January 8th, 2014
Women in Cardiology: The Challenge to Have Both Career and Family
Monika Sanghavi, MD
Monika Sanghavi’s recent Circulation: Cardiovascular Quality and Outcomes article tackles the important topic of the under-representation of women in cardiology and the reasons behind it, particularly the challenge of balancing a demanding career with family. CardioExchange asked Monika to share why she wrote the blog and the reaction she’s received.
The book Lean In was released on March 11th 2013, the last day of ACC 2013. As part of the book promotion, Katie Couric had interviewed Sheryl Sandberg on her talk show and tweeted a statement from Sandberg: “Women should go for the big job and deal with family later.” I immediately tweeted back, “I agree women should strive for greatness, but at the expense of their family, not sure.”
After I sent the tweet, I had an instant realization that I was being a hypocrite. I had been living apart from my husband for two years during fellowship in order to pursue my career ambitions. If that isn’t deferring family obligations, what is? I considered that many would think that living apart from their spouse was too high of an opportunity cost to pursue a cardiology fellowship. I reflected on this and the other sacrifices we make in order to pursue our passion in medicine.
While at the ACC sessions, I began to notice how most of the panelists of the late-breaking trials were men and how the conference was attended by more men than women. I also reflected on the fellows and faculty in my division and realized that women were disproportionately affected by family responsibilities: compared with our male counterparts, more of the female fellows had deferred starting a family and more of the female faculty had taken part-time positions to balance their family obligations.
I began to wonder if this is why we have such an under-representation of women in cardiology and what could be done to level the playing field for women. It is obviously not the hard work, overnight call, or subject matter that deters women, or there wouldn’t be so many in General Surgery, OBGyn, and Pediatric Cardiology.
When I flew home that night I couldn’t sleep; I wrote all of my thoughts on paper and began discussing this topic with other people. My informal survey of the women faculty at my institution reflects the findings of the ACC Professional Life Survey. The struggles these women were facing were not isolated, but part of a national struggle.
With the encouragement of my co-fellows and faculty mentors, I decided to publish my thoughts. The response has been great. I received an e-mail from a resident applying to cardiology in which she said, “You have captured my fears exactly.” I’ve also gotten emails from more senior faculty of both genders who appreciate the discussion. I really hope this article helps others reflect on this important issue and is a catalyst for greater discussion on what can be done to help recruit women into the field of cardiology and to balance both their career goals and family responsibilities.
This is an excellent topic!
My colleague here at Duke-Prateeti Khazanie-has been very interested in these questions and did a great series of interviews with women leaders in cardiology such as Drs. Lynn Stevenson and Pam Douglas:
I feel that we need to rebuild our training programs from scratch rather than the current practice of tacking on more and more years to training.
Medicine has moved way beyond the time of Osler- its about time we start training to reflect that reality.
Thanks for posting this!
The interview with Dr. Pam Douglas touched on an important point about recruiting women into cardiology. Dr. Douglas’ career path changed completely when she was approached and encouraged to be a cardiologist, otherwise she may have been a rheumatologist today. If you work with a medical student or resident with a knack for or keen interest in cardiology, I think it’s important to let them know of their potential, it could really influence their career choice.
A topic very close to my heart, and I am so glad we have a chance to discuss it! As a cardiologist with 12 years of academic and private practice experience, and a mother of three wonderful children, I have lived a hectic life of never feeling fully committed and available either at home or at work. I have a supportive husband who is also a medical professional, and hired help at home. Despite that, I often felt excessive stress and substantial burnt out. I strongly believe that to encourage more women to pursue cardiology as a career, we need to change not just our expectations and perceptions, but our entire work philosophy. It is not a surprise that women in technology and business world have achieved significant leadership roles. These spheres tend to be more structured with more permissive hours and less urgency in tasks needed to be accomplished while at work. Unfortunately, the medical workplace remains rigidly focused on ancient adage that “when you take call once every 2 days, you miss half the stuff”. It is an impossibility for women to try to rise to the top in the medical field if they are expected routinely (not just in training) to work 10 or more hours per day, start early, finish late, and do same or more work as their men colleagues for less compensation (recently confirmed by salary survey) while also pulling in a second shift at home! To change this philosophy, training programs and academic departments have to be accountable for promoting women into leadership roles, becoming transparent about salary gaps at comparable qualifications levels, etc. Otherwise, we can only lament our plight with no hope of change in sight…
Dr. Druz, thanks for sharing your personal experience and insight.
What are your thoughts on part-time employment options for physicians? Do you think this is a solution for working mothers and the burnout you mentioned, an option that will attract more women into cardiology?
Maybe underlying “man vs. woman” there is another issue which applies to both sex: ambition and striving for success as defined by the society. Higher salaries and higher positions and titles are not equivalent to true leadership or significant contribution to general welfare. And it’s possible to have meaningful human relationships outside the boundaries of traditional “family”. I think the change that needs to take place is in our inner world in order to be instantly free of external pressures.
Dear Dr. Partovian, thanks for your insight. I absolutely agree that if we create our own benchmarks for success, we will likely be happier. However, if our promotion is based on external measures of success I think it makes it more difficult.
Part-time employment, while accepted fairly well in other professional arenas, seems to run contrary to the requirements of our specialty. After all, how can we be able, affable AND available while working part-time? Such is a traditional point-of-view. However, I believe it is about to change. The key forces are several. There is a slowly expanding presence of women in cardiology that may accelerate as decline in reimbursements will shift the women to men ratio. Think of primary care as an example of that. The other formative force is expansion of insurance coverage with more physician power likely to be needed in the outpatient domain. In many practices, women make sizable contributions even if working part-time, and attract increasing patient following. However, the fundamental changes will not occur until women emerge as a strong leadership cohort. So, here is the challenge: how do you retain your early and mid-career women (who often have families and children) and allow them to rise to the top without stumbling along the way?
Dear Dr. Druz,
Interesting points. I am curious to see how things play out.
Regarding the challenge you mentioned at the end, I think it is a tough question and will require creative, out of the box solutions (? additional on-site resources for parents, shorter training time for physicians, opportunities to work from home – reading EKGs, echos, nucs, tele-medicine).
Thanks again for sharing your thoughts.