This article is authored by Beth Abramson, MD, FACC, associate professor of medicine at the University of Toronto and cardiologist at St. Michael’s Hospital in Toronto, Canada.

As a successful and respected female cardiologist in a man’s world, I wanted to share some life experiences with younger women and trainees. There are hidden barriers to achievement; however, recognizing and addressing them head-on will allow you to overcome obstacles, achieve success and be recognized for who you are. 

When I was interviewing for my cardiology residency, the chief’s secretary asked me if I was dating someone and planning to get pregnant during my training. As this question was planted by her boss, I could have complained, but instead I went on to become the chief resident and a mentor to others today.

Fast forward 20 years and the narrative is similar. This year, I was awarded a prestigious professorship through the university in Cardiac Prevention and Women’s Health (fellows are welcome). As part of the search, I presented to hospital and university officials. I was asked by someone in a senior leadership position if I would be “able to take on the demands of this role given that I had a young child at home.”  My response was blunt: “You can’t ask me this.” While others in the room were somewhat apologetic for the question, they really did not understand the magnitude of the comment. Sometimes, bias is more than subconscious.

In my academic institution at the University of Toronto, there are 183 active cardiology faculty and 16 percent of them are female. According to the Department of Medicine at the University of Toronto, in the last 15 years, 55 cardiologists have been recruited as full-time faculty and only 18 percent are women. Although 60 percent of medical school graduates are female, only 18.5 percent of Canadian cardiologists are women.

Fortunately, times are changing. In 2016, 35 percent of trainees were women. According to the Canadian Medical Association, 46 percent of cardiologists younger than 35 – and 30 percent younger than 45 – are women. In contrast, only 13 percent of female cardiologists are older than 45. As someone currently in the “older” minority, I have written a few brief pointers based on life experiences.

Misogyny, as outlined in my examples above, does exist and can be conquered. It is a strong word and should not be used lightly. Thankfully, it occurs infrequently and is not condoned by most. However, just like the hatred we are now seeing in this world politically, if we do not call it for what it is, it will continue to fester. As you grow older, you realize there are hidden barriers to achievement. I have overcome many of these barriers in my career. Trying to find the balance of being perceived as in charge and not “bitchy” is always a challenge for women and continues to be a struggle for me today.

Mentors are important, and most of my significant role models have been male. My father is a cardiologist. He worked hard but always had time for family, and he encouraged me to stick to an academic route as a younger trainee. I also had a strong mentor in my early years of training who is still there for me today, even though he is now at a different institution. He is a sounding board for challenging situations and has always reminded me to stick to the task at hand, work hard, do the right thing and that sometimes good guys finish first. Unfortunately, mentorship is not always as straight forward as having a parent there for you. My greatest detractors have been women who were threatened by me in my early career. You need to be pro-active and focused; sometimes egos and agendas that have nothing to do with you get in the way.

Recognize imposter syndrome, the feeling that you really do not deserve to be where you are and are just fooling everyone around you, for what it is and fight through it! I am the poster child for this syndrome, and women tend to be more prone to it. Underestimating your worth can put you at a disadvantage in your career.

Knowledge and networking are key. When I was first hired, I had the lowest base-support in the history of my institution, and the financial manager pulled me aside asked me why I did not negotiate my salary. I did not even know you were allowed to negotiate. I just thought I was lucky enough to land this job (imposter syndrome, again). It did not cross my mind that I was actually wanted and added value to the team. Years ago, when a new chief joined, I was invited to play golf with the group. I do not play golf so  I decided to take a lesson and join the group after for dinner. I may have missed some of the locker room conversation, but I made sure I was “present.” Find a way to equalize the playing field. 

My last pointer is the most important: Find a path that you enjoy. Do not pick a career track or sit on a committee because there is an opening; do it because it interests you. Find time for balance and enjoyment outside of your career, learn to say “no” and gain resilience – even though all of these are easier said than done. Happiness is underestimated. My contentment comes from a rewarding career; I truly enjoy clinical care and my academic role, as well as a supportive and loving family who has kept me grounded over the years. You do not have to cross the border for this, but it is sometimes a long journey to find.