Joining forces for gender equity in interventional cardiology: results of a national survey in Portugal

Background

Women remain under-represented in interventional cardiology. This study aimed to assess perceptions and lived experiences of cardiology trainees and specialists, identifying barriers, concerns, and opportunities to promote a more equitable training environment and clinical practice.

Methods

A national online survey was distributed to all cardiology residents and specialists in Portugal. The questionnaire was disseminated with the support of the Portuguese Society of Cardiology, APAPE and APIC. Responses were collected between September and November 2025.

Results

A total of 248 responses were obtained (54% women, mean age 42±13 years, 73% specialists, 51%). Overall, both genders agreed that interventional cardiology is still perceived as predominantly male and that gender-related differences in career opportunities persist and that radiation exposure is a major concern. Most participants did not perceive inequality in access to training or in the response to error/feedback.

Among women (n=133), most reported equal opportunities to act as first operator but identified insufficient training in radiation-protection and inadequate protective equipment for female body types. Among those who considered but did not pursue an interventional career (n=23; 17%), the main reasons were radiation concerns, family expectations, and a perceived non-inclusive culture. Among those who chose or are pursuing intervention (n=49; 37%), the main challenges were maternity-related issues and inadequate protective equipment. Motherhood was associated with postponed pregnancy or a reduced number of planned children. Most women suspended invasive activity during pregnancy, but returned to interventional work while breastfeeding. The most valued potential solutions included clear maternity-support policies and protective equipment adapted to female anatomy.

Most men recognized these difficulties and reported feeling personally responsible for promoting equity within their teams. Both genders reported that institutional initiatives to reduce gender disparities were largely absent.

Conclusions

Perceptions from both genders indicate that gender inequities persist in interventional cardiology and that no structured institutional efforts are in place to mitigate them. Policies on radiation protection, maternity support, and appropriate protective equipment may be essential to promote gender equity and increase female representation in interventional cardiology.