JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

VOL. 67, NO. 5, 2016

ª 2016 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION

ISSN 0735-1097/$36.00

PUBLISHED BY ELSEVIER

http://dx.doi.org/10.1016/j.jacc.2015.12.010

LEADERSHIP PAGE

Diversifying Our Ranks A Call to Action Kim Allan Williams, SR, MD, FACC, ACC President Richard A. Chazal, MD, FACC, ACC President-Elect

A

ddressing disparities in care and ensuring the

through mentoring programs and focused member

ultimate well-being of patients has been a

sections and councils. Targeted educational programs

priority throughout our careers, and is a key

and quality initiatives are directed at the entire spec-

focus of this year as president and president-elect of

trum of the cardiovascular care team and the various

the American College of Cardiology (ACC). Doing

cardiovascular specialty areas. Yet, a new study, led by

this successfully requires a focus on building a

former ACC President Pamela Douglas, suggests there

quality-driven health care system, advocating for pol-

is even more work to be done in this area.

icies that facilitate patient access to care, developing

The study was presented during the American

strategies for improving the health of populations,

Heart Association Annual Scientific Sessions in

and finding innovative ways to put the latest science

Orlando this past November and simultaneously

in the hands of those providing care. Another crucial

published in JACC. The results showed not only

element, but 1 that sometimes gets overlooked, is

substantial salary differences between male and

ensuring provider stability and diversity. Stability of

female practicing cardiologists, but also dramatically

the workforce demands appropriate working condi-

different job descriptions—despite sharing the same

tions and fair reimbursement for all members of the

specialty.

cardiovascular team. Diversity helps to improve and

The study looked at 2,679 subjects (229 female and

ensure the crucial relationships between caregivers,

2,450 male) reported by MedAxiom from 161 U.S.

communities, and patients.

practices in 2013. The authors found that women

In the ACC’s recent 2015 Environmental Scan

were more likely to specialize in general or noninva-

Update, changing workforce needs ranked among the

sive cardiology (53.1%) compared with their male

top issues affecting the cardiovascular landscape.

counterparts (28.2%), who were more likely to be

“Health care is possibly the most complicated in-

involved in interventional cardiology. Additionally,

dustry in the United States,” the authors note, “and,

men generated a median 9,301 relative value unit,

as such, it is difficult to predict changes in supply and

whereas women generated 7,430, and the proportion

demand for the country as a whole and for more than

of women working full time was less than men (79.9%

several years in the future” (1). However, despite the

vs. 90.9%) (2).

complications, it is widely acknowledged that a

Overall, the findings show an unadjusted differ-

workforce diverse in job function, sex, specialty, and

ence in compensation between male and female car-

race and ethnicity is necessary to meet the needs of

diologists of more than $110,000/year. After adjusting

an increasingly diverse and growing cardiovascular

the data using more than 100 personal, practice, job

patient population.

description, and productivity measures, the differ-

As the home to more than 50,000 cardiovascular

ence was $37,000 annually, or over $1 million across a

professionals around the world, the ACC understands

career. A separate independent economic analysis of

the importance of a diverse workforce and has focused

wage differentials yielded a similar difference of

on finding ways to encourage greater diversity

$32,000/year (2). In the context of the national and international epidemic of heart disease, these data are a wake-up

From the American College of Cardiology, Washington, DC.

call that our profession should focus on aligning the

Williams, Sr. and Chazal

JACC VOL. 67, NO. 5, 2016 FEBRUARY 9, 2016:588–9

Leadership Page

pool of medical students and qualified internal

reflect the diversity of its members and encourage

medicine residents. If not addressed promptly and

greater involvement in committees and work groups

appropriately, this threatens to become a much

by a broader group of individuals.

greater health care issue going forward. American

Moving forward, the College is committed to

cardiology is failing to capitalize on recruiting enough

growing these efforts even further. Working with

talented female residents into cardiology. This can

other organizations and institutions, as well as our

hurt our ability to best care for our patients.

own member sections and councils, like Women in

In a corresponding JACC editorial comment, Mark

Cardiology, to develop strategies that will locally

A. Hlatky, MD, FACC, and Leslee Shaw, PhD, FACC,

evaluate and mitigate workforce disparities will be

wrote: “The reasons for these very different career

key. Forums like the ACC Annual Scientific Session

choices ought to be explored further, and we need to

also provide important venues for research like this to

understand whether women physicians are repelled

be discussed, debated, and built upon. Last, we also

from cardiology, or simply attracted to other fields.

should all pause and reflect on our own hiring and

Perhaps more attention to work-life balance in car-

compensation practices and make changes where

diology would make it more attractive to women, and

needed. One of this year’s first Leadership Pages stressed

better for us all” (3). Drs. Hlatky and Shaw are absolutely right. We need

the ACC’s commitment to working with its members

to pay special attention not only to this particular

to improve public trust, “whether it’s showing

issue, but also to the broader issue of workforce di-

that we can and will hold each other accountable

versity. This study is an important reminder that in

for

spite of all good intentions there can still be obstacles

involving our patients in their care decisions so that

that handicap cardiology as a profession and diminish

they best understand the best course of treatment

an effective workforce. Research has shown that our

and why; or using data from registries like those in

culture tends toward unconscious biases that can

the NCDR (National Cardiovascular Data Registry) to

create barriers to careers, advancement, and other

improve patient outcomes and close gaps in care” (4).

opportunities. This problem is not ours alone to solve,

We need to own our actions—both good and bad—and

but it provides us an opportunity to lead.

be visible to the public and our patients in positive

providing

appropriate,

evidence-based

care;

The ACC can and must be both a leader and a

ways that affect their lives. When it comes to

convener in this area. Our Leadership Academy,

diversity in our workforce and closing gaps in our

Emerging

mentoring

own ranks to best meet the needs of our ever-growing

program are among our most recent efforts designed

patient base, we must be leaders. Our mission

to identify, nurture, and grow diverse leaders across

depends on it. Let us own this and fix it.

Advocates

initiative,

and

the cardiovascular care continuum. Additionally, quality initiatives like Surviving MI are providing

ADDRESS

practices and institutions with best practices for

Williams, Sr., MD, FACC, American College of Cardi-

CORRESPONDENCE

TO:

changing hospital culture to improve care. The ACC is

ology, 2400 N Street NW, Washington, DC 20037.

also making changes to its own governance policies to

E-mail: [email protected]

Kim

Allan

REFERENCES 1. Laslett L, Anderson H, Clark B III, et al. American College of Cardiology: Environmental Scanning

2. Jagsi R, Biga C, Poppas A, et al. Work activities and compensation of male and female cardiolo-

Report update 2015. J Am Coll Cardiol 2015;66 Suppl 19:D1–44.

gists. J Am Coll Cardiol 2016;67:529–41.

3. Hlatky MA, Shaw LJ. Women in cardiology: very few, different work, different pay. J Am Coll Cardiol 2016;67:542–4. 4. Williams K Sr. A challenge: let us strive to be #2. J Am Coll Cardiol 2015;65:1700–1.

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