A published in JAMA Cardiology revealed internal medicine residents showed a lack of interest in pursuing a career in cardiovascular disease and more prominently so amongst the female residents. The conclusion showed that this was due to concern for adverse job conditions, work hours, compensation, lifestyle, and lack of diversity. This is the problem, but we are the solution.
My name is Rachel Marie Bond, MD. I am a black, female cardiologist -- I'm not sure if it can get any more diverse than that. There are not many of us and there are many subtle reasons why that's the case.
Throughout my journey, I've learned a lot of life lessons as to why this may be, but also how these same experiences have made my journey all the more rewarding. Last year, I read an in the New England Journal of Medicine from a female physician to her younger self; this inspired me to do the same. I think of me ten years ago when I was a naive medical student going through my clerkships. I think of all of those young women who are in the same position and the advice I would have given to myself now knowing all that I know. I hope my advice will reach other young ladies who dream to be a cardiologist. I hope that my letter may impact them as much as the letter I read impacted me. I hope this will be one step to the solution to serve as a beacon for future women in this amazing field.
To Younger Rachel,
I am so happy that you decided to be a cardiologist. You are going to go through many hardships on the way. But trust me when I tell you: it will all be well worth it in the end. To be frank, you are walking into this male-dominated field, which is full of implicit bias, having two strikes against you right off the bat. One -- the main one -- you are a female. Two, you are a black female.
Gender disparities in cardiology have been well established through the years. As a medical student, you are now seeing an abundance of female peers amongst your medical school class. Trust me, this isn't a rare occurrence but goes along with the national average showing that approximately half of those in medical school are female. I want to let you know, this percentage will steadily drop the minute you step foot into your cardiology fellowship where it will be obvious that as a female, you are now the minority. In fact, data shows that women constitute only 21% of general cardiology trainees. These numbers are even more staggering when looking at the subdivisions with only 7.2% of interventional fellows and 6% of electrophysiology fellows being female. Please do not let this deter you, as you will form bonds with women within the field who will become your mentors, advisors, and champions to compensate for this. Once you become an attending physician, you will soon realize that you are joining a small niche of amazing women who account for only 13.2% of general cardiologists.
Beyond that, you will get a rude awakening that gender inequality in compensation exists among most specialties in medicine. A study published in 2016, showed that female cardiologists, on average, earn 7.3% less than their male peers after accounting for clinical and academic productivity and subspecialty training. To put this into logical terms, a published most recently in JAMA had a physician estimate that, on average, a woman in cardiology will earn $2.5 million less than a man over a 35-year career. But, times are changing. In fact, most recently the ACC resolution committee has called for the AMA to take several steps to limit this by advocating for institutional and departmental policies of transparent criteria for physician compensation, creation of a specified approach, and -- most importantly -- implementation of educational programs to help all physicians recognize your value and negotiate equitable compensation. With experience, you will master the art of negotiation and help your mentees to do the same.
Now Rachel, if you think that being a female cardiologist places you in the minority, wait until you go through your career and realize that being a black cardiologist is even rarer. Racial disparities amongst physicians are very apparent when you look at the national data where African Americans and Hispanics (who consists of the largest underrepresented minority in medicine) account for only 6% of the current cardiovascular workforce combined, compared to 25% of the general U.S. population. This will become very apparent to you as you will be the only African American in your fellowship class and one of a very few to practice at your workplace. Although the trend for diversity in cardiology has been slow, you will be one factor to the solution. You will go on to mentor a whole generation of underrepresented students and trainees. Over time, you will realize that such efforts will prove to help a larger, population-based problem where a composite of Americans, mainly Black Americans, are disproportionately plagued by cardiovascular disease and have the highest rates of mortality from it. This group is notoriously undertreated and underrepresented in clinical research studies. By recruiting, training and retaining diverse students and trainees, the cardiology workforce has the potential to have physicians who are sensitive to their patients' cultural background and are better prepared to relate to their patients' health needs, provide more effective and efficient services and push for inclusion of such populations into pivotal studies.
With the above being said, it seems like a daunting task. But like I said in the beginning, you are part of the solution, and I hope you realize that now more than ever. Things won't be easy. There will be many sleepless nights during cardiology fellowship taking care of the sickest of the sick. You may be yelled at by your supervising attending. You may carry a pager that goes off every five minutes. You may be mistaken for basically anything but a medical doctor -- even after you introduce yourself as such and wear your credentials along with your long white coat. But at the end of it, you could not imagine being anything but a cardiologist. You will realize how exciting this field is and that there are new medical breakthroughs on a daily basis that will allow you to continue learning every day. You also will have formed never-ending bonds with colleagues, closer relationships with your family and friends who have encouraged and supported you through it all and you will have learned the skill set that you will apply to save so many lives in the future. When you become an attending physician you will further apply all that you've learned and encourage a whole generation of young students and doctors to do the same through your passion of the field. You will make close relationships with patients and families and appreciate the gratitude of those that you've helped. You will go home and sleep well at night knowing you've made a difference.
Thank you, Rachel, for choosing to be a cardiologist. It wasn't the easiest choice, but thank you for making the right choice for yourself and following your heart. To all the young females to follow, I look forward to mentoring you and I am so happy because you are the solution.
Best,
Rachel M Bond, MD, FACC
, is the associate director of the Women's Heart Health Program at Northwell Health, Lenox Hill Hospital and assistant professor of cardiology at Hofstra Northwell School of Medicine. Dr. Bond is a women's heart health and prevention specialist and spokesperson for the American Heart Association's Go Red For Women campaign. She wrote this piece for ѻý.