Sex Differences in the Well-Being of Interventional Cardiologists

Several studies suggest differences in burnout and coping mechanisms between female and male physicians. We conducted an international, online survey exploring sex-based differences in the well-being of interventional cardiologists. Of 1251 participants, 121 (9.7%) were women. Compared with men, women were more likely to be single and under 50 years old, and they asked more often for development opportunities and better communication with administration. Overall burnout was similar between women and men, but women interventional cardiology attendings were more likely to think that they were achieving less than they should.  Improved communication with administration and access to career development opportunities may help prevent or mitigate burnout in women interventional cardiologists.

Several studies suggest differences in burnout and coping mechanisms between female and male physicians.^1-3 We conducted an international, anonymous, online survey exploring sex-based differences in the well-being of interventional cardiologists.

The survey was administered via the Research Electronic Data Capture (REDCap) and was distributed via email lists and social media in January 2023. Seventy-eight questions were included in the survey. All statistical analyses were performed using R Statistical Software, version 4.2.2 (R Foundation for Statistical Computing). Categorical variables were presented as absolute numbers and percentages and were compared using Chi-square or Fisher’s exact test, as appropriate. Continuous variables were presented as median (lower quartile-upper quartile) and compared using the Mann-Whitney U test.  The study was approved by the Allina Health institutional review board. The survey was completed by 1159 interventional cardiology (IC) attendings and 192 IC fellows. Participants with a missing value for gender were excluded from the analysis.

Of 1251 survey participants, 121 (9.7%) were women (Figure). Compared with male participants, women were more likely to be under 50 years old (82.6% vs 73.1%, P = .031), single (25.6% vs 7.9%, P < .001), and more likely to practice at academic institutions or hospitals with academic affiliation (69.2% vs 59.3%, P = .046). There was no difference in the self-reported overall burnout between women and men (68.7% vs 63.4%, P = .353). On a scale of 0 to 10, men reported more often too much paperwork (6.9 ± 2.5 vs 6.2 ± 2.7, P = .013) and government regulations (4.8 ± 3.1 vs 3.6 ± 2.8, P < .001) as contributors to burnout. Women reported less often getting along well with colleagues (7.0 ± 2.9 vs 7.5 ± 2.1, P = .047) and more often feeling lonely during the prior year (5.5 ± 3.1 vs 4.3 ± 3.2, P=.001). Men more commonly chose exercise as a coping mechanism for burnout (4.8 ± 3.2 vs 3.8 ± 3.1, P = .005), while women more often chose talking with family/friends (6.8 ± 2.5 vs 5.8 ± 2.8, P = .003). Women prioritized additional paid time off (7.5 ± 2.5 vs 6.9 ± 2.7, P = .041) as the most preferable wellness-related action and asked more often for respect/recognition from administration, opportunities for professional growth, and mentorship opportunities. Almost half (44.3%) of women IC attendings considered leaving their job during the prior year (vs 40.6% men, P = .572) and 45.5% reported decreased enthusiasm towards work compared with the prior year (vs 44.2% men, P = .590). Almost 1 in 10 (9.1%) reported suicidal ideation during the prior year (vs 6.1% men, P = .387). Seventy-five percent of women IC attendings reported thinking they are achieving less than they think they should at least twice a week (vs 56.1% men, P = .001). Two-thirds (69%) of women IC attendings reported having somebody with whom they could share their mental health concerns (vs 66.9% men, P = .791), and 28.7% reported not having access to mental health support if needed through their hospital/practice (vs 36.9% men, P = .167).

The main findings of the present survey are that (1) women interventional cardiologists are more likely to be single and under 50 years old, (2) overall burnout is similar between women and men, (3) women ask more often for development opportunities and better communication with administration, and (4) women IC attendings are more likely to think that they are achieving less than they should. Previous studies report sex differences in burnout in the field of general cardiology,^1-3 however there is no study focusing on interventional cardiology. A past survey investigating sex differences in the pursuit of interventional cardiology between cardiology fellows revealed barriers for women, including old-boys’ club culture, lack of female role models, little flexibility in job opportunities, and sex discrimination.⁴ A different survey conducted among cardiologists with an interest in interventional cardiology indicated that women were more likely to cite radiation exposure, work environment, on-call, and family reasons as deterrents from choosing interventional cardiology, while men more commonly reported lack of opportunity and personal preference.⁵

Limitations. Our study has limitations, including selection bias (physicians with greater interest in mental health may be more likely to respond) and recall bias.

In summary, our survey shows sex differences in contributors and coping mechanisms to burnout in the field of interventional cardiology. Better communication with administration and access to career development opportunities might be especially valuable for reducing the risk of burnout in women.

We found important sex differences in contributors and coping mechanisms related to burnout among interventional cardiologists. These findings shed light on the unique challenges faced by women in the field and emphasize the importance of addressing these issues. Improved communication and access to career development opportunities are crucial in supporting the well-being of women interventional cardiologists.

From the ¹Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; ²Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA; ³Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA; ⁴Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA; ⁵Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA; ⁶Department of Cardiology, Athens Naval Hospital, Athens, Greece; ⁷Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA; ⁸Institute for Professional Worklife, Hennepin Healthcare, Minneapolis, Minnesota, USA; ⁹Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK; ¹⁰Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK; ¹¹Department of Medicine, Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Funding/Acknowledgments: The authors are grateful for the philanthropic support of our generous anonymous donors, and the philanthropic support of Drs. Mary Ann and Donald A Sens; Mrs. Diane and Dr. Cline Hickok; Mrs. Wilma and Mr. Dale Johnson; Mrs. Charlotte and Mr. Jerry Golinvaux Family Fund; the Roehl Family Foundation; the Joseph Durda Foundation. The generous gifts of these donors to the Minneapolis Heart Institute Foundation's Science Center for Coronary Artery Disease (CCAD) helped support this research project.

Address for correspondence: Emmanouil S. Brilakis, MD, PhD, Minneapolis Heart Institute, 920 E 28th Street #300, Minneapolis, MN 55407, USA. Email: esbrilakis@gmail.com