Kicking Open the Door of Diversity, Equity, and Inclusion at Interventional Cardiology Meetings
…the predominantly female panel may have kicked open the door of DEI for some women, but will it remain ajar for the daughters of interventional cardiologists with faces that look like mine?
The annual Transcatheter Cardiovascular Therapeutics (TCT) meeting was held recently in Orlando, Florida. TCT is one of the world’s leading conferences in interventional cardiovascular medicine. Specialists from all over the world gather to discuss the latest evidence-based procedural therapies that could be applied to improve outcomes for our cardiovascular patients. In 2011, I had a unique opportunity to attend the meeting as a panelist, present a case, and discuss the upfront use of intraaortic balloon pump (IABP) for balloon counterpulsation prior to PCI in STEMI care. Why was this a unique opportunity? First, as an early-career cardiologist, I was in a room with leaders in the field of interventional cardiology from prestigious institutions across the United States and definitely out of my league. At the time, I was grateful for the opportunity but oblivious to the second unique thing about the meeting: the fact that as a Black interventional cardiologist, I’m an anomaly. As a minority, within a minority, within a minority, how did we get here that there are so few Black interventional cardiologists? And is the diversity, equity, and inclusion movement living up to its credo by creating opportunities on the national stage to cure the disparity?
Medicine, Cardiology, and the American Caste System
Although it is not commonly characterized this way, America is a caste system, in which the social construct of race is used as a vehicle to maintain the prevailing hierarchy with Black people in the subordinate caste. In the book Caste: The Origins of Our Discontents, Isabel Wilkerson writes, “Caste is the operating system for economic, political, and social interaction in the United States since the time of its gestation.” The fingerprints of the system can be found throughout society and since medicine is a microcosm, it is not immune from influence. The residua of this unjust system has likely contributed to the paucity of Black doctors.
Approximately 5% of Doctors in the United States identify as Black or African-American and that shortage is greater in cardiology. It is estimated that only 3% of the U.S. adult cardiology workforce identifies as Black or African-American. Although 20% of practicing cardiologists work in the interventional space, at the time of this writing I was unable to locate statistics as to the number of interventional cardiologists that identify as Black or African-American in the United States. A fellow Black interventional cardiologist has told me that the Society for Cardiovascular Angiography and Intervention (SCAI) is attempting to capture the data and believes it to be estimated around 2–3%.
The Paradox and Hypocrisy of Diversity, Equity, and Inclusion
“The difference between a broken community and thriving one is the presence of women who are valued.” -Michelle Obama
There has been a lot of advocacy for both gender and racial diversity, equity, and inclusion (DEI)–and since medicine and healthcare are microcosms, those discussions have not stopped at the hospital doors.
In the wake of the protests surrounding the murder of Mr. George Floyd by a Minneapolis Police Officer, medicine and healthcare organizations pledged to take inventory of their systems and implement changes. However, there is a potential hypocrisy surrounding DEI, which has been described in a previous essay in which I suggest the exclusion of Black people. It is rarely scrutinized while the inclusion of women is often praised and viewed as checking the box for DEI with hashtags like #HeforShe on social media. This was recently seen at the annual TCT 2021 meeting in which a predominantly female panel was appropriately lauded for DEI, without any discussion of the scarcity of Black cardiologists participating on panels. Let me be crystal clear: This is not a repudiation of gender diversification, equity, and inclusion–our society, and by default medicine, is better and stronger with the inclusion of female leaders. One common thread that many of the countries with the most effective responses to the pandemic have is they are led by women–and their success is not by accident. At a U.S. State Department award ceremony in 2009, then First Lady Michelle Obama said, “The difference between a broken community and thriving one is the presence of women who are valued.” However, this is a call to action to fulfill the promises and pledges that were made in the aftermath of the protests of 2020 by continuing to bring attention to the disparate representation of Black doctors on national stages and to take inventory of our progress. Over the 10 years since I got an opportunity to present at TCT, how much progress has been made for people who look like me? How many Black interventional cardiologists were on the stage discussing innovative strategies for our cardiovascular patients? If we don’t take inventory of our progress, then DEI will have been merely colonized, coopted, exploited for credentialism and career advancement of some, and will have the paradoxical effect of maintaining the hegemony as currently constructed.
Conclusion
As Mrs. Obama once said, “Our glorious diversity–our diversity of faiths and colors and creeds–that is not a threat to who we are, it makes us who we are.”
In conclusion, there is a paucity of Black doctors and that dearth is greater in cardiology and its subspecialties. The reasons are multifactorial but can include the residua of an unjust system. The question if we are truly meeting the goals of the DEI movement is a provocative one or are we merely checking boxes. Examining these meetings through the complete lens of DEI initiatives will ensure that both gender and racial disparities of representation are both equally addressed. Female representation at national meetings–on the big stages– adds strength and I’m confident that the addition of Black physicians could be equally as impactful. As Mrs. Obama once said, “Our glorious diversity–our diversity of faiths and colors and creeds–that is not a threat to who we are, it makes us who we are.” DEI does not have to be a zero-sum game–there is plenty of room at the table for everyone: Black people, Native-Americans, those with disabilities, Hispanics, Asians, LQBTQ, etc. Finally, the predominantly female panel may have kicked open the door of DEI for some women, but will it remain ajar for the daughters of interventional cardiologists with faces that look like mine?
