options may be limited or they may need to travel outside of their geographic area to meet this need.”

The gender gap is “a topic of robust discussion within the interventional community,” Dr. Wang said, “but the question now is how to act on these data.”

A greater emphasis on mentorship for early career clinicians would be a good start, she said. “It would be great to let fellows know what to expect and, in some cases, how compatible an interventional career would be with other career and life priorities.”

In addition, “low case volumes can be viewed as a stigma, and [that situation] is potentially worsened by tackling mostly call cases where the acuity is much higher. Peer mentorship in that regard would be valuable as well,” Dr. Wang concluded.

Note: Study coauthor Roxana Mehran, MD, is a faculty member of the Cardiovascular Research Foundation, which owns and operates TCTMD.

Source: 
Wang TY, Grines C, Ortega R, et al. Women in interventional cardiology: update in percutaneous coronary intervention practice patterns and outcomes of female operators from the National Cardiovascular Data Registry. Cath Cardiovasc Interv. 2015;Epub ahead of print.

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