October 10, 2025 • 31 mins
This week we review a recent work from the "Women In Pediatric Cardiology" group which is a 4 year old initiative to help lift up women pediatric cardiologists through the fostering of connections and also via mentorship programs. Why did this program develop and what are the most pressing issues affecting female pediatric cardiologists? What are the best solutions to help address gender inequities in our field? We speak with two co-authors of this week's work, Drs. Sarah Ford of Brown University and Kristin Laraja of University of Massachussetts. For those interested in participating in their work, feel free to email Pediheart@gmail.com and your information will be passed along to the authors.
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Episode Transcript
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Speaker 1 (00:16):
Welcome to Pdheart Pediatric Cardiology Today. My name is doctor
Robert Pass and I'm the host of this podcast. I
am Professor of Pediatrics at the Icon School of Medicine
at Mount SINAI thank you for joining me for this
three hundred and fifty eighth episode of Pdheart. I hope
everybody enjoyed last week's episode, in which we spoke about
imaiosuppression and the pediatric heart transplant patient with doctor Kevin Daily.
(00:37):
For those of you interested in this important topic, I'd
recommend you to take a listen to last week's three
hundred and fifty seventh episode of Pdheart. As I say
every week, if you'd like to get in touch with me,
my email is easy to remember. It's Pdheart at gmail
dot com. This week, the title of the work we'll
be reviewing is a novel Approach to Mentorship in Pediatric Cardiology,
a group for women. The first authors of this work
(00:59):
are christ In Lauraja and Laura Mansfield and the senior author,
Tiffany Moore Seemus and this work comes to us from
the Division of Pediatric Cardiology at the University of Massachusetts
in Worcester, Massachusetts, as well as the Department of OBGYN
at the University of Massachusetts in Worcester, Massachusetts, and finally
the Department of Pediatrics and Cardiology at Harvard Medical School,
(01:21):
Boston Children's Hospital. Whenwards done reviewing the paper, I'm hopeful
that one of the authors will be able to speak
with us about it. Therefore, let's move straight down to
this article and then a conversation about women in medicine
and specifically pediatric cardiology. The work begins by reminding us
of what is increasingly clear, which is that gender disparities
exist in medicine for women and how this affects things
(01:43):
like promotion, leadership positions, scholarship opportunities, and compensation. They reference
works that demonstrate that women on average earn twenty five
percent less than their male counterparts, and also how they
are believed to suffer from more burnout than males, and
finally reference to work that we highlighted in twenty twenty two,
with doctor Mally Shaw demonstrating that this was true in
(02:04):
our field of pediatric cardiology as well. Given the challenges
facing women in medicine and particularly women in pediatric cardiology,
the authors explained that they formed a support and collaboration
group called the Women in Pediatric Cardiology Group in March
of twenty twenty one to address these inequities and to
provide support and mentorship for women in our field. They
(02:25):
mention how mentorship groups for women have been successfully created
in other fields of medicine and how access to mentorship
has been positively associated with improved career satisfaction and increased
success in academic medicine, and the authors explain that the
Women in Pediatric Cardiology Group was founded to bring women
together and advance women forward by providing discussions, friendship, mentorship
(02:48):
and collaboration. With this as a background, the authors performed
a formal needs assessment survey to better understand the challenges
that female pediatric cardiologists face, as well as to explore
resources needed to overcome barriers and to generally discuss topics
of importance in upcoming meetings. The group started from the
New England Congenital Cardiology Association or NECA and was open
(03:11):
to fifteen centers in the region to pediatric cardiology and
ADHD practitioners in New England, and the initial invite was
by email and was a zoom meeting. The authors explained
that the title of that first meeting was quote are
You Okay? Struggles and silver Linings during the pandemic, and
they explained that fifty percent of eligible pediatric cardiologists in
(03:32):
the region attended virtually and they have explained that subsequent
meetings have had an average of roughly forty members per meeting,
and formal needs assessments were performed to determine what the
members wanted to speak about. Mostly the meetings were midday
and they were scheduled on Zoom in advance, and so
what the authors of this work did was create a
needs assessment survey among all the eligible members to understand
(03:55):
first what challenges pediatric female cardiologists face and second what
supports or resources might help to overcome those challenges. The
study design was an anonymous survey online to REDCAP between
March twenty twenty two and May twenty twenty two, with
things like demographics of the respondents, number of dependents at home,
childcare arrangements and support systems at home, as well as
(04:18):
the area of cardiology that the respondent was in, the
sort of practice they were in, the academic rank they had,
or leadership roles that they played. They were asked to
comment on challenges encountered and perceived, and gender inequities they
observed personally and to others, and to the results. In all,
the survey was sent to seventy seven female pediatric and
(04:38):
adult congenital heart disease cardiologists and fifty nine respondent for
a sixty three percent response rate. Ninety percent of the
responders said that the women in pediatric cardiology group was
a valuable networking and mentorship experience. The mean age of
the respondents was forty five and the average years since
training twelve. Challenges reported by RESPEC spondents included demands related
(05:01):
to dependent care or family responsibilities, lack of mentorship, inadequate
research support, and inequitable clinical responsibilities. There were also a
number of free.
Speaker 2 (05:11):
Text responses and some of the highlighted ones were my
male cofellows are treated very differently than I am by
attending's nurses leadership. I feel as though I need to
work harder. Another response noted as a trainee, academic opportunities
were offered more frequently to male colleagues, same ideas considered
less seriously than from male colleagues. Finally, the last response,
(05:34):
there is a negative perception for having a child during fellowship.
Survey respondents mentioned barriers to academic promotion and professional development,
and highlighted demands of pregnancy and dependent care during training
and early career as challenges, and many felt that the
absence or relatively lower numbers of women leaders in the
field was a barrier. Respondents were also asked what sorts
(05:56):
of resources would be in their view most important to
combat this, and sixty eight percent suggested mentorship, sixty one
percent administrative assistance, and fifty nine percent more transparency in salary.
The authors explained that the meeting topics of this group
were based on requests from the respondents and included things
such as discussions on imposter syndrome, sponsorship or mentorship, reducing
(06:19):
physician burnout and physician coaching, Gender inequity in compensation, and
how to advocate for yourself at work in navigating mid
career challenges was the last of the major topics thus
far reviewed in their discussion. The author's review how despite
making up forty one percent of all pediatric cardiologists, women
are only twenty five percent of full professors, eighteen percent
(06:41):
department chairs, and eighteen percent medical deans. The authors suggest
that Understanding these barriers is important given that over fifty
percent of new medical school graduates and pediatric residents are female.
The authors feel that the most important achievement so far
of this Women in Pediatric Cardiology group is that it
brought female physicians together to discuss topics not often addressed
(07:02):
or certainly inadequately addressed, and they suggest that it is
their impression that the speakers they have had have been
inspiring and the topics of great interest and benefit to
the members. They explain that their goal is to formalize
one on one mentorship programs, as well as getting grant
funding and maybe even facilitating small group sessions to support
one another. They mention that they have recently expanded the
(07:24):
group beyond New England by including female cardiologist from the
Children's Hospital Philadelphia. The authors also mention how they are
trying to determine, amongst themselves, how their male colleagues may
play a role in this organization and so. In summary,
the Women in Pediatric Cardiology initiative demonstrated that structured, pure
based mentorship groups can be powerful tools to reduce inequities,
(07:46):
but broader adoption, formal outcome measurement and institutional support are
needed to maximize impact well. This is certainly an interesting
and important initiative, and the members of this new women
in Pediatric Cardiology group should be applauded for their efforts
to lift one another up and search for causes of
inequity in our field. It seems clear that the members
of this group are trying to make this group as
(08:07):
helpful and useful as possible for its members, and it
seems that their efforts and mentorship are critical. I do
think that having men involved in some manner would be
of some benefit, and I myself do strive to help
lift up all of my faculty and create an environment
that helps all its faculty deal with any non cardiology
issues that affect our ability to practice and do our jobs,
(08:28):
such as childcare or pregnancy. It seems that this would
make the most sense as well, since supported faculty will
achieve more and be able to help more patients through
research and clinical activities. Despite this, there is much to do,
and I am hopeful that this and other such groups
will continue to identify the sources of inequity in our
field and also offer for us suggestions on how to
(08:50):
address this important problem of gender inequity. In our field.
At this point, I think it makes sense to move
forward to our conversation with two of the works authors
training us now to discuss this week's work. Are two
of its authors. Doctor Sarah Ford is the director of
pediatric Cardiology at Hasbro Children's Hospital and Providence, Rhode Island.
She is a particular expert in non invasive imaging, fetal
(09:11):
cardiology and disorders of lipid metabolism, and is a graduate
of Albany Medical College, followed by residency and fellowship at
the University of Virginia. Also joining us is doctor Kristin Lariah,
who is Assistant Professor of Pediatrics at the University of
Massachusetts Chance School of Medicine in Worcester, Massachusetts, where she
is an active general pediatric cardiologist. She's a graduate of
(09:31):
Tufts University School of Medicine and completed her residency at
Hasbro Children's Hospital in Rhode Island, followed by general cardiology
followship at Boston Children's Hospital. It is a delight to
have both authors and active cardiologists join us this week
to discuss this work. Welcome doctor Ford and doctor Lariah
to Pdhart.
Speaker 3 (09:49):
I'm here now with doctor Sarah Ford and doctor Kristin Lariah,
doctor Ford, Doctor Larah, thank you very much for joining
me this week on PDHART.
Speaker 4 (09:57):
Thank you so much for having us bad being.
Speaker 3 (10:00):
Thank you for having us real great pleasure. I'm wondering
if you could share with the audience how you and
your colleagues came to create the Women in Pediatric Cardiology
Group through a NECA. I read a little bit about
it in your paper, had something to do with COVID,
But maybe you could share with us the story of
how this actually happened.
Speaker 4 (10:20):
Sure, you know.
Speaker 5 (10:21):
What I'd like to do is just provide a little
bit of context for our listeners about what our Women
in Pediatric Cardiology Group is. It's a group that consists
of about one hundred women in pediatric and adult cardiology,
ranging from first year fellows to most seasoned professors. We
straddle seventeen academic sites in the Northeast and really four
(10:45):
years ago we formed this peer mentorship group to foster
collaboration and support for women in our field. And really
the goal of this group is to build connections through mentorship,
paying it forward, advice and opportunities, and really to empower
and advocate for women within our group to promote career longevity,
academic promotion, and really work life integration and you know,
(11:08):
job and career satisfaction. That's great, And Kristin, it's going
to tell a little bit more about COVID's impact on
the formation of this group.
Speaker 6 (11:20):
So, as a woman in cardiology, having multiple kids in fellowship,
as a young attending, you know, struggling to climb that
promotion ladder, all of a sudden, here's COVID. I fund
ourselves home doing telehealth clinics with preschooler underneath our desks
and a first grader on zoom for school.
Speaker 4 (11:43):
And we're there at.
Speaker 6 (11:46):
Online regional cardiology conference and we start to reach out
to our friends, how are you doing not that great?
How are you doing it quite awful? And realize that
there's a little difference in some of how the women
and men are doing throughout COVID. So we thought to
send out a survey to all men and women throughout
the Northeast, all the pediatric cardiologists really to see how
(12:09):
COVID impacted their careers. And what we found was female
pediatric cardiologists where two and a half times more likely
to report decrease academic productivity, increased feelings of burnout, decrease,
career satisfaction, and a good amount of them we're considering
leaving medicine for another career path. And as we looked
(12:32):
at the pipeline of female physicians entering pediatric cardiology fellowship,
which was greater than fifty percent, we really thought that
in order to train and retain female cardiologists, it's really
important that we acknowledged these desperate experiences of female physicians
and really their increased risk of burnout and career satisfaction.
(12:54):
So really what drove us to start this pure mentorship group.
Speaker 4 (12:59):
Was if we realize.
Speaker 6 (13:02):
In the setting of COVID there's less time for academic
productivity and we're disproportionately affected by the pandemic, we really
need to help each other so.
Speaker 4 (13:11):
We can close this gender gap.
Speaker 6 (13:13):
And what we were seeing gender gaps and promotion, leadership
and compensation.
Speaker 3 (13:17):
Wow, very interesting. COVID did a lot to a lot
of people, and not in such a positive way. It's
very interesting how it affected women differently than men. I
was not aware of that very important point. You know,
doctors amongst the women in pediatric cardiology group members, I'm
wondering if you could share with us, what is their
(13:39):
impression of the most pressing problems that women face in
our field, and have they offered for you or have
you guys come to some solutions about what you feel
are the best ways to solve some of the problems
of inequity that have crept into pediatric cardiology or maybe
have always been part of pediatric cardiology.
Speaker 5 (14:00):
So, and you know, the manuscript in the journal, the
Pediatric Critiology Journal is really a thorough summary of our
research survey exploring those questions and just to kind of
summarize that, you know, from our survey, we found, uh
surveying our group that overwhelmingly the responses were that women
(14:25):
had experienced or witness gender inequity in leadership, compensation, training, scholarship,
and promotion. And more specifically, they've identified in adequate research support,
inequitable clinical responsibilities, lack of mentorship in inequities, and dependent
(14:49):
care as some of the pressing problems in the group.
And then you know, we also in the survey, we
asked for open ended responses to this survey and we
got some really interesting and I think, you know responses
that kind of tell tell the story pretty well.
Speaker 4 (15:11):
Kristen has some specifics on that, so our need's assessment
which we did.
Speaker 6 (15:19):
I just want to also mention it was myself, doctor Ford,
doctor Laura Mansfield, and doctor Chris and Lombardi. The four
of us started this group and also put out this
survey to our colleagues. But these over open ended responses
really highlighted consistent themes, which were the experience of being
(15:41):
offered fewer academic opportunities quotes where my male co fellers
are treated very differently than I am as a trainee.
Academic opportunities are offered more frequently to my male colleagues.
There was less of a buy in or opportunities given
to women who had children within training and fellowship, feeling
(16:01):
there's left buy in for their training, and really an
overwhelming theme of difficulty identifying mentors or champions within a
specific area of interest. It really highlighted this need for
female leaders to be more visible as role models, as mentors,
as sponsors, and when as specifically, what are the resources
(16:23):
women in Northeast United States need in the field of
pediatric cartiology. The most common one is mentorship, then as
administrative assistants, research assistants, and transparency of salary and bonuses.
Speaker 3 (16:38):
Yeah, yeah, very interesting. I cannot say that these are
discordant with what I hear as a chief of pediatric
cardiology in New York. So, Jeff, I'm sure that people
listening to this feel strongly that this rings true. So
these are real data, for sure. You know, this is
(16:59):
a self serving question, uestion as the only man on
this little conversation here, but at one point in the work,
you do mention the concept of potentially including men in
the work that you're doing, and I was wondering how
you might conceptualize this going forward.
Speaker 5 (17:14):
Yeah, that's a great question, and we've talked about it
in as individuals and a group setting as well. You know,
we recognize that there's really great value and growth opportunity
and having multiple viewpoints at the table. That's true really
of any dialogue on any problem solving. And so we have,
you know, intentionally and formally presented our data and our
(17:41):
experience over the evolution of this group this past four
years at our annual NECA meeting, which of course is
a mixed group of men and women. And then more
recently we had the opportunity to present our research and
our experience to the Pediatric Cardiology group at MGH, which
(18:01):
was also a mixed group, and in that forum there
was some opportunity for more individual conversation about ideas to
incorporate men.
Speaker 4 (18:14):
Interesting basically.
Speaker 5 (18:19):
Had some specific ideas that we had come up with
from that meeting.
Speaker 6 (18:24):
When we first started, we kept at all women only
because it was honestly difficult to talk about these things
in the hospital and in our academic centers. Now it's
much more open, especially with all these mentorship groups to
and much more research coming out. But obviously to move
the needle, we need to include everybody within our divisions
(18:44):
and our departments. I think going forward we'd like to
start our mixed gender panel discussions.
Speaker 4 (18:52):
But doctor Pass, we would actually love.
Speaker 6 (18:53):
Your idea as well as the division chief, how best
incorporate our male colleagues.
Speaker 3 (18:58):
It's an interesting question, and I'm not really sure. I think,
you know, it's very difficult for a man to appreciate
the problems that women encounter. I think as a chief
of cardiology I maybe have slightly better insight because I
have a very large number of women in leadership roles
in my division. But I think the key thing is
(19:21):
understanding more than anything else, and equity. You know, I
grew up in a time where as a pediatric cardiologist.
You know, I have a lot of very very close
friends in pediatric cardiology who are women. And I've heard
stories in the nineteen seventies and eighties of chiefs of
pediatric cardiology telling colleagues and friends of mine that they
(19:42):
couldn't give them as much money as a man, for example,
because this guy was maybe divorced and had two families
to pay for us. If somehow this was you know,
a responsibility of a female faculty bepper, or being told
that a faculty member was married to a well healthy
person and therefore they didn't need to make as much
money as a male doctor who didn't have a wealthy spouse.
(20:06):
I mean, I think we've moved quite a bit from
that Europe, But I think we would all agree that
that was patently ridiculous and horrible. But you know, I
think to me, the value of your work is that
you identify some of the more subtle issues, particularly with childcare,
with care in general. And I've had some wonderful mentors
(20:27):
in this, including in my own division. I want to
single out doctor Rika Arnan, who into her eighties has
been a full time practicing pediatric cardiologist for the last
nearly fifty years and is still going strong and has
children and a big family and has been able to
do it all. I certainly see that my cardiology fellows
(20:50):
are very They're really all in love with doctor arna On,
and I think they really have learned a lot, not
only about cardiology, but you know, what it means to
have a career that says challenging is the one we've
all chosen, but also to have all of the many
challenges of life. And certainly I think women unfairly have
(21:11):
even more of those challenges than men, very often, so
I do think involving men is important, if for any
other reason than awareness amongst men more than anything else.
Speaker 4 (21:21):
To be honest, well.
Speaker 5 (21:23):
And to your point, doctor Past, you know, you're really
what you're touching on, at least the way I see
it is, you know, acknowledging really the culture change in
not only the practice of medicine, but in the gender
roles of men and women in you know, the past
(21:43):
several decades, and how that's evolved, you know, practice of medicine.
The culture has changed from what used to be a
very paternalistic approach and the doctor makes all the decisions
and explains why it's going to be done a certain way.
Speaker 4 (21:56):
To now you know, it is the norm.
Speaker 5 (21:59):
To you the term shared decision making with patients and
families for all of the work we do, and we
really can't imagine doing it the old way, and I
think we'd feel uncomfortable and feel some guilt about paternalistic
approach and that way. And that really aligns with the
changing philosophies and roles for families and you know, family
(22:24):
units and the roles of men in parenting and home
and work life balance. And you know, all of my
younger faculty have a very different viewpoint on their roles
at home and at work. And I think that's you know,
a pendulum that has swung much more and you know,
(22:45):
in a favorable direction for equity, and that really enables
us to address these issues and on a much more
level platform.
Speaker 3 (22:53):
I think, I think that's a wonderful point you were
as doctor Ford, which is that seeing the issues that
affect women in the present year where they affect men also,
and so not only is the work you're doing of
value to my female colleagues, but I think it actually
has a positive impact on everybody in terms of quality
of life, avoidance of burnout, et cetera, et cetera. There's
(23:17):
many levels. Well, you know, I was wondering both of you.
You know, this has obviously been a known problem. We
just talked about that for many decades. Any thoughts on
why now is the time to finally address these issues.
Speaker 4 (23:32):
Well, I think.
Speaker 6 (23:32):
There's been a lot of studies that have come out
a lot over COVID, but most importantly, there was a
survey in twenty twenty which show that women make twenty
five percent less than their male colleagues over all their lifetime.
They make two million less than their male colleagues, which
is very upsetting to everybody. We all do the same
(23:54):
amount for medical school and put in the same sacrifice
for residency and fellowship and are just as brilliant. And
then there's these papers showing that over thirty five years,
more and more women are going into medical school, They're
going into cardiology and pediatrics, and yet there's still twenty
five percent less likelier than their male colleagues to be
promoted to associate or full professor. Nothing's changed in thirty
(24:16):
five years, So it's not a pipeline issue.
Speaker 4 (24:19):
And then Elena.
Speaker 6 (24:20):
Kipps out of Stanford recently put out this paper showing
that despite women in pediatric crtiology representing forty percent, they
only hold thirty percent of leadership positions and thirteen.
Speaker 4 (24:30):
Percent of division chief positions.
Speaker 6 (24:33):
So really this women need to be more visible as mentor.
Speaker 4 (24:37):
The sponsors.
Speaker 6 (24:39):
Unfortunately are still hidden, and so there's a lot we
can do to help them, raise them up, help promote them.
Speaker 3 (24:46):
Yeah, yeah, well that's I'm lucky in that I have
a female chairman in my division, my department, and it
was a very big push a few years ago to
have everybody promoted because there were a number of faculty
in my own pract is who really were deserving a promotion,
and thankfully that all went through, and so we now
have a very senior faculty, which is great and it's appropriate.
(25:09):
And of course, in most centers, promotion is also associated
with a better salary, so that's the practical benefit of that. Well,
for those of you listening in the audience, it's right
smack dab in the middle of two very busy clinicians
days as well as mine. So I'm going to wrap
it up with my final question which is you know
what's next for the group. I mean, you've seems like
(25:30):
you've clearly identified the problem. But what do you think
is going to be the next directions that the Women
in Pediatric Cardiology of New England group moves.
Speaker 6 (25:42):
So one of our next ideas is to use our
platform to help with promotion process for women in our group.
So our group consists of one hundred women from seventeen
different academic centers and so we have started one session
a year to invite women to present their research and
fellowship mid career, early career to give them a platform
(26:05):
to speak so they don't have to leave their families
and young children and fly to a conference.
Speaker 4 (26:11):
It's just another opportunity to raise them up.
Speaker 3 (26:14):
That's great, very nice idea, Doctor Ford, any thoughts on that, Yes.
Speaker 5 (26:20):
I think it's this is a great opportunity to bolster
some of the academic and research opportunities for the region
and for particularly junior faculty to work. You know, focus
more on some of the academic collaborative collaboration and opportunities
uh to to share work and projects and to your
(26:46):
point about improving the process for promotion for our colleagues.
So you know, within the group, there are really some
you know, everyone has their strengths and they're really powerhouses
in all aspects of academic medicine that we can really
tap into and help each other move forward and really
(27:07):
succeed and achieve promotion and the other academic.
Speaker 3 (27:12):
Well, that's great. You know. For those who listen to
the podcast, you probably remember that we had Molly Shaw
on the podcast three years ago talking about a similar
topic amongst pediatric female electrophysiologists. I think that was in
twenty twenty two. I'll put a link to that in
the show notes. And of course at the end of
last year we had the great pleasure of talking about
(27:33):
Helen Tausig reading where we reviewed the most recent wonderful
novel about doctor Tausig, of course, the mother of pediatric carreology.
So this theme keeps coming up. It's an important one.
We'll address it again in the future. I want to
thank you doctor Loriah, doctor Ford for spending time with
us and congratulate you and your co authors on this
important work.
Speaker 4 (27:53):
Thank you, We so appreciate it you interviewing us. Yeah,
that was great, Thank you so.
Speaker 3 (27:58):
Much, Thank you very much.
Speaker 2 (28:00):
Well, this was really a great opportunity to speak with
two people who have clearly given a lot of thoughts
to the challenges of women in pediatric cardiology and medicine
in general, and they offered a lot of thoughts for
us about why what they were doing and working on
is so critically important and needed in these times. I
think the notion of holding one another up is an
important one, especially in the present era where many of
(28:22):
us are increasingly getting that corporate feeling that we're all
expendable pieces in a larger machine, which really is not
how medicine was portrayed at the start of our careers.
I think the efforts of this group to build connections
and help one another are inspiring, and I hope you
found it so as well. Offline, Doctor Loriah and doctor
Ford mentioned that if anyone listening was interested in joining
(28:44):
this group, even if you're not living in the Northeast,
they would be very happy to add you to their
mailing list and distribution list and invite you to their activities.
And for those interested, you can email me at my
normal email Pdheart at gmail dot com and I'll pass
along your contact information to the group. I'd like to
thank doctor Ford and doctor Larah once more for joining
us this week on Pedihart. To conclude this three hundred
(29:07):
and fifty eighth episode of ped Heart Pediatric Cardiology, today
we hear the lovely brief lullaby entitled Nana by the
great Spanish composer Difaya, and who better to sing this
than the Spanish mezzo soprano Teresa Berganza, who essentially owned
this repertoire from the nineteen fifties till nineteen nineties. Mis
Berganza was particularly well known for her Rossini portrayals and
(29:31):
also as Carmen, but was known as well on the
concert stage for recitals which were always filled with classical
Spanish songs.
Speaker 3 (29:38):
Such as this one.
Speaker 2 (29:39):
Thanks so much for joining me this week, and thanks
once again to our guest. I hope a'll have a
good week ahead.
Speaker 3 (30:07):
When me.
Speaker 1 (30:13):
No day, no.
Speaker 5 (30:28):
Nony, not.
Speaker 3 (30:37):
No need, no.
Speaker 1 (30:48):
War me
Speaker 3 (30:51):
O no
Welcome to Pdheart Pediatric Cardiology Today. My name is doctor
Robert Pass and I'm the host of this podcast. I
am Professor of Pediatrics at the Icon School of Medicine
at Mount SINAI thank you for joining me for this
three hundred and fifty eighth episode of Pdheart. I hope
everybody enjoyed last week's episode, in which we spoke about
imaiosuppression and the pediatric heart transplant patient with doctor Kevin Daily.
(00:37):
For those of you interested in this important topic, I'd
recommend you to take a listen to last week's three
hundred and fifty seventh episode of Pdheart. As I say
every week, if you'd like to get in touch with me,
my email is easy to remember. It's Pdheart at gmail
dot com. This week, the title of the work we'll
be reviewing is a novel Approach to Mentorship in Pediatric Cardiology,
a group for women. The first authors of this work
(00:59):
are christ In Lauraja and Laura Mansfield and the senior author,
Tiffany Moore Seemus and this work comes to us from
the Division of Pediatric Cardiology at the University of Massachusetts
in Worcester, Massachusetts, as well as the Department of OBGYN
at the University of Massachusetts in Worcester, Massachusetts, and finally
the Department of Pediatrics and Cardiology at Harvard Medical School,
(01:21):
Boston Children's Hospital. Whenwards done reviewing the paper, I'm hopeful
that one of the authors will be able to speak
with us about it. Therefore, let's move straight down to
this article and then a conversation about women in medicine
and specifically pediatric cardiology. The work begins by reminding us
of what is increasingly clear, which is that gender disparities
exist in medicine for women and how this affects things
(01:43):
like promotion, leadership positions, scholarship opportunities, and compensation. They reference
works that demonstrate that women on average earn twenty five
percent less than their male counterparts, and also how they
are believed to suffer from more burnout than males, and
finally reference to work that we highlighted in twenty twenty two,
with doctor Mally Shaw demonstrating that this was true in
(02:04):
our field of pediatric cardiology as well. Given the challenges
facing women in medicine and particularly women in pediatric cardiology,
the authors explained that they formed a support and collaboration
group called the Women in Pediatric Cardiology Group in March
of twenty twenty one to address these inequities and to
provide support and mentorship for women in our field. They
(02:25):
mention how mentorship groups for women have been successfully created
in other fields of medicine and how access to mentorship
has been positively associated with improved career satisfaction and increased
success in academic medicine, and the authors explain that the
Women in Pediatric Cardiology Group was founded to bring women
together and advance women forward by providing discussions, friendship, mentorship
(02:48):
and collaboration. With this as a background, the authors performed
a formal needs assessment survey to better understand the challenges
that female pediatric cardiologists face, as well as to explore
resources needed to overcome barriers and to generally discuss topics
of importance in upcoming meetings. The group started from the
New England Congenital Cardiology Association or NECA and was open
(03:11):
to fifteen centers in the region to pediatric cardiology and
ADHD practitioners in New England, and the initial invite was
by email and was a zoom meeting. The authors explained
that the title of that first meeting was quote are
You Okay? Struggles and silver Linings during the pandemic, and
they explained that fifty percent of eligible pediatric cardiologists in
(03:32):
the region attended virtually and they have explained that subsequent
meetings have had an average of roughly forty members per meeting,
and formal needs assessments were performed to determine what the
members wanted to speak about. Mostly the meetings were midday
and they were scheduled on Zoom in advance, and so
what the authors of this work did was create a
needs assessment survey among all the eligible members to understand
(03:55):
first what challenges pediatric female cardiologists face and second what
supports or resources might help to overcome those challenges. The
study design was an anonymous survey online to REDCAP between
March twenty twenty two and May twenty twenty two, with
things like demographics of the respondents, number of dependents at home,
childcare arrangements and support systems at home, as well as
(04:18):
the area of cardiology that the respondent was in, the
sort of practice they were in, the academic rank they had,
or leadership roles that they played. They were asked to
comment on challenges encountered and perceived, and gender inequities they
observed personally and to others, and to the results. In all,
the survey was sent to seventy seven female pediatric and
(04:38):
adult congenital heart disease cardiologists and fifty nine respondent for
a sixty three percent response rate. Ninety percent of the
responders said that the women in pediatric cardiology group was
a valuable networking and mentorship experience. The mean age of
the respondents was forty five and the average years since
training twelve. Challenges reported by RESPEC spondents included demands related
(05:01):
to dependent care or family responsibilities, lack of mentorship, inadequate
research support, and inequitable clinical responsibilities. There were also a
number of free.
Speaker 2 (05:11):
Text responses and some of the highlighted ones were my
male cofellows are treated very differently than I am by
attending's nurses leadership. I feel as though I need to
work harder. Another response noted as a trainee, academic opportunities
were offered more frequently to male colleagues, same ideas considered
less seriously than from male colleagues. Finally, the last response,
(05:34):
there is a negative perception for having a child during fellowship.
Survey respondents mentioned barriers to academic promotion and professional development,
and highlighted demands of pregnancy and dependent care during training
and early career as challenges, and many felt that the
absence or relatively lower numbers of women leaders in the
field was a barrier. Respondents were also asked what sorts
(05:56):
of resources would be in their view most important to
combat this, and sixty eight percent suggested mentorship, sixty one
percent administrative assistance, and fifty nine percent more transparency in salary.
The authors explained that the meeting topics of this group
were based on requests from the respondents and included things
such as discussions on imposter syndrome, sponsorship or mentorship, reducing
(06:19):
physician burnout and physician coaching, Gender inequity in compensation, and
how to advocate for yourself at work in navigating mid
career challenges was the last of the major topics thus
far reviewed in their discussion. The author's review how despite
making up forty one percent of all pediatric cardiologists, women
are only twenty five percent of full professors, eighteen percent
(06:41):
department chairs, and eighteen percent medical deans. The authors suggest
that Understanding these barriers is important given that over fifty
percent of new medical school graduates and pediatric residents are female.
The authors feel that the most important achievement so far
of this Women in Pediatric Cardiology group is that it
brought female physicians together to discuss topics not often addressed
(07:02):
or certainly inadequately addressed, and they suggest that it is
their impression that the speakers they have had have been
inspiring and the topics of great interest and benefit to
the members. They explain that their goal is to formalize
one on one mentorship programs, as well as getting grant
funding and maybe even facilitating small group sessions to support
one another. They mention that they have recently expanded the
(07:24):
group beyond New England by including female cardiologist from the
Children's Hospital Philadelphia. The authors also mention how they are
trying to determine, amongst themselves, how their male colleagues may
play a role in this organization and so. In summary,
the Women in Pediatric Cardiology initiative demonstrated that structured, pure
based mentorship groups can be powerful tools to reduce inequities,
(07:46):
but broader adoption, formal outcome measurement and institutional support are
needed to maximize impact well. This is certainly an interesting
and important initiative, and the members of this new women
in Pediatric Cardiology group should be applauded for their efforts
to lift one another up and search for causes of
inequity in our field. It seems clear that the members
of this group are trying to make this group as
(08:07):
helpful and useful as possible for its members, and it
seems that their efforts and mentorship are critical. I do
think that having men involved in some manner would be
of some benefit, and I myself do strive to help
lift up all of my faculty and create an environment
that helps all its faculty deal with any non cardiology
issues that affect our ability to practice and do our jobs,
(08:28):
such as childcare or pregnancy. It seems that this would
make the most sense as well, since supported faculty will
achieve more and be able to help more patients through
research and clinical activities. Despite this, there is much to do,
and I am hopeful that this and other such groups
will continue to identify the sources of inequity in our
field and also offer for us suggestions on how to
(08:50):
address this important problem of gender inequity. In our field.
At this point, I think it makes sense to move
forward to our conversation with two of the works authors
training us now to discuss this week's work. Are two
of its authors. Doctor Sarah Ford is the director of
pediatric Cardiology at Hasbro Children's Hospital and Providence, Rhode Island.
She is a particular expert in non invasive imaging, fetal
(09:11):
cardiology and disorders of lipid metabolism, and is a graduate
of Albany Medical College, followed by residency and fellowship at
the University of Virginia. Also joining us is doctor Kristin Lariah,
who is Assistant Professor of Pediatrics at the University of
Massachusetts Chance School of Medicine in Worcester, Massachusetts, where she
is an active general pediatric cardiologist. She's a graduate of
(09:31):
Tufts University School of Medicine and completed her residency at
Hasbro Children's Hospital in Rhode Island, followed by general cardiology
followship at Boston Children's Hospital. It is a delight to
have both authors and active cardiologists join us this week
to discuss this work. Welcome doctor Ford and doctor Lariah
to Pdhart.
Speaker 3 (09:49):
I'm here now with doctor Sarah Ford and doctor Kristin Lariah,
doctor Ford, Doctor Larah, thank you very much for joining
me this week on PDHART.
Speaker 4 (09:57):
Thank you so much for having us bad being.
Speaker 3 (10:00):
Thank you for having us real great pleasure. I'm wondering
if you could share with the audience how you and
your colleagues came to create the Women in Pediatric Cardiology
Group through a NECA. I read a little bit about
it in your paper, had something to do with COVID,
But maybe you could share with us the story of
how this actually happened.
Speaker 4 (10:20):
Sure, you know.
Speaker 5 (10:21):
What I'd like to do is just provide a little
bit of context for our listeners about what our Women
in Pediatric Cardiology Group is. It's a group that consists
of about one hundred women in pediatric and adult cardiology,
ranging from first year fellows to most seasoned professors. We
straddle seventeen academic sites in the Northeast and really four
(10:45):
years ago we formed this peer mentorship group to foster
collaboration and support for women in our field. And really
the goal of this group is to build connections through mentorship,
paying it forward, advice and opportunities, and really to empower
and advocate for women within our group to promote career longevity,
academic promotion, and really work life integration and you know,
(11:08):
job and career satisfaction. That's great, And Kristin, it's going
to tell a little bit more about COVID's impact on
the formation of this group.
Speaker 6 (11:20):
So, as a woman in cardiology, having multiple kids in fellowship,
as a young attending, you know, struggling to climb that
promotion ladder, all of a sudden, here's COVID. I fund
ourselves home doing telehealth clinics with preschooler underneath our desks
and a first grader on zoom for school.
Speaker 4 (11:43):
And we're there at.
Speaker 6 (11:46):
Online regional cardiology conference and we start to reach out
to our friends, how are you doing not that great?
How are you doing it quite awful? And realize that
there's a little difference in some of how the women
and men are doing throughout COVID. So we thought to
send out a survey to all men and women throughout
the Northeast, all the pediatric cardiologists really to see how
(12:09):
COVID impacted their careers. And what we found was female
pediatric cardiologists where two and a half times more likely
to report decrease academic productivity, increased feelings of burnout, decrease,
career satisfaction, and a good amount of them we're considering
leaving medicine for another career path. And as we looked
(12:32):
at the pipeline of female physicians entering pediatric cardiology fellowship,
which was greater than fifty percent, we really thought that
in order to train and retain female cardiologists, it's really
important that we acknowledged these desperate experiences of female physicians
and really their increased risk of burnout and career satisfaction.
(12:54):
So really what drove us to start this pure mentorship group.
Speaker 4 (12:59):
Was if we realize.
Speaker 6 (13:02):
In the setting of COVID there's less time for academic
productivity and we're disproportionately affected by the pandemic, we really
need to help each other so.
Speaker 4 (13:11):
We can close this gender gap.
Speaker 6 (13:13):
And what we were seeing gender gaps and promotion, leadership
and compensation.
Speaker 3 (13:17):
Wow, very interesting. COVID did a lot to a lot
of people, and not in such a positive way. It's
very interesting how it affected women differently than men. I
was not aware of that very important point. You know,
doctors amongst the women in pediatric cardiology group members, I'm
wondering if you could share with us, what is their
(13:39):
impression of the most pressing problems that women face in
our field, and have they offered for you or have
you guys come to some solutions about what you feel
are the best ways to solve some of the problems
of inequity that have crept into pediatric cardiology or maybe
have always been part of pediatric cardiology.
Speaker 5 (14:00):
So, and you know, the manuscript in the journal, the
Pediatric Critiology Journal is really a thorough summary of our
research survey exploring those questions and just to kind of
summarize that, you know, from our survey, we found, uh
surveying our group that overwhelmingly the responses were that women
(14:25):
had experienced or witness gender inequity in leadership, compensation, training, scholarship,
and promotion. And more specifically, they've identified in adequate research support,
inequitable clinical responsibilities, lack of mentorship in inequities, and dependent
(14:49):
care as some of the pressing problems in the group.
And then you know, we also in the survey, we
asked for open ended responses to this survey and we
got some really interesting and I think, you know responses
that kind of tell tell the story pretty well.
Speaker 4 (15:11):
Kristen has some specifics on that, so our need's assessment
which we did.
Speaker 6 (15:19):
I just want to also mention it was myself, doctor Ford,
doctor Laura Mansfield, and doctor Chris and Lombardi. The four
of us started this group and also put out this
survey to our colleagues. But these over open ended responses
really highlighted consistent themes, which were the experience of being
(15:41):
offered fewer academic opportunities quotes where my male co fellers
are treated very differently than I am as a trainee.
Academic opportunities are offered more frequently to my male colleagues.
There was less of a buy in or opportunities given
to women who had children within training and fellowship, feeling
(16:01):
there's left buy in for their training, and really an
overwhelming theme of difficulty identifying mentors or champions within a
specific area of interest. It really highlighted this need for
female leaders to be more visible as role models, as mentors,
as sponsors, and when as specifically, what are the resources
(16:23):
women in Northeast United States need in the field of
pediatric cartiology. The most common one is mentorship, then as
administrative assistants, research assistants, and transparency of salary and bonuses.
Speaker 3 (16:38):
Yeah, yeah, very interesting. I cannot say that these are
discordant with what I hear as a chief of pediatric
cardiology in New York. So, Jeff, I'm sure that people
listening to this feel strongly that this rings true. So
these are real data, for sure. You know, this is
(16:59):
a self serving question, uestion as the only man on
this little conversation here, but at one point in the work,
you do mention the concept of potentially including men in
the work that you're doing, and I was wondering how
you might conceptualize this going forward.
Speaker 5 (17:14):
Yeah, that's a great question, and we've talked about it
in as individuals and a group setting as well. You know,
we recognize that there's really great value and growth opportunity
and having multiple viewpoints at the table. That's true really
of any dialogue on any problem solving. And so we have,
you know, intentionally and formally presented our data and our
(17:41):
experience over the evolution of this group this past four
years at our annual NECA meeting, which of course is
a mixed group of men and women. And then more
recently we had the opportunity to present our research and
our experience to the Pediatric Cardiology group at MGH, which
(18:01):
was also a mixed group, and in that forum there
was some opportunity for more individual conversation about ideas to
incorporate men.
Speaker 4 (18:14):
Interesting basically.
Speaker 5 (18:19):
Had some specific ideas that we had come up with
from that meeting.
Speaker 6 (18:24):
When we first started, we kept at all women only
because it was honestly difficult to talk about these things
in the hospital and in our academic centers. Now it's
much more open, especially with all these mentorship groups to
and much more research coming out. But obviously to move
the needle, we need to include everybody within our divisions
(18:44):
and our departments. I think going forward we'd like to
start our mixed gender panel discussions.
Speaker 4 (18:52):
But doctor Pass, we would actually love.
Speaker 6 (18:53):
Your idea as well as the division chief, how best
incorporate our male colleagues.
Speaker 3 (18:58):
It's an interesting question, and I'm not really sure. I think,
you know, it's very difficult for a man to appreciate
the problems that women encounter. I think as a chief
of cardiology I maybe have slightly better insight because I
have a very large number of women in leadership roles
in my division. But I think the key thing is
(19:21):
understanding more than anything else, and equity. You know, I
grew up in a time where as a pediatric cardiologist.
You know, I have a lot of very very close
friends in pediatric cardiology who are women. And I've heard
stories in the nineteen seventies and eighties of chiefs of
pediatric cardiology telling colleagues and friends of mine that they
(19:42):
couldn't give them as much money as a man, for example,
because this guy was maybe divorced and had two families
to pay for us. If somehow this was you know,
a responsibility of a female faculty bepper, or being told
that a faculty member was married to a well healthy
person and therefore they didn't need to make as much
money as a male doctor who didn't have a wealthy spouse.
(20:06):
I mean, I think we've moved quite a bit from
that Europe, But I think we would all agree that
that was patently ridiculous and horrible. But you know, I
think to me, the value of your work is that
you identify some of the more subtle issues, particularly with childcare,
with care in general. And I've had some wonderful mentors
(20:27):
in this, including in my own division. I want to
single out doctor Rika Arnan, who into her eighties has
been a full time practicing pediatric cardiologist for the last
nearly fifty years and is still going strong and has
children and a big family and has been able to
do it all. I certainly see that my cardiology fellows
(20:50):
are very They're really all in love with doctor arna On,
and I think they really have learned a lot, not
only about cardiology, but you know, what it means to
have a career that says challenging is the one we've
all chosen, but also to have all of the many
challenges of life. And certainly I think women unfairly have
(21:11):
even more of those challenges than men, very often, so
I do think involving men is important, if for any
other reason than awareness amongst men more than anything else.
Speaker 4 (21:21):
To be honest, well.
Speaker 5 (21:23):
And to your point, doctor Past, you know, you're really
what you're touching on, at least the way I see
it is, you know, acknowledging really the culture change in
not only the practice of medicine, but in the gender
roles of men and women in you know, the past
(21:43):
several decades, and how that's evolved, you know, practice of medicine.
The culture has changed from what used to be a
very paternalistic approach and the doctor makes all the decisions
and explains why it's going to be done a certain way.
Speaker 4 (21:56):
To now you know, it is the norm.
Speaker 5 (21:59):
To you the term shared decision making with patients and
families for all of the work we do, and we
really can't imagine doing it the old way, and I
think we'd feel uncomfortable and feel some guilt about paternalistic
approach and that way. And that really aligns with the
changing philosophies and roles for families and you know, family
(22:24):
units and the roles of men in parenting and home
and work life balance. And you know, all of my
younger faculty have a very different viewpoint on their roles
at home and at work. And I think that's you know,
a pendulum that has swung much more and you know,
(22:45):
in a favorable direction for equity, and that really enables
us to address these issues and on a much more
level platform.
Speaker 3 (22:53):
I think, I think that's a wonderful point you were
as doctor Ford, which is that seeing the issues that
affect women in the present year where they affect men also,
and so not only is the work you're doing of
value to my female colleagues, but I think it actually
has a positive impact on everybody in terms of quality
of life, avoidance of burnout, et cetera, et cetera. There's
(23:17):
many levels. Well, you know, I was wondering both of you.
You know, this has obviously been a known problem. We
just talked about that for many decades. Any thoughts on
why now is the time to finally address these issues.
Speaker 4 (23:32):
Well, I think.
Speaker 6 (23:32):
There's been a lot of studies that have come out
a lot over COVID, but most importantly, there was a
survey in twenty twenty which show that women make twenty
five percent less than their male colleagues over all their lifetime.
They make two million less than their male colleagues, which
is very upsetting to everybody. We all do the same
(23:54):
amount for medical school and put in the same sacrifice
for residency and fellowship and are just as brilliant. And
then there's these papers showing that over thirty five years,
more and more women are going into medical school, They're
going into cardiology and pediatrics, and yet there's still twenty
five percent less likelier than their male colleagues to be
promoted to associate or full professor. Nothing's changed in thirty
(24:16):
five years, So it's not a pipeline issue.
Speaker 4 (24:19):
And then Elena.
Speaker 6 (24:20):
Kipps out of Stanford recently put out this paper showing
that despite women in pediatric crtiology representing forty percent, they
only hold thirty percent of leadership positions and thirteen.
Speaker 4 (24:30):
Percent of division chief positions.
Speaker 6 (24:33):
So really this women need to be more visible as mentor.
Speaker 4 (24:37):
The sponsors.
Speaker 6 (24:39):
Unfortunately are still hidden, and so there's a lot we
can do to help them, raise them up, help promote them.
Speaker 3 (24:46):
Yeah, yeah, well that's I'm lucky in that I have
a female chairman in my division, my department, and it
was a very big push a few years ago to
have everybody promoted because there were a number of faculty
in my own pract is who really were deserving a promotion,
and thankfully that all went through, and so we now
have a very senior faculty, which is great and it's appropriate.
(25:09):
And of course, in most centers, promotion is also associated
with a better salary, so that's the practical benefit of that. Well,
for those of you listening in the audience, it's right
smack dab in the middle of two very busy clinicians
days as well as mine. So I'm going to wrap
it up with my final question which is you know
what's next for the group. I mean, you've seems like
(25:30):
you've clearly identified the problem. But what do you think
is going to be the next directions that the Women
in Pediatric Cardiology of New England group moves.
Speaker 6 (25:42):
So one of our next ideas is to use our
platform to help with promotion process for women in our group.
So our group consists of one hundred women from seventeen
different academic centers and so we have started one session
a year to invite women to present their research and
fellowship mid career, early career to give them a platform
(26:05):
to speak so they don't have to leave their families
and young children and fly to a conference.
Speaker 4 (26:11):
It's just another opportunity to raise them up.
Speaker 3 (26:14):
That's great, very nice idea, Doctor Ford, any thoughts on that, Yes.
Speaker 5 (26:20):
I think it's this is a great opportunity to bolster
some of the academic and research opportunities for the region
and for particularly junior faculty to work. You know, focus
more on some of the academic collaborative collaboration and opportunities
uh to to share work and projects and to your
(26:46):
point about improving the process for promotion for our colleagues.
So you know, within the group, there are really some
you know, everyone has their strengths and they're really powerhouses
in all aspects of academic medicine that we can really
tap into and help each other move forward and really
(27:07):
succeed and achieve promotion and the other academic.
Speaker 3 (27:12):
Well, that's great. You know. For those who listen to
the podcast, you probably remember that we had Molly Shaw
on the podcast three years ago talking about a similar
topic amongst pediatric female electrophysiologists. I think that was in
twenty twenty two. I'll put a link to that in
the show notes. And of course at the end of
last year we had the great pleasure of talking about
(27:33):
Helen Tausig reading where we reviewed the most recent wonderful
novel about doctor Tausig, of course, the mother of pediatric carreology.
So this theme keeps coming up. It's an important one.
We'll address it again in the future. I want to
thank you doctor Loriah, doctor Ford for spending time with
us and congratulate you and your co authors on this
important work.
Speaker 4 (27:53):
Thank you, We so appreciate it you interviewing us. Yeah,
that was great, Thank you so.
Speaker 3 (27:58):
Much, Thank you very much.
Speaker 2 (28:00):
Well, this was really a great opportunity to speak with
two people who have clearly given a lot of thoughts
to the challenges of women in pediatric cardiology and medicine
in general, and they offered a lot of thoughts for
us about why what they were doing and working on
is so critically important and needed in these times. I
think the notion of holding one another up is an
important one, especially in the present era where many of
(28:22):
us are increasingly getting that corporate feeling that we're all
expendable pieces in a larger machine, which really is not
how medicine was portrayed at the start of our careers.
I think the efforts of this group to build connections
and help one another are inspiring, and I hope you
found it so as well. Offline, Doctor Loriah and doctor
Ford mentioned that if anyone listening was interested in joining
(28:44):
this group, even if you're not living in the Northeast,
they would be very happy to add you to their
mailing list and distribution list and invite you to their activities.
And for those interested, you can email me at my
normal email Pdheart at gmail dot com and I'll pass
along your contact information to the group. I'd like to
thank doctor Ford and doctor Larah once more for joining
us this week on Pedihart. To conclude this three hundred
(29:07):
and fifty eighth episode of ped Heart Pediatric Cardiology, today
we hear the lovely brief lullaby entitled Nana by the
great Spanish composer Difaya, and who better to sing this
than the Spanish mezzo soprano Teresa Berganza, who essentially owned
this repertoire from the nineteen fifties till nineteen nineties. Mis
Berganza was particularly well known for her Rossini portrayals and
(29:31):
also as Carmen, but was known as well on the
concert stage for recitals which were always filled with classical
Spanish songs.
Speaker 3 (29:38):
Such as this one.
Speaker 2 (29:39):
Thanks so much for joining me this week, and thanks
once again to our guest. I hope a'll have a
good week ahead.
Speaker 3 (30:07):
When me.
Speaker 1 (30:13):
No day, no.
Speaker 5 (30:28):
Nony, not.
Speaker 3 (30:37):
No need, no.
Speaker 1 (30:48):
War me
Speaker 3 (30:51):
O no
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