From the Women in Cardiology Section Survey Says: CV Career Satisfaction High, But Diversity Challenges Remain Differences in career experiences between female and male cardiologists have lessened over the past 20 years; however, personal life choices and levels of discrimination continue to diverge significantly, according to a Council Perspective from ACC’s Women in Cardiology (WIC) Section published in the Journal of the American College of Cardiology. The third decennial Professional Life Survey, conducted by the Leadership Council of the WIC Section, found that career satisfaction remains high for both female and male cardiologists. Most respondents said they were satisfied with their financial compensation. Both sexes reported that they would like to see more educational initiatives from the College regarding practice management issues such as job negotiations and leadership training. Changes in the field of cardiology have affected both sexes. “Dramatic changes have occurred in the practice patterns of cardiologists; fewer than a quarter now work in a private practice setting, down from almost three-quarters of cardiologists 20 years ago,” says senior author Claire Duvernoy, MD, FACC, chair of the WIC Section. “Cardiologists have been aging; significantly greater numbers are over age 60 in the present survey than previously. Our profession must find ways to improve the pipeline of new cardiologists. To that end, we need to increase the diversity of our workforce, and find ways to recruit higher numbers of women, who currently number only 13 percent of the cardiology workforce, as well as underrepresented minorities.” Despite experiencing the same career changes, female and male cardiologists reported substantial differences in their personal and professional experiences. “Men were much more likely to have children than women (87 percent vs. 72 percent),” said Sandra J. Lewis, MD, FACC, immediate past-chair of the WIC Section and first author of the paper. “For most of these men (57 percent), spouses provided all of the childcare. Female cardiologists with children at home were far more likely to pay for full- or parttime childcare, either in home or at a daycare center. Strikingly, 37 percent of women reported that family responsibilities had a negative impact on their career advancement, while only 20 percent of men reported the same.” “Men are increasingly balancing career and family,” stated the authors. “Women continue to be less likely to marry and to have children.” The majority of women who do marry have spouses who work full-time outside the home, creating a need for paid or unpaid childcare. Discrimination remains a problem reported by a clear majority of female cardiologists – at a rate almost three times as frequently as men. “Sex and parenting discrimination was significantly more likely to have been experienced by women compared with men,” adds Lewis, while men were most likely to have experienced racial and religious discrimination. In a sign of possible progress, there was a decline in the number of women reporting discrimination overall between the first Professional Life Survey in 1996 and the 2015 survey (71 percent vs. 65 percent, respectively). “Women in cardiology continue to experience record rates of discrimination – 65 percent of women who responded to the survey reported experiencing some form of discrimination, as compared with 23 percent of men,” says Duvernoy. “We must work to change the culture that allows this to occur in our field.” “With the third iteration of the Professional Life Survey, we now have data that provide us with 20 years of longitudinal information on the personal and professional lives of U.S. cardiologists – the largest study of its kind,” reflects Duvernoy. “These data reflect movement in the delivery of cardiology care, with subspecialization and employment models, but also underscore the failure of our profession to meet diversity challenges identified in the previous surveys.” But these challenges won’t be met without the support of the entire cardiovascular community. “If half of all medical residents but only 13 percent of our cardiology community are women, we are missing the inclusion of some of the most talented young physicians,” says Lewis. “These data support an opportunity for cardiology leadership, both men and women, to assure that our future cardiologists represent the best and most inclusive group possible, free of discrimination in our community.” “The Professional Life Surveys conducted over the years have been invaluable in furthering our understanding of the concerns, values and experiences of cardiologists,” states Mary Norine Walsh, MD, FACC, ACC president-elect and a co-author of the paper. “Important differences in experience between male and female cardiologists have emerged with each survey. This will be an important activity for the WIC Section Council to continue in the future to encourage the development of solutions with a focus on improving the lives of cardiologists.” From the Interventional Section PCI Before TAVR? A perspective from ACC’s Interventional Section Leadership Council published in JACC: Cardiovascular Interventions, recommends updating current PCI guidelines to address the role of PCI in patients pre transcatheter aortic valve replacement (TAVR). Stephen Ramee, MD, FACC, et al., explain that there is no evidence proving the safety of TAVR without prior PCI of severe coronary lesions. Because the guidelines for PCI were completed before the role of PCI in pre-TAVR patients became a clinical issue, they state that “it would be wrong to extrapolate current ACC/American Heart Association recommendations against invasive procedures in asymptomatic patients to the TAVR population when evaluating the quality of care by cardiologists or hospitals.” Ultimately, they suggest that PCI should be considered in all patients with significant proximal coronary stenosis in major coronary arteries before TAVR. However, they do not advocate performing PCI on a chronic total occlusion in the absence of ischemia or symptoms prior to TAVR.
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