Women in Medicine
The issues women in medicine care about
“Gender inequality does not just affect our patients, but also remains a significant problem within the cardiology profession.” That is the opening statement in an American Heart Association article published in 2019 that examined the women in cardiology. The all-female research team found that while women make up most medical graduates, they are less than 15% of practicing cardiologists and less than 5% of interventional cardiologists. There are a couple of reasons why this finding is alarming. The first deals with perception. Fewer women in cardiology “unfortunately creates an opinion that heart disease is not a disease that affects women; if there aren’t women in the field, it must not affect them. That is incorrect as we know,” stated Dr. Phelan. Heart disease is the number one killer of men and women, responsible for about one in every five female deaths in the United States. “Women are often ill-informed or go undiagnosed for heart disease. Helping women recognize how prominent heart disease is in the female population is important, especially at a young age in making good lifestyle choices,” added Dr. Phelan. Knowing your blood pressure, quitting smoking, limiting alcohol use, managing stress levels, making healthy food choices, maintaining daily activity or exercise, and most importantly, regular visits with your health care provider are all steps to lowering the chance of developing heart disease.
“So much of what we think about preventing cancer applies to reducing the risk of heart disease.”
The reality is that cardiovascular disease is largely the most important women’s health issue, mainly because it can be prevented. The American Heart Association’s “Go Red for Women” campaign has helped raise awareness of heart disease at all stages in life. This is key, as there are two points in life where physical and psychological changes can significantly impact women’s risk of heart disease. The first is pregnancy. “Pre-existing conditions like high blood pressure or other congenital issues need to be recognized as potentially problematic when planning for a family or pregnancy,” adds Dr. Phelan. Weight gain is a discussion women need to have with their healthcare provider. Researchers show that overweight or obese pregnant women are more likely to develop heart disease later in life. There are also health risks to the baby, like gestational diabetes or preterm labor, associated with weight. It’s important for women to have open discussions on their physical health, mental well-being, and family health history with their healthcare provider as they begin family planning. “There are many cardiovascular conditions that can arise during pregnancy that often require a cardiologist’s assistance to get [the mother] successfully through pregnancy. There are also conditions that can make the potential for having more children dangerous to the mother’s health.”
Later in life, menopause, which usually happens in the mid-’50s, can be problematic for some women when there are lower levels of estrogen in their body. Researchers say women are susceptible to coronary artery disease during the menopause transition due to a deficiency in estrogen from the loss of ovarian function. Post-menopausal women often have higher cholesterol levels than men and are at greater risk of developing high blood pressure, even if they had normal levels throughout life. Many women have difficulty managing some or all of these added personal well-being needs. “There are natural changes in a woman’s health as she ages that must be discussed ahead of time to try and minimize the issues that can come about,” advised Dr. Phelan.
Issues women physicians care about
A 2020 Medscape survey of more than 3000 women physicians revealed interesting insight on the issues that absorb them the most. Work-life balance was by far the most important issue for women. 64% of respondents named it as their #1 problem. “Among female physicians and I suspect across most fields that require intense work schedules, I imagine an on-going discussion on how to prioritize work and family and your children all at once,” Dr. Phelan acknowledged. Taking care of aging parents or combining parenthood and work schedules are viewed as the largest challenge for women in the workforce today. Dr. Phelan also noted how this concern has intensified during the COVID pandemic. “It’s a constant struggle, something we face regularly, and there is no real solution.” Single parents or in families where both parents work, adults have used their vacation to spend time with their family, exhausted personal time off hours to attend their children’s school functions, or in the time of COVID, utilized the work-from option to provide homeschooling support or child care this past summer. For female physicians, there is also the reality that even when mom is home, she is still on-call for patient care. “There are endless evenings and weekends when I am calling patients back or looking at their testing results after hours. That’s where that juggling is difficult. I’m at home, working, and my kids are used to it.”
Medical students considering a career in specialized medicine understand the significant time investment required to obtain their goal. After completing high school, the path to becoming a board-certified cardiologist includes graduate school, medical school, with an additional two to six years of specialty training after receiving a doctorate. Most young women may be thinking about having a family, and that is a lifestyle that is hard to juggle. This decision either leads to delaying a family’s start, spacing out the birth of children (more than four years apart), or choosing to have one child. It takes a lot of dedicating and motivation to pursue a career in the field of cardiology,” Dr. Phelan commented. An overwhelming majority of women physicians said they have had to make such tradeoffs. A professional choice may include avoiding leadership or supervisory roles in order to maintain a more flexible schedule. According to the American Medical Association, women account for 3% of healthcare CMOs, 6% of department chairs, and 9% of division chiefs. Today, there is a push for more female leaders in healthcare as about one-third of women physicians indicating they are interested in achieving a higher position.
Mentors and support
The rigors of medical school are challenging for every student. As we discussed the different desires and goals between men and women, Dr. Phelan shared the unique connection female students form during their education. “Unfortunately, during medical school and training, you don’t have time for a social life. Your colleagues are the people you spend the most time with,” she shared. We discussed the friendship Dr. Phelan formed with a fellow female student while pursuing their medical degrees at Albany Medical College in the late 1990s. Donna Phelan and Allison DeTommasi were both young women who shared an interest in math, medicine, and science. They also had a passion for taking care of others. These women were part of a change in the dynamic of the healthcare industry; more women are replacing the stereotype of a doctor being a man in a white coat wearing a stethoscope.
More than half of today’s medical students are women, while in 1915, less than 3% of med school graduates were women. In October of 2018, Drs. DeTommasi and Phelan were highlighted during WTEN/Channel 10’s Inspiring Women segment. “The proportion of young women that are going into medicine has escalated tremendously, and I think there is great value in that,” Phelan said. DeTommasi spoke about the young women who approach her, with a similar interest in medicine, seeking her advice. “You really have to love this,” Dr. DeTommasi advised. Both physicians addressed the support system that exists from women in medicine. “An important motivator and support system is having colleagues who have gone or are going through this experience together. We are one big team, looking out for our patients and taking care of our families,” said Dr. Phelan.
Written by Michael Arce, Host of HeartTalk, presented by Capital Cardiology Associates