Leveling the Playing Field in Cardiothoracic Surgery

by Micaela Harris
October 3, 2023

The field of Cardiothoracic Surgery is an enticing discipline for those pursuing a medical profession. However, there is a large discrepancy between the number of men and women pursing a long-term career in academic Cardiothoracic Surgery. As of 2017, women filled only 7% of thoracic surgery faculty positions.  At the same time, Cardiothoracic Surgery Training Programs consisted of 23.8% of women.

A recent study involving general surgery physicians showed male surgeons were more than twice as likely to be interested in Cardiothoracic Surgery than women. There are many factors that could inhibit women’s desire to pursue careers in Cardiothoracic Surgery, including work-life balance, the possibility of receiving unequal pay, exposure to explicit and implicit bias, harassment, and barriers facing mentorship and academic advancement. Furthermore, surgeons who practice in an academic setting potentially face additional discriminatory barriers in gaining leadership positions, grant funding, first-author papers, and more. In order to explore the  elements of career progression of women in academic cardiothoracic surgery related to research productivity, a team of researchers at Stanford University’s School of Medicine, led by Kiah M. Williams, MD and Jack Boyd, MD, analyzed the current state of women in faculty positions at institutions with training programs recently published in Annals of Thoracic Surgery.

Percentage of women faculty at 79 UC academic institutions that offer cardiothoracic surgery training. Fifteen institutions (19%) have no female faculty at all.

Through sourcing data from academic institutions accredited by the Accreditation Council for Graduate Medical Education websites and other public resources, the researchers collected information on academic rank, appointments as program director, NIH funded research, publications, first author publications, and more. Strikingly, out of the 1065 academic cardiothoracic surgeons, only 113 (10.6%) were women. Moreso, only ten out of 203 department chairs or division chiefs were women (5.2%).

After calculating publications per year as attending surgeons, women and men authored a similar number of publications and a similar number of first-author publications, but there were fewer papers with women as the senior author. This study revealed a lack of women in the field and leadership positions within the field.

Women are underrepresented in the field of cardiothoracic surgery. Within the small pool of women in the field, women who belong to racial minorities may also experience a minority tax1: minority faculty often are expected to spend resources and time on diversity committees and serve as mentors for trainees of similar backgrounds taking up time that others may spend in research. This study found that only 8% of Black women in CTS are full professors, and fewer than 12 Black women have been awarded NIH funding for Cardiothoracic Surgery research in the years between 1998 and 2017. The small percentage of women from underrepresented racial/ethnic backgrounds in Cardiothoracic Surgery has repercussions on patient care, impacts the variety and diversity of research, and places a large burden on women faculty to serve as mentors for early career physicians looking for mentorship from leaders with similar backgrounds.

Ultimately, the study reveals the importance of delineating factors that impede women from pursuing careers in the field of academic Cardiothoracic Surgery with the goal of eliminating systematic bias.  The field of Cardiothoracic Surgery can utilize this knowledge to take actionable steps to ensure women are equally represented, treated, and rewarded.

Additional Stanford Cardiovascular Institute-affiliated investigators who contributed to this study include Kiah Williams, MD; Hanjay Wang, MD; Simar S. Bajaj; Patpilai Kasinpila, MD; Christian O’Donnell, MD; Amelia Watkins, MD; Natalie Lui, MD; and Leah Backhus, MD.

Dr. Jack Boyd

Dr. Kiah Williams