Cover Story | ACC: One Mission. One Vision. Many Voices.
The ACC Board of Trustees (BOT) adopted a Diversity and Inclusion Strategic Plan in early 2018, launching a broad and prominent initiative to improve diversity and inclusion in cardiovascular medicine over the next five years. Through this effort, the ACC will more effectively harness the power of the diversity of its members to advance patient care, spur innovation and improve health equity among individual patients and populations. The result will be that the ACC will ensure opportunity for all cardiovascular professionals by working towards a fully inclusive organization and profession.
As the chair of the Task Force on Diversity and Inclusion, I’m happy to share that ACC has been hard at work laying the foundations of the College’s diversity and inclusion work and we’ve already seen early successes. One such success is the recent BOT approval of ACC’s Distinguished Award for Leadership in Diversity and Inclusion — and will be awarded for the first time at ACC.19 in New Orleans. The College will begin accepting applications and nominations for this and other Distinguished Awards on June 25.
Some additional successes include launching two new workforce policy documents, expected to focus on Compensation Equity and Flexible Careers; building outreach efforts to high school- and college-aged underrepresented minorities to expose students to careers in medicine and cardiology; surveying ACC chapters to learn about local diversity and inclusion efforts; partnering with a variety of ACC committees to advance diversity and inclusion goals; launching a library of diversity and inclusion resources at www.ACC.org/Diversity; and much more.
This issue of Cardiology focuses on the achievements, experiences and challenges in our journey. The College looks forward to more accomplishments as we strive to support our members, our profession and our patients in achieving our mission of a fully inclusive and diverse organization and profession.
Shattering the Glass Ceiling
Roxana Mehran, MD, FACC
When leading interventional cardiologist Roxana Mehran, MD, FACC, entered medicine in the early 1990s, interventional cardiology was still in its relative infancy. “There were very few centers performing any PCIs,” says Mehran. In fact, the world’s first successful percutaneous transluminal coronary angioplasty had been performed just over a decade before, in 1977 by Andreas Gruentzig, MD, FACC.
Not only was the field in its early stages, but those practicing in the emerging field of interventional cardiology were mostly men. “There were just a handful of female interventional cardiologists at the time,” says Mehran.
“Truly, I can count them on my hands and name them to this day. Cindy Grines, MD, FACC, was one of those female trailblazers I admired,” adds Mehran. But she wasn’t truly conscious of this disparity initially. “At first, I didn’t notice that I’d jumped into a ‘man’s world’ — I focused on my passion and the field that I felt was innovative and cutting edge,” she says. “My attention was on doing the work and giving my very best every day in the field.” Read More >>>
Mehran was the first female interventional cardiology fellow at Mount Sinai Hospital in New York City, but she said she was so focused on the work that being the only woman in the rotation didn’t seem to impact her at the time. However, when she began to look for a job after she completed her fellowship, Mehran found that her sex became more of an issue in interviews. “I was a woman of childbearing age who was recently married. I could tell this made my interviewers uncomfortable,” she recounts. “They seemed to question if I was capable or wonder if I would actually be able to perform if push came to shove,” Mehran adds. She says she “lucked out” and landed a role at Washington Hospital Center in Washington, DC, with an incredibly welcoming environment and a male mentor, Martin B. Leon, MD, FACC, who embraced her energy and passion.
Mehran believes mentorship is key for women to be successful. “Mentorship is critical — and mentorship from men is more important than ever, because men who do not have as many perceived barriers in medicine can make a big difference for women,” she says. In fact, if she could change just one thing, it would be establishing that men in leadership positions mentor early career women, because it’s such an important way for women to break through and advance.
While the ratio of men to women in interventional cardiology has improved slightly since Mehran’s early days in medicine, it remains a subspecialty dominated by men. According to Mehran, only approximately 5 percent of the board certified interventional cardiologists are women, and women are more likely to choose urology over interventional cardiology. “This is an incredibly rewarding and fascinating subspecialty. It’s a shame there are so many preconceived notions — among women and men — about what it takes to be an interventional cardiologist,” she says.
"It is time that things change, and that starts by first acknowledging that there is an issue and disparities do exist. So now, let’s each do our part to ensure the future of cardiology is brighter for all." — Roxana Mehran, MD, FACC
Radiation exposure during childbearing years and during pregnancy is one of the primary reasons cited by some women for avoiding the cath lab. In truth, however, Mehran says that both women and men should be taking precautions in the cath lab to protect their health. “That narrative needs to change,” says Mehran. “First, radiation doesn’t discriminate. It’s just as toxic to the cells of men as it is to women. Second, if there is such a concern about female interventional cardiologists in the cath lab, why aren’t we also discussing female nurses, techs, and cath lab personnel, who spend even more time in the lab on many more cases than physicians?”
Culture change is needed says Mehran. “The talented women who have devoted extensive amounts of time to become interventional cardiologists are ready and willing to take on the responsibilities of the job. We cannot lose them to other fields of medicine or even to general cardiology, just because they aren’t afforded the same amount of time in the cath lab as men or because we assume they won’t want to work as hard if they choose to have a family.”
This culture change also requires society to change how they think about the roles of women and men and about family life. “It’s no one’s business what a cardiologist — woman or man — decides to do on the family side. Both women and men should be able to be involved in a family unit and have a career in medicine if they so choose.”
Mehran has spent her career working hard and shattering glass ceilings — as a leader in her field, in research, and as a mother of three teenage daughters. But, she says the work is far from done. “It is time that things change, and that starts by first acknowledging that there is an issue and disparities do exist. So now, let’s each do our part to ensure the future of cardiology is brighter for all.”
Reflections on Diversity and Inclusion
Akshay Khandelwal, MD, FACC, Board of Governors Chair-Elect and Governor of ACC’s Michigan Chapter
I’ll be honest. I had great difficulty in addressing diversity and inclusion as a topic, in no small part because of my own identity. As a male, is it disingenuous for me to address this topic? Is being of Asian descent an asset, given that I’m a minority within the U.S. population, or is it a liability as Asians constitute a plurality of cardiologists? What does diversity and inclusion really mean? Do we risk division by encouraging diversity? Do we risk exclusion by focusing on inclusion?
Merriam-Webster defines diversity as “the condition of having or being composed of differing elements.” We can’t be true to ACC’s Core Values — patient-centered, teamwork and collaboration, and professionalism and excellence — without mirroring the diversity of our members and our patients, and reducing and/or eliminating barriers such as harassment, inequality and unconscious bias. If we are to truly transform cardiovascular care and improve heart health, we can only be successful when we recruit the most brilliant, talented and competent team members, without other qualification. By definition this means we must be composed of differing elements. Read More >>>
It’s important that the College has defined improvements in gender, racial and ethnic diversity as critical components for organizational success. These historically undervalued or underrepresented segments suggest that we must continue to evolve as a collective. In the coming months we can expect action plans from our College content experts. Additionally, there are elements of diversity and inclusivity that exist “outside of the box” that we should also consider: career/life stage; subspecialty; academic/integrated/independent practice style; urban/suburban/rural practice location; physician/cardiovascular team; nationality/language; U.S./international graduates; gender identification/sexual orientation; economic background; life experience; among others. We should consider ourselves fortunate that we can be represented in so many different ways, yet remain singularly unified in our Mission and Vision.
Thus, to achieve a bright world in which innovation and knowledge optimize cardiovascular care and outcomes, we must invest in diversity and inclusion, without being exclusionary, to advance patient care, spur intellectual curiosity, and improve health equity among patients and populations. So, what can ACC members and leaders do to address diversity and inclusion? Plenty!
Join Us! 8 Things You Can Do Now
Lead. At the chapter level, our Board of Governors Chair Andy Miller, MD, FACC, challenged governors to be a community of leaders and incorporate a few first steps to weave diversity into our chapters’ strategic planning. Similarly, we can make diversity a focus within our sections, councils and places of work.
Engage. Nobody wants a handout, but many people deserve a hand up. If you have an opening or opportunity to hire or appoint, this is an opportunity to consider diversity when making a change. Creating diverse nominating committees will help ensure that well-qualified candidates are broadly sought from all corners and walks of life.
Investigate. We should encourage cardiovascular population health research that focuses on inequities of health care delivery.
Start the conversation. We must lead conversations about harassment and inequality in our places of work, our chapters, our sections, and more. An otherwise uncomfortable conversation could prove illuminating.
Drive the right data. Download the ACC Connect app at ACC.org/MobileResources and then login, so we have accurate, actionable member-level data.
Reach out to female residents. Fewer women enter cardiology fellowship than internal medicine, and even fewer enter interventional or electrophysiology fellowships. I support an individual’s right to choose a career path, but let’s make sure everyone makes an informed choice — let’s reach out to female internal medicine residents and invite them into our offices, living rooms or Women in Cardiology section meetings, so we ensure we’re attracting the best and brightest for our patients. If the gender gaps in these subspecialties persist, perhaps we’ve missed a message about subspecialty wellness and lifestyle, and we’re off our mark on the Quadruple Aim.
Reach out to high schools and colleges. Encourage underrepresented minorities and inform them that not only is health care a great career option, but as we all know cardiology is clearly the best! Offer job or practice shadowing opportunities and share the passion of being a physician or clinician — let’s spend a day to impact a lifetime.
Share. As ACC members, let’s share our success stories of (and challenges for) greater inclusivity. Visit www.ACC.org/diversity to learn more about how to get involved in ACC’s diversity and inclusion efforts — and share your story on social media by tagging your posts with #TheFaceOfCardiology.
Diversity Makes Us Stronger
Annette Ansong, MD, FACC
Why is diversity in the cardiology workforce important to you?
Diversity in the cardiology workforce is important to me as it brings a variety of thoughts and ideas that can only make our field stronger. It minimizes a homogeneity that may skew and bias our field in one direction and thus be a disservice to our patients. Also, patients like to see doctors who look like them.
A diverse workforce allows doctors to reach out into certain communities because these doctors share a similar background and have earned their “street cred.” These communities are more likely to heed the valuable advice of practitioners and lead a better heart-healthy life. This change in lifestyle is then witnessed by their children and passed on.
What is the biggest challenge to diversity in cardiology or health care overall?
The biggest challenge to diversity in cardiology is having more participants of diverse backgrounds at the table where major decisions and policies are being made. Meaning, more recruitment is needed to have diverse participants sit on national committees, lead major program initiatives and clinical trials.
"More recruitment is needed to have diverse participants sit on national committees, lead major program initiatives and clinical trials." — Annette Ansong, MD, FACC
If there is a dearth in the number of practitioners of diverse backgrounds, training and opportunities should be created to expand this pool. Diversity is the gift that keeps on giving. As more diverse faces of cardiology are seen as agents of change, the more accepting a diverse community will be of our organization’s guidelines and recommendations.
Annette Ansong, MD, FACC, is a pediatric cardiologist with Pediatric Cardiology Associates and at Inova Fairfax Hospital Inova Heart Center, Fairfax, VA.
Deepak L. Bhatt, MD, MPH, FACC
ACC’s Distinguished Mentor award was bestowed on Deepak L. Bhatt, MD, MPH, FACC, during the ACC.18 convocation ceremony in Orlando, FL. Well known as a prolific researcher and contributor to the published literature, interventional cardiologist and professor of medicine at Harvard Medical School, this award recognizes Bhatt’s contributions to developing the next generation of academic leaders and the careers of innumerable students, residents and fellows. “I would really like to thank my mentees and colleagues who nominated me for this award — it means a lot to me. I would also like to thank the ACC for all the valuable mentorship different members have provided to me through the years,” Bhatt says.
“Being a good mentor is much like being a good parent,” says Bhatt, the father of four sons. It requires investing a lot of time, energy and nurturing, he says, along with providing the advice, guidance and opportunities needed to learn, grow and reach the next level or goal. Read More >>>
Bhatt’s genuine concern for his mentees and his generosity of time are among the attributes highlighted when he was presented the award. “Despite his involvement in several hundred manuscripts on a yearly basis, and other academic, clinical, research and administrative commitments, there has not been a single occasion where Dr. Bhatt has not been available to provide invaluable guidance and mentorship,” says Ankur Kalra, MD, FACC. Bhatt’s support and mentoring has helped Kalra to transition into a junior faculty position.
Brigham and Women’s Hospital in Boston, MA, where Bhatt is the executive director of Interventional Cardiology Programs, has a strong culture of mentorship, he says, with a belief that there’s a responsibility and legacy of training the next generation of academic leaders. Eugene Braunwald, MD, MACC, a legend in cardiovascular medicine, has helped to establish this culture and has been an important role model for Bhatt. “Dr. Braunwald has taught me a lot about being a good mentor, not only to medical students, residents and fellows, but also for junior faculty,” Bhatt says. Mentoring for each of these different stages and beyond, requires a slightly different skill set to get the mentee to their next level, Bhatt notes, and a good mentor works to gain the needed fund of knowledge and adapt to the current needs of the mentee.
Equally important is recognizing the mentee is an independent professional working to develop an independent career and rejoicing in their achievements and success. Fortunately for his many mentees, Bhatt is at a stage in his career that he can afford to provide opportunities for them to advance.
What’s some of the key advice from Bhatt to his mentees? Be introspective and honest about what you truly want from your professional and personal life and try to strike a balance. Be willing to adjust your course as you learn what you truly do and don’t like to do professionally. “It’s just as important to learn what you don’t like or don’t feel you’re good at and change your path,” says Bhatt.
"Despite his involvement in several hundred manuscripts on a yearly basis, and other academic, clinical, research and administrative commitments, there has not been a single occasion where Dr. Bhatt has not been available to provide invaluable guidance and mentorship." — Ankur Kalra, MD, FACC
This advice also applies to the perennial issue of work-life balance. Take stock and make honest decisions about what’s important in your professional and personal life and use this to guide conscious choices about using your time wisely, he says. “We must prioritize what’s important and focus on this,” he adds. For him, at this stage of his life, this means a focus on his work and his family.
As an interventional cardiologist, Bhatt appreciates the immediacy of being able to help a patient, as with a lifesaving primary PCI in the middle of the night — much like his own life was saved when a surgeon traveled through a nighttime blizzard in Boston to remove his ruptured appendix. This first exposure to the hospital environment and his admiration of the physicians and nurses who were helping people were the first seeds planted that led him into medicine. Medical school and an early experience as an anatomy tutor for the thorax while working with a cardiology fellow contributed to his interest in cardiology. While many areas of cardiology held his interest, interventional cardiology married the cognitive component with the procedural component for Bhatt, who has always liked working with his hands.
Bhatt’s service to ACC includes being the senior associate editor of ACC.org and a member of its editorial board; guest editor for the Journal of the American College of Cardiology; vice chair of the Accreditation Management Board; outgoing chair of the NCDR ACTION Registry-GWTG Steering Committee; member of the NCDR Science and Quality Oversight Committee; and a recent term as a Board of Trustee member.
“One of his unique qualities is his perennial availability, despite being one of the busiest and most sought-after people within the cardiology community,” says Dharam J. Kumbhani, MD, SM, FACC. “No question, however minor, is unimportant, and I know that I will have his undivided attention whenever needed,” he adds. True to form, Bhatt is paying it forward, serving as a role model for those he mentored, like Kumbhani, as they move into mentorship roles.
ACC’s Diversity and Inclusion Goals
- To ensure that cardiovascular medicine in general, and the ACC in particular, benefit from a diversity of backgrounds, experiences and perspectives in leadership, cardiovascular health care delivery, business, education and science.
- To ensure that cardiovascular medicine in general, and the ACC in particular, attracts and provides rewarding careers and leadership opportunities for the full range of talented individuals.
- To ensure that the diverse health needs of cardiovascular patients and populations are met by cardiovascular clinicians sensitive to and prepared to meet the unique needs of their gender, cultural, racial and ethnic and other dimensions of diversity.
Three Objectives to Accomplish These Goals
- Enhance the culture within the cardiology profession and the perceptions of the field to be inclusive, professional, equitable and welcoming.
- Realize and sustain the value of diversity over the long term by implementing structures and continuous improvement programs within the ACC to ensure accountable execution.
- Engage and leverage all available talent by attracting and providing value to underrepresented groups in cardiology across the career lifespan.
Keywords: ACC Publications, Cardiology Magazine, Accreditation, Achievement, Angioplasty, Balloon, Coronary, Awards and Prizes, Cardiovascular Agents, Committee Membership, Continental Population Groups, Delivery of Health Care, Electrophysiology, Emotions, Ethnic Groups, Exploratory Behavior, Faculty, Fellowships and Scholarships, Financial Management, Goals, Internal Medicine, Leadership, Life Change Events, Medicine, Mentors, Minority Groups, Nuclear Family, Patient Care, Percutaneous Coronary Intervention, Physicians, Pregnancy, Registries, Risk, Rotation, Schools, Medical, Sexual Behavior, Socioeconomic Factors, Students, Students, Medical, Surgeons, Trustees, Urology, Work-Life Balance
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