Gender of Electrophysiologists*

When did you last see a female plumber or electrician ?

by IAN MC - 2023-09-17 07:13:20

Fascinating question on gender bias in the medical profession, Penguin.

Despite there being a rough overall 50 / 50 split of male and female doctors . the vast majority of consultant surgeons  are male. A quick Google  search gave me a current percentage of 86 %  . Why is this ?

Another question for you  .. more females  appear to write to the Pacemaker Club than males. Why is this ?

I must ask my wife .... she will know !

Ian

Take a look at the first link for a possible answer?

by Gemita - 2023-09-17 07:16:49

Perhaps the attached first link might hold some clues.  As an introduction:

Women represented 29% of cardiology trainees and 16% of consultants in the UK in 2021. While the numbers of women in cardiology have increased over the last 20 years, these proportions remain among the lowest in comparison with other medical specialities. This essay aims to explore the contributing factors behind, and plans to reduce, gender disparity in cardiology.  Reasons for gender equality include inflexible working hours and poor work-life balance. . . . The under-representation of women in cardiology appears to be a worldwide issue

https://bjcardio.co.uk/2023/05/reasons-and-resolutions-for-gender-inequality-among-cardiologists-and-cardiology-trainees/#:~:text=Reasons for gender inequality included,lack of female role models.

The second link is for a very talented and charming EP apparently, one I would most definitely consult for a complex arrhythmia

https://www.rbhh-specialistcare.co.uk/specialists/sabine-ernst

Ian MC

by Penguin - 2023-09-17 08:06:10

I noted the title of your post and the 'tone'.  Do I detect that you're fed up of women and people of other genders pushing to be heard / seen / represented?  There has certainly been a lot of it recently and as an egalitarian (rather than a feminist) I may well agree with you in lots of cases.  

Why do more women than men post on this forum? Perhaps we should open that one up to the community to comment?  It probably merits a separate thread as it's slighltly off topic, but I'd say that sometimes non male patients can struggle to be heard in medical consultations and 'may' be judged differently.  Perhaps a forum is a safer space for that?  It is easier to get away from gender bias online, afterall an online penguin could be what ever they want to be! 

 Ian MC is a less ambiguous pen name. 

Gemita

by Penguin - 2023-09-17 08:09:57

I have heard of the female consultant you mention. She certainly does look very well qualified. 

I will read your article to give it the attention it deserves and come back to you. 

When did you last see a female plumber or electrician ?

by atiras - 2023-09-17 08:48:27

Woman plumber? 2 weeks ago, and she's coming to refit my bathroom next month.

Woman electrician? Earlier this year.

Woman roofer? A week ago.

And I'm out in the sticks. 

Getting back on topic, in the 20ish years I've been dealing with cardiology departments, I'd estimate a third of the cardiologists I've seen have been women -- and those were in 'specialist' areas (arrythmias, heart failure/transplant) rather than general cardiology teams which skewed all male.

Atiras & Gemita

by Penguin - 2023-09-17 09:38:07

'I'd estimate a third of the cardiologists I've seen have been women -- and those were in 'specialist' areas (arrythmias, heart failure/transplant) rather than general cardiology teams which skewed all male.'

Interesting! I've been reading the article that Gemita posted.  It estimates that specialisms like electrophysiology see fewer females than general cardiology. 6% is cited. One of the reasons that Gemita's article suggests is that mentoring and female role models are important when encouraging more women to join the profession.  Do you think that could be relevant in the hospitals you attend e.g. more women is those positions and therefore more role models and more encouragement?

 If Gemita's article is a fair representation of the reasons behind women deciding not to become cardiologists / electrophysiologists, I'm struggling to see why electrophysiology / cardiology is more affected than other areas of medicine.  Could attitudes such as those Ian expressed, e.g. that men are drawn more towards becoming an electrician or plumber  than their female counterparts, still be affecting new recruits to medicine? Perhaps other sectors have tried harder to overcome those attitudes? 

The lack of female role models, gender positive mentoring and (concerningly) harrassment are the issues which stand out to me in the article. The latter has been in the news recently without direct mention of any particular disciplines.  I was shocked to see it mentioned.

Penguin

by atiras - 2023-09-17 10:36:59

'Do you think that could be relevant in the hospitals you attend e.g. more women is those positions and therefore more role models and more encouragement?'

Certainly, I've seen more women in the bigger/more specialist hospitals (Bristol Heart Institute, Queen Elizabeth Birmingham) than in my local hospital (Swindon).

P.S. I think the electrician/plumber analogy is overworked. Anyone going into medicine expects to be dealing with the messy/practical aspects of human bodies -- or if they don't they're in for a nasty surprise.

Atiras and Penguin

by Gemita - 2023-09-17 11:53:31

Penguin, firstly I am confident that the article from the British Journal of Cardiology has been well researched and there are plenty of references for further study if we wish to dig deeper.  In my experience, Cardiology is still a male-dominated field and there appears to be a perception of gender related bias, discrimination, and sexual harassment.  Cardiology is often described as a ‘men’s club’, and I feel it all around me when I attend my appointments.

My experience in my 75 years and my husband’s in his 85 years has been much the same.  We have only seen male cardiologists/EPs.  We both attend two main London hospitals (St. Thomas' Hospital and King's College Hospital) and have been seen locally too in district hospitals and they have always been appointments with male cardiologists/EPs.   At times I have felt uncomfortable and have not received the best of care, especially at the beginning of my journey (in our local hospital).

I think most women feel more comfortable being treated by a female doctor anyway, and get better treatment as a result.  Female doctors simply understand female patients better than men do.

My sister, who has heart failure is now under the care of a female heart failure consultant who also runs the CIED department at her hospital (William Harvey, Ashford, Kent).  She is doing remarkably well under her care.  She didn't do so well under the care of a male cardiologist who seemed to lack compassion.

Atiras, I have certainly never seen a female Cardiologists/EP in the two main London Hospitals we attend, but I see the "heart failure/transplant" area is beginning to attract more women now 

Gender Choice

by Stache - 2023-09-17 15:07:09

I am in the U.S. and all of my heart doctors are male.  All doctors choose what field or what to specialize in.  It seems males chose the heart procession same as why males choose to be plumbers or brick layers.  Certain fields attract males and others attract females.  I don't have an issue with which field a person chooses, I just want them to be the best at it in my case.  My last heart surgeon was a female, I just wanted the best person and she did amazing work on me.  Gender doesn't matter being the best does matter.

Fair Comment Stache

by Penguin - 2023-09-17 15:17:40

'My last heart surgeon was a female, I just wanted the best person and she did amazing work on me.  Gender doesn't matter being the best does matter.'

That's a really important point Stache and I agree with it. If equalising opportunities means ignoring some of the better candidates based on gender we won't help anyone.  Providing opportunities and ensuring that people of all genders are encouraged to achieve their best, rather than being discouraged by a dominant male contingent is probably important too. Do you agree? 

Gemita

by Penguin - 2023-09-17 16:02:30

Gemita, I don't doubt the quality of the essay / article that you posted. I thought it was an excellent and extremely pertinent link so thank you. It adds a great deal more depth to the subject than I brought to the table myself.  I actually had no idea that cardiology were in the firing line re: the recent news articles detailing sexual harassment / assault and misogyny. I found that quite disturbing.  I don’t think that we can disbelieve the experiences of young women in medicine who have suffered at the hands of powerful cardiologists behaving inappropriately and who have sufficient influence to silence them and ruin their careers.  That kind of behaviour cannot continue.

I too feel that cardiology is a men's club. I’ve never seen a female EP or cardiologist in 15 years of cardiac care and have been a patient at both major teaching hospitals and local hospitals. Electrophysiology is an elitist part of that club.

I'm thrilled to hear about Sabine Ernst!

I agree totally with Stache

by IAN MC - 2023-09-17 16:09:17

I believe that the gender of my doctors is totally irrelevant as is their nationality.

All I want from the medical profession is an accurate diagnosis , appropriate treatment and a clear explanation of what's going on.

I am genuinely saddened to read that Gemita finds male doctors to be lacking in compassion but, having said that, I'm not sure that I paricularly need compassion from my doctor.  Friends and  family is where I would expect ( and appreciate ) the compassion BUT we are all different and have totally different needs.

Ian

Ian

by Gemita - 2023-09-17 16:53:50

I am doing well under the care of my new electrophysiologist and I have made excellent progress with arrhythmia control, but it hasn’t always been this way.   

I was actually referring to my sister’s cardiologist who lacked compassion when he first told her the news about a dangerously low ejection fraction (16%) which came as a complete shock.  Her early weeks of trying to come to terms with her heart failure, saw her condition worsen rapidly.  As soon as she was referred to another consultant (a woman) she was immediately referred for psychological support, support that she needed which I feel has tipped the balance in her favour.  The family isn’t always able to answer the question “why” and sometimes professional help is needed.  A more communicative, caring doctor might have picked up the signs of distress much earlier.  A good heart failure doctor doesn't just treat the patient's symptoms, he/she treats the whole person too

Gender

by Julros - 2023-09-17 16:55:22

I am in the US. The first cardiology office (actually the local cardiology office) was all male. I felt like my concerns about pain, subclavian vein stenosis, adusting my pacer to my activity level were all brushed off as unimportant. 

After 2 years of feeling like just the receptacle for the device, I switched to a female EP and what a difference! My sister, who has the same condition as me, also switched and is much more satisfied with her care. Yes, we have to drive 1 1/2 hours for in office appointments, but it is worth it to me to be treated as a whole person. 

Julros

by Penguin - 2023-09-17 18:03:06

Thank you for adding your experiences. I can relate to feeling like a receptacle / host. I used to feel as if I was being physically invaded and taken over at pacing appointments if I wasn't allowed some involvement - still do! 

In total agreement about holistic, involved care.  

It depends a lot on the patient and conditon...

by crustyg - 2023-09-17 18:27:23

It's never easy for male docs to contribute to this type of discussion, for obvious reasons.

I've heard some female patients really dislike female Ob/Gyn docs, alleging that they can be a lot less sympathetic about some reproductive issues - think one-up-manship about duration of periods, flows, clots - you get the picture. (You think *your* periods are heavy.....).

My own plea would be that we stop counting men/women in jobs/positions of authority and automatically assuming that the numbers prove discrimination/lack of opp etc. Yes, there's no doubt that there has been discrimination in medicine (look at the brilliant test done by Goldacre and colleague that nearly had them prosecuted for fraud which proved beyond any doubt that a S Asian name reduced the chance of an offer to study medicine in the UK at that time).

There are a number of jobs in medicine that require relatively little physical contact with patients, or caring for patients who die on a frequent basis, and some people gravitate to those jobs, others deliberately avoid them.

There's no doubt that 1950s attitudes to patients still persist in some centres - and contributors here know what I mean - while others are more modern and practice a shared approach to decision making and information dissemination.  A lot depends on the culture of a centre.  The Bristol children's Heart hospital scandal was heavily influenced by the local culture.

Why any doc in training goes into a particular speciality is affected by a huge range of factors, some personal, some the trainer(s), some the culture of the institutions attended and some just chance.

No-one seemed to care when the female:male ratio of med students swung heavily in favour of females during the 1980s and onwards in the UK.  Supposedly just that the female teenagers were better at getting good grades than males at the time, but simple counting numbers would be have been obvious 'discrimination' if the ratios had been reversed.

I think it's long past the time that we stopped counting <your preferred group> and then claiming that they aren't being given a fair chance if the numbers don't meet expectations.  And whose expectations: population level ratios of <your preferred group>, big city levels of the same, or just a ratio that you feel should be achieved?

It's an uncomfortable truth that if your medical advisors OF EITHER SEX don't understand your needs then at least some of the 'fault' lies with you, the patient, not explaining those needs well enough.  Of course you (and I) may need to work much harder to make ourselves understood with some medical folk than others.

Let the flame wars begin...

female cardiologist

by new to pace.... - 2023-09-17 19:56:30

I read in our local paper about the  one here in Sarasota.  It was written she specializes  in the female heart.  So i moved to  that location, where she is one of many.  Cannot tell the difference bewteen her and my former  male cardiologist.

I see her annually.

new to pace

flame wars crustyg?

by Gemita - 2023-09-18 04:04:15

We try not to have flame wars here, just healthy debate and tolerance of each other’s views based on our own unique experience and health condition.

Good communication/rapport between the patient and doctor is important for a successful outcome and yes I accept many of us may need to work a bit harder with our doctors to try to achieve this.  A work in progress for many of us I suspect

Crustyg

by atiras - 2023-09-18 05:39:25

As Gemita says, this is not the place for flame wars, so I shall refrain from expressing a reaction to your post.

Communications/rapport

by atiras - 2023-09-18 06:24:02

Early in my adventures with NHS hospital consultants, I asked my GP why they made a point of mentioning my degree in some detail in the referral letters they wrote. (They are that rare beast, somebody who made it to consultant surgeon level in the NHS and then decided they'd rather be in General Practice, so they've seen the process from both ends).

The answer?

'You have a first-class degree from a top-rated university in a hard science subject, a subject that still daunts many doctors. From dealing with you over the years, I know you're well-qualified to discuss all aspects of your care and arrive at an informed decision; in fact, you insist on understanding the detail. Telling my colleagues about your degree is the way I inform them that they must expect to have those discussions with you, because they will otherwise assume that as a woman they should gloss over the technicalities.'

20 years later, they still have to do it. I find that quite telling.

New to Pace & Atiras

by Penguin - 2023-09-18 06:59:56

NTP - Great news for Sarasota residents who want a female cardiologist then! It's fine if a female cardiologist isn't important to you. Your body, your choice. 

Atiras - Groan! .. but nice for you to have the respect of your GP. 

CrustyG

by Penguin - 2023-09-18 07:06:16

Crusty,  Thank you for your comments. I don’t know why you’re expecting flame wars and I don’t understand why you’ve leapt towards sharing fault/blame with the patient?  Perhaps we should stick to discussing why women aren’t applying for jobs in cardiology - although you are of course very welcome to contribute as you see fit too. 

 Gemita supplied an excellent article / essay from a cardiology journal and I read it with interest. Did you take a look at it? If the reasons for few female recruits expressed in that article are correct, who could, with any conscience, ignore the lack of gender diversity in Cardiology?  I’d be interested to hear what you think about those reasons. 

I do agree that the best person for the job is more important than assessing race / gender / diversity ratios and I too dislike tick box recruitment.  

However, underlying any lack of diversity in the workplace there is usually a reason.  If the reasons are simple e.g. women don’t have the ability or simply aren’t interested  - that’s easy to accept, but it’s simply not true.

What does seem to be true is that women don’t apply for these jobs because they don’t like the conditions that prevailed whilst they were training and felt that they didn’t fit in with a predominantly male culture. . Those reasons need to be addressed.

Any thoughts?

by Beni - 2023-09-18 10:48:13

This has been an absolutely fascinating discussion to follow.  I especially found the directions it veered off into interesting.  

Can I add something to the discussion?  I am including three links to studies I am aware of.  All are from reliable publications.  They are to do with survival rates of patients, both male and female, when attended by a female physician.

The first two links are to do with women and heart attack survival.

The third one is about surgical outcomes for both men and women when attended by a female surgeon.  Pay particular attention to the reasons the researchers thought what the better results could be attributed to.

Please note:  I have updated thefirst  link below.  Sorry for any inconvenience.

https://www.theguardian.com/society/2018/aug/06/women-more-likely-to-survive-heart-attack-if-treated-by-female-doctor-study

https://www.scientificamerican.com/article/women-die-more-from-heart-attacks-than-men-mdash-unless-the-er-doc-is-female/

https://www.utoronto.ca//news/study-suggests-patients-treated-female-surgeons-less-likely-suffer-post-op-complications

Now, I am aware that these links may cause some to take offence but I didn’t conduct these studies nor did I publish the findings.  I am only passing their findings on.  In other words, don’t shoot the messenger.

Beni

by Penguin - 2023-09-18 11:00:07

Hey Beni, 

Thank you so much for contributing these articles. I'll take some time to read them and post once I've done so.  I'm sure others will be interested as well, so don't worry about being shot down. 

All opinions welcome from my perspective.  Hope you're well? 

PS: I couldn't get the first link to work. Could you re-post it? 

Best Wishes

Beni - Articles

by Penguin - 2023-09-18 11:57:03

How interesting! They seem to sort of confirm what Gemita was saying about her sister's heart failure in an earlier post e.g. that care from a woman makes a difference. I wonder why?  After ruling out better education / knowledge than the male doctors (which we can't assume) the softer skills like listening really well and a thorough caring approach seem like the most obvious clues, alongside recognising the unique heart attack symptoms that women may have. 

Perhaps there's a psychological component. Feeling cared for, wanted, feeling like you have purpose keeps you going. Who knows, but really a fascinating contribution. Thank you Beni. 

Fairly sure that I *did* share my thoughts on why so few women go into EP-work

by crustyg - 2023-09-18 13:23:03

I wasn't asking to be flamed, but wearily aware that it's not currently fashionable to decry counting outcomes as a valid measure of equality of opportunity, so I half-expected to be criticised.  And I was, but for different reasons.

I've seen, first hand, why some women might be put off some specialities.

One of my mentors pointed out that all of the really important single component problems in the world have been fixed.  Now we're left with the ones that have more than one component.  Why there are big sex differences in some professions (e.g. IT, Medicine, etc.) falls into that group, IMHO.

I read some of the top-flight obits in the BMJ and one message keeps coming across: these docs persisted in their efforts because they felt that the outcome was too important to ignore.  Given the relentless pressure, miserable work/life balance, and impact on possible reproduction, many women doctors avoid certain careers (I'm not saying this is right, but it's the reality).  Perhaps their view of some specialities is that the benefit that they could add doesn't justify the personal cost.

CrustyG & Marybird

by Penguin - 2023-09-18 14:37:08

You're right I missed your comments. I've highlighted them below in case anyone else missed them too.

'Why any doc in training goes into a particular speciality is affected by a huge range of factors, some personal, some the trainer(s), some the culture of the institutions attended and some just chance.'

That makes sense. Apologies for missing what you said. 

This rather long article from Harvard Business School backs up a lot of what you (very honestly) say about the challenges for women in medicine and suggests how to accommodate women better as much needed workers post pandemic.   I thought it provided food for thought on what could be achieved. 

https://hbr.org/2022/01/why-so-many-women-physicians-are-quitting

Marybird - Your reasons for choosing your cardiologist are, IMO, the best that anyone can use. I'm pleased that he does such a great job for you. 

For the sake of Completeness ..........

by IAN MC - 2023-09-18 15:00:40

Not all published studies show superior performance from female surgeons . As to be expected , many show there to be NO DIFFERENCE. This is a conclusion from a large Japanese gastro-surgery study which was published in the B.M.J. in 2022 :-

..........................................................................................................

" After adjustment for characteristics of patients, surgeons, and hospitals, we observed no significant difference in the risk for surgical mortality in distal gastrectomy, total gastrectomy, and low anterior resection between male and female surgeons, "

........................................................................................................

There is probably published evidence to support either conclusion about gender performance in various types of surgery     ( if we had time to look for it ! )

Ian

A Just Ending

by Penguin - 2023-09-18 15:51:41

That study referring to women being equally good at surgery takes me back to what you said at the beginning of this thread.

' 86% of surgeons in the UK are men' 

It seems to me that this study provides a fitting end to this thread and underlines the injustice. Thank you Ian.  Well said!