Fellows in Training: Breaking into the Boys’ Club
One of the things that I remember most vividly as an undergraduate is the overwhelming male majority at Massachusetts Institute of Technology. Because women were so outnumbered (something like 4 or 5 men to 1 woman), we had a joking slogan for the dating scene on campus: "MIT—where the odds are good, but the goods are odd!" I'm sure the ratios were similar at other major engineering schools, like CalTech and Berkeley (although, perhaps the goods were less odd there...). It was clear that, despite all the strides society had made towards gender equality, science and engineering fields remained dominated by men.
Medical school provided a refreshing change. For the first time, I noticed that there were more women than men at Harvard Medical School. Whether this was "doctored" (forgive the pun!) to eliminate gender disparity, or whether it reflected a general trend of medical school enrollment, I will never know. But I found comfort in the fact that one of the most intellectually and physically demanding professions attracted just as many young, intelligent women from all over the world as men.
It's (Still) a Man's World
And yet, over a decade later, I find myself alone within a world full of men again! Despite more female physicians overall, there are as few female cardiologists as ever. ACC membership statistics and nationwide censuses dampen our hopes that the proportions are evening out a little: the percentage of women in cardiology has held steady between 10 and 15% over the last several years.
What seems to be the problem? Why are women continuing to go into fields like pediatrics and dermatology, while turning their backs on exciting fields like cardiology and surgery? Among female cardiologists, there are many fewer women going into academics than men.
Well, there is the obvious challenge that female cardiologists face: achieving a work-life balance that remains compatible with societal (and sometimes marital) expectations. For instance, women are commonly expected to be the "stay-at-home" spouse who provides child care; a woman in an unpredictable field like cardiology, however, might have to prioritize family more than a male counterpart, who may already have that support at home. It also seems quite difficult to be on-call to perform stat echoes or take STEMI calls while 7 months pregnant. (Although, I do have to give enormous credit to some amazing colleagues who pulled it off.)
The duration of cardiology fellowships, compared to those in other internal medicine disciplines, seem to be growing lengthier—another factor that is not helping matters. Granted, fellowship doesn't last forever, but it continues to pose a significant stumbling block for many female medical residents who, if they are contemplating having children, often have to wait until they are no longer on-call every other night before even thinking about becoming pregnant.
The less obvious barrier, which I think is much more paramount for many young women in the field (like me), is finding female role models. At every major crossroads in our lives, we look to our mentors to help guide us through decisions, and maybe get a sneak preview into our lives in the future. Faced with a discouraging percentage like 10–15% female cardiologists, who do we turn to as female fellows for this type of guidance?
Don't get me wrong, I have been privileged to have some amazing male mentors in my life who I respect very much and learned a ton from: Deepak Bhatt, MD, Roger Blumenthal, MD, and Peter Ganz, MD, (my newest mentor at UCSF), to name just a few. However, there are professional and personal challenges unique to women that male mentors have simply not experienced.
How Do We Correct This Imbalance?
I ended up going into cardiology somewhat accidentally; cardiology is my passion, but I had no strong female role model holding my hand through the decision-making process. As I stand at the crossroads of academic medicine and private practice, I feel much less confident making a decision, with the majority of my uncertainty coming from the lack of women within my field who have made these decisions before me.
The gender imbalance in our field doesn't go unnoticed by patients, either; a patient in my clinic told me she had been trying to get an appointment with a female cardiologist for over a year. When I heard that, I began reflecting and realized she wasn't alone. Another patient of mine—an elderly man—had said to me (with a mix of condescension and endearment), "Oh honey, it's so good to see a woman doing cardiology."
Everyone seems to be aware of this problem, so the obvious question is: What are we doing to fix it? I've certainly decided to take a more active role as a preceptor for young medical students and residents, encouraging more of them to become cardiologists. I have also joined the ACC's Women in Cardiology Council and hope to promote awareness and networking opportunities among female trainees.
Unfortunately I haven't yet had the opportunity to work with some of the amazing women in our field, like Joanne Foody, MD, or Roxanna Mehran, MD, who have overcome numerous barriers to prove that we, as women, can actually have it all—family, career, and academic cardiology. They do give me hope that it is possible.
What about you, readers? What do you think we can do to increase the number of women in cardiology and increase the opportunities for women to interact with other women?
Payal Kohli, MD, graduated from MIT and received her MD from Harvard Medical School. She completed her internal medicine residency at Brigham and Women's Hospital in Boston and was a research fellow at the TIMI Study Group. Dr. Kohli is now a clinical fellow at the University of California, San Francisco.
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