Revealed: the specialties with the worst gender imbalances

Medical politics

By Geir O'Rourke

24 Oct 2022

The global gender imbalance in specialist internal medicine won’t be going away soon because women still make up less than half of trainees, researchers are warning.

However, some specialist groups are worse than others, with women comprising just 15% of all cardiologists and 7% of interventional cardiologists in particular.

The figures are based on an analysis of the specialist workforce across eight countries in North America, the UK and Australasia – a total of more than 380,000 specialists and trainees.

While cardiology was a “clear outlier” in having especially low female representation, the researchers stressed the specialty wasn’t alone. In gastroenterology, only a fifth of consultants were women and in respiratory medicine it was 24% (respiratory, when counted in the US and Canada, included critical care).

The figures were remarkably consistent between countries, they added. For example, Canada had greatest proportion of women in cardiology at 21%, only 10 percentage points better than the lowest, Wales.

“Underrepresentation of women among physicians is not limited to surgical specialties, individual countries, or healthcare systems,” they wrote in The American Journal of Cardiology (link here).

“These data suggest that there are features of our healthcare systems and training programs internationally that disproportionately favour the status quo. Identifying and addressing these features may decrease the gender gap.”

More troublingly, women made up only 43% of trainees across all adult internal medicine specialties, a figure that was even lower in cardiology (27%), gastroenterology (36%) and respiratory (39%).

This was lower than the 44% of women trainees in surgery, a field notorious for its gender imbalance, the authors pointed out.

“Although surgery has been well-known to be male-dominated, specialists within this field have actively sought potential solutions for positive change, focusing on training flexibility, mentorship, institutional support, and identifying and acting upon gender discrimination,” they wrote.

“In contrast, medical specialties in which these issues have been less recognised have had a slower rate of change.”

Led by Sydney cardiologist Associate Professor Sonya Burgess, the authors argued it was wrong to blame the on-call hours or physical demands of cardiology for the problem.

Careers in obstetrics and gynaecology had similar challenges but a far better gender balance, with women constituting 45% of registered obstetricians and 81% of trainees, they wrote.

“Concerns regarding radiation safety in pregnancy may also impact specialty choice for doctors in training but may be disproportionate to risk, as research demonstrates that the actual foetal risk is very low to negligible,” the authors added.

“Cardiology and gastroenterology training, particular interventional sub specialities, and orthopaedics require radiation exposure.”

They also encouraged health authorities to ensure women had access to paid maternity leave.

“The value of diversity within a broad range of workplaces is well-established. These data are a call to action to establish more successful strategies to provide a diverse and representative cardiology workforce.”

Across all internal medicine specialties, representation of women at consultant level ranged from 32% in Wales, 35% in Australia, 35% in the United States, 37% in England, 37% in New Zealand, 37% in Canada, 38% in Northern Ireland, and 41% in Scotland.

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