Advertisement

Representation of Women in Internal Medicine Specialties in North America, the United Kingdom, and Australasia: Cardiology's Outlier Status and the Importance of Diversity

Published:October 07, 2022DOI:https://doi.org/10.1016/j.amjcard.2022.08.030
      Decades of research demonstrate the value of workplace diversity. Reports from individual countries show that women are underrepresented in internal medicine workforces. However, large pooled international studies are not available. This study investigates the current representation of women in the internal medicine workforce internationally and identifies specialties in which underrepresentation is evident. Peer-reviewed studies, government reports, and medical association reports were used to determine proportions of specialists and doctors training in internal medical specialties and in comparator surgical specialties. Data were available from Australia, Canada, England, New Zealand, the United States, Wales, Scotland, and Northern Ireland. A total of 380,263 doctors were studied, including 268,822 practicing specialist physicians (also known as attendings or consultants) and 53,226 doctors in internal medicine specialty training programs (also known as residents, fellows, advanced trainees, or specialist registrar trainees). Among practicing physician specialists, the rate of representation of women was 35% (95,195/268,822, p <0.001). Among trainees, the rate of representation of women was 43% (22,728/53,226, p <0.001). Among physician specialties evaluated, cardiology (15%, 4,152 of 27,328), gastroenterology (20%, 3,765 of 18,893), and respiratory/critical care (24%, 5,255 of 21,870) had the lowest representations of women compared with men (p <0.001 for all). Cardiology and particularly the subspecialty of interventional cardiology were clear outliers as the internal medicine specialties with the lowest representation of women at practicing specialist and trainee levels. In conclusion, this study is the largest international study of women in internal medicine specialties. It found that cardiology, gastroenterology, and respiratory/critical care specialties have the most substantial underrepresentation of women. These data are a global call to action to establish more successful strategies to provide a diverse and representative cardiology workforce.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Burgess S
        • Morice MC
        • Alasnag M
        • Grines C
        • Mehran R
        • Zaman S.
        Women and cardiology: the value of diversity.
        Heart Lung Circ. 2021; 30: 3-5
        • Burgess S
        • Shaw E
        • Ellenberger K
        • Thomas L
        • Grines C
        • Zaman S.
        Women in medicine: addressing the gender gap in interventional cardiology.
        J Am Coll Cardiol. 2018; 72: 2663-2667
        • Wang TY
        • Grines C
        • Ortega R
        • Dai D
        • Jacobs AK
        • Skelding KA
        • Mauri L
        • Mehran R.
        Women in interventional cardiology: update in percutaneous coronary intervention practice patterns and outcomes of female operators from the National Cardiovascular Data Registry®.
        Catheter Cardiovasc Interv. 2016; 87: 663-668
      1. Australian Health Practitioner Regulation Agency. National Health Workforce Dataset. Available at: https://hwd.health.gov.au/datatool/. Accessed on November 01, 2021.

      2. Canadian Institute for Health Information (CIHI). Supply, Distribution and Migration of Physicians in Canada 2017. Available at: https://secure.cihi.ca/estore/productSeries.htm?pc=PCC34. Accessed on November 01, 2021.

      3. Walton M, Rourke J, Bowmer I, Kearney R, Buske L. Canadian Post-MD Education Registry Annual Census. CAPER RCEP. Available at: https://caper.ca/sites/default/files/pdf/annual-census/2020-21-CAPER_Census_EN.pdf?. Accessed on November 01, 2021.

      4. Royal College of Physicians. Focus on physicians. Census of consultant physicians and higher speciality trainees in the UK, 2016-17. Available at: https://www.rcplondon.ac.uk/projects/outputs/2016-17-census-uk-consultants-and-higher-specialty-trainees. Accessed on November 01, 2021.

      5. NHS Digital. Monthly NHS Hospital & Community Health Service (HCHS) Workforce Statistics. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/monthly-nhs-hospital-and-community-health-service-hchs-workforce-statistics. Accessed on November 01, 2021.

      6. Ludman PF. British Cardiovascular Intervention Society Audit. Vol. 2019; 2019.

      7. Information Services Division (ISD) Scotland. Surgery and General Physicians Report. Available at: https://beta.isdscotland.org/. Accessed November 01, 2021.

      8. Medical Council of New Zealand. The New Zealand medical workforce in 2020. Avaiable at: https://www.mcnz.org.nz/assets/Publications/Workforce-Survey/78253ef9cd/Workforce-Survey-Report-2020.pdf. Accessed on November 01, 2021.

      9. Association of American Medical Colleges. 2020 Physician Specialty Data Report. Available at: https://www.aamc.org/data-reports/workforce/report/physician-specialty-data-report. Accessed on November 01, 2021.

        • Woodward Z
        • Rodriguez Z
        • Jou JH
        • Keyashian K
        • Chen Y
        • Thomas Jr, CR
        • Elta GH
        • D'Souza SL
        Gender disparities in gastroenterology fellowship director positions in the United States.
        Gastrointest Endosc. 2017; 86: 595-599
        • Douglas PS
        • Rzeszut AK
        • Bairey Merz CN
        • Duvernoy CS
        • Lewis SJ
        • Walsh MN
        • Gillam L
        American College of Cardiology Task Force on Diversity and Inclusion and American College of Cardiology Women in Cardiology Council. Career preferences and perceptions of cardiology among US internal medicine trainees: factors influencing cardiology career choice.
        JAMA Cardiol. 2018; 3: 682-691
        • Coylewright M
        • Dodge SE
        • Bachour K
        • Hossain S
        • Zeitler EP
        • Kearing S
        • Douglas PS
        • Holmes D
        • Reddy VY
        • Nair D.
        Women in procedural leadership roles in cardiology: the Women in Local Leadership (WILL) observational study.
        Heart Rhythm. 2022; 19: 623-629
        • Burgess S
        • Shaw E
        • Zaman S.
        Women in cardiology: underwhelming rate of change.
        Circulation. 2019; 139: 1001-1002
        • Yong CM
        • Abnousi F
        • Rzeszut AK
        • Douglas PS
        • Harrington RA
        • Mehran R
        • Grines C
        • Altin SE
        • Duvernoy CS
        American College of Cardiology Women in Cardiology Leadership Council (ACC WIC), Society for Cardiovascular Angiography and Interventions Women in Innovations (SCAI WIN). Sex differences in the pursuit of interventional cardiology as a subspecialty among cardiovascular fellows-in-training.
        JACC Cardiovasc Interv. 2019; 12: 219-228
        • Eaton AA
        • Saunders JF
        • Jacobson RK
        • West K.
        How gender and race stereotypes impact the advancement of scholars in STEM : professors’ biased evaluations of physics and biology post-doctoral candidates.
        Sex Roles. 2020; 82: 127-141
        • Jaijee SK
        • Kamau-Mitchell C
        • Mikhail GW
        • Hendry C.
        Sexism experienced by consultant cardiologists in the United Kingdom.
        Heart. 2021; 107: 895-901
        • Capranzano P
        • Kunadian V
        • Mauri J
        • Petronio AS
        • Salvatella N
        • Appelman Y
        • Gilard M
        • Mikhail GW
        • Schüpke S
        • Radu MD
        • Vaquerizo B
        • Presbitero P
        • Morice MC
        • Mehilli J.
        Motivations for and barriers to choosing an interventional cardiology career path: results from the EAPCI Women Committee worldwide survey.
        EuroIntervention. 2016; 12: 53-59
        • Kurdi H
        • Morgan H
        • Williams C.
        Women not in cardiology: where are we going wrong? a survey of the perceptions and barriers to training.
        Br J Cardiol. 2020; 27: 30
        • Lewis SJ
        • Mehta LS
        • Douglas PS
        • Gulati M
        • Limacher MC
        • Poppas A
        • Walsh MN
        • Rzeszut AK
        • Duvernoy CS
        American College of Cardiology Women in Cardiology Leadership Council. Changes in the professional lives of cardiologists over 2 decades.
        J Am Coll Cardiol. 2017; 69: 452-462
        • Sharma G
        • Douglas PS
        • Hayes SN
        • Mehran R
        • Rzeszut A
        • Harrington RA
        • Poppas A
        • Walsh MN
        • Singh T
        • Parekh R
        • Blumenthal RS
        • Mehta LS.
        Global prevalence and impact of hostility, discrimination, and harassment in the cardiology workplace.
        J Am Coll Cardiol. 2021; 77: 2398-2409
        • Oliveros E
        • Burgess S
        • Nadella N
        • Davidson L
        • Brailovsky Y
        • Reza N
        • Squeri E
        • Mehran R
        • DeFaria Yeh D
        • Park K
        Becoming a parent during cardiovascular training.
        J Am Coll Cardiol. 2022; 79: 2119-2126
        • Mehta LS
        • Blumenthal RS
        • Sharma G.
        The implications of restrictive maternity leave in cardiology: a time to hold the levers.
        J Am Coll Cardiol. 2022; 79: 1088-1091
        • Manzo-Silberman S
        • Velázquez M
        • Burgess S
        • Sahni S
        • Best P
        • Mehran R
        • Piccaluga E
        • Vitali-Serdoz L
        • Sarma A
        • Barbash IM
        • Mauri J
        • Szymański P
        • Hinterbuchner L
        • Stefanini G
        • Gimelli A
        • Maurovich-Horvat P
        • Boersma L
        • Buchanan GL
        • Pontone G
        • Holmvang L
        • Karam N
        • Neylon A
        • Morice MC
        • Leclercq C
        • Tarantini G
        • Dudek D
        • Chieffo A.
        EAPCI statement on radiation exposure and safety in catheterization laboratories for healthcare professionals during pregnancy: how barriers could be overcome; in collaboration with EHRA, EACVI, the ESC Regulatory Affairs and Women as One.
        EuroIntervention. 2022;
        • Khan E
        • Brieger D
        • Amerena J
        • Atherton JJ
        • Chew DP
        • Farshid A
        • Ilton M
        • Juergens CP
        • Kangaharan N
        • Rajaratnam R
        • Sweeny A
        • Walters DL
        • Chow CK.
        Differences in management and outcomes for men and women with ST-elevation myocardial infarction.
        Med J Aust. 2018; 209: 118-123
        • Burgess SN
        • Juergens CP
        • Nguyen TL
        • Leung M
        • Robledo KP
        • Thomas L
        • Mussap CJ
        • Zaman SJ
        • Lo STH
        • French JK.
        Comparison of late cardiac death and myocardial infarction rates in women vs men with ST-elevation myocardial infarction.
        Am J Cardiol. 2020; 128: 120-126
        • Greenwood BN
        • Carnahan S
        • Huang L.
        Patient–physician gender concordance and increased mortality among female heart attack patients.
        Proc Natl Acad Sci U S A. 2018; 115: 8569-8574
        • Tsugawa Y
        • Jena AB
        • Figueroa JF
        • Orav EJ
        • Blumenthal DM
        • Jha AK.
        Comparison of hospital mortality and readmission rates for medicare patients treated by male vs female physicians.
        JAMA Intern Med. 2017; 177: 206-213
      10. Canadian Association of Interventional Cardiology executive committee. Canadian Association of Interventional Cardiology 2021 census data. Dataset. Available at: www.caic-acci.org. Accessed on November 01, 2021.