Introduction

Gender disparities for female physicians in academic medicine are longstanding. Inequities in promotion, leadership positions, scholarship opportunities, and compensation have been consistently demonstrated across medical specialties [1,2,3]. Compared to their male counterparts, women in medicine are less likely to hold leadership positions and less likely to be promoted to rank of associate or full professor [4,5,6]. Female physicians receive 25% less compensation over the course of a career than their male counterparts [7,8,9,10]. Furthermore, female physicians have been shown to experience higher rates of burnout then their male colleagues, driven by unequal patient expectations, role expectations outside of work, and personal experiences within the workplace [11,12,13]. These trends have been demonstrated in the field of pediatric cardiology as well [7].

The COVID-19 pandemic further exposed and exacerbated challenges for women faculty in medicine trying to advance their careers during a time of disruption and uncertainty [14,15,16,17,18,19,20,21,22,23,24,25,26]. In a survey of pediatric cardiologists in the Northeast United States, female pediatric cardiologists disproportionately reported decreased career satisfaction, decreased academic productivity, and increased burnout. Female respondents were also more likely to report considering leaving medicine for a different career path [27]. Given this concerning context, we identified a need for support and collaboration among female pediatric cardiologists in New England and launched the Women in Pediatric Cardiology (WIPC) group in March 2021.

Mentorship groups for female physicians have been successfully implemented in several specialties, including anesthesiology, emergency medicine, neonatology, and radiology. These groups have demonstrated encouraging results, including increased access to research opportunities, mentoring, and networking [29,30,31,32]. Improved access to mentorship has been associated with better career satisfaction and increased success in academic medicine, which may help increase retention of women faculty in academia [33,34,35]. The WIPC was founded to bring women together and advance women forward. The goals of the group were to provide a forum for discussion, friendship, mentorship, and collaboration. We subsequently performed a formal needs assessment survey to better understand the challenges faced by women in pediatric cardiology, resources needed to overcome these barriers, experiences of gender inequity in our field, and topics important to the group to discuss at upcoming meetings.

Methods and Materials

Recruitment

The Women in Pediatric Cardiology group was launched in March 2021. The initial idea evolved during informal discussions at a regional meeting of the New England Congenital Cardiology Association (NECCA). Members from three academic centers collaborated in the formation and development of the group after informally gathering perspectives from around the region. Potential participants included all female fellows in training and practicing pediatric and adult congenital heart disease specialists from the 15 academic centers in New England. Participants were invited via email to join the initial virtual meeting held via Zoom. Email serves as the primary route of communication and recruitment, but active participants have also encouraged their colleagues by word-of-mouth to join the meetings.

Curricular Design

The initial meeting was titled, “Are you Ok? Struggles and silver linings during the pandemic.” The meeting topic was inspired by the general sentiment that exhaustion and burnout were becoming increasingly common among female pediatric cardiologists in New England. 50% of eligible pediatric cardiologists in the region joined the inaugural meeting, which allowed for open discussion of the challenges facing practicing cardiologists as well as a forum to brainstorm how the WIPC might serve to address these challenges. Subsequent meetings have continued to have representation from most of the academic centers in New England, with average virtual attendance of ~ 40 members (ranging from 20–65) per meeting. Meeting topics and presenters were initially selected by the founding members of the group. After the first meeting, many members provided feedback with topic and presenter suggestions. In addition, the formal needs assessment solicited recommendations that now almost exclusively inform the curriculum.

Membership in the WIPC is free. Meetings have been largely virtual, held during one-hour mid-day sessions during the work week. Each meeting invitation includes recent articles of interest that are often referenced during the discussion. During a regional cardiology conference, the WIPC group hosted an evening working session to further brainstorm and plan for future directions of the group. All meetings and WIPC activities have thus far occurred without any funding.

Needs Assessment Survey

Given the high immediate uptake and enthusiasm, associated with a previously unmet need, we performed a formal needs assessment to inform future curriculum development. Our goal was to better understand the challenges faced by women in pediatric cardiology, resources needed to overcome these barriers, experiences of gender inequity in our field, and topics important to the group to discuss at upcoming meetings. The information garnered has informed meeting logistics and an evolving curriculum designed to promote career longevity, work-life integration, professional development, and academic promotion, with an overall aim to address gender inequities in academic pediatric cardiology.

Study Design

Members of the WIPC were surveyed anonymously using an online REDCap-based survey that was distributed via email to all eligible participants between March 2022 and May 2022. This was a prospective descriptive survey study. The Institutional Review Board of the University of Massachusetts Chan Medical School approved this study. This study was conducted in accordance with institutional guidelines. This survey was designed by the authors and piloted among practicing physicians at Boston Children’s Hospital, Hasbro Children’s Hospital, and University of Massachusetts Chan Medical School.

Eligible participants included 94 fellows in training and practicing female pediatric and adult congenital heart disease specialists in Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. Participants were identified by a search of faculty listings at academic pediatric hospitals and private practices.

Data Collection

The survey collected demographic information including age, race, dependents at home, childcare arrangements, and support system at home. It also collected career information including years since training, primary work location, primary area of focus within the field of pediatric cardiology, center size, call group size, academic rank, and leadership positions. Participants were asked which challenges to academic promotion and professional development they have experienced, and which resources could help overcome these barriers. Open responses were encouraged. Participants were asked about gender inequities that they have experienced or witnessed in the realms of leadership, compensation, training, scholarship, and academic promotion. The survey also collected data on meeting logistics, future meeting topics, future meeting guest speakers, advocacy opportunities, and satisfaction with the group thus far.

Statistical Analysis

For discrete variables, frequencies and percentages of the total sample were calculated and for continuous variables, mean and standard deviation were calculated.

Results

Demographics

This survey was sent to 77 female pediatric and adult congenital cardiologists and 17 female pediatric cardiology fellows from the 6 states in New England, including 15 academic sites. There were 59 survey respondents for a response rate of 63%. Demographic variables for respondents can be found in Table 1.

Table 1 Demographics
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90% of respondents agree that the Women in Pediatric Cardiology group is a valuable networking and mentorship experience. 71% have been able to join at least one meeting. The preferred timing of meetings is mid-day. Alternating meeting days/times and recording meetings for those who are unable to make it were requested. 95% would recommend this group to a colleague.

Gender Inequity

Survey respondents were asked if they had experienced or witnessed gender inequities in academic promotion, scholarship, residency/fellowship training, compensation, and leadership. See Fig. 1 for results.

Fig. 1
figure 1

Have you experienced or witnessed gender inequities?

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Survey respondents could also provide open-ended responses in this section. These open-ended responses highlighted themes of inequitable opportunity and unequal expectations for female cardiologists. Highlighted responses included “my male co-fellows are treated very differently than I am—by attendings, nurses, leadership. I feel as though I need to work harder (and get volunteered to organize things) with little recognition or reward.” Another response noted: “As a trainee, academic opportunities [were] offered more frequently to male colleagues; same ideas considered less seriously than from male colleagues.” An additional theme was inequity experienced by female trainees who had children during cardiology fellowship training: “[There is a] negative perception for having a child during fellowship.” Respondents also reported feeling there was less “buy-in” for their training.

Perceived and observed inequities extended beyond training and were widespread. One response highlighted “Compensation inequity, lack of mentorship, lack of opportunity, lack of champions or those who want one to succeed … lack of administrative and clinical assistance, inequity in promotion and who is advanced.” Additionally, “In many subspecialties in Cardiology there are minimal number of women or fellows such as interventional cardiology”. Also, “there is a minimal amount of women carrying leadership positions.” Respondents reported “[There is a] lack of understanding that decreased availability for off hours events did not equal decreased ability, interest and potential.” Many responses highlighted the challenges of navigating demands outside the hospital.

Barriers to Academic Promotion and Professional Development:

Survey respondents were asked about the most common barriers and challenges unique to being a female in training and/or practicing pediatric and adult congenital cardiology. See Fig. 2 for full results. Survey respondents could also provide open-ended responses to this question. Open-ended responses highlighted the demands of pregnancy and dependent care during training and early career. Several respondents noted the lack of women in leadership positions as a barrier, and several noted lack of mentors or inconsistent mentorship as a challenge. Several respondents noted that there are “inequitable citizenship tasks not directly work-related, inequitable distribution of patient-care and family-facing tasks such as difficult family conversations/multidisciplinary meetings” as well as “Items that do not help with promotion or career advancement have been typically performed by women.”

Fig. 2
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Challenges to promotion/professional development

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Resources Needed

Survey respondents were asked which resources could help overcome barriers to academic promotion and professional advancement. Respondents were encouraged to select up to 3 of the provided responses. The most common responses were mentorship (68%), administrative assistance (61%), transparency of salary/bouses (59%), increased compensation (54%), and research assistance (49%). Additional resources included clinic scribe (44%), more role models (41%), physician coaching (41%), affordable childcare (37%), mentorship/sponsorship from an outside institution (31%), supportive family leave policies (25%), and flexible tenure policies (22%).

Open-ended responses highlighted the need for female leaders to be more visible as role models and the need for improved mentorship and sponsorship within our region. One respondent noted, “I think having equal time for paternity leave, and for men to use the full amount of time given is a step in the right direction of creating this equality mindset.” Several respondents identify a need for coaching from peers and desire to have more “senior women sharing tricks of the trade.”

Curricular Design

Meeting topics have been informed by the survey results and participant feedback. Presentations and panel discussions have addressed imposter syndrome, sponsorship/mentorship, reducing physician burnout with an introduction to physician coaching, gender inequity in compensation, how to advocate for yourself at work and navigating mid-career challenges. See Table 2 for full list of meeting topics. Speakers have included practicing pediatric cardiologists in the region, a pediatric critical care physician, a physician coach, and a nationally recognized female entrepreneur and author, among others. The meetings with the highest attendance included: “Find your power: How to advocate for yourself at work,” “Navigating Mid-career challenges,” “How to do Scholarship Right.” Future meeting topics suggested in the survey include navigating fellowship as a woman, retirement/financial planning, and a request for additional multigenerational panel discussions.

Table 2 WIPC curriculum topics
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Discussion

Despite great progress across the field of medicine, gender disparities for women physicians persist. According to the American Association of Medical Colleges, in 2018–2019 women now make up 41% of full-time faculty in academic medicine. However, women remain underrepresented in leadership roles, with women representing only 25% of full professors, 18% of department chairs, and 18% of medical school deans [28]. From 1979 to 2018, Richter and colleagues demonstrated that women physicians in academic centers were less likely than men to be promoted to rank of associate or full professor, with no narrowing in the gap over these 35 years [4]. Given that over half of current medical student graduates, pediatric residents and pediatric cardiology fellows in the United States are female [28], we need to better understand the barriers that disadvantage women in academic medicine and identify solutions to improve gender equity in promotion, leadership, and compensation.

The WIPC Northeast group has, thus, far succeeded in bringing female pediatric cardiologists and trainees together to highlight shared experiences and brainstorm solutions to our collective challenges. Our topics and speakers have been varied and inspiring. Enthusiasm for the group was high from the beginning, and there has been consistent attendance and growing participation. There was a 63% response rate to the needs assessment survey, reflecting membership engagement and speaking to the high level of investment in the growth and success of the group. The needs assessment results highlight consistent themes, including the experience of being offered fewer academic opportunities, feeling that there was less “buy-in” for training, and difficulty identifying mentors or champions within a specific area of interest. Given that majority of survey respondents have experienced or witnessed gender inequities in academic promotion, scholarship, compensation, and leadership, it is imperative that our group collaborate to identify solutions to these longstanding problems.

The WIPC group is committed to progress for female pediatric cardiologists in our region, and we strive to use the lessons from the needs assessment to inform future directions. We anticipate formalizing a one-on-one mentorship program, applying for grant funding, arranging for additional outstanding speakers, facilitating small group sessions to collaborate on scholarship or other projects, and working together to support the promotion and advancement of each of our members. Given that our members are from multiple academic centers and include a range of academic rank from fellows to professors, we are uniquely positioned to foster the practice of sponsorship across the region. We strive to create a framework that is relevant and transferrable to other specialties. We have recently expanded to include female pediatric cardiologists at Children’s Hospital of Philadelphia, and we are optimistic that the group could further expand to a include cardiologists from a greater geographic region. We continue to consider how best to include men in the group, and anticipate more formally soliciting input and participation from our male colleagues. Lastly, we remain committed to using our group to build connections through mentorship, pay forward advice and opportunities, and advocate for women to promote work-life integration, academic productivity, and career longevity.