Few Women Choose a Career in Interventional Cardiology. Is That About to Change?

Cindy L. Grines, MD, FACC, FSCAI, is vice president of academic and clinical affairs at the Detroit Medical Center Cardiovascular Institute. She is also the chair of the Society for Cardiovascular Angiography and Interventions’ Women in Innovations (WIN) group. Dr. Grines can be reached at the DMC Heart Hospital, 311 Mack Ave, Detroit, MI 48201; Email: cgrines@dmc.org.

It’s no secret that women are underrepresented within the interventional cardiology profession. Within the United States, only 4.5 percent of interventional cardiologists are women, and only 2.8 percent of angioplasty procedures are performed by women. These statistics were revealed during research recently conducted by the Society for Cardiovascular Angiography and Interventions’ (SCAI) Women in Innovations (WIN) group.

It seems anomalous that interventional cardiology remains such a male-dominated profession in light of the advancements that women have made within the medical field. Women now make up more than 50% of medical students and nearly 33 percent of the nation’s practicing physicians, according to the Kaiser Family Foundation. This substantially exceeds broader career averages, where only 26 percent of women hold jobs in the science, technology, engineering and mathematics (STEM) professions, according to the U.S. Census Bureau.

So, why are so few women pursuing careers in interventional cardiology? I’ve observed several factors alienating women from the profession during my 25 years as an interventional cardiologist, which includes being the vice president of a cardiovascular institute and the chair of the SCAI WIN group. These factors include the profession’s culture, physical demands and potential for radiation exposure — all of which contribute to steering women away from interventional cardiology. 

Some of these challenges, however, are being overcome with technological innovations. With these innovations, is the industry on the cusp of seeing more women pursue careers in interventional cardiology?

Evaluating the culture

The culture within the interventional cardiology profession is perhaps the biggest hurdle for women to overcome. It’s a macho culture that requires the trainee to be tough physically and emotionally, and requires a lot of self-confidence. This requirement to be “tough” and assertive may backfire on women, who are also expected to be kind, nurturing and friendly. The hours can be grueling, especially when one considers ST-elevation myocardial infarction (STEMI) call. Once out of training, procedural volume is a huge competition among physicians, and striving for more patients and procedures may be driven, in part, by ego and personal income. Many women do not have a “practice-building” mentality, and are not accustomed to the self-promotion required to build a large practice. 

From my experience, many women seem more focused on the individual patient and the science of medicine. In fact, I’ve witnessed that female interventional cardiologists spend more time with their patients, which is counterintuitive to a practice-building mentality that is focused on procedure volume. 

Practice-building also presents challenges for those who wish to achieve a work/life balance, and those who choose to have children. Most women are 32 or 33 years old when they land their first job in the profession after years of formal education and training. During those prime childbearing years, female physicians often feel forced to choose between starting a family and pursuing their careers. 

All of these cultural barriers can seem overwhelming to women becoming interventional cardiologists, but there are alternatives, as my career demonstrates. I’ve spent my career focusing more on quality of care than procedure volume. Simultaneously, I’ve expanded my presence in the field through publishing, embracing new technology, participating in physician organizations, clinical trials, and speaking engagements. While these extra efforts have helped me earn the recognition to advance my career, there have still been other challenges to overcome.

Physical demands and radiation exposure

Being an interventional cardiologist takes a physical toll on physicians. 

The physical demands of wearing personal protective equipment (PPE) —lead aprons, eyeglasses, sleeves and other shielding — to prevent radiation exposure from the fluoroscopy that is used during procedures. The PPE is heavy, awkward and fatiguing — particularly for women who tend to be physically smaller than men. This can be exacerbated by the constant need to lean over patients during procedures, which is not only fatiguing, but can also lead to chronic neck and back injuries, which have been well documented in numerous medical journals. In fact, nearly all interventionalists from my generation have neck or back injuries.

Additionally, many women remain concerned about the impact of chronic radiation exposure on current or future pregnancies. This is a legitimate concern, but effective use of PPE can prevent exposure. I continued performing procedures through both of my pregnancies, taking special precautions to shield my abdomen from radiation exposure. As is standard, I wore a radiation dosimeter on my waistband, and it indicated that my exposure remained at safe levels during my pregnancies. 

Reducing physical demands and radiation concerns

A new approach for percutaneous coronary intervention (PCI) procedures is to use a vascular robotic system. Our hospital has used the CorPath Vascular Robotic System (Corindus Vascular Robotics) in our cath lab for the past two years and we are impressed with the increased physician safety that it offers. 

CorPath allows physicians to perform procedures from behind a workstation, or “cockpit,” instead of being next to the patient during the procedure. The radiation-shielded cockpit contains monitors to view the angiography and hemodynamics screens during the procedure, and digital controls for the physician to precisely control the movement of the interventional devices by a bedside-mounted robotic arm. 

The robotic system allows for sub-millimeter measurements and 1mm movements to position guidewires, stents, and balloons during procedures. I use the CorPath System for about five PCI procedures per week from the comfort of the cockpit. My body feels noticeably better at the end of the day when I use the robotic system and I have fewer concerns about radiation exposure due to the cockpit’s radiation shielding. 

For women, robotic-assisted technology can help reduce concerns about radiation exposure that may affect pregnancy, while also decreasing the physical demands that are obstacles for both men and women.

Will more women become 

interventional cardiologists? 

Conditions are certainly changing within the interventional cardiology profession and opening the door for more women to enter the field. On one hand, the use of robotic systems is helping to alleviate many concerns about radiation exposure and physical demands that may encourage women to pursue the profession. Reimbursement may change to a “pay for performance” model where volume may not matter as much.

Cultural change, on the other hand, may be a much more complex issue to resolve. As I pointed out earlier, women should be creative and feel empowered to blaze their own trails that lead to a fulfilling career. It’s an approach that has worked for me for more than two decades in interventional cardiology.