Plateau Seen in Women Pursuing Cardiology Training

The proportion of women enrolled in US cardiology fellowships has plateaued over the last few years, according to new data. The findings are all the more striking because the overall number of women in internal medicine has grown, with other fields such as endocrinology, gastroenterology, and geriatric medicine attracting more women than cardiology.

“From 1991 to 2016, there have been increases in the percentage of women in nine medical subspecialties but substantial differences between specialties remain,” write Anna Stone, MD (St. Vincent Hospital and Heart Center, Indianapolis, IN), and colleagues in a research letter published online September 23, 2019, ahead of print in JAMA Internal Medicine. “As compared with the other eight subspecialties, cardiology had the lowest percentage of women, which is an important issue that the cardiology profession should continue to address.”

Speaking with TCTMD, senior author Mary Norine Walsh, MD (St. Vincent Hospital and Heart Center), said the findings, which show the percentage of women in cardiology fellowships has hovered around 21% for the past 6 years, are not unexpected. Survey data published over the last year have shown that more female than male internal medicine residents “never consider” cardiology as an option, she highlighted. In response, she said, “the American College of Cardiology has undertaken some pretty robust measures to try to address that.”

Specifically, Walsh referred to efforts like programming by the Women in Cardiology section as well as the ACC’s Diversity Inclusion task force to try and engage more women in the field.

“It’s all in the perception of women who are training, firstly in medical school and then in internal medicine—what they see and what their experiences are, what the external forces are that indicate to them what cardiology's like,” she said. “For example, if a woman has few or no female role models who are cardiologists in an institution, for example in a medicine residency, it may be less likely that she’d even consider it. So I think visibility is important.”

For the study, the researchers pulled numbers on the gender of physicians in internal medicine residency and subspecialty fellowships between 1991 and 2016 from the Accreditation Council for Graduate Medical Education (ACGME) database. Overall, the percentage of internal residents who were women increased from 30.2% in 1991 to 43.2% in 2016. Interestingly, while the number of women doing subspecialty training increased, the overall numbers indicate that the proportion of female residents who pursued subspecialty training, relative to their male counterparts, actually decreased from 33.3% to 23.6%, over this same period.

It’s not clear why fewer women are pursuing subspecialty training after residency, but Walsh explained that studies have shown that women are more likely than men to be interested in pursuing long-term patient relationships (and perceive subspecialty careers as less likely to involve these kinds of interactions). “Does that skew their view of subspecialty medicine?” she asked, adding that this will have to be explored both in general and on a subspecialty-by-subspecialty basis going forward.

Having somebody take an interest in you and make a comment that you might really like cardiology because you seem interested—those type of encouragements go a long way. Mary Norine Walsh

Notably, the percentage of women in cardiology doubled from 10.1% in 1991 to 21.3% in 2016, but in comparison, the proportion of women going into endocrinology increased 0.96% faster. Also, women going into the fields of gastroenterology, geriatric medicine, rheumatology, and hematology and oncology increased 0.5% faster.

Because previous studies have shown that women have a different perception of a life in cardiology and face different challenges compared with men, Walsh urged current cardiologists to be better mentors and also encourage talented prospective cardiologists who might not have considered the field as their career path. “Having somebody take an interest in you and make a comment that you might really like cardiology because you seem interested—those type of encouragements go a long way,” she said.

Lastly, Walsh said she would like to see a comprehensive study looking at trends in the proportion of women in other specialties outside of internal medicine.