Catherine D. Krawczeski, MD, FAAP, FACC, FAHA
As I gathered my thoughts for this newsletter, I reflected on my experiences as a woman (and now a woman leader) in pediatric cardiac critical care. Although pediatric training has had a female preponderance for decades, pediatric critical care medicine and pediatric cardiology have lagged behind. CCM only crossed the 50% threshold for female trainees in 2010, though women now make up over 60% of fellows. Pediatric cardiology continues to lag behind. In 2014, for the first time, there were more women than men in cardiology fellowships (51 vs 49%) but those numbers have reversed again in recent years. At the end of my dual fellowship training in 2000, only 40% of CCM fellows and only 20% of cardiology fellows were women.
As a fellow, I had strong women mentors and role models in CCM, but I took my first faculty position as the second woman and the only female cardiac intensivist in a division of 20 cardiologists. While few of us in cardiac critical care would be described as wallflowers, I think my experience was similar to that of many women, and I struggled with finding the right balance: I needed to have a voice– but not too loud, so that I didn’t come across as “pushy”, “arrogant”, or another much more derogatory term. Families sometimes mistook me for the bedside nurse and complained that they hadn’t seen a doctor. At times, my viewpoints weren’t taken as seriously as my colleagues’. I saw a second woman intensivist who joined our team treated unfairly as she tried to navigate the challenges of pregnancy, maternity leave, and balancing family and career. These are all common occurrences that women in medicine still experience today. At that time, however, they weren’t discussed and there were few resources and even fewer mentors to provide guidance. Learning to lead, to direct care, and, even worse, to give correction often seemed like navigating a mine field. I relied on supportive colleagues, a trusted division chief, and former mentors for advice as I moved forward.
While the gender gap in cardiac critical care has diminished overall, it has persisted in leadership. In our recent workforce survey of US pediatric cardiac intensivists, white males still made up 84% of medical director positions, a shocking lack of racial and gender diversity. While this is unfortunately also common in other subspecialties, it is discouraging and as a field we must pledge to improve mentorship and to provide a supportive and unbiased working environment to develop our future leaders. Our field, our patients, and their outcomes all benefit from diversity in our teams and leaders but this won’t happen by chance. We need to make a concerted effort as a group to recognize potential and to foster leadership skills, particularly in those who might be overlooked by our implicit bias of how a leader “should” look or act.
Each of us has experiences that shape who we are and where we end up. I am grateful that during my fellowships I had women mentors in critical care medicine to serve as role models both clinically and as leaders and I feel privileged to now be able to impact the next generation. My advice to women in academic pediatrics: find a profession you love, find a career mentor you trust and can emulate, and most importantly, have confidence in yourself. You can achieve more than you imagine. And if I can ever help, let me know!