Courageous Conversations: Shattering the Glass Ceiling

Courageous Conversations
Shattering the Glass Ceiling
Roxana Mehran, MD, FACC

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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.”

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Addressing the Gender Gap in Physician Compensation

At its June meeting, the House of Delegates for the American Medical Association (AMA) passed a resolution proposed by the ACC aimed at addressing the substantial gender gap in physician compensation.

The resolution resulted from the work of the College’s Task Force on Diversity and Inclusion Initiative, which recently released a five-year strategic plan to improve diversity and inclusion in cardiology. Specifically, the resolution called for the AMA to take the following steps:

  • Advocate for institutional and departmental policies to make more transparent the criteria for physician compensation.
  • Advocate “for equal base pay based on objective criteria.”

Work to promote bias and compensation determination training for people in positions to decide physician compensation.

Promote “a specified approach, sufficient to identify gender disparity, to provide oversight of compensation models, metrics and actual total compensation for all employed physicians.”

Begin educational programs to help all physicians negotiate equitable compensation.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: ACC Publications, Cardiology Interventions, Mentors, Leadership, Female, Pregnancy, Fellowships and Scholarships, American Medical Association, Angioplasty, Balloon, Coronary, Nuclear Family, Marriage, Research


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