You’re Not Childbearing for Eternity
Launched in early 2019, Women as One is an independent nonprofit organization that aims to promote talent in medicine by providing unique professional opportunities to women physicians. Starting in cardiology, Women as One is seeking to unite the global efforts to support women across their institutions and professional organizations, and to provide novel support structures to assure their professional success.
An area of interest for the organization in its early stages is to assist in the effort to standardize parental leave and return to work practices for pregnant cardiologists, and to normalize the idea that childcare is a shared responsibility between women and men.
Currently, there are close to 1,800 women across cardiology fellowship programs in the United States. (1) The fact that very few of these programs recognize and appropriately support the women who choose to become pregnant during this time is disturbing. We must and we will do better, and Women as One will be there to support the standardization, implementation and evaluation of these efforts as they continue to move forward.
As we collectively press upon the need to develop these support systems, there is a tendency, however, to get lost among the trees, narrowing in on specific time frames, semantics and other minutia. These details can admittedly have great impact, both positive and negative, on women in cardiology, but can also, on occasion, distract us from the larger picture. So, for the purpose of this piece, we offer you; the forest.
Women as One runs a regular podcast series, featuring women in medicine sharing their stories as a means of unifying women around the world in their experiences, and as an effort to assure that their voices are heard. The first pass at the podcast series matched three women in cardiology across subspecialties and in different countries, all telling the stories of how they first became interested in medicine, and then cardiology. They share their challenges and successes, their tips and warnings.
One of these episodes featured Cecilia Linde, a Professor and consultant in Cardiology at Karolinska University Hospital in Stockholm, Sweden. Professor Linde is a former Chief of Cardiology, a current Vice President within the European Society of Cardiology and is a widely respected clinician researcher on a global level. During her podcast episode Professor Linde said something so simple, yet striking, that it inspired this entire post;
“You’re not childbearing for eternity. Maybe a couple of years and that’s it. Most people have two or three children and not more than that. It’s not forever, and the career is very long. At least in my country, you don’t look so much at chronological age. You look more at what this person can achieve.”
Put much less poetically; what is the big, flipping deal?
Over 60% of women applying for cardiology fellowship positions are asked of their intention to have children during the interview process. (2) Even when given the benefit of assuming this question is intended for planning purposes, it does not negate the fact that this question is illegal. We say it again; it’s illegal. Both the Pregnancy Discrimination Act and the Family Medical Leave Act make it illegal to discriminate against women on the basis of pregnancy. Yet it’s asked more often than not, making women feel shame for wanting to have children and a career.
Further, as diversity is generally becoming more accepted, and even desired, the consequences of actively attempting to diversify fellowship programs can be harsh on those who are brought into the fold. A recent Twitter thread, including hundreds of related responses, starkly illustrated how these experiences extend across medicine;
It isn’t a stretch to understand that if and when a woman becomes pregnant, and there are no resources available to her within her institution with which to guide her decision making, it becomes incredibly difficult to come forward with requests that might be helpful to her experience. Even in an otherwise supportive institution, women who become pregnant are left without a paddle to row with, often choosing to maintain silence on these issues as they are never discussed, or worse, in fear of potential retribution.
It is no surprise that women in cardiology are married less frequently and have fewer children than their male counterparts. This is true in both the United States and in Europe (3, 4) and likely in other countries as well. It is an uphill battle and they simply opt out in favor of their career. Alternately, the women who are unwilling to make these concessions are opting out of cardiology. Women represent just 23% of cardiology trainees in the United States and only 14% (1,5) of practicing cardiologists. Think about that. The attrition rate for women in cardiology is huge, no doubt exacerbated by the blockades they face beyond the walls of training. There are very few women entering the field to begin with, and then they actively leave.
We believe that the general lack of discussion and the specific lack of resources for women who want, have or are planning to have children, is a massive barrier to women entering the field of cardiology. But guess what? Women have babies. Outside of the 1994 cinematic masterpiece, “Junior,” in which Arnold Schwarzenegger experimentally impregnates himself, this responsibility falls to women 100% of the time. Women are also doctors. In fact, women have officially been doctors for nearly 125 years. That we cannot successfully reconcile these very basic and fundamental ideas within the field of cardiology is insane.
So, let’s do better. Let’s acknowledge and accept the fact that women are the members of the species with uteri and that in a world where many people want to procreate, we will need for women to continue having babies in order to achieve this goal. Let’s also acknowledge that women can be doctors and that there is a small window of time, that primarily falls during a woman’s medical training, when she may become pregnant. This window should not preclude her from a) becoming a doctor or b) becoming pregnant. Let’s also hope that most sane, rational people would not only agree with that statement, but that in doing so, those same people might also jump to the logical conclusion that these women who are pregnant while training to become doctors, might need a bit of support in order to navigate that transitional time successfully.
If the majority of us can agree to these principles, then the majority of us should take action in developing and adopting the systemic tools required to reach that goal. Women as One is working on such tools right now, as are many others. Open the door to these conversations. Empathize. Proactively help to identify and breakdown the barriers which stand in the way of making these long held dreams a reality. For we should not be holding a talented woman back from the field of cardiology based on a small window of time. The career is long. We should more look to what this person can achieve.
- Accreditation Council of Graduate Medical Education (ACGME) GME Data Resource Book 2017-2018 https://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book
- Sarma AA, Nkonde-Price C, Gulati M, Duvernoy CS, Lewis SJ, Wood MJ; American College of Cardiology Women in Cardiology Leadership Council. Cardiovascular Medicine and Society: The Pregnant Cardiologist. J Am Coll Cardiol. 2017 Jan 3;69(1):92-101. doi: 10.1016/j.jacc.2016.09.978. Review. PubMed PMID: 28057255.
- Lewis S.J., Mehta L., Douglas P., et al. The professional life of cardiologists: insights from the third American College of Cardiology professional life survey (abstr). J Am Coll Cardiol. 2016;67:1928.
- Capranzano P, Kunadian V, Mauri J, et al. Motivations for and barriers to choosing an interventional cardiology career path: results from the EAPCI Women committee worldwide survey. EuroIntervention. 2016;12:53-59.
- Association of American Medical Colleges (AAMC) 2018 Physician Specialty Data Report https://www.aamc.org/data/workforce/reports/492536/2018-physician-specialty-data-report.html
Twitter reference: https://www.physiciansweekly.com/gender-bias-narratives-in-medicine/