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Why are so few interventional cardiologists women? A new study offers a few clues

Less than 5 percent of interventional cardiologists are women. A study has found that changing hours, male-dominant culture and radiation are deterrents.

As a cardiovascular fellow-in-training, Celina Yong, MD, found her passion in interventional cardiology. Threading catheters through arteries to open blockages in heart attack patients, she said, "was very rewarding, and it was fun."

It wasn't until Yong, now an assistant professor in cardiovascular medicine at Stanford, attended a national conference that she realized what an anomaly she was. "I was completely shocked to find I was the only woman in some of the sessions," she said.

While women make up a little more than half of medical school students and are reaching parity in many medical specialties, they constitute less than 13 percent of cardiologists, and a mere 4.5 percent of practicing interventional cardiologists, physicians who primarily use catheters to treat a variety of heart conditions. Yet half of their patients are women, Yong pointed out, creating a drastic imbalance.

Knowing that a gender-lopsided field can affect patient care, Yong decided to study why so few female trainees choose the subspecialty. From a survey of 574 cardiology fellows in training, she found that women are put off by the unpredictable hours, the radiation used during procedures and the male-dominated culture.

Her research was published in JACC: Cardiovascular Interventions.

In the survey, more women than men said they were concerned about the conflict between family life and the job demands. "Heart attacks happen at all hours," Yong said, and interventional cardiologists "take pride in caring for their own patients."

"It makes for good patient care," but it's hard on the personal lives of the physicians, she said, men as well as women. She noted that one male fellow said in the survey that he chose another subspecialty because he had kids and he wanted to have time to take care of them.

The X-ray machines the interventional cardiologists use to guide their catheters also scared off some women taking the survey, Yong found. Some respondents said they were afraid of their effect on fertility and pregnancy, although data suggests that the work can be safe with appropriate precautions, according to the research paper.

In addition, more female than male trainees who took the survey worried about the weight of the heavy lead aprons worn to protect against radiation. Yong said that some interventional cardiologists experience back problems after years of donning the aprons.

The lack of female mentors, an "old boys' club" culture and discrimination also deterred some women.

Yong noted that there are solutions to some of these barriers. Interventional cardiologists could work in shifts, for example, she suggested. Like heart attacks, babies arrive at all hours, but in obstetrical practices, typically the physician on call delivers the baby.

And physicians who work with radiation can now protect themselves with "weightless lead" innovations, such as standing inside a lead tube and working through arm casings, although the getup remains imperfect, Yong said.

As for the old-boys'-club feel of the subspecialty, she said, "Overcoming the culture is going to take a concerted effort."

But it would be worth it and benefit patients, Yong is convinced. "Women approach patients' problems differently," she said, which can expand possibilities for effective treatment. Also, women can bring a different perspective when it comes to research: "When both men and women design studies and analyze data together, we do a better job, especially when it comes to treatment of female patients."

She added that the subspecialty is also missing out on talent: "If we consistently fail to recruit the best female trainees, we are losing out on the opportunity to advance our field."

Yong, a mother of three who is married to another interventional cardiologist, said that the supportive culture at her institution has been a great help. One day, when she had to pick up her kids from day care no later than 6:30 p.m., a male colleague offered to cover her last case so she could make it in time.

"While it may seem like a small gesture, for me, that was a powerful moment in my early career," Yong said. "I realized that while my profession was still mostly composed of 'old boys,' there was hope that it wasn't a closed club after all."

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