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Women In Cardiology: A Mother’s Day Tribute to Women, Wives, Weekend Warriors, & Workaholics In Cardiology

Briana Costello, MD

*Buzz*. Most of us can relate to that alarm going off way earlier than we would like. Wake up, make coffee, throw the clothes in the washer or dryer, clean up the kitchen, put on your office attire or scrubs, and run out the door to start the day taking care of patients, reading nuclear studies, reviewing echocardiograms, or doing catheterizations. For many, this sort of routine is comforting. Enter motherhood or pregnancy to start. This topic in cardiology, a field dominated by men who make up 85% of the workforce, can be an exciting topic to navigate.

The Pregnant Cardiologist

Pregnancy is supposed to be one of the most joyous celebrations in life. I often reminded myself of this while recently pregnant with my second child as I squeezed in OB appointments between patients while simultaneously reassuring them that I would be back after eight weeks. Women in cardiology face obstacles that their male counterparts do not have to use mental bandwidth on. We finish training in our early 30s keenly aware that our “biological clock” is ticking. We try to decide when the right time is to have children whilst trying to grow our own practice and make our footprint. Many questions zoom through our brains. When is the “right” time to take off anywhere from six to twelve weeks with our employer and partners accepting it, covering call, and caring for our patients? How will pregnancy and motherhood affect my career? Is there a maternity leave policy? What if I have complications during pregnancy? Will my partners assume I am going to scale back after I have a child and give preferential treatment to the men? How will pregnancy impact my salary? We sacrifice some of our professional growth to achieve one of the most joyous life events. Or do we? Dr. Martha Gulati, et al recently surveyed women who were members of the American College of Cardiology Women in Cardiology section to assess real life experiences during pregnancy. 341 responded they had children as a practicing cardiologist. Of these, most notified their chair, chief, or practice that they were pregnant in the late first or early second trimester. The most common reason for waiting to report was due to concern of adverse treatment or perception (37.5%). Maternity leave varied dramatically among respondents. The most common leave time was three months (48.9%) followed by less than six weeks (22.6%). 41.2% of respondents had a salary decrease during pregnancy. 37.2% reported performing extra calls or service while pregnant “making up” for being on maternity leave. 21.5% of women thought that taking extra calls or service contributed to pregnancy complications. I must share that I am fortunate to work with some of the most wonderful, understanding, partners and bosses. This was reflected in my pregnancy and leave experience. Not all of us will have a positive experience, but we should. The lack of consistency in maternity leave and support for childbearing is not only a problem in cardiology. We hear this among colleagues of all specialties. Cardiology just so happens to pose a unique challenge given the historical lack of women in the specialty and the rigorous schedule for many. Efforts to create a more uniform maternity leave policy and welcoming pre and post-natal experience are more than past due.

Wonderwomen in Cardiology

Getting back to work after having a child can be overwhelming. The “routine” has changed to a less “routine” routine. That alarm clock buzz is most likely replaced by a crying baby and cold coffee left on the counter somewhere around the house. You are tired. When the sun comes up it is time to feed the baby, get them ready for whatever care you have arranged, and, if breastfeeding, pumping JUST before you leave so you can maximize work time when you arrive. Pumping while doing charts or on zoom calls has become a norm. The concerns about perception at work continue. You wonder, “will I be perceived as fragile or more interested in home life now?”. Struggling to “prove” that motherhood has not taken away your passion for work is almost inevitable. An inherent bias exists. While we juggle motherhood, being a wife (which for many includes cooking, laundry, nighttime routine), and work, we try to convince our colleagues that we are still the same. But are we? I would argue we return better. Finding a group to work with who thinks the same might be hard, but it is attainable. I can attest to that.  Raising children as a cardiologist is a busy new journey. Working together with your spouse is a must. Finally admitting that maybe you cannot do it all at home is okay. Asking for help is okay.  “Subcontracting” household tasks is sometimes necessary to get back to being you: a woman—no, a Wonder Woman both in cardiology and at home. Happy Mother’s Day to all the moms, soon-to-be moms, and those hoping to be moms one day.

Footnote: This was 50% written while pumping and 50% while the children were napping.

REFERENCE

  1. Gulati M, Korn R, Wood M, et al. Childbearing Among Women Cardiologists. J Am Coll Cardiol. 2022 Mar, 79 (11) 1076–1087. https://doi.org/10.1016/j.jacc.2021.12.034

“The views, opinions, and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness, and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions, or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your health matters. If you think you are having a heart attack, stroke, or another emergency, please call 911 immediately.”
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It is February again!! The American Heart and Go Red for Women Month!!

Lina Ya'qoub, MD

 

It is February again of a new year of hope and progress!! Since it is the “The American Heart and Go Red for Women Month”, I would like to talk about the American Heart Association (AHA) GO RED initiative and discuss why heart disease in women is unique, urging my colleagues across the globe to work diligently to ensure optimal health and heart care for everyone, irrespective of their sex or gender.

 

What is the GO RED initiative and what does it mean?

The GO RED for Women initiative was launched in 2004 by the AHA with the aim to end heart disease and stroke in women worldwide; by increasing awareness of these diseases in women and removing barriers women face to achieve a healthy life.

Here is what GO RED means:

  • G: GET YOUR NUMBERS

Check your blood pressure and cholesterol level regularly, and early in life if there is a strong family history of heart disease or hypertension.

  • O: OWN YOUR LIFESTYLE

Encourage healthy lifestyle by stop smoking, losing weight, exercising, and eating healthy.

  • R: REALIZE YOUR RISK

Know your risk; heart disease is responsible for 1 in every 5 female deaths [1].

  • E: EDUCATE YOUR FAMILY

Educate your family members and make healthy food choices for you and your family.

  • D: DON’T BE SILENT

Spread the knowledge that heart disease is No. 1 killer in women [1]. It is also the No. 1 killer of pregnant women per Center for Disease Control and Prevention (CDC) data [2].

Why is heart disease unique in women?

Not only women tend to have atypical symptoms when they present with heart attacks, but also various diseases might behave differently in women potentially leading to differences in outcomes; highlighting the importance of vigilant clinicians in these cases. Women tend to have atypical symptoms when they present with heart attacks; so they tend to have nausea, vomiting, stomach pain, or atypical chest pain, in contrast to the typical exertional chest pain. Moreover, women have differences in their risk factor profile; a recent study has shown that women tend to have a different blood pressure trajectory; with blood pressure elevation starting as early as the third decade of life, and steeper increments of blood pressure over a lifetime compared to men [3]. In addition to the risk factors, there are certain heart conditions that mainly affect women, including spontaneous coronary artery dissections, which is one of the major causes of heart attacks especially in young and pregnant women [3], eclampsia/pre-eclampsia, and peripartum cardiomyopathy, which still carry significant morbidity and mortality [2].

The medical community is still learning about these diseases and the exact mechanism of each condition; urging the need for more research in this area, launching more initiatives to support these projects, similar to the “Research Goes Red” initiative by the AHA, and expanding related sub-specialties like “cardio-obstetrics”, which is a niche subspecialty focused on the care of pregnant women with heart disease.

Although February is the “American Heart and Go Red for Women Month”, we should celebrate women’s heart health every single day by doing our best in our daily clinical practice, increasing awareness of heart disease and risk factors among women, and by working relentlessly to understand the knowledge gaps we have in order to provide better and optimal care for all of our patients.

I would like to say a special thank you to my mom, Laila Abdullah, and my sisters, Rawan, Razan, and Raghad, for their help on this blog and for their continued support.

 

REFERENCES

[1] Women and Heart Disease: Center for Disease Control and Prevention (CDC): https://www.cdc.gov/heartdisease/women.htm

[2] Center for Disease Control and Prevention (CDC): https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillancesystem.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Freproductivehealth%2Fmaternalinfanthealth%2Fpregnancy-mortality-surveillance-system.htm

[3] Ji H, Kim A, Ebinger JE, Niiranen TJ, Claggett BL, Bairey Merz CN, Cheng S. Sex Differences in Blood Pressure Trajectories Over the Life Course. JAMA Cardiol. 2020 Mar 1;5(3):19-26. doi: 10.1001/jamacardio.2019.5306. Erratum in: JAMA Cardiol. 2020 Mar 1;5(3):364. PMID: 31940010; PMCID: PMC6990675.

[4] Hayes SN, Kim ESH, Saw J, Adlam D, Arslanian-Engoren C, Economy KE, Ganesh SK, Gulati R, Lindsay ME, Mieres JH, Naderi S, Shah S, Thaler DE, Tweet MS, Wood MJ; American Heart Association Council on Peripheral Vascular Disease; Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Genomic and Precision Medicine; and Stroke Council. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. Circulation. 2018 May 8;137(19):e523-e557. doi: 10.1161/CIR.0000000000000564. Epub 2018 Feb 22. PMID: 29472380; PMCID: PMC5957087.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

 
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AHA Women in Cardiology Blog Series: DEVELOPING YOUR NICHE

Sherry-Ann Brown, MD, PhD

Written by :Sherry-Ann Brown MD PhD and Renee P. Bullock-Palmer MD

As the subspecialty of cardiology continues to expand, opportunities abound for developing new niches. A few, among others, of great interest to Women In Cardiology, are Cardiovascular Disease in Women, Cardio-Obstetrics, and Cardio-Oncology (especially breast cancer), as well as Structural Heart Disease and Sports Cardiology, among others. How does one develop a new niche? Various strategies are summarized in this blog as outlined below. Review all of these tips and take away the ones most relevant to your career, needs, goals, and interests.

EX.C.E.L.
Gain as much exposure as you can to the area within your subspecialty to which you would like to devote most of your career (1). The more you learn, and the more experience you gain, the more you will become an expert.

Networking is incredibly important. This applies locally, Regionally, nationally, and globally. The more exposure you gain to your colleagues and other leaders at your institution and in your national societies (1), the more you will become known as an international expert.

As you introduce yourself and market your brand, you must be aware of your own capabilities, as well as the capabilities of your institution (1). Gauge your talents, strengths, passions, and personality. Assess your background, training, and preparation. Determine how to best apply your abilities. Evaluate the availability off the tools, resources, and personnel you will need to achieve your professional goal of building a niche.

Expectations are key. Early on, establish expectations that your institution may have of you as you develop a new program (1). Expectations for patient care, education, research, community engagement, and institutional citizenship should be made clear. Your own expectations of support for your vision, as well as administrative time as applicable, ought to be delineated.

Know your limitations (1), weaknesses, and opportunities for growth. Stretch and develop yourself, but not beyond where your intellect and training are willing to go. Know too the limitations of what you have available to you at your institution.

P.Q.R.S.T.
Cultivate partnerships (2) with colleagues at various stages of building similar programs at other institutions. Being able to share mutual insights on patients in your niche will be invaluable.

As you attempt different approaches in your program building, be willing to be flexible and take “quicksteps” (a lively combination of steps in ballroom dancing). Adaptability in medicine and leadership are key, just like in ballroom dancing.

Make your rounds among various departments and divisions. Offer to give and coordinate multidisciplinary grand rounds and short presentations at the division or department meetings. Provide didactics for the fellows, residents, and students.

Consider knowledge gaps or needs in complementary subspecialties locally, and devise solutions that can help other subspecialists and enhance collaboration (2).

Remember, patient care occurs best in the setting of teamwork (2). Build your team. Know your team. Lead your team.

3Ls
Look at the landscape to assess changes on the horizon within your area of expertise. Adapt to these changes. Cardiology as a field is always evolving in several areas and this will affect your practice. There are ever emerging fields, such as Adult Congenital Heart Disease, Cardio-Oncology, Interventional Echocardiography, and Cardio-Obstetrics. Therefore, it is important to never stop learning and acquiring new skills. Do not become stagnant, otherwise, there is a risk of becoming irrelevant. Lean in, be present both at your institution by participating actively at department meetings, volunteering for committees at your institution in your area of interest, and offering your expertise to lead and/or guide initiatives in your department.

3As
Find and align yourself with other experts locally, nationally, and even globally. This will help develop new leadership skills and promote your skills. Networking is crucial in one’s career and is one of the key benefits of professional societal involvement. Professional societal involvement is also a great way to learn and develop new research ideas.

Being accessible to your colleagues is important and will be helpful in developing your niche. Accessibility can be a great way to promote your practice, as well as increase your patient referral base.

Being accountable for your work is critical as you establish your niche. Accountability is a vital part of good patient care and being an effective leader in your practice.

2Ps
Find a platform to share your expertise either through outreach by giving educational talks to providers at local grand rounds, or dinner talks and participation in regional conferences and webinars. Participate in writing groups when the opportunity arises, and publish articles in your field. Opportunities for research may be either locally at your institution or nationally with multi-institutional national studies or registries.

Patient care is paramount, to demonstrate the effectiveness of your practice on clinical outcomes. After all, we entered this profession to take care of patients – do not practice in a vacuum. Excellent patient care will establish you as a meaningful contributor to the Cardiology service line at your institution.

Conclusion
Finding your niche is an important part of establishing your career. Never forget your career goals and focus and do not lose sight of these. We have outlined several strategies that may be customized to your practice environment and professional goals.

REFERENCES:

  1. Kilic A. How to develop a niche: Focus on adult cardiac surgery. J Thorac Cardiovasc Surg. 2016;151(3):636-9.
  2. https://www.acc.org/membership/sections-and-councils/early-career-section/section-updates/2016/08/16/08/53/developing-a-niche-in-structural-heart-disease

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

 
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HOW TO SAY NO: R5

Sherry-Ann Brown, MD, PhD

American Heart Association Early Career Guest Blog

Sherry-Ann Brown MD PhD FAHA, Mehnaz Rahman MD

For many of us, to nurture our continuous and whole sense of well-being, we are in a constant process of learning to say “no”. Here is one scenario that can help provide an effective framework for saying “no”.

Consider a new junior attending faculty member at the same academic institution where she trained as a Cardiology fellow. Her pursuit of wellness in this new role has fallen to the sidelines, as she first tries to establish a sense of authority within a society that has only ever known her as a trainee. While navigating this unfamiliar territory, a surprising source of anxiety has come from responding to requests to collaborate on projects. She consistently accepted almost every single one. The fellow in her aimed to please.

Although she approached each with the same work ethic, her interest in them was not as equitably distributed. At the end of her first year, her cup had “runneth over” – she was overworked and overcommitted admittedly she felt by her own doing.

She then realized that she had agreed to those undertakings because she did not quite have the words ready at the tip of her tongue to say “no”.  When respectfully declining a specific ask, she determined that it can help to have a practiced approach to the conversation, one that can produce a beneficial result for both parties.

As we discuss this scenario, we can recognize that in general, people appreciate ideas and potential solutions. Accordingly, we may not be able to fulfill every request, yet we can still be a resource and offer alternatives.

One framework for saying “no” is grounded in R5: Reframe, Refer, Reduce, Reorient, and Recommend. Saying “no” can be challenging. Sometimes we need to say “no” to the way the ask is presented or the specific focus of the ask.

If we can perceive benefit from modifying the ask so that it actually fits with our career goals and specialty interests, then we can say “no” to the original ask while reframing it to a more fitting ask for us.

If we choose not to reframe the ask, we can refer the asker to someone else who we feel could be interested in working on such a task.

Alternatively, we could reduce the original ask to limit the portion for which we would be responsible.

Further, often those asking do not know how full our plates are and may need to be kindly informed or reoriented, so that they can better understand your perspective as you say “no”; you can even solicit their input as you think about how to prioritize your time on pre-existing projects.

Finally, recommend a new deadline or seeking out more resources if you would find working on the opportunity valuable but time-consuming or limited in available resources.

Remember, those asking for your involvement are genuinely interested in working with you, recognize you as an asset, and will more often than not be receptive to your counteroffer. Saying “no” the right way will leave the door open to future opportunities that you may be waiting or looking for.

We can continue to recalibrate our expectations of ourselves, as we engage in projects that keep us passionate and hope that our journeys to wellness become smoother with time and practice.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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Work life balance- Is This a Myth?

Heather M. Johnson, MD, MMM, FAHA, FACC

Work-life balance: for many in Cardiology it’s an elusive idea. Now, our worlds of work and “life outside of work” are even more blurred among Zoom meetings and facemasks.  However, over the years, I have learned 3 important concepts (Figure 1) that has made work-life balance POSSIBLE, not just a myth.

Figure 1. Outlining the three key concepts of work-life balance.

Concept #1: Who are you outside of work?

As Cardiologists, researchers, educators, and team members we know the day, night, and weekend hours that define our careers. However, how do you describe yourself outside of work? Who are “you” after shedding the scrubs and white coat, away from the office, hospital, and lab?   Beyond Cardiology, what are your interests?  The answers to these questions help to define you and an important part of your life. When we lose our work-life balance, we are losing a part of ourselves.

To begin recapturing your interests, look at your calendar over the next month, and schedule small increments of time (just 5-10 minutes!) to reconnect with your personal interests (of course staying safely physically distant for now).  These baby steps will move you closer to capturing the “life” in work-life balance.

Concept #2: “Balance” is dynamic.

How do you define “work-life balance”? Is it an equal distribution of time? Is it a certain quantity of time for specific activities?

Work-life balance is very similar to the field of Cardiology – it is constantly changing. For most people, work-life balance will not mean that there is “equal” or balanced time between work and personal life. Especially in Cardiology, our job usually engulfs the majority of hours in a week – clinical duties, grant deadlines, presentations, emails… and the list continues.  However, for work-life balance, one of the goals is to “balance” the transition from work to “life outside of work”. This means your presence, attention, and focus should completely shift from work to your personal interests and interactions. Work-life balance is beyond physically leaving the job, but balancing the mental transition to fully shift away from work.  It will take practice to avoid checking email or mulling over work.  The amount of time between work and your personal life will remain dynamic; but the “balance” is your ability to commit your focus and attention to those precious personal moments, just as you do for work.

Concept #3:   You are Responsible for You! 

Cardiology requires you to constantly learn and practice to achieve and maintain competency. You are upholding a professional commitment. The same commitment is required to grasp work-life balance.  You have to make a personal commitment to you!!  It is not sufficient to just “wish for it”.  We cannot expect anyone else to understand our needs or create our work-life balance.

To reframe this important concept, consider your self-care and work-life balance as critical as filling your car with gas (or charging your car):  you cannot function without it!  Your personal commitment has to be as strong as your professional commitment.   No, it’s not easy, but it is possible.  Some find it helpful to be accountable to a colleague or friend, check-in regularly (set a reminder) about small steps to promote work-life balance. We understand our responsibility to patients.  Now, it’s time understand your responsibility to you!

During these uncertain times of the COVID-19 pandemic, healthcare workers are working longer hours and under even greater stress. It is normal to feel overwhelmed. Now, more than ever, it is important to find creative ways to focus on precious moments and commit to your well-being!  Below are 5 tips to stay committed to yourself and safely connect with others:

  1. Take three minutes.  Listen to your favorite song, dance while nobody’s watching, or take a few extra minutes in a hot shower. You do not need a long time to be kind to yourself.
  2. Join a Virtual group or class.  Physical distancing and long work hours can be very isolating. Take advantage of the numerous virtual options to safely connect with others who have similar interests.
  3. Share and listen.  Try moving beyond texting and talk on the phone. Commit to that moment, engage in the conversation and focus on listening.  The human connection remains very powerful to strengthen our mind and body.
  4. Protect Your Time. I know it is easier said than done. However, learning to set boundaries is critical to sustain your commitment to work and participate in the joys of life.
  5. Be Kind to Your Body. Find time to sleep, eat healthy snacks, and participate in small amounts of physical activity. Mental health and physical health are equally important.

In summary, work-life balance is a journey, not a destination.  Remember, that “balance” in work-life balance is dynamic – the amount of personal time will change, but your commitment and focus to that time should only grow.

 

About the Author:

Heather M. Johnson, MD, MMM, FAHA, FACC is a Cardiologist & Preventive Cardiologist at the Christine E. Lynn Women’s Health & Wellness Institute at Boca Raton Regional Hospital/Baptist Health South Florida.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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NEGOTIATING YOUR FIRST CONTRACT

Sherry-Ann Brown, MD, PhD

American Heart Association Women in Cardiology Blog Series

NEGOTIATING YOUR FIRST CONTRACT

Victoria Thomas MD, Simone Bailey MD, Sherry-Ann Brown MD PhD

Women are less likely to negotiate their contracts than men 1-3. Approximately 20% of women do not engage in contract negotiation 1. Despite improvements over time in the number of women negotiating their contracts, disparities persist in compensation and rank 4-5. Further, few resources exist to specifically guide women on how to negotiate salary and other beneficial components of the contract.

Optimal negotiation of your contract positions you well for future opportunities, promotion, visibility, and professional satisfaction. Know the process of negotiating your contract (Box 1, Image), know the perks or components of your contract (Box 2, Image), and know the resources available to you as you navigate and negotiate your contract (Box 3, Image). When reviewing contracts, consider the entire package, including malpractice insurance (with tail), paid time off, noncompete stipulations, salary, and incentives 6. Remember, time is money! Negotiate the allocation of your time: in/outpatient, research, medical education, and administration. If you are in academics, consider your incoming rank, clinical title, future promotion opportunities, and research funding if applicable. A clinical title may not cost the department and could set you up for deserved recognition and administrative time. Contracts should specify the requirements and duties of the physician and the employer explicitly, provide clear compensation models, and define term and termination protocols.

Weigh all options, such as preferences for an academic or private practice setting. Be cognizant of important non-work factors: geographic location, significant others, children, and recreational activities, as these greatly affect working decisions. Be firm on your deal makers and breakers prior to contract negotiations 6. Ask for more than you really want. This will likely lead to compromise down to a mutually accepted agreement. Be sure to present special requests in a manner that creates shared interests, and have these written into the contract. It is acceptable to communicate your desires early on and your concerns as the process evolves and recommend modifications that you would like to implement. Remember, verbal promises or assurances are not contractually valid. It is also advised to seek legal counsel with expertise in physician contracts to help you identify loopholes, pitfalls, and modifiable terms.

When entering negotiations, remember to be respectful, humble, appreciative, and also know your worth. The 2020 Medscape Cardiology Compensation Report found that male cardiologists earn approximately 16% more than their female colleagues 7. The average salary for men was $449,000, while women averaged $386,000 7. A study has shown that women lose an average of $7,000  in their first-year salary and may lose up to $1,000,000 over the span of each of their careers 1. As a means to reduce the wage gap, women must increase their efficacy and advocacy through contract salary negotiations. Let the employer make the initial salary offer so that you do not ask for less than you may have been offered or lead them to think that salary is your top priority. Review national reports to determine average salaries for similar physicians in your state of interest and talk with trusted colleagues 8. Other factors such as call, relocation fees, sign-on bonus, student loan repayment, and continuing medical education time and expenses can be negotiated as part of your compensation packet.

In your negotiations, make your best pitch 9. Demonstrate your uniqueness as a candidate and show your creativity. Develop new strategies using your specific skillsets to benefit your employer in areas with knowledge or personnel gaps. Adequate preparation is the most emphasized skill in negotiating any contract. Look ahead of time at what your employer needs and listen well in conversations (in and out of the formal scheduled interview) and emails 9-10. Recognize that every conversation whether in-person, by phone, or through email is part of the negotiation process, and small talk is necessary (often sprinkled in fairy dust). Lead with confidence, and be open to concessions, to show your collaborative nature.

Align with the American Heart Association or American College of Cardiology Women in Cardiology Section, with an emphasis of early matriculation while in training. These organizations not only offer career development and networking opportunities, but they also offer sessions for contract negotiation. Contract negotiation preparation and practice will allow for greater success when navigating your first contract. This will help to overcome challenges related to compensation and promotion inequities, and better communicate career expectations prior to solidifying post-training employment.

BOX 1. NEGOTIATING YOUR FIRST CONTRACT: TIPS ON PROCESS

  • Consider life outside of work: social climate, recreation, partner, children
  • Discuss shared priorities and interests to support solutions with your employer
  • Ensure the contract clearly states non-clinical roles and other promises which may have been made to you during the interview process
  • Get in writing any specific unique requests that you may desire
  • Review national reports on average salaries in your specialty and state
  • Speak with trusted colleagues for an idea of fair wages for your specialty
  • Ask for a higher salary if what is offered does not meet your expectations

 

BOX 2. NEGOTIATING YOUR FIRST CONTRACT: TIPS ON PERKS

  • Sign-on bonus
  • Relocation stipend
  • Non-compete stipulations
  • Malpractice insurance coverage with tail
  • Inpatient vs. outpatient service
  • Salary
  • Student Loan Repayment Plans
  • Dedicated Administrative or Research Time
  • Bonus/incentives
  • PTO (CME, Vacation, Sick days, etc)
  • Academic rank, promotion, and protected time for academic pursuits

 

BOX 3. NEGOTIATING YOUR FIRST CONTRACT: TIPS ON RESOURCES

  • PracticeLink (website); understanding the job search process
  • Getting to Yes (book); understanding negotiation
  • Good to Great (book); understanding the goals of your employer
  • ACC and AHA WIC Discussions; understanding strategies for women
  • Negotiation Skills: Negotiation Strategies and Negotiation Techniques
    to Help You Become a Better Negotiator; understanding power of negotiation
  • American Medical Group Association (AMGA) Compensation Survey;
    comparing compensation by specialty, region, and group size
  • Association of American Medical Colleges (AAMC) Faculty Salary Survey Results; comparing compensation within academia

 

REFERENCES:

  1. https://hbr.org/2018/06/research-women-ask-for-raises-as-often-as-men-but-are-less-likely-to-get-them
  2. Kugler, K. G., Reif, J. A. M., Kaschner, T., & Brodbeck, F. C. (2018). Gender differences in the initiation of negotiations: A meta-analysis. Psychological Bulletin, 144(2), 198–222
  3. Bowles  HR. Why women don’t negotiate their job offers.Harvard Business Review.https://hbr-org.proxy.library.vanderbilt.edu/2014/06/why-women-dont-negotiate-their-job-offers/. Published June 19, 2014. Accessed April 16, 2016.
  4. Jagsi  R, Biga  C, Poppas  A,  et al.  Work activities and compensation of male and female cardiologists. J Am Coll Cardiol. 2016;67(5):529-541.
  5. Mehta, L. S., Fisher, K., Rzeszut, A. K., Lipner, R., Mitchell, S., Dill, M., … & Douglas, P. S. (2019). Current demographic status of cardiologists in the United States. Jama Cardiology, 4(10), 1029-1033
  6. Fisher, Roger, William L. Ury, and Bruce Patton. Getting to yes: Negotiating agreement without giving in. Penguin, 2011.
  7. Lo Sasso  AT, Richards  MR, Chou  CF, Gerber  SE.  The $16,819 pay gap for newly trained physicians: the unexplained trend of men earning more than women. Health Aff (Millwood). 2011;30(2):193-201.
  8. https://www.medscape.com/slideshow/2020-compensation-cardiologist-6012721
  9. Bowles, Hannah Riley, Bobbi Thomason, and Julia B. Bear. “Reconceptualizing what and how women negotiate for career advancement.” Academy of Management Journal62.6 (2019): 1645-1671.
  10. Fischer, Lauren H., and Anureet K. Bajaj. “Learning how to ask: women and negotiation.” Plastic and Reconstructive Surgery139.3 (2017): 753-758.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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Women’s History Month: Cardiology Edition

Christa Trexler, PhD

Somehow it’s already March, which means it’s Women’s History Month, so I wanted to take this opportunity to highlight some of the many amazing cardiologists and researchers (who also happen to be women) who have shaped our field.

Last month, I wrote about the importance of science outreach, especially with regard to promoting science and cardiology to young girls and women, because women still make up around only a third of scientific researchers and only around 13% of cardiologists are women. To learn more, Renee P. Bullock-Palmer’s most recent blog is a great resource.

This month I wanted to highlight some of the women who paved the way for the rest of us.


Now, unsurprisingly, simple Google searches for things like “scientists who shaped cardiology” or “most famous cardiologists” provide results that are pretty male and pale. There weren’t that many pieces that included women in their lists of cardiologists/researchers, and there were only a handful of sources I found that focused specifically on women. Lucky for you, I’ve collected what I found here! I’m also going to highlight several of the brilliant women who shaped our field – this is by no means an exhaustive list of amazing women in cardiology (or their accomplishments) because there are too many to fit on one list.

 

Maude Abbott, MD was a Canadian physician who invented an international classification system for congenital heart disease in the 1930’s. Her work the Atlas of Congenital Heart Disease became the definitive reference guide on the subject.

 

Helen B. Taussig, MD, FACC is widely regarded as the Founder of Pediatric Cardiology. In the 1940’s she developed the operation to correct the congenital heart defect that causes “blue baby” syndrome. She received the Medal of Freedom from President Lyndon B. Johnson and was the first female president of the American Heart Association.

 

Myra Adele Logan, MD was the first woman (and only the 9th person!) to operate on a human heart in 1943.

 

Marie Maynard Daly, PhD was first African American woman to obtain a PhD in chemistry in the United States, whose research in the 1950’s was invaluable in demonstrating the relationship between high cholesterol levels and heart attacks.

 

Celia Mary Oakley, MD was one of the first women cardiologists in the United Kingdom and was part of the team that coined the term hypertrophic cardiomyopathy in the late 1950’s.

 

Sharon A. Hunt, MD was just one of seven women in her 1967 medical school class and she went on to revolutionize the field of heart transplantation by working to improve survival rates by identifying and treating rejection and determining how to reduce the side effects of the drugs.

 

Nanette Kass Wenger, MD, was among the first cardiologists to focus on heart disease in women, and to evaluate the different risk factors and manifestations of the condition, specifically coronary artery disease, in women and men. I was lucky enough to talk with her about her work at AHA Sessions 2018, which I wrote about here. You can also follow her on twitter @NanetteWenger.

 

Christine Seidman, MD, is a researcher who transformed the field of cardiovascular genetics with her research that uncovered the genetic basis of many human cardiovascular disorders, including cardiomyopathy, heart failure and even congenital heart malformations.

 

Elizabeth O. Ofili, MD, MPH, FACC is a clinical scientist who led the effort to implement the landmark African American Heart Failure Trial (AHEFT), whose findings improved the practice guidelines for the treatment of heart failure in African Americans. She also became the first woman president of the Association of Black Cardiologists in 2000.

 

Ileana Piña, MD, MPH, FACC is a nationally renowned cardiologist known for her work in heart failure and improving patient rehabilitation outcomes. Her work has also upturned preconceived notions about women in the medical community and she works tirelessly to get more women into clinical trials.

 

Rong Tian, MD, PhD is a leader in the field of cardiac metabolism whose work has been translated to clinical trials. Among her many contributions, she was the first to demonstrate that AMP-activated protein kinase (AMPK) acted to remodel cardiac energy metabolism, which critically informed the heart failure field. You can also follow her on twitter @Rongtian2.

 

I want to note, that these cardiologists and researchers are not important just because they are women – they are talented scientists and cardiologists who happen to also be women. But pieces like this are important because representation matters. It’s important for everyone, especially young girls and women, to see that it’s possible not just to be successful in this field, but also to revolutionize it.

 

Helpful sources & suggested reading:

 

 
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The Invaluable Importance of Mentorship Throughout Your Career as a Female Cardiologist

Renee Bullock-Palmer, MD

Featuring an Interview with Dr. Stacey Rosen recipient of the American Heart Association (AHA) 2018 “Women in Cardiology Mentoring Award”

 

Lack of Females in the Cardiology Field

Over 36% percent of Internal Medicine residents are females. Despite this fact, females account for less than 20% of the Adult Cardiologist workforce in the United States and account of less than 10% of Interventional Cardiologists in the United States1. Recruitment and retention of many talented female cardiologists remain a constant challenge and is due to a variety of reasons. Some of these reasons include the thought that cardiology is a grueling field that does not allow for work life balance and is often inhospitable for females desiring to start a family. There is also difficulty in retaining females in the field due to increased gender discrimination in the field1. In fact the Professional Life Survey conducted by the American College of Cardiology had reported that many female cardiologists in the field report a high level of career satisfaction which has not changed over the last 20 years1. However, there are many challenges that have remained the same for female cardiologists over the last 2 decades, such as gender discrimination, the need to arrange for paid or unpaid childcare, being single and not having any children1. In addition, there has been aging of the workforce and there are increasingly more female cardiologists practicing in an academic and/or hospital employed setting rather than in private practice1 and therefore having less autonomy over their work schedule and environment.

 

Need for Effective Mentorship For Female Cardiologists and the American Heart Association Women in Cardiology Mentoring Award

 

There is an ever increasing need to not only recruit more females in the field of Cardiology, but to also retain many talented female cardiologists in the field. Finding a good mentor and fostering good mentorship is invaluable for many females throughout their career in Cardiology. The Women in Cardiology Committee of the American Heart Association (AHA) values the importance of good mentorship and as such bestows the Women in Cardiology Mentor Award that is sponsored by the AHA Council on Clinical Cardiology to Cardiologists who have been recognised as having an outstanding record of effectively mentoring and supporting female cardiologists. Dr. Stacey E. Rosen,  Endowed Chair and Vice President for the Katz Institute for Women’s Health at Northwell Health, Partners Council Professor of Women’s Health at Hofstra North Shore-LIJ School of Medicine at Hofstra University and Professor of Cardiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell is the recipient of the 2018 AHA Women in Cardiology Mentoring Award. She has mentored and supported numerous female cardiologists, and in the following interview, I had the honor of discussing the following questions with Dr. Rosen.

Courtney could we add a hyperlink to the AHA WIC mentor award nomination site?

 

What attracted you to the field of Cardiology?

Dr. Rosen: “I am the first member of my family to become a doctor. I am the daughter of educators and while in high school , I volunteered at Memorial Sloan Kettering in the pediatric child-life center. I thought that the medical field would allow me to pursue various professional options including clinical care, education, advocacy and research. I felt one could never be bored in medicine! As a student in the 6-year medical program at Boston University, we dissected a bovine heart and I was so amazed by the “simplicity” of the structure. Nothing else seemed intriguing after that – my only important decision was between pediatric cardiology and adult cardiology.”

Who were the inspirational persons that influenced this decision?

Dr. Rosen: “The Division of Cardiology at Boston University School of Medicine in the 1980’s – and ever since – was extraordinary. The faculty at Boston City Hospital (BCH) demonstrated commitment and passion for those in the underserved neighborhoods near BCH and the faculty at University Hospital were national respected clinicians , investigators and educators.”

Who were your mentors in Cardiology and how did they contribute to the advancement of your career?

Dr. Rosen: “I completed Internal Medicine residency and a chief resident year at Montefiore Medical Center in the Bronx, and was privileged to work with an impressive Division of Cardiology. Hildrud S. Mueller, MD and James Scheuer , MD taught me the importance of rigor and attention to detail in both clinical work and research. I presented my first oral presentation with John Fisher, MD – the recently retired division chief – and learned to perform a complete and thorough cardiac exam with Mark Menegus, MD.

As a fellow at Cornell – New York Hospital, Mary Roman, MD, Peter Okin, MD, Paul Kligfiled, MD, and Richard Devereux, MD fostered my fascination with imaging and non-invasive cardiology. Doppler physics was replacing hemodynamic assessment in the cardiac catheterization lab and I was hooked!

Finally, my first faculty position was at Mount Sinai Medical Center. Working in the echo lab with Martin Goldman, MD was an extraordinary opportunity. He inspired me to view echocardiography as a critical tool to enhance optimal patient care and helped me to develop the skills to become a lab director in my next position.

You have mentored many colleagues in the Cardiology field and have been valued by many as a great mentor, which led to your selection for the 2018 AHA Women in Cardiology Mentorship Award. What are the factors that mentees should consider when selecting a mentor?

Dr. Rosen: “Mentees should consider several critical factors:

  • Compatibility – Choose someone with whom you are compatible but not someone who is a “mini me“ of yourself. You do want a mentor who will challenge you, be comfortable providing feedback, and teach you to internalize and utilize feedback to advance your goals.
  • Trust – You want a mentor whom you can trust – you will likely be sharing important and perhaps confidential conversations. It is also critical to know that you must earn a sense of trust from your mentor.
  • Expertise – Your mentor does not have to have the most senior titles or positions, but should have the requisite expertise to help you advance your career and help navigate challenges.
  • Willingness – A great mentor is one who is devoted to helping you develop a vision and is delighted to share knowledge and wisdom. It should be someone who is a good listener and has sufficient time to commit to the relationship.

 

Would you recommend having more than one mentor?

Dr. Rosen:  “Absolutely! But do remember that the mentee needs to commit sufficient time to each relationship in order to optimize the value of the partnership

 

How can mentees truly harness the power of strong mentorship?

Dr. Rosen: “First – choose your mentor wisely and respect the relationship. Meet with individuals who you think may be good mentors and ask questions that will help you make a decision and get advice from friends and colleagues. Networking is often the key to identifying good choices.

Second – do the work and always respect the relationship! Discuss the goals and expectations of the partnership, as well as the process for communication, meetings and feedback. Be respectful of your mentor’s time and build trust immediately.

 

What are the differences between mentorship and sponsorship?

Dr. Rosen: Simply put – mentors advise you, while sponsors advance your career. A mentor is someone who can offer support, guidance and feedback, and allow you to develop your personal vision. A sponsor is earned – not chosen. A sponsor connects us to opportunities and advocates for our career advancement. It has been said that women are over-mentored and under-sponsored.

 

 

How has the experience of being a great mentor for so many colleagues contributed to your own career and personal growth?

Dr. Rosen: My late father was a middle school principal and my mother is a retired school teacher who taught in an underserved community in Brooklyn, NY. I learned from them the deep satisfaction one gets from teaching and advancing someone’s skills and abilities. I am also so grateful to MY mentors and get great satisfaction from “paying it forward.”  I am certain that I have learned as much from my mentors as they have learned from me!

What have been the 3 most rewarding experiences you have had throughout your career?

Dr. Rosen: As the director of the fellowship program at Northwell, I have had the privilege to work with dozens of trainees. I have helped impact their professional success and hopefully, the joy they find from practicing cardiology.

As chief of cardiology at Long Island Jewish Medical Center, I was able to rebuild a division that had weathered a hospital merger. Together with my colleagues, we completely revamped the division.

As a lifelong advocate for women’s heart health, I get enormous pride seeing the impact we have had on women’s health through improved clinical care, advances in gender-specific investigation and through advocacy and changes in policy. I know that our work is not done and that we still need to continue to advance women’s heart health agenda.

How has the field of Cardiology evolved over the duration of your career with regards to gender diversity and inclusivity of women in Cardiology?

Dr. Rosen: Unfortunately, our field has not advanced sufficiently when it comes to gender diversity and inclusion in Cardiology. Currently, fewer than 25% of cardiology fellows are female and fewer than 15% of board-certified cardiologists are women. Now that women are 50% of medical school graduates, the importance of developing a strategic approach to this lack of diversity is critical, or we will see a true talent drain in the near future. The good news is that both the American Heart Association and the American College of Cardiology have focused on lessening this disparity by better understanding the barriers facing female cardiologists and by making changes that will encourage young women to choose Cardiology.

What advice would you give to females considering a career in Cardiology?

Dr. Rosen: I can honestly think of no better choice! As clinicians, we can develop long-term longitudinal relationships and have an enormous impact on health and longevity. I believe that cardiology combines the best features of primary care and subspecialty medicine. As investigators, we can have a lasting impact on individuals and communities. Cardiology is also a field that is perfect for those who enjoy advocacy and advancing health policy improvements. I urge women NOT to eliminate Cardiology as a possibility because of concern about the challenges. Find the area of the field that you love, without fear or compromise, and then make decisions that will allow you to fulfill your vision of work – life integration.

References:

  1. Lewis SJ, Mehta LS, Douglas PS, et al. Changes in the Professional Lives of
    Cardiologists Over 2 Decades on behalf of the American College of Cardiology Women in Cardiology Leadership Council. J Am Coll Cardiol 2017

 
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Women In Cardiology & The 2:00am Leadership

Mirvat Alasnag, MD

The Women In Cardiology (WIC) community has grown in recent years and has represented professional women in many ways. Tangible accomplishments include advocacy for more women on panels (#NoManels), curbing harassment (#MeToo), opening leadership opportunities and much more. Many have recruited men into the campaign for women (#HeForShe). Guidance into what men can do has also been emphasized, for example, speaking up when a committee lacks diversity and lending an early career woman a research opportunity. But, have we given women enough guidance? I fear not. Allow me to display examples where women have failed other women. It’s a collection that I’ve discussed over the course of the last several months in WIC workshops across the globe.

 

Time: 2:00 am

Place: Cathlab

Setting: STEMI & shock

Woman interventional cardiologist (IC) calls the on-call anesthetist (a fellow woman) to provide deep anesthesia because “I need to cardiovert this patient who had primary PCI and now in AF with RVR and is hemodynamically unstable”.

Anesthetist: Okay the patient is asleep, but does he really need cardioversion?

IC: Yes.

IC calls to technician: 200 Joules.

Anesthetist: No. It should be 100 Joules according to the AHA algorithm.

With an unstable patient on the table, is this the time to be questioning a colleague’s judgment in front of her staff? I fear using “patient advocacy” as an excuse to lecture a qualified cardiologist on the management of arrhythmias is inappropriate. Many electrophysiologists have reservations about the very conservative algorithm. 2:00 am in the cathlab is hardly the time or place for such a discourse. Perhaps at a more suitable time, a scientific discussion can educate everyone on the indications of cardioversion for AF. Why is this incident reckless and detrimental on many levels?

  1. It undermines a colleague in front of her staff to whom she has to prove herself every day.
  2. It doesn’t help a patient who is unstable. Every failed shock reduces the chance for the next shock to work.
  3. It portrays an image of two professional women “bickering” over a crashing patient.

 

Time: 2:00 am

Place: Email

Setting: Clinic Schedule

Cardiologist (a woman) fires off an email to the Chief of Staff expressing disillusion with the “disruptive” clinic schedule that was planned by her immediate section head (a woman). Why is this incident reckless and detrimental on many levels?

  1. It undermines the leadership of the section head, a woman nonetheless.
  2. It negatively impacts the relationship between colleagues (2 women).

Wouldn’t it have been more constructive if she spoke to her head first and made her recommendations? The worst part of this whole story is that the immediate section head did not design the clinic schedule. It was the Chief of Staff. The “backstabbing” backfired and the notion was that this cardiologist is not a team player. It would have been wiser and more respectable to go through the appropriate channels with suggestions for improvements. Why is this incident reckless and detrimental on so many levels?

  1. It doesn’t build team spirit or trust. It does the exact opposite.
  2. It damages future prospects for both women in the workplace. It leaves the impression that the head cannot inspire or lead and the other woman is not a trustworthy team player (late night backstabbing email).
  3. On a larger scale, it suggests men can be more professional even when competitive.

 

Time: 2:00 am

Place: International Teleconference

Setting: Planning of a Scientific Activity

A woman participant claims ownership of an idea that belongs to the chair of one of the subcommittees (a woman) and bypasses her. The worst part of this story is the director of this scientific activity (also a woman) allows her to do so. She does not empower the head of the subcommittee by channeling all projects/decisions through her. She does not acknowledge the other participants. Instead, this woman’s name is placed first in all communications. Why is this incident reckless and detrimental on so many levels?

  1. It proves that women can do other women more injustice by stripping them of credit and authority.
  2. It projects an image that women leaders lack fair leadership suggesting that it’s no better (perhaps worse) than men’s leadership.
  3. It casts doubt on the efficiency of the various WIC programs in providing leadership training and addressing such inconsistencies.

 

The purpose of this month’s blog is not to be critical of women. To the contrary, there have been many women exhibiting true leadership and effecting concrete changes. Now we find lactation areas at major meetings, opportunities for women to serve as proctors and live transmission operators, and emphasis on diversity in training programs and the workplace. I do believe we have to build on that momentum. The purpose of this blog is to allow for some self-reflection on our part as women in the field. Whether we like it or not we are held to higher standards. Any deviation by one woman is considered a setback for all and any success story of one woman is a stride forward for all. It is not a fair world and prejudice/inconsistencies are noted on all fronts. I am a catheterization laboratory director and have been for a couple of years now. Every single day I have to prove I’m capable and reliable. Every single day, and no matter how much time has passed, I still need to assert my authority and earn respect from men and women. I know that when men are given leadership opportunities, the respect and authority are automatic until proven otherwise. For a woman, it gets exhausting after a while…and that’s why we have more work to do & more self-reflection can only help.

 

Not references for this blog, but worthwhile data for WIC:

  1. O’Sullivan S. Women in medicine: deeds not words. Lancet. 2018;392(10152)1002-1003.
  2. Mehran R. Women’s Voices in Cardiology: An Uncomfortable Silence. JAMA Cardiol.2018;3(8):676–677. doi:10.1001/jamacardio.2018.1289
  3. Breaking the Catheterization Laboratory Ceiling. JACC 2017;69(21)2668-2271.
  4. Lautenberger DM, Dandar VM, Raezer CL, Sloane RA. 2013–2014 The State of Women in Academic Medicine: The Pipeline and Pathways to Leadership. Washington, DC: Association of American Medical Colleges, 2014.
  5. Prasad M. Gender in cardiology: work yet to be done. J Am Coll Cardiol 2016;67:3016–9.
  6. Wang TY, Grines C, Ortega R, et al. Women in interventional cardiology: update in percutaneous coronary intervention practice patterns and outcomes of female operators from the National Cardiovascular Data Registry. Catheter Cardiovasc Interv 2016;87:663–8.
  7. Carr PL, Gunn CM, Kaplan SA, Raj A, Freund KM. Inadequate progress for women in academic medicine: findings from the National Faculty Study. J Womens Health 2015;24:190–9.
  8. Lewis SJ, Mehta LS, Douglas PS, et al., for the American College of Cardiology Women in Cardiology Leadership Council. Changes in the professional lives of cardiologists over 2 decades. J Am Coll Cardiol 2017;69:452–62.
  9. Bates C, Gordon L, Travis E, et al. Striving for gender equity in academic medicine careers. Acad Med 2016;91:1050–2.
  10. Marchant A, Bhattacharya A, Carnes M. Can the language of tenure criteria influence women’s academic advancement? J Womens Health (Larchmt) 2007;16:998–1003.
  11. Hlatky MA, Shaw LJ. Women in cardiology: very few, different work, different pay. J Am Coll Cardiol 2016;67:542–4.