Mind the gap in cardiology: An interview with Anne B. Curtis, MD

By Liz Meszaros, MDLinx
Published October 2, 2018

Key Takeaways

In the field of cardiology, women are vastly underrepresented. Women make up only 21% of general cardiology trainees, 7.2% of interventional fellows, and 6% of electrophysiology fellows. Further, currently only 13.2% of cardiologists and 4% of interventional cardiologists are women. But why?

According to results from a national survey published in JAMA Cardiology, female internal medicine residents reported that their professional development requirements—in descending order of significance—included stable hours, family and female friendliness, positive role models, financial benefits, professional challenges, patient focus, and the opportunity to have a stimulating career.

Unfortunately, respondents also reported that their perceptions of the field of cardiology included adverse job conditions, interference with family life, and a lack of diversity. Finally, women and those who did not choose careers in cardiology had a greater tendency to highly value work-life balance and had more negative perceptions of cardiology compared with men and those who chose cardiology as a career.

For some insight into why there seems to be a shortage of women in the field, MDLinx spoke with Anne B. Curtis, MD, SUNY Distinguished Professor of Medicine, and Charles and Mary Bauer Chair, Department of Medicine, University at Buffalo, Buffalo, NY, who was the lead author of an invited commentary on women in cardiology recently published in the same issue of JAMA Cardiology.

MDLinx: What characteristics of a cardiology practice may not appeal to female residents?

Anne B. Curtis, MD (ABC): A part of it is taking care of emergencies on call. If you’re an interventional cardiologist, the idea that you would have to come in in the middle of the night to put a stent in somebody [may not be appealing]. Unstable patients in cardiology may also more often need the cardiologist to come into the hospital physically at night than some other fields that are more outpatient oriented.

Of course, that can be true of surgery as well. Acute MI or major problems with a patient can often require someone to drop everything and come in. So, that aspect of it is not necessarily appealing to women.

MDLinx: What would you say to residents to encourage them to consider cardiology?

ABC: It’s a fascinating field, and there’s a huge amount of variety in cardiology in terms of the different areas you can get involved in your practice.

We have both procedural aspects and nonprocedural aspects of our field. If one really liked the nonprocedural side of it, there’s heart failure. You can take care of adults with congenital heart disease and not necessarily be a catheter-based physician. There’s also electrophysiology and interventional cardiology as well as imaging. Cardiology offers a wide range of activities somebody can do.

You can be primarily out-patient, or almost exclusively in-patient. For example, a field like infectious disease will mostly be an in-patient specialty. Others like rheumatology are primarily out-patient. In cardiology, you can tailor things to the way you find most satisfying over time.

MDLinx: In your opinion, what is the most important thing that could be changed to attract more women into the field of cardiology?

ABC: The more role models there are, the more women [will] see that it’s a possibility. We have some national statistics that 6% of electrophysiologists are women. I trained a number of them because they saw me doing it. That does help.

In terms of regulating hours, one of the ways to do that is to be part of larger groups and hospitals. The day of the solo practice cardiologist is pretty much gone. The majority of cardiologists now practice in hospitals as part of larger groups.

That does have the potential to lend itself to a more regular set of hours, although it’s just the nature of the field—there’s going to be some weekend call coverage that you have to deal with. True in many other fields as well.

MDLinx: How does cardiology compare to other fields as far as the number of women in them?

ABC: We’re low but probably the best examples would be that you see comparable numbers in some of the surgical fields. A field like neurosurgery is very low in the number of women. For surgery itself, I don’t know the exact numbers, but it also tends to be low. Women tend to dominate more in fields like pediatrics, OB/GYN, and primary care.

MDLinx: What can women who are cardiologists do to encourage female residents to take up cardiology as a specialty?

ABC: First of all, just be on rounds and show your own enthusiasm for the field. In any field that we go into, if people see attending physicians who are excited about what they do, it makes a big difference, versus people who are just struggling through every day.

Enthusiasm can be infectious. Every time I round on the service, it’s fun showing the residents an electrocardiogram where it’s an unusual finding. You talk them through it. I know that has made an impression on people.

We need to talk to residents who are good, and encourage them to pursue the field. We have to do that in a bit more of an overt way than we often do. When you go to somebody and say “Have you considered going into cardiology?” right then and there, you’ve made it sound like it’s a realistic goal.

MDLinx: Where is the field of cardiology today and how can women play a role?

ABC: We absolutely need more women in cardiology, in all areas. Cardiovascular disease is still a major factor affecting the health of adults, particularly older adults. There are a lot of women who appreciate being able to see a female cardiologist. It’s doable, it’s exciting, and we need all the talent we can get in the field. To leave half of the medical school population—because it’s about 50/50 women and men now—out of considering going into the field is just a loss of talent that we don’t want to see.

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