Recently, CardioNerds correspondent Dr. Liane Arcinas spoke with Kamala Tamirisa, MD, FACC, FHRS, Cardiac Electrophysiology, Advanced Cardiac Imaging, Texas Cardiac Arrhythmia Institute, about two recent studies focused on women in underrepresented racial/ethnic groups and about the field of cardiac electrophysiology. Dr. Tamirisa spoke about, among other things, how to promote diversity in the cardiac space, and how to undo the implicit biases women often face in the field, specifically women who are ethnic minorities.

Also, check out a previous CardioNerds podcast which featured Dr. Tamirisa on the topic of “Empowerment & Growing Together as Women in EP.”

Dr. Liane Arcinas:  Hello, everyone. I’m Dr. Liane Arcinas, PGY6 Cardiology Fellow at the University of Manitoba, Canada, and soon-to-be Cardiac Electrophysiology Fellow. I’m a proud cardio unit fellow-in-training trialist and medical journalism correspondent for DocWire News in collaboration with CardioNerds.

Dr. Liane Arcinas: It’s my great pleasure to introduce Dr. Kamala Tamirisa, a Clinical Cardiac Electrophysiologist at Texas Cardiac Arrhythmia, Co-chair for American College of Cardiology, Women in Cardiology Advocacy Work Group, and National ACC Women in Cardiology Leadership Council member. Today, we will be talking about two studies recently published in Heart Rhythm and JET EP on women in underrepresented racial and ethnic groups and cardiac electrophysiology.

Dr. Liane Arcinas: But before we dive into these studies, I would like to welcome Dr. Tamirisa first. Dr. Tamirisa, I am so excited to talk to you today. Can you tell us a little bit more about yourself and why you chose a career in cardiac electrophysiology?

Dr. Kamala Tamirisa: Thank you for having me, Liane. This is an absolute pleasure to talk to a mentee and someone who is going to be another woman in EP. I’ll answer a question, just your first question. I am a clinical electrophysiologist and I’ve been doing EP for about 14 years now. I recently moved to Texas and I’m with Texas Cardiac Arrhythmia Institute.

Dr. Kamala Tamirisa: Another exciting thing is I am the chair for the HRS DNI Council, and it’s an honor to play that role. I love EP. I decided on doing EP, let’s see, probably end of my medical school or internship. EKGs are my passion. Anyone who knows me, I love EKGs and anything to do with EKGs and EP. That’s the driving force behind why I chose EP.

Dr. Liane Arcinas: Well, EP truly is a very gratifying and exciting field, and it sounds like you really truly enjoy the job, which is great. It’s so nice to have a mentor like you. Dr. Tamirisa, I would like to know more about your feedback on two recent studies presented at heart rhythm this year. The first one is by Dr. Howell and her colleagues.

Dr. Liane Arcinas: They found that only about 5% of moderate volume EP operators in the United States are women, and this is despite the increase in the number of female trainees and ablationists over the last few years. Although an estimated 12% of EP trainees are women, there are only 5% moderate volume EP operators, pointing to possible attrition or preference of female training needs to do only clinical EP after training, instead of also doing procedures.

Dr. Liane Arcinas: Can you think of reasons why this may be, and what can we do to help improve not only the number of female EPS, but also the number of female EP procedure lists?

Dr. Kamala Tamirisa: That’s a great question and a few plausible reasons come to my mind. I’ll start off dividing these into categories. One is issue of a plugged pathway. As you know, for the ACGME report, even though the number of total EP trainees increased between 2013 and 2019 by 75%, that is 146 to 255 only EP trainees, the number of women EP trainees increased only from 17 to 28. I want our audience to know this, that we just increased from 17 to 28, with the percentage of women EP trainees actually decreasing from 12% in 2013 to 9% in 2019 to 2020.

Dr. Kamala Tamirisa: Now, you asked me, what would be the possible reasons? I’ll just jump on and talk about some solutions, because I think we have enough data, Liane. We need to start talking about solutions. Let’s talk about solution. I think the early exposure to the field is super important. How do you expose people to EP? Start off with electives in medical school, start off with training people and bringing them into the EP lab. I think each program director, each training program, we need to do that. Listening to the stories of Women in EP.

Dr. Kamala Tamirisa: How do they live outside the lab? How do they manage their life outside the lab is also important for other women who want to pursue the field. And then, how can we have more exposure to the role models? How about we organize some regional meetings through HRS or any other organization? Regional meetings where more medical students and even the interns can submit abstracts, they get to interact with the role models of Women in EP. And then I want the audience to know there are mentor-mentee programs, including the ACC one, and also the Women as One is an incredible organization where they can have an access to the mentors.

Dr. Kamala Tamirisa: Moving on to the second solution, it’s the issue of the leaky pathway. As you know, there’s several causes; pay inequity, gender inequity with regards to pay, and poorly defined paternal and maternal leaves, parental leaves, and then environment and the culture. This is not something that you and I are just … it’s not an opinion-based thing. We know from the JET paper, these were looked at, and these were actual facts. And what are the solutions? Solutions are women are not very good negotiators when it comes to their own contract. We negotiate on behalf of everyone else, but we are not super good at about negotiating what we want, how to customize our own lives and our careers. That’s number one.

Dr. Kamala Tamirisa: Then having standardized policies for parental leave is important. Another important thing is women as leaders, or even as coming into the field, I think we need to be sitting in the boardroom at the table. For us to change policies or talk about it, let’s meet and participate in a dialogue. Then for the organizations, whether at an institutional level or at HRS or ACC, as you know, incredible job has been done with regards to zero tolerance for sexual harassment or any kind of harassment, and protecting women from repercussions. If they go and complain against someone, there should not be repercussions, and we need to protect them. Then let’s engage our male allies. I think that’s another key important part of the solution. Then training and support for younger generation women into leadership.

Dr. Kamala Tamirisa: The last point I’ll touch on are the barriers and the misconceptions. As you know, we already talked about the barriers. Mind you, there are also misconceptions. People still think that A-fib ablation, for example, is a five to six-hour procedure. It’s not. It’s much shorter. Then radiation, as you know, is another barrier that we worry about. The truth of the matter is for the younger generations like yourself, I think the zero-fluoroscopy procedures using 3D mapping, intracardiac echo, it’s an exciting part of the field. The radiation risk is going down and it’s much better than when I trained several years ago. The procedure times are not as long.

Dr. Kamala Tamirisa: The last point is the lactation facilities and the pregnancy flexibility. It’s a work in progress, but we are in much better shape than we were several years ago.

Dr. Liane Arcinas: Well, thank you for that very insightful feedback and for laying out very detailed solutions. That’s amazing. In another study by Dr. Batnyam and her colleagues, they found that women only comprised 13 to 15% of clinical cardiac EP fellowship applicants.

Dr. Liane Arcinas: Moreover, there was an even smaller number of applicants who self-identified with underrepresented racial and ethnic groups last year, with only 3% Black or African Americans, 5% Hispanic, Latino or Spanish origin, and no applicants at all identifying as American Indian, Alaska Native, Native Hawaiian, or Pacific Islander. Why do you think this is the case, and how can we promote increased diversity in fellowship training?

Dr. Kamala Tamirisa: Again, another great question. Just adding onto the above factors, Liane, lack of role models. We were just talking about paucity of Women in EP leadership or EP operators in the previous article. Now, if you have low number of role models, obviously we will have lower number of people who are interested in the field. Starting again, in high school and premed, and even medical school or internship year. Start early.

Dr. Kamala Tamirisa: Something I commonly use; see me, be me. The more you see people like me, the more people are going to do this. Then making the environment more inclusive. How can we do that on the individual level, organization levels? I think it’s commonsense and kindness. Be an ally. If you see something where the environment is not amenable for adequate and optimal growth, call it out. Be an ally, be a self-advocate, and be an up-stander for others, and that is super important.

Dr. Kamala Tamirisa: Then also, start off with undoing the implicit bias. Just recently, I’ll tell you, a patient asked me, “Oh, you are a woman? You are a surgeon? You do procedures?” I said, “Yes, I am a woman.” There are a bunch of implicit biases out there within us, within our patients, and as an organization. Making a conscious and a constant effort to undo those implicit biases are important. Then encourage each other, cause a ripple effect, and we will get there.

Dr. Kamala Tamirisa: Last thing is the mentors. Having mentors and sponsors is so important, and then reach out to mentors and sponsors. How can we at this level be good sponsors? Always invite others to write papers. If a male is invited and if he is too busy, I ask our male allies, “Please invite women trainees to come in and say, ‘Hey, do you want to write a paper with me?’ Or just call, help us out and make space for us to grow.” Because truly, I think we have a great potential and we are making good strides, but we have long ways to go.

Dr. Liane Arcinas: Thank you. Can you please talk about the HRS Leadership and DEI Council roadmap, and the actionable steps that the council is planning to help promote increased diversity, equity and inclusion in cardiac electrophysiology?

Dr. Kamala Tamirisa: Absolutely. As the current chair of HRS DEI Council, under the guidance of the HRS Leadership and the Board of Trustees, we recently developed a strategic roadmap to achieve our goal to increase representation of underrepresented faculty, including women at HRS sponsored events to at least 25% by May of 2026. That’s our midterm goal. We as a team and our organization have also developed several short term goals to create DE&I standards for events and panels supported by HRS, using collected data to diversify our activities and capitalizing on the GLOW Program, which is already there for early career women EPS.

Dr. Kamala Tamirisa: We are currently working on another exciting program under the council, called the GLOBE Program. The GLOBE is for the Black electrophysiologists, to increase and diversify our field. Maybe you heard about this, HRS TV is another entity within the organization which is working with us, looking at Women in EP Mentorship Series. I have done several interviews. Again, promoting the role models, promoting the mentors and the sponsors, people who have done excellent work. Lastly, the HRS Presidents and our CEO, Pat Blake, are passionate about diversifying our world and inclusion, and it’s the fabric of this passion is inclusion. Ultimately, why do all this, Liane? Why do we talk about all this? Ultimately, it’s to benefit our patients.

Dr. Liane Arcinas: Yes. It sounds like there’s many amazing initiatives that are coming on the road ahead, and I’m really looking forward to how it would improve diversity in electrophysiology and improve patient care. That is so exciting.

Dr. Liane Arcinas: What message do you want to convey to our audience right now who may be thinking of pursuing a career in cardiac electrophysiology, and how about to those who are already practicing electrophysiologists?

Dr. Kamala Tamirisa: Well, EP is an exciting field, cutting edge technology, the deductive logic, innovation, and it’s a beautiful field for the future young mentees like yourself, and trainees like yourself. Integration of AI, precision medicine, there’s so much to look forward to, and so I just hope a lot of women come and join our field. The flexibility and subspecialty advantages are there, Liane.

Dr. Kamala Tamirisa: This is something I tell people, “Once you become an EP physician, as a woman in EP, you can negotiate your hours.” I do lab days and clinic days, and they do translate into excellent or very good quality of life. Work-life integration is a work in progress and it’s something that needs to be customized. That is absolutely, can be done in EP. The last thing, we don’t get up in the night to do STEMI calls. Our calls are much easier.

Dr. Kamala Tamirisa: Women in EP is a wonderful core group. We are very close. We lift each other. Then reach out to all the mentors, get guidance. For those women who are in EP and who are wonderful leaders, thank you to everything that they do. My mentors and my sponsors, like Dr. Russo, Dr. Alkajib and Dr. Hurwitz and many more, they’re incredible leaders in the field. I’m just grateful to be in the field and look forward to having many more women join our team.

Dr. Liane Arcinas: Well, thank you, Dr. Tamirisa. I’m so grateful to be able to talk to you today. Thank you so much for talking about this very important topic.

Dr. Kamala Tamirisa: Thank you for having me and good luck with everything. Reach out to your mentors and sponsors.

Dr. Liane Arcinas: Thank you so much.