Feature | She Needed a Hero, So That's What She Became

“Freedom cannot be achieved unless women have been emancipated from all forms of oppression” – Nelson Mandela

“No, I would like a female interventional cardiologist to do my heart catheterization. There are so few of them in this profession, so they must have to work much harder and have to be much better to get where they are,” said a 67-year-old male patient when my office offered to reschedule his heart catheterization with one of my extremely talented and experienced male colleagues who had an earlier availability. My first reaction was a pleasant startle, a gratifying inquisitiveness almost immediately followed by an ardent desire to investigate the facts in that statement for myself.

We have known for a long time that female physicians have a distinct method of practice in medicine. This discrete technique has been shown to translate into lower 30- day mortality and readmission rates in beneficiaries of U.S. Medicare that were treated by female general internists compared to their male counterparts. Female physicians were shown to embrace a patient centered approach with more rigorous adherence to clinical guidelines.

Does this hold any actuality when scrutinizing the surgical specialties, which have been by far much more monopolized by men?Interestingly, patients treated by female surgeons had a small but statistically significant decrease in 30-day mortality compared to male surgeons after accounting for patient, surgeon and hospital characteristics. Despite all this data, it is astounding that the surgical disciplines continue to represent disproportionately higher number of men. These proportions are quite dispiriting considering the increasing numbers of female medical students.

Is this fueled by the “unspoken” gender inequity, including disparities in compensation and promotion? We are well acquainted with the fact that female medical school faculty neither advance as rapidly nor are compensated as well as professionally similar male colleagues. While these deficits are markedly greater for all female physicians, it is quite intriguing that the inadequacy is greater for faculty with more seniority. When gender matching, female physician faculty have a noticeable deficit (–$11,691; P = 0.01) in their salary compared to their male counterparts, and this gap widens with greater seniority (–$485 per year of seniority; P = 0.01). The gender disparity in lethargic rank promotion in female physicians is not explained by productivity or differential attrition from academic medicine. These issues need to be imperatively investigated and ironed out.

The paucity of resolution to plunge into inspecting this aspect is outrageous. I am skeptical whether the medical community does not seek altering the dynamics significant enough or it is just the convenience of ignorance. I believe every woman who steps into a profession which has been male dominated – be it pilots, police officers, military personnel, surgeons or cardiologists – makes a tenacious statement of her fortitude and grit. This is heroism and must not be muted away at the far back end of a conference room.

In an attempt to further scrutinize this recent realization, I conducted a brief, completely anonymous “Female Cardiologist Satisfaction” survey. This survey was intended to dive deeper into how my female counterparts are doing since it is crucial to pay attention and care.

We formulated an online, anonymous survey of 17 questions requested out to 33 actively practicing female cardiologists. Of these requested, 20 responded (60.6 percent response). The time spent in the current job ranged from 1 to 15 years with the majority (70 percent) having spent less than 5 years. Sixty percent of the female cardiologists who participated in our survey have held two or more jobs. Majority have clinical cardiology as their major assignment (80 percent), 85 percent are working full-time and a staggering 70 percent are in private practice.

Of their job assignments, substantial time (40 percent or more) is spent in inpatient care (75 percent) and office work (75 percent). Based on our study results, most women in cardiology are spending less than 10 percent of their time in echocardiography, nuclear medicine, invasive cardiology and research. Only two-thirds of female cardiologists reported having a mentor to guide them and of those who had a mentor, 91 percent reported a positive impact of the mentorship on their career.

The number of females in our profession continues to be astoundingly low with 70 percent reporting less than 5 percent female cardiologist comrades in their practice. Fifty percent of participating female physicians in cardiology are married and 40 percent divorced. Quite interestingly, on our scoring system (1 – 10), we were able to roughly quantify the level of satisfaction with time off, time off during pregnancy, recognition at the workplace and overall job satisfaction. Seventy percent of physicians opted for a score of five or less for both satisfaction with time off and recognition at work place. Sixty-five percent of female cardiologists reported pregnancy while working as a practicing cardiologist. Of these women, 84.6 percent reported inadequate time off during pregnancy. Additionally, around 65 percent of female cardiologist who participated in our survey reported feeling discriminated at work place. More than half (55 percent) also said they would not choose the same job again. Of the 45 percent who would choose the job again, one of our anonymous colleagues mentioned, “I am lucky to be in this job; however, I feel like I have to work harder than my male counterparts to get the same respect.”

We recognize the limitations of this current survey with such a small number of participants and the selection bias. Nevertheless, these results bring a few admissible aspects into prominence that should be addressed. While most female cardiologists are already pursuing full-time careers, we probably need more focus on research engagements where we continue to be decidedly underrepresented. Dynamic and abiding mentorship from our senior seasoned female cardiologists is key to achieving enhanced female participation. Organizing interactive conferences with instruction of female leadership to galvanize, endorse and embolden the fledgling female physicians could serve as a supplementary avenue. We must undeniably and imperatively urge for a standard protocol in place for maternity leave, including both male and female physicians.

Profession should not jeopardize our family life; in fact, it should enhance it. However, amplified female presence is the most imperative to direct the assiduity of medical community to recognize and address these issues specific to female sex. We aspire that enhanced representation emanates more voices, with procreation of cognizance and optimistically translating into higher recognition and rightful job satisfaction. It looks like we have a lot of work to do, so let’s get on with it!

This article is authored by Nishtha Sareen, MD, FACC, cardiologist at Cardiology and Vascular Associates in Bloomfield Hills, MI.