Work Activities and Compensation of Male and Female Cardiologists

Working in interventional cardiology laboratories: The perceived impact of radiation exposure as a health and gender hazard. A NEXT generation ANMCO initiative

BACKGROUND

Gender-related discrepancies in personal and professional life have been reported among radio-exposed workers. We assessed this topic among cardiac catheterization workers in Italy, with a focus on gender and working position.

METHODS

Radio-exposed workers affiliated with the Italian Association of Hospital Cardiologists were invited to answer an online survey, which included 41 questions formatted as multiple choice.

RESULTS

Overall, 237 workers responded. The proportion of males was significantly higher than that of females in the population aged >50 years. A greater portion of females than males perceived female-gender discrimination regarding career advancement (77.2% vs 30.9%, p < 0.001) and work compensation (49.1% vs. 17.1%, p < 0.001). There was no difference in perceived gender- discrimination in terms of career advancement opportunities between physician and non-physicians. A larger portion of females than males experienced workplace discrimination (51.8% of females vs. 8.1% of males, p < 0.0001). Non-physician responders made up 38.8% of all respondents and reported a lower yearly radiation exposure than physicians. Non-physicians were more aware of the laws regulating lab access during pregnancy than physicians (93.5% vs. 48.3%, p < 0.0001). A greater percentage of female nurses than physicians communicate without hesitation the pregnancy status to their employers (45.6% vs 20%, p < 0.001).

CONCLUSIONS

Gender-based career disparities were perceived among physicians and non-physician staff of cardiology interventional laboratories. Strategies should be implemented to ensure gender equality in career opportunities and to increase knowledge of radioprotection and the laws regulating access to laboratories during pregnancy.

Gender inequality in genitourinary malignancies clinical trials leadership

BACKGROUND

Over the past 2 decades, there has been a growing interest in the significance of gender roles in healthcare and several efforts and initiatives have focused on increasing female representation in the medical field. Clinical trials play a very important role in shaping medical practice; moreover, the leaders of clinical trials often represent the upper echelon of researchers in any designated field. Presently, there is no data regarding women's representation in urological oncology clinical trials leadership. Therefore, the aim of this study is to examine the extent of female representation in leading urological clinical trials.

METHODOLOGY

To thoroughly examine the representation of females as principal investigators (PIs) in urological cancer clinical trials between 2000 and 2020, we conducted a comprehensive search of completed trials focused on kidney, prostate, and bladder cancer on ClinicalTrials.gov. We extracted relevant information regarding the PIs and analyzed the data using univariate analyses to identify any significant differences between male and female PIs.

RESULTS

A total of 9145 cancer clinical trials were conducted over the last 2 decades, and 11.3% (n = 1033) of them were urological cancer clinical trials. We were able to obtain detailed information about the principal investigators (PI) in 79.0% (n = 816) of the clinical trials, and we found that 16.8% (n = 137) of them were led by female investigators. Upon evaluating the characteristics of the PIs, female PIs had a significantly lower median age and median total citations as compared to male PIs (55.0 vs 59.0 and 5333 vs 7902; p-value < 0.001 and 0.006, respectively). However, there was no statistically significant difference between the termination rate, publication rate, funding source, cancer type, and the subject of conducting the clinical trials between male and female PIs.

CONCLUSION

Between 2000 and 2020, only 16.8% of urological cancer clinical trials were led by a female PI, perhaps reflective of a low percentage of senior female researchers in the fields of urology, oncology and radiation oncology. Universities, research institutes and funding agencies should work to improve mentorship, representation and opportunities for female investigators to encourage more involvement for female researchers in these clinical trials.

The physician gender pay gap in Maryland: current state and future directions

BACKGROUND

Over the last few decades, more attention has been paid to the physician gender pay gap and more interventions have been attempted. This paper discusses the physician gender pay gap between 2017 and 2021 in Maryland.

METHODS

An online cross-sectional survey was distributed to over 10,000 physicians in the Maryland Medical Society, featuring questions regarding employment characteristics, compensation, impact of the COVID-19 pandemic, and educational debt. Using descriptive and regression analyses, we explored cross-sectional associations between gender and employment characteristics.

RESULTS

Male physicians reported a significantly higher average 2020 pre-tax income ($333,732 per year) than female physicians ($225,473 per year, p < 0.001), amounting to a nearly 50% difference in raw income, consistent with a previously reported pay gap in 2016. Women physicians earned 31.5% less than their male colleagues in 2020 and were projected to earn 28.7% less in 2021. Female physicians were also more likely to have educational debt (33.6% vs.12.9%, p < 0.001) and also more likely to have a high burden of debt, with 36% owing over $200,000 in education loans, compared to 14.7% of men (p < 0.01).

CONCLUSION

The physician gender pay gap in Maryland has remained relatively stable over four years, including the period of the COVID-19 pandemic.

Representation of Women and Minority Faculty and Fellows in Academic Pediatric Cardiology Training Programs

BACKGROUND

Studies have shown that diverse care teams optimize patient outcomes. Describing the current representation of women and minorities has been a critical step in improving diversity across several fields.

OBJECTIVES

To address the lack of data specific to pediatric cardiology, the authors conducted a national survey.

METHODS

U.S. academic pediatric cardiology programs with fellowship training programs were surveyed. Division directors were invited (July 2021 to September 2021) to complete an e-survey of program composition. Underrepresented minorities in medicine (URMM) were characterized using standard definitions. Descriptive analyses at the hospital, faculty, and fellow level were performed.

RESULTS

Altogether, 52 of 61 programs (85%) completed the survey, representing 1,570 total faculty and 438 fellows, with a wide range in program size (7-109 faculty, 1-32 fellows). Although women comprise approximately 60% of faculty in pediatrics overall, they made up 55% of fellows and 45% of faculty in pediatric cardiology. Representation of women in leadership roles was notably less, including 39% of clinical subspecialty directors, 25% of endowed chairs, and 16% of division directors. URMM comprise approximately 35% of the U.S. population; however, they made up only 14% of pediatric cardiology fellows and 10% of faculty, with very few in leadership roles.

CONCLUSIONS

These national data suggest a "leaky pipeline" for women in pediatric cardiology and very limited presence of URRM overall. Our findings can inform efforts to elucidate underlying mechanisms for persistent disparity and reduce barriers to improving diversity in the field.

Impact of racial, ethnic and gender disparities in Cardiology

Literature shows evidence of racial and gender biases in many sub-specialties of medicine including cardiology. Racial, ethnic, and gender disparities exist along the path to cardiology residency, beginning as early as medical school admissions. Approximately 65.62% White, 4.71% Black, 18.06% Asian, and 8.86% Hispanic are cardiologists, while there are a total of 60.1% White, 12.2% Black, 5.6% Asian, and 18.5% Hispanic people in the US in 2019, showing evident underrepresentation. Gender disparities have an inevitable role in the lack of a diverse cardiovascular workforce. According to a recent study, only 13% of practicing cardiologists in the US are women, even though the female population in the US is 50.52% as compared to 49.48%- of men. These disparities led to underrepresented physicians earning less than their similarly qualified counterparts, decreased equity, increased workplace harassment, and also results in patients facing unconscious bias from their physicians leading to deteriorated clinical outcomes. Implications in the field of research include the underrepresentation of minorities and the female population despite the increased burden of cardiovascular disease they face. However, efforts are underway to eradicate the disparities that exist in cardiology. This paper aims to increase awareness regarding the issue and inform future policies with the goal of encouraging underrepresented communities to join the cardiology workforce.

Women physicians in cardiovascular magnetic resonance: Past, present, and future

Women's engagement in medicine, and more specifically cardiovascular imaging and cardiovascular MRI (CMR), has undergone a slow evolution over the past several decades. As a result, an increasing number of women have joined the cardiovascular imaging community to contribute their expertise. This collaborative work summarizes the barriers that women in cardiovascular imaging have overcome over the past several years, the positive interventions that have been implemented to better support women in the field of CMR, and the challenges that still remain, with a special emphasis on women physicians.

International consensus statement on challenges for women in cardiovascular practice and research in the COVID-19 era

The challenges to academic and professional development and career advancement of women in cardiology (WIC), imposed by the pandemic, not only impinge the female cardiologists' "leaky pipeline" but also make the "leakiness" more obvious. This consensus document aims to highlight the pandemic challenges WIC face, raise awareness of the gender equity gap, and propose mitigating actionable solutions derived from the data and experiences of an international group of female cardiovascular clinicians and researchers. This changing landscape has led to the need for highly specialized cardiologists who may have additional training in critical care, imaging, advanced heart failure, or interventional cardiology. Although women account for most medical school graduates, the number of WIC, particularly in mentioned sub-specialties, remains low. Moreover, women have been more affected by systemic issues within these challenging work environments, limiting their professional progression, career advancement, and economic potential. Therefore, it is imperative that tangible action points be noted and undertaken to ensure the representation of women in leadership, advocacy, and decision-making, and increase diversity in academia. Strategies to mitigate the negative impacts of the pandemic need to be taken during this COVID-19 pandemic to ensure WIC have a place in the field of Cardiology.

Analysis of Physician Compensation Studies by Gender, Race, and Ethnicity

Purpose:

This report investigated physician compensation studies by gender, race, and ethnicity.

Methods:

Published U.S. physician compensation studies were assessed.

Results:

Of the 47 data sets within 46 studies, 36 analyzed compensation by gender and 32 (88.9%) found disparities. Thirteen and eight analyzed for race and ethnicity, with disparities found in four (30.8%) and none, respectively. The sample sizes of the four data sets with differences by race were among the largest in the subset.

Conclusion:

Most studies demonstrate pay disparities for women, but not for people who identify with underrepresented race/ethnic groups; however, small sample sizes may affect results.

Gender differences in cardiology professionals: A Latin American Survey

BACKGROUND

Gender-based differences among cardiology professionals have been reported in North America and Europe. However, the perspective of Latin American cardiologists remains unexplored.

OBJECTIVES

The objectives of the study were to analyze the gender gap perspective among cardiologists from Latin America.

METHODS

A cross-sectional study using an online survey directed to Latin American cardiologists from five different cardiology societies. The survey included questions on demographic data, professional development in the field of cardiology, and perceived barriers in clinical practice.

RESULTS

A total of 240 professionals were surveyed, of which 41.7% were women (100) and 58.3% were men (140). The majority of women tend to work in the subfields of clinical cardiology and cardiovascular imaging. Women were underrepresented as heads of departments, earn less, and report less work satisfaction than men. The barriers that female cardiologists face at their workplace include labor discrimination, sexual harassment, family-related concerns, and lack of career development.

CONCLUSIONS

The survey points toward the prevalence of a gender gap among cardiologists in Latin America, which is primarily driven by labor discrimination, sexual harassment, family-related concerns, and lack of career development among female cardiologists. Actions aimed at addressing this issue should be considered by different parties.

Lack of Equity in the Cardiology Physician Workforce: A Narrative Review and Analysis of the Literature

The gender and racial diversity in the cardiology workforce in Canada does not reflect that of the population we serve. As social awareness of the principles of equity, diversity, and inclusion rises, our profession must rise to meet the challenges they present. We detail contemporary examples of publication bias in the cardiac sciences literature and describe the factors that led to oversight in the peer-review process. We performed a narrative review to summarize the published literature on equity and diversity among cardiac physicians. We also summarize the challenges faced by women and racial-minority physicians when pursuing and thriving in a career in cardiology, and the systemic barriers to their success. In the past decade, social justice movements have advanced. Professionalism standards are changing, and awareness and understanding of these advances in terminology is imperative for all physicians. In this review, we summarize key language and concepts, with cardiology-specific examples, and propose a new paradigm of professionalism.

The Pivotal Role of Women in Cardiology Sections in Medical Organizations: From Leadership Training to Personal Enrichment

Women in cardiology (WIC) sections have emerged as important leadership, career development, and advocacy forums for female cardiologists. Over the past 3 decades, they have grown from small groups to large sections within volunteer science organizations. In addition to providing a sense of community and promulgating the principles of diversity, equity, inclusion, and belonging, the WIC sections have contributed to improving workplace culture and dynamics by generating evidence-based and actionable data, fostering leadership by and scientific enrichment of women, developing task forces and health policy documents targeted toward reduction of burnout and bias in medicine, and providing a platform to voice the unique challenges and opportunities of female cardiologists. The future holds great promise, as the WIC sections continue to play a pivotal role by being intentional, transparent, iterative, and sustainable, and working with important stakeholders, including men, to share data, best practices, and strategies to create and maintain a culture of equity and achieve its core principles.

Sex Disparity Among Canadian Cardiologists in Academic Medicine: Differences in Scholarly Productivity and Academic Rank

Background

Women remain relatively underrepresented in all subspecialties of academic medicine. While sex disparity is prevalent in a number of specialties, the association between academic productivity and sex in academic cardiology has not been assessed in the Canadian context.

Methods

Academic faculty of accredited Canadian Resident Matching Service (CaRMS) programs were included from cardiology division websites across 17 universities. Cardiology faculty members’ names, academic ranks, leadership positions, and sex were obtained from each institutions’ website. The Elsevier database Scopus© was used to extract the Hirsch index (H-index), years of active research, and number of publications of each faculty member. The H-index was used as a metric of academic output and research productivity. Univariate regression was run with the H-Index as the outcome of interest, and multiple linear regression analysis was used to determine factors associated with higher H-index.

Results

Sex was identified for 1,040 members, of whom 836 (80%) were male. Male members had higher numbers of publications (p <0.001). There was a trend for males in a leadership position to have a higher H-index (p = 0.07). Median H-index was lower for women (p = 0.02). Males across assistant and associate professor ranks had a higher H-index. Women achieving professor rank demonstrated greater productivity with a higher median H-index (p = 0.002).

Conclusions

There is a prevalent sex gap in academic cardiology with regard to scholarly productivity and academic achievement. Factors that may help narrow the sex gap need to be identified and corrective measures implemented to enhance sex equity.

Sex Differences in Cardiovascular Research: A Scientometric Analysis

Background We sought to investigate sex-specific differences in authorship of cardiovascular research over the past decade. Methods and Results All 387 463 cardiovascular publications between 2010 and 2019 were retrieved from Web of Science. Articles increased from 19 960 to 29 604 articles per year (P>0.001). The number of articles written by female first authors increased by 76.3% (6434-11 343 articles) and by 35.0% for male first authors (13 526-18 261) (P<0.001). The first author was more likely to be a female author in articles with female last authors. The median impact factor (IF) for articles by female first authors was lower (2.46 [interquartile range, 7 1.11-4.03] versus 2.51 [interquartile range, 1.17-4.10]; P<0.001). Female authorship articles reached the highest IF in North America (average IF, 3.7), with the lowest in Africa (average IF, 1.8). Conclusions Publications in cardiovascular research have increased over the past decade, particularly by female authors. Female researchers are cited less often compared with their male peers. The IF remains lower for articles by female researchers.

Gender Differences in Medicare Payments Among Cardiologists

Importance

Women cardiologists receive lower salaries than men; however, it is unknown whether US Centers for Medicare & Medicaid Services (CMS) reimbursement also differs by gender and contributes to the lower salaries.

Objective

To determine whether gender differences exist in the reimbursements, charges, and reimbursement per charge from CMS.

Design, Setting, and Participants

This cross-sectional analysis used the CMS database to obtain 2016 reimbursement data for US cardiologists. These included reimbursements to cardiologists, charges submitted, and unique billing codes. Gender differences in reimbursement for evaluation and management and procedural charges from both inpatient and outpatient settings were also assessed. Analysis took place between April 2019 and December 2020.

Main Outcomes and Measures

Outcomes included median CMS payments received and median charges submitted in the inpatient and outpatient settings in 2016.

Results

In 2016, 17 524 cardiologists (2312 women [13%] and 15 212 men [87%]) received CMS payments in the inpatient setting, and 16 929 cardiologists (2151 women [13%] and 14 778 men [87%]) received CMS payments in the outpatient setting. Men received higher median payments in the inpatient (median [interquartile range], $62 897 [$30 904-$104 267] vs $45 288 [$21 371-$73 191]; P < .001) and outpatient (median [interquartile range], $91 053 [$34 820-$196 165] vs $51 975 [$15 622-$120 175]; P < .001) practice settings. Men submitted more median charges in the inpatient (median [interquartile range], 1190 [569-2093] charges vs 959 [569-2093] charges; P < .001) and outpatient settings (median [interquartile range], 1685 [644-3328] charges vs 870 [273-1988] charges; P < .001). In a multivariable-adjusted linear regression analysis, women received less CMS payments compared with men (log-scale β = -0.06; 95% CI, -0.11 to -0.02) after adjustment for number of charges, number of unique billing codes, complexity of patient panel, years since graduation of physicians, and physician subspecialty. Payment by billing codes, both inpatient and outpatient, did not differ by gender.

Conclusions and Relevance

There may be potential differences in CMS payments between men and women cardiologists, which appear to stem from gender differences in the number and types of charges submitted. The mechanisms behind these differences merit further research, both to understand why such gender differences exist and also to facilitate reductions in pay disparities.

Work-life balance: a comparison of women in cardiology and other specialties

OBJECTIVE

Significant gender disparities exist in some medical specialties, particularly cardiology. We assessed work, personal life and work-life balance in women in cardiology in Australia and New Zealand (NZ), compared with other specialties, to determine factors that may contribute to the lack of women in the specialty.

METHODS

This study is a prospective survey-based cohort study comparing cardiology and non-cardiology specialties. An online survey was completed by female doctors in Australia and NZ, recruited via email lists and relevant social media groups. The survey included demographics, specialty, stage of training, work hours/setting, children and relationships, career satisfaction, income and perceptions of specialty.

RESULTS

452 participants completed the survey (median age 36 years), of which 57 (13%) worked in cardiology. Of all respondents, 84% were partnered and 75% had children, with no difference between cardiology and non-cardiology specialties. Compared with non-cardiology specialties, women in cardiology worked more hours per week (median 50 hours vs 40 hours, p<0.001), were more likely to be on call more than once per week (33% vs 12%, p<0.001) and were more likely to earn an annual income >$3 00 000 (35% vs 10%, p<0.001). Women in cardiology were less likely to agree that they led a balanced life (33% vs 51%, p=0.03) or that their specialty was female friendly (19% vs 75%, p<0.001) or family friendly (20% vs 63%, p<0.001).

CONCLUSIONS

Compared with other specialties, women in cardiology reported poorer work-life balance, greater hours worked and on-call commitments and were less likely to perceive their specialty as female friendly or family friendly. Addressing work-life balance may attract and retain more women in cardiology.

Pharmacy students' perceived willingness and ability to negotiate for paid co-operative education positions

Background

Evidence of a gender wage gap has been identified across many professions, with some evidence in pharmacy. Negotiation is one potential strategy to address this gap and it is underutilized, especially among women. No studies to date have examined pharmacy student perceptions of negotiation when applying for co-operative education positions – a potential sign of willingness to negotiate for entry-level positions upon graduation.

Objectives

To examine pharmacy students' comfort with and ability to engage employers in negotiation over wage and other work-related considerations for mandatory and paid co-operative education work terms at the University of Waterloo (Waterloo, Ontario, Canada).

Methods

Two focus groups, one for female and one for male students, were performed with students who had completed at least one co-operative education placement. Focus groups aimed to elucidate students perceived ability to negotiate with potential employers, to identify strategies that educators can employ to better support students through the hiring and negotiation process, and to elicit student perceptions on the gender wage gap in pharmacy. Focus groups were audio recorded and transcribed verbatim, and data were coded inductively by two independent reviewers, employing thematic analysis.

Results

Three major and two minor themes were identified: Preservation of the relationship; Power differential and perceived ability to negotiate; Institutional support and training; Negative experience with negotiation and wage gaps; and the presence of a gendered approach to negotiation. Pharmacy students rarely engage in negotiation during co-operative hiring processes at the University of Waterloo, with some female students expressing hesitation to negotiate due to concerns about being perceived as “bossy”. Students of both genders felt poorly equipped to engage in negotiation with a potential employer, and lacked confidence in initiating such a conversation.

Conclusions

Students identified a number of factors which influence their ability and desire to negotiate wages during co-op placement, including the requirements and logistics of placements, the perceived power imbalance between students and potential employers, and a concern that any wage negotiation may overshadow the value placed by students on the opportunities to provide patient care. Educators can play a role in equipping students, especially female students, with tools to enter into conversations on wages with potential employers.

Sexism experienced by consultant cardiologists in the United Kingdom

OBJECTIVES

The aims were to compare the frequency with which male and female cardiologists experience sexism and to explore the types of sexism experienced in cardiology.

METHODS

A validated questionnaire measuring experiences of sexism and sexual harassment was distributed online to 890 UK consultant cardiologists between March and May 2018. χ² tests and pairwise comparisons with a Bonferroni correction for multiple analyses compared the experiences of male and female cardiologists.

RESULTS

174 cardiologists completed the survey (24% female; 76% male). The survey showed that 61.9% of female cardiologists have experienced discrimination of any kind, mostly related to gender and parenting, compared with 19.7% of male cardiologists. 35.7% of female cardiologists experienced unwanted sexual comments, attention or advances from a superior or colleague, compared with 6.1% of male cardiologists. Sexual harassment affected the professional confidence of female cardiologists more than it affected the confidence of male cardiologists (42.9% vs 3.0%), including confidence with colleagues (38% vs 10.6%) and patients (23.9% vs 4.6%). 33.3% of female cardiologists felt that sexism hampered opportunities for professional advancement, compared with 2.3% of male cardiologists.

CONCLUSION

Female cardiologists in the UK experience more sexism and sexual harassment than male cardiologists. Sexism impacts the career progression and professional confidence of female cardiologists more, including their confidence when working with patients and colleagues. Future research is urgently needed to test interventions against sexism in cardiology and to protect the welfare of female cardiologists at work.

Gender and career in cardiology-a cross-sectional study

BACKGROUND

The proportion of women as leading physicians in cardiology in university medicine has stagnated and the share of women in senior positions in cardiology is low compared with other medical specialist fields. Here, we analyze the typical barriers for women as doctors in cardiology and point to issues that make the discipline less attractive for both genders.

METHODS

In a cross-sectional study, a standardized online questionnaire was sent to 3873 members of the German Cardiac Society (DGK). Answers from 567 (278 women, 289 men) were analyzed, using comparisons between groups, correlation analyses, and tests of normal distribution.

RESULTS

For 47.4% of respondents (52.0%, of women; 42.8%, of men; p = 0.049), training had lasted longer than anticipated. Average monthly gross income (full-time work) differed significantly between women and men as specialists (p = 0.004) and assistant doctors (p = 0.030). Of women, 32.1% had experienced sexual harassment in the workplace. The main arguments against a career in university medicine were an extremely competitive working climate (66.7% of women, 63.2% of men), lack of work-life balance (66.7% women, 55.3% men), and excessive workload (57.8% women, 62.5% men). As strategies to increase job attractiveness, both mentioned measures to improve the work-life balance, and the flexibility of working times and improved financial provision. Women asked for gender balance at management level (76.3% vs. 32.9% of men) and opportunities for sharing management tasks (82.4% vs. 57.9%). Flatter hierarchies were requested by more men (67.1 vs. 54.8%).

CONCLUSION

Further development of the work culture in cardiology seems necessary. In order to increase the attractiveness of the field overall and to provide equal opportunities in cardiology, more targeted support should be provided to young doctors and more flexibility introduced into work.

Sex Disparity Among Faculty of Physiology in North American Academia: Differences in Scholarly Productivity and Academic Rank

Medical academic research done in various specialties shows sex disparity in terms of academic and leadership rank. Research shows that in many medical academic research fields, there are a greater number of men with higher academic and leadership ranks, as well as higher research productivity. This begs the question: What is the case for medical academic research specifically in physiology departments throughout North America? Upon review of the literature, we found that a knowledge gap still exists in North America regarding sex differences among the faculty of physiology. Our rationale for this study is that if a sex disparity among the faculty of physiology in North American academia is found, steps can be taken to lower this disparity. The very first step is identifying that a problem exists. Scopus was used to obtain the h-index, years of active research, and the number of publications and citations of each faculty member. The h-index was used as a metric of academic output and scholarly productivity. Univariate regression was run with the h-index as the outcome of interest and multiple linear regression analysis was used to determine factors associated with a higher h-index. The analysis showed that while the overall number of females holding academic positions in physiology departments throughout North America has increased over the years, a large sex disparity still exists between males and females in the field. This disparity exists not only in academic and leadership rank but also in research productivity, a key predictor of success in the field. This finding warrants that further work be done to find what is causing this disparity and how it can be addressed.

The risk factors of adverse pregnancy outcome for pre-pregnancy couples in Hunan, China: A cross-sectional study based on population

To identify the prevalence of chronic disease and behavior risk factors of adverse pregnancy outcome for pre-pregnancy couples in Hunan province, China.A retrospective study including cross-sectional datas from the Free Pre-pregnancy Health Check (FPHC) surveillance system of Hunan, China in 2019 was conducted. Microsoft Excel 2010 was used for preliminary data analysis. The fowllowing descriptive analysis, t-tests, and Chi-Squared tests were carried out using SPSS 25.0.Among 419,971 couples, 182,450 (21.72%) individuals were older than 35 years, 257,471(69.48%) couples planned to have a second or additional child and 114,892 (27.36%) individuals had a history of adverse pregnancy outcomes. The mean number of risk factors of adverse pregnancy outcome was higher in males than that in females (2.17 per male vs 1.92 per female). The prevalence/proportions of hypertension, increased psychological pressure, high alanine transaminase or creatinine, smoking, passive smoke exposure, alcohol use, and exposure to environmental risk factors were higher in males than that in females (2.43% vs 1.35%, 0.68% vs 0.54%, 12.80% vs 5.93%, 2.52% vs 1.47%, 27.70% vs 0.24%, 10.94% vs 3.58%, 15.62% vs 1.07%, and 1.46% vs 1.15%, respectively). The proportion of females with an abnormal cervix was 3.35%, and the proportion of males with abnormal wrapping was 1.90%. The prevalence/proportions of anemia and work-related pressure or social tensions were higher in females than that in males (5.53% vs 0.51%, 15.39% vs 13.61%, and 8.22% vs 7.88%, respectively).History of adverse pregnancy outcomes and age olderthan 35 years were important risk factors for pre-pregnancy couples in Hunan province. The mean number of risk factors was higher in males than that in females. Hypertension, increased psychological pressure, high alanine transaminase and creatinine levels, smoking, passive smoke exposure, alcohol use, and exposure to dangerous environmental factors were the major risk factors for males. Anemia, work-related pressure and social tensions were the major risk factors for females.

Characteristics of Heart Failure Trials Associated With Under-Representation of Women as Lead Authors

BACKGROUND

Clinical trials change practice in cardiology, and leading them requires research training, mentorship, sponsorship, and networking. Women report challenges in obtaining these opportunities.

OBJECTIVES

The purpose of this review was to evaluate temporal trends in representation of women as authors in heart failure (HF) randomized controlled trials (RCTs) published in high-impact medical journals and explore RCT characteristics associated with women as lead authors.

METHODS

We searched MEDLINE, EMBASE, and CINAHL for HF RCTs published in journals with an impact factor ≥10 between January 1, 2000, and May 7, 2019. We assessed temporal trends in the gender distribution of authors, and used multivariable logistic regression to determine characteristics associated with women as lead authors.

RESULTS

We identified 10,596 unique articles, of which 403 RCTs met inclusion criteria. Women represented 15.6% (95% confidence interval [CI]: 12.2% to 19.6%), 12.9% (95% CI: 9.8% to 16.6%), and 11.4% (95% CI: 8.5% to 14.9%) of lead, senior, and corresponding authors, respectively. The proportion of women authors has not changed over time. Women had lower odds of lead authorship in RCTs that were multicenter (odds ratio [OR]: 0.58; 95% CI: 0.18 to 0.96; p = 0.037), were coordinated in North America (OR: 0.21; 95% CI: 0.08 to 0.70; p = 0.011) or Europe (OR: 0.33; 95% CI: 0.09 to 0.91; p = 0.039), tested drug interventions (OR: 0.42; 95% CI: 0.16 to 0.97; p = 0.043), or had men as the senior author (OR: 0.50; 95% CI: 0.21 to 0.93; p = 0.043).

CONCLUSIONS

Women are under-represented as authors of HF RCTs, with no change in temporal trends. Women had lower odds of lead authorship in RCTs that were multicenter, were coordinated in North America or Europe, tested drug interventions, or had men as senior authors.

Leadership, recognition awards, and publication by men and women in the American Academy of Neurology

Objective

To study sex differences with respect to publications, leadership, and recognition awards in the American Academy of Neurology (AAN) in light of recent research highlighting inequities in these domains.

Methods

We examined medical school graduation, neurology residency (using American Medical Association and American Council for Graduate Medical Education data), membership in the AAN, first and last authorship in Neurology®, membership on AAN committees, and AAN recognition awards by sex for 1997, 2007, and 2017.

Results

Female medical students were less likely to enter neurology residency in 1997 only. In 2007 and 2017, there was no proportionate difference between men and women as last author, a surrogate for senior member of the author panel. In 2017, women were proportionately more likely to be first authors than men, a surrogate for principal investigator of the study. Committee membership was less for women in 1997 and 2007 (p < 0.001) but was not proportionately different in 2017 (p = 0.534). Women were proportionately more likely to receive recognition awards in all years studied (1997 p = 0.008, 2007 p < 0.001, 2017 p < 0.001), although absolute numbers of women were lower.

Conclusions

Female membership, leadership (through committee membership), and publications as last author were lower in 1997 in the AAN. These same metrics demonstrated substantial proportionate changes, with no differences in last authorship in 2007 and 2017, greater likelihood for women to be first author in 2017, no differences in committee membership in 2017, and greater likelihood of receiving awards determined by merit in all 3 years.

Relative value units in health care: Friend, foe, or necessary evil?

The purpose of this article is to describe this use of relative value units (RVUs) among nurse practitioners (NP), including the challenges NPs may experience. Relative value units were developed as a means to determine reimbursement for health care based on time spent with the patient and skills required to complete the interaction, while addressing any disparities of reimbursement based on geography or insurance. Increasingly, providers such as NPs are being evaluated based in large part on how many RVUs they generate, which seems to prioritize productivity and may overlook many nonbillable aspects of the NP role such as emotional support or patient education. Nurse practitioners working in settings that require more invasive procedures may seem to be more productive on paper, regardless of the number of patients seen. Relative value units may not adequately reflect the skill and time taken to care for patients with chronic illness. Gender differences have been noted, both in terms of the number of RVUs generated for care of male or female patients, and those generated by male or female providers. If NPs are evaluated primarily based on productivity as measured by RVUs, we must consider how this might minimize or even invalidate the therapeutic relationship and holistic approach to patient care. Relative value units may negatively affect the willingness of NPs to serve as preceptors. Finally, as NPs experience less face-to-face time with patients and more demands for productivity, there may be a loss of quality care and professional integrity, which raises the risk of burnout among NPs.

Perceptions on Diversity in Cardiology: A Survey of Cardiology Fellowship Training Program Directors

Background

The lack of diversity in the cardiovascular physician workforce is thought to be an important driver of racial and sex disparities in cardiac care. Cardiology fellowship program directors play a critical role in shaping the cardiology workforce.

Methods and Results

To assess program directors’ perceptions about diversity and barriers to enhancing diversity, the authors conducted a survey of 513 fellowship program directors or associate directors from 193 unique adult cardiology fellowship training programs. The response rate was 21% of all individuals (110/513) representing 57% of US general adult cardiology training programs (110/193). While 69% of respondents endorsed the belief that diversity is a driver of excellence in health care, only 26% could quote 1 to 2 references to support this statement. Sixty‐three percent of respondents agreed that “our program is diverse already so diversity does not need to be increased.” Only 6% of respondents listed diversity as a top 3 priority when creating the cardiovascular fellowship rank list.

Conclusions

These findings suggest that while program directors generally believe that diversity enhances quality, they are less familiar with the literature that supports that contention and they may not share a unified definition of "diversity." This may result in diversity enhancement having a low priority. The authors propose several strategies to engage fellowship training program directors in efforts to diversify cardiology fellowship training programs.

Role of Critical Care Medicine Training in the Cardiovascular Intensive Care Unit: Survey Responses From Dual Certified Critical Care Cardiologists

Background Cardiovascular intensive care units ( CICUs ) have evolved from coronary care wards into distinct units for critically ill patients with primary cardiac diseases, often suffering from illnesses that cross multiple disciplines. Mounting evidence has demonstrated improved survival with the incorporation of dedicated CICU providers with expertise in critical care medicine ( CCM ). This is the first study to systematically survey dual certified physicians in order to assess the relevance of CCM training to contemporary CICU care. Methods and Results Utilizing American Board of Internal Medicine data through 2014, 397 eligible physicians had obtained initial certification in both cardiovascular disease and CCM . A survey to delineate the role of critical care training in the CICU was provided to these physicians. Among those surveyed, 120 physicians (30%) responded. Dual certified physicians reported frequent use of their CCM skills in the CICU , highlighting ventilator management, multiorgan dysfunction management, end-of-life care, and airway management. The majority (85%) cited these skills as the reason CCM training should be prioritized by future CICU providers. Few (17%) agreed that general cardiology fellowship alone is currently sufficient to care for patients in the modern CICU . Furthermore, there was a consensus that there is an unmet need for cardiologists trained in CCM (70%) and that CICU s should adopt a level system similar to trauma centers (61%). Conclusions Citing specific skills acquired during CCM training, dual certified critical care cardiologists reported that their additional critical care experience was necessary in their practice to effectively deliver care in the modern CICU .

Gender differences in industry payments among cardiologists

BACKGROUND

There is a wage gap among men and women practicing cardiology. Differences in industry funding can be both a consequence of and a contributor to gender differences in salaries. We sought to determine whether gender differences exist in the distribution, types, and amounts of industry payments among men and women in cardiology.

METHODS

In this cross-sectional analysis, we used the Centers for Medicare & Medicaid Services Open Payment program database to obtain 2016 industry payment data for US cardiologists. We also used UK Disclosure data to obtain 2016 industry payments to UK cardiologists. Outcomes included the proportions of male and female cardiologists receiving industry funding and the mean industry payment amounts received by male and female cardiologists. Where possible, we also assessed 2014 and 2015 data in both locations.

RESULTS

Of the 22,848 practicing Centers for Medicare & Medicaid Services US cardiologists in 2016, 20,037 (88%) were men and 2,811 (12%) were women. Proportionally more men than women received industry payments in 2016 (78.0% vs 68.5%, respectively; P < .001). Men received higher overall mean industry payments than women ($6,193.25 vs. $2,501.55, P < .001). Results were similar in 2014 and 2015. Among UK cardiologists, more men (24.4%) than women (13.5%) received industry payments in 2016 (P < .001). However, although the difference in overall industry payments was numerically larger among men compared to women, this did not achieve statistical significance (£2,348.31 vs £1,501.37, respectively, P = .35).

CONCLUSIONS

Industry payments to cardiologists are common, and there are gender differences in these payments on both sides of the Atlantic.

Empowering Women Researchers in the New Century: IADR's Strategic Direction

Gender inequality in science, medicine, and dentistry remains a central concern for the biomedical research workforce today. Although progress in areas of inclusivity and gender diversity was reported, growth has been slow. Women still face multiple challenges in reaching higher ranks and leadership positions while maintaining holistic success in these fields. Within dental research and academia, we might observe trends toward a more balanced pipeline. However, women continue to face barriers in seeking leadership roles and achieving economic equity and scholarship recognition. In an effort to evaluate the status of women in dental research and academia, the authors examined the role of the International Association for Dental Research (IADR), a global research organization, which has improved awareness on gender inequality. The goal of this article is to review five crucial issues of gender inequality in oral health research and academics-workforce pipeline, economic inequality, workplace harassment, gender bias in scholarly productivity, and work-life balance-and to discuss proactive steps that the IADR has taken to promote gender equality. Providing networking and training opportunities through effective mentoring and coaching for women researchers, the IADR has developed a robust pipeline of women leaders while promoting gender equality for women in dental academia through a culture shift. As knowledge gaps remained on the levels of conscious and unconscious bias and sexist culture affecting women advancement in academics, as well as the intersectionality of gender with race, gender identity, ability status, sexual orientation, and cultural backgrounds, the IADR has recognized that further research is warranted.

A Structured Compensation Plan Results in Equitable Physician Compensation: A Single-Center Analysis

OBJECTIVE

To assess adherence to and individual or systematic deviations from predicted physician compensation by gender or race/ethnicity at a large academic medical center that uses a salary-only structured compensation model incorporating national benchmarks and clear standardized pay steps and increments.

PARTICIPANTS AND METHODS

All permanent staff physicians employed at Mayo Clinic medical practices in Minnesota, Arizona, and Florida who served in clinical roles as of January 2017. Each physician's pay, demographics, specialty, full-time equivalent status, benchmark pay for the specialty, leadership role(s), and other factors that may influence compensation within the plan were collected and analyzed. For each individual, the natural log of pay was used to determine predicted pay and 95% CI based on the structured compensation plan, compared with their actual salary.

RESULTS

Among 2845 physicians (861 women, 722 nonwhites), pay equity was affirmed in 96% (n=2730). Of the 80 physicians (2.8%) with higher and 35 (1.2%) with lower than predicted pay, there was no interaction with gender or race/ethnicity. More men (31.4%; 623 of 1984) than women (15.9%; 137 of 861) held or had held a compensable leadership position. More men (34.7%; 688 of 1984) than women (20.5%; 177 of 861) were represented in the most highly compensated specialties.

CONCLUSION

A structured compensation model was successfully applied to all physicians at a multisite large academic medical system and resulted in pay equity. However, achieving overall gender pay equality will only be fully realized when women achieve parity in the ranks of the most highly compensated specialties and in leadership roles.

Gender Wage Disparities in Medicine: Time to Close the Gap

Women physicians are paid less than their male peers across medical specialties and geographies. While the medical literature to date has focused on documenting the existence of a wage gap, less attention has been paid to fixing this gap. We focus on interventions around auditing, salary transparency, family leave, and childcare that can be implemented to advance gender wage parity.

Assessment of Differences in Clinical Activity and Medicare Payments Among Female and Male Radiation Oncologists

IMPORTANCE

Although physician sex is known to influence salary even after controlling for productivity, sex-based differences in clinical activity and reimbursement among radiation oncologists are poorly understood.

OBJECTIVES

To evaluate differences by sex in productivity, breadth of practice, and payments and to characterize Medicare reimbursement by sex among similarly productive groups of radiation oncologists.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective cohort study was conducted using the January 1 to December 31, 2016, Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use File (POSPUF) to identify charge and payment information for individual radiation oncologists. Clinicians were part of a population-based sample of US radiation oncologists who bill Medicare in both non-facility-based (NFB) and facility-based (FB) practice settings. Analysis was conducted from June 5 to 25, 2018.

MAIN OUTCOMES AND MEASURES

Outcome measurements included physician productivity (measured by number of Medicare charges), physician payments (reported as total Medicare payments as well as mean payments per charge submitted and per beneficiary treated), and physician breadth of practice (measured by number of unique Medicare billing codes) in NFB and FB settings.

RESULTS

A total of 4393 radiation oncologists (1133 women and 3260 men) were included in the POSPUF in 2016. Compared with their male counterparts, female physicians in the NFB setting submitted a mean of 1051 fewer charges (95% CI, -1458 to -644; P < .001), collected a mean of $143 610 less in revenue (95% CI, -$185 528 to -$101 692; P < .001), and used a mean of 1.32 fewer unique billing codes (95% CI, -2.23 to -0.41; P = .004). Compared with their male counterparts, female radiation oncologists in the FB setting submitted a mean of 423 fewer charges (95% CI, -506 to -341; P < .001), collected a mean of $26 735 less in revenue (95% CI, -$31 910 to -$21 560; P < .001), and submitted a mean of 1.28 fewer unique billing codes (95% CI, -1.77 to -0.78; P < .001). Women represented 46 of the 397 most highly productive radiation oncologists in the FB setting (11.6%) and collected a mean of $33 026 less (95% CI, -$52 379 to -$13 673; P = .001) than men who were similarly productive. In the NFB setting, women represented 54 of the 326 most highly productive radiation oncologists (16.6%) and collected $345 944 (95% CI, -$522 663 to -$169 225; P < .001) less than similarly highly productive men. Women collected a mean of $8.49 less per charge (95% CI, -$14.13 to -$2.86; P = .003) than men in the NFB setting.

CONCLUSIONS AND RELEVANCE

This study suggests that female radiation oncologists submit fewer Medicare charges, are reimbursed less per charge they submit, and receive lower Medicare payments overall compared with male radiation oncologists. Even among similarly productive radiation oncologists, women in this study still collected less revenue than men. Further research is required to understand the sex-based barriers to economic advancement within radiation oncology.

Women in Cardiology in Australia-Are We Making Any Progress?

Women remain largely under-represented in cardiology worldwide, despite gender parity among medical graduates. This is particularly notable in procedural subspecialties such as interventional cardiology and electrophysiology and is consistent at all levels of training. Cardiology continues to have the lowest proportion of females of all adult medicine specialties. This is a review of existing literature and statistics pertaining to women in cardiology and highlights the relative paucity of data or publications within Australia. Australian data from the Medical Training Review Panel reported that the proportion of females in cardiology advanced training (˜22%) has not changed over the last 9 years and that there is a significant attrition as trainees progress through the various stages of training. In 2018, females represent only 16% of first year cardiology advanced trainees in Victoria and Tasmania. This represents a decrease from 20-25% in previous years. The factors affecting gender parity in cardiology are complex and diverse, from personal reasons such as family planning, work-life balance and perceived gender bias, to recruitment inertia and an imbalance in opportunities for career progression, research, financial remuneration and leadership positions. Worldwide, a number of initiatives have been explored to address the gender divide in cardiology, including networking and mentorship programs and Women in Cardiology working groups, dedicated to addressing the issue of female under-representation in cardiology. Unfortunately, the progress we are seeing worldwide is not being realised in Australia. A collaborative approach is essential to achieve gender parity in cardiology. This involves introspection and accountability by College bodies and policy changes committed to promoting workplace diversity by welcoming and retaining female talent. We must recognise and address the current barriers and support women pursuing a career in cardiology.