Breaking the Catheterization Laboratory Ceiling.

A t my first Transcatheter Cardiovascular Therapeutics (TCT) conference a few years ago, I came upon a shocking discovery, which had nothing to do with novel stents or valves. Upon exiting the 1,000-seat main auditorium, I bumped into a massive line for the men’s bathroom—and there was no one in line for the women’s bathroom. I skipped with glee into a stall, but then started to wonder, do all female interventionalists have bladders of steel? Why are there no other women here? What I designate as the “reverse bathroom sign” was a blatant red flag that the challenges to gender equity in the field that I had chosen to dedicate my life’s work were far from resolved. It is well known that in academic medicine and general cardiology, gender gaps are slowly improving, with equal numbers of women now entering medical school and achieving faculty instructor levels. Still, very few women are reaching full professor and dean levels (1). Recent efforts to reduce barriers to gender equity in cardiology have met some success (2). However, large hurdles persist for women who wish to pursue a career in interventional cardiology. Although women represent >40% of third-year internal medicine residents and 22% of cardiology fellows, by the time fellows reach the interventional cardiology training level, only 9% of them are female (3). Female interventionalists perform only 3% of percutaneous coronary interventions in the United States (4). Why the persistent disparities? Can it really be that women are just not interested in having the ability to save someone’s life in 90 min during an ST-segment elevation myocardial infarction (STEMI)? Or, are there other–perhaps institutional, cultural, or biological–barriers that are still getting in the way (5,6)?