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- Kim Allan Williams Sr., MD, FACC, ACC President∗ ( and )
- Richard A. Chazal, MD, FACC, ACC President-Elect
- ↵∗Address correspondence to:
Kim Allan Williams, Sr., MD, FACC, American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
Addressing disparities in care and ensuring the ultimate well-being of patients has been a priority throughout our careers, and is a key focus of this year as president and president-elect of the American College of Cardiology (ACC). Doing this successfully requires a focus on building a quality-driven health care system, advocating for policies that facilitate patient access to care, developing strategies for improving the health of populations, and finding innovative ways to put the latest science in the hands of those providing care. Another crucial element, but 1 that sometimes gets overlooked, is ensuring provider stability and diversity. Stability of the workforce demands appropriate working conditions and fair reimbursement for all members of the cardiovascular team. Diversity helps to improve and ensure the crucial relationships between caregivers, communities, and patients.
In the ACC’s recent 2015 Environmental Scan Update, changing workforce needs ranked among the top issues affecting the cardiovascular landscape. “Health care is possibly the most complicated industry in the United States,” the authors note, “and, as such, it is difficult to predict changes in supply and demand for the country as a whole and for more than several years in the future” (1). However, despite the complications, it is widely acknowledged that a workforce diverse in job function, sex, specialty, and race and ethnicity is necessary to meet the needs of an increasingly diverse and growing cardiovascular patient population.
As the home to more than 50,000 cardiovascular professionals around the world, the ACC understands the importance of a diverse workforce and has focused on finding ways to encourage greater diversity through mentoring programs and focused member sections and councils. Targeted educational programs and quality initiatives are directed at the entire spectrum of the cardiovascular care team and the various cardiovascular specialty areas. Yet, a new study, led by former ACC President Pamela Douglas, suggests there is even more work to be done in this area.
The study was presented during the American Heart Association Annual Scientific Sessions in Orlando this past November and simultaneously published in JACC. The results showed not only substantial salary differences between male and female practicing cardiologists, but also dramatically different job descriptions—despite sharing the same specialty.
The study looked at 2,679 subjects (229 female and 2,450 male) reported by MedAxiom from 161 U.S. practices in 2013. The authors found that women were more likely to specialize in general or noninvasive cardiology (53.1%) compared with their male counterparts (28.2%), who were more likely to be involved in interventional cardiology. Additionally, men generated a median 9,301 relative value unit, whereas women generated 7,430, and the proportion of women working full time was less than men (79.9% vs. 90.9%) (2).
Overall, the findings show an unadjusted difference in compensation between male and female cardiologists of more than $110,000/year. After adjusting the data using more than 100 personal, practice, job description, and productivity measures, the difference was $37,000 annually, or over $1 million across a career. A separate independent economic analysis of wage differentials yielded a similar difference of $32,000/year (2).
In the context of the national and international epidemic of heart disease, these data are a wake-up call that our profession should focus on aligning the pool of medical students and qualified internal medicine residents. If not addressed promptly and appropriately, this threatens to become a much greater health care issue going forward. American cardiology is failing to capitalize on recruiting enough talented female residents into cardiology. This can hurt our ability to best care for our patients.
In a corresponding JACC editorial comment, Mark A. Hlatky, MD, FACC, and Leslee Shaw, PhD, FACC, wrote: “The reasons for these very different career choices ought to be explored further, and we need to understand whether women physicians are repelled from cardiology, or simply attracted to other fields. Perhaps more attention to work-life balance in cardiology would make it more attractive to women, and better for us all” (3).
Drs. Hlatky and Shaw are absolutely right. We need to pay special attention not only to this particular issue, but also to the broader issue of workforce diversity. This study is an important reminder that in spite of all good intentions there can still be obstacles that handicap cardiology as a profession and diminish an effective workforce. Research has shown that our culture tends toward unconscious biases that can create barriers to careers, advancement, and other opportunities. This problem is not ours alone to solve, but it provides us an opportunity to lead.
The ACC can and must be both a leader and a convener in this area. Our Leadership Academy, Emerging Advocates initiative, and mentoring program are among our most recent efforts designed to identify, nurture, and grow diverse leaders across the cardiovascular care continuum. Additionally, quality initiatives like Surviving MI are providing practices and institutions with best practices for changing hospital culture to improve care. The ACC is also making changes to its own governance policies to reflect the diversity of its members and encourage greater involvement in committees and work groups by a broader group of individuals.
Moving forward, the College is committed to growing these efforts even further. Working with other organizations and institutions, as well as our own member sections and councils, like Women in Cardiology, to develop strategies that will locally evaluate and mitigate workforce disparities will be key. Forums like the ACC Annual Scientific Session also provide important venues for research like this to be discussed, debated, and built upon. Last, we also should all pause and reflect on our own hiring and compensation practices and make changes where needed.
One of this year’s first Leadership Pages stressed the ACC’s commitment to working with its members to improve public trust, “whether it’s showing that we can and will hold each other accountable for providing appropriate, evidence-based care; involving our patients in their care decisions so that they best understand the best course of treatment and why; or using data from registries like those in the NCDR (National Cardiovascular Data Registry) to improve patient outcomes and close gaps in care” (4). We need to own our actions—both good and bad—and be visible to the public and our patients in positive ways that affect their lives. When it comes to diversity in our workforce and closing gaps in our own ranks to best meet the needs of our ever-growing patient base, we must be leaders. Our mission depends on it. Let us own this and fix it.
- American College of Cardiology Foundation
- Laslett L.,
- Anderson H.,
- Clark B. III.,
- et al.
- Jagsi R.,
- Biga C.,
- Poppas A.,
- et al.
- Hlatky M.A.,
- Shaw L.J.
- Williams K. Sr..