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In the PA.ACC – CardioNerds Narratives in Cardiology episode, CardioNerd Amit Goyal joins Dr. Miranda Merrill (FIT, Oregon Health & Science University), Dr. Stephanie Fuentes Rojas (FIT, Houston Methodist Hospital), and Dr. Natasha Cuk (FIT, Cedars-Sinai Medical Center) for a discussion with Dr. Kamala Tamirisa (Clinical Cardiac Electrophysiologist, Texas Cardiac Arrhythmia, National ACC Women in Cardiology Leadership Council Member and Co-Chair for ACC Women in Cardiology Advocacy Work Group, and current co-chair of the Texas Chapter ACC EP section) about gender equity and women in cardiology and electrophysiology. This episode focuses on the experiences of women in cardiology across the spectrum of training, from medical school, fellowship, through the procedural field of electrophysiology, to local and national leadership and beyond. Listen to the episode to learn about the factors which have led to Dr. Tamirisa’s success as a private practice electrophysiologist incorporating leadership roles in medical education and national organizations. Closing remarks by Texas ACC chapter governor, Dr. Kenneth Shaffer. Episode script was developed by Dr. Miranda Merrill and episode notes were developed by Dr. Natasha Cuk.
The PA-ACC & CardioNerds Narratives in Cardiology is a multimedia educational series jointly developed by the Pennsylvania Chapter ACC, the ACC Fellows in Training Section, and the CardioNerds Platform with the goal to promote diversity, equity, and inclusion in cardiology. In this series, we host inspiring faculty and fellows from various ACC chapters to discuss their areas of expertise and their individual narratives. Join us for these captivating conversations as we celebrate our differences and share our joy for practicing cardiovascular medicine. We thank our project mentors Dr. Katie Berlacher and Dr. Nosheen Reza.
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Video version – Women in EP
Quotables – Women in EP
“The exciting part today is to see three women who are interested in EP… like RBG said, when all EP physicians are women, that’s the day we’re going to celebrate” 07:15
“There’s nothing (more) exciting… than EP, just that technology, the marriage between analytical thinking, tactile, touch, with a deductive logic.” 09:18
“Multiple studies have documented sex disparities in cardiovascular care… (Historically) women and minorities did not receive implantable cardioverter defibrillators or even BiV (biventricular) pacers… a potential driver for these disparities in cardiovascular disease is lack of diversity in the workforce. Very simple.” 19:28
“I still want to wear my lipstick. I still want to wear my heels. I want to do my hair. I still want to be a proceduralist and that’s okay. Make room.” 28:00
Show notes – Women in EP
While this episode and the following notes are specific to women in electrophysiology, these same basic principles apply to fostering a more inclusive and welcoming environment in other subspecialties for all persons regardless of sex, gender, race, ethnicity, IMG status, and the other factors which make us different from one another and which enrich our workforce.
1. Why choose electrophysiology?
- An EP career is unique – it combines the biology, physiology, and procedural skills learned in residency and fellowship training with engineering, mathematic, and imaging principles learned and refined in advanced EP fellowship.1
- EPs work in a spectrum of settings and with a spectrum of modalities: inpatient, outpatient clinic, EP lab and with fluoroscopy, echocardiography (including intracardiac echo), 3D mapping systems, intracardiac EGMs, surface EKGs. Bedside medicine is still key to this field.
- Curative procedures performed in EP have a meaningful impact on patients’ quality and quantity of life1 and life saving devices such as implantable cardioverter defibrillators have profound impacts on mortality with a number needed to treat to save one life between 3-27 for both primary and secondary prevention indications from multiple randomized controlled trials.2
- If you LOVE EKGs, find yourself dissecting telemetry strips, and bonding with your mentors over EKG analysis, then EP is the field for you!
- 40% of the 130 clinical cardiac electrophysiology fellowship positions in the U.S. remain unfilled and there is a decline in the number of fellows choosing EP for advanced training over the last 5 years. Early exposure to internal medicine residents and first year cardiology fellows to the field will allow time for exploration and may help direct more trainees with an interest to this career.1
2. What are some opportunities for an electrophysiologist in private practice?
- Private practice can facilitate a certain level of independence and flexibility including directing choices both large and small such as which devices and tools are used, how the lab is set up, or even the ability to build an entirely new ablation program.
- Leadership is inherent to private practice, especially in EP – there are opportunities everywhere!
- Private practice facilitates close, longitudinal relationships with patients.
- Understanding the finances is important – take time to learn about this from mentors not just in EP but in other fields of medicine or even outside of medicine.
- Community initiatives can be a fulfilling aspect in addition to procedures, patient care, and leadership opportunities. Dr. Tamirisa earned a Healthcare Heroes Award for Northwest Ohio in 2017 for making an impact on community wellbeing, domestic violence/impact on cardiovascular disease, and health of minority women and was nominated for the Thomas Jefferson Award for the Northwest Ohio region in 2016 for her contribution to women’s empowerment in the community.
3. Why and how should we promote diversity within electrophysiology?
- Women physicians across subspecialties are more likely to provide patient centered communication and may provide improved outcomes for certain patient populations.3,4
- Diversity drives innovation, which is why drawing more women and underrepresented minorities to EP will advance the field.5
- Women are “unicorns” in the procedural subspecialties of cardiology.6 Their representation is not growing at the same rate as in other parts of medicine; only 7-10% of EPs currently in practice are women and there remains limited visibility in leadership roles for women at the national level.1,7,8
- How can we address barriers to entry into the field? Dr. Tamirisa makes several suggestions in her EP lab digest article and in the podcast.1
- Adjust work and training environments so that they are more inclusive to women and URiM.
- Address sexual harassment and discrimination on the basis of sex, gender, race, ethnicity, and other factors which make us different and enrich our field.9
- Advocate for work-life integration for all, including flexible (full- and part-time) work schedules such as 4 day-a-week schedules.
- Acknowledge and respond to family planning concerns given that childbearing age may overlap with the training period: limit radiation exposure, protect research and family leave time, provide access to lactation areas, and consider reduced or flexible training schedules (such as 2.5 years/30 months of cardiology fellowship and 18 months of EP training).
4. Mentorship in Electrophysiology and Empowering Women to Succeed
- Mentorship in EP for women can and should be from both women and men! Initiatives such as social media hashtags #HeforShe and #TakeAWomanToTheCathLab and official speaking opportunities eliminating “manels” at national conferences are creating a more inclusive field.10
- Tips for mentors:
- Be kind always.
- Listen to your mentees – even without offering advice, just listening can lead to profound insights.
- Show your flaws – shattering the illusion of a perfect career or trajectory can help your foster confidence and the ability to tackle obstacles.
- Be open, vulnerable, and honest (both as a mentor and mentee!)
- Be inclusive with your projects.
- Understand the microaggressions that women and underrepresented minorities face in training and their careers. Help them with tools to address those issues including microresistance response strategies.11,12
Tamirisa KP. The Importance of Choosing Cardiac Electrophysiology as a Career: Thoughts on the EP Fellow Shortage. EP Lab Digest. 2020;20(2). https://www.hmpgloballearningnetwork.com/site/eplab/importance-choosing-cardiac-electrophysiology-career-thoughts-ep-fellow-shortage
2. Al-Jefairi N, Burri H. Relevance of guideline-based ICD indications to clinical practice. Indian Heart J. 2014;66 Suppl 1:S82-87. https://www.ncbi.nlm.nih.gov/pubmed/24568834
3. Roter DL, Hall JA. Physician gender and patient-centered communication: a critical review of empirical research. Annu Rev Public Health. 2004;25:497-519. https://www.ncbi.nlm.nih.gov/pubmed/15015932
4. Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians. JAMA Intern Med. 2017;177(2):206-213. https://www.ncbi.nlm.nih.gov/pubmed/27992617
5. Welson-Rossman T. Healthcare Needs More Diverse Experts To Guide Innovation. ForbesWomen. 2021. https://www.forbes.com/sites/traceywelsonrossman/2021/02/09/healthcare-needs-more-diverse-experts-to-guide-innovation/?sh=358d5b2769e6
6. The Unicorns: Women in Cardiac Electrophysiology and Interventional Cardiology [Webinar]2020. https://www.acc.org/education-and-meetings/meetings/meeting-items/2020/04/01/12/41/the-unicorns
7. Burgess S, Shaw E, Ellenberger K, Thomas L, Grines C, Zaman S. Women in Medicine: Addressing the Gender Gap in Interventional Cardiology. J Am Coll Cardiol. 2018;72(21):2663-2667. https://www.ncbi.nlm.nih.gov/pubmed/30466523
8. Yong CM, Balasubramanian S, Douglas PS, et al. Temporal Trends in the Proportion of Women Physician Speakers at Major Cardiovascular Conferences. Circulation. 2021;143(7):755-757. https://www.ncbi.nlm.nih.gov/pubmed/33587663
9. Tamirisa KP, Volgman AS, Parwani P, Lundberg GP. Advocacy to End Sexual Harassment: Voices From Women in Cardiology. JACC Case Rep. 2021;3(6):975-977. https://www.ncbi.nlm.nih.gov/pubmed/34319306
10. Harrington RA. 5 Questions: Robert Harrington on research, health equity and the gender gap in cardiology. 2020. https://med.stanford.edu/news/all-news/2020/02/harrington-on-research-health-equity-and-more.html. Accessed August 5, 2020. Accessed February 19, 2020.
11. POD Diversity Committee White Paper. 2016 POD Network Conference; November 9-13, 2016, 2016; Louisville, Kentucky. https://podnetwork.org/content/uploads/DC-white-paper-2016_Final2.pdf
12. Wheeler DJ, Zapata J, Davis D, Chou C. Twelve tips for responding to microaggressions and overt discrimination: When the patient offends the learner. Medical Teacher. 2019;41(10):1112-1117. https://doi.org/10.1080/0142159X.2018.1506097
13. Tamirisa KP. Poem | Metaphors For a Woman. ACC WIC Section Online. 2020. https://www.acc.org/membership/sections-and-councils/women-in-cardiology-section/section-updates/2020/02/27/12/42/a-poem-metaphors-for-a-woman