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.
589
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.
589
