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Cardiologists and trainees hold varied views of their professional culture and climate, with half desiring change, according to a national online survey conducted by the ACC and published in JACC. These findings “provide granular support for continued targeted interventions and are essential to enhancing the effectiveness of efforts to improve cardiovascular educational, research, and practice environments,” said the authors led by Kevin L. Thomas, MD, FACC, and Laxmi S. Mehta, MD, FACC.

The survey of roughly 1,500 cardiologists spanning all career stages, including Fellows in Training (FITs), asked questions about professional climate in the following four areas: 1) cardiology workforce related to diversity; 2) respect; 3) primary workplace climate; and 4) workplace effectiveness. Nearly 75% of survey respondents were men, 90% were heterosexual/cisgender, and a little more than half self-identified as white, while 23% identified as Asian. Approximately 60% of survey participants were born in the U.S., while 20% arrived before or during training.

Participants were classified into four different profile groups (A-D) based on their responses. Profile A (n=441), representing 29% of respondents, perceived the CV professional climate as empowering, inclusive and no change being needed. Profile B (n=501), representing 33% of participants, felt the professional climate was inclusive, but needed change. Those in Profile C (n=293), making up 19% of survey respondents, perceived the climate as stifling but were unsure about change. The 18% of respondents who made up Profile D (n=278) felt the climate was stifling, exclusionary and in need of change. Across all profile groups, the majority of survey participants (77%) reported experiencing incivility, harassment or discrimination, while 29% reported feeling burned out.

Thomas, Mehta, et al., noted that Profile A was independently associated with Whites and males who were later in their career and with no mistreatment, while in contrast Profile D was associated with families, Blacks, Hispanics, Asians or other race individuals, in their early to mid-career who had experienced mistreatment. In other findings, higher proportions of older career cardiologists and those born in the U.S. or who had immigrated prior to training were in Profiles A and B. Burnout was greatest among those in Profile D at 43%, compared with 25% in Profile A and B and 32% in Profile C.

While mistreatment was high across all groups, specific types of mistreatment were reported up to 3 times more frequently by those in Profile D compared with Profile A and varied by role. For example, among those in Profile D doing clinical work, delayed professional advancement (55% vs. 18%), differing clinical work expectations (43% vs. 16%), hiring practices (36% vs. 11%), and compensation (40% vs. 12%) were common mistreatments. Among those in academic settings, common mistreatments among those in Profile in D included delayed professional advancement (34% vs. 14%), compensation (32% vs. 20%) and access to research opportunities (35% vs. 11%).

“These findings, plus perceptions of organizational ineffectiveness, support a call to action to improve the cardiology climate and identify a need to incorporate climate assessments in national and local efforts to address critical challenges,” write the authors. “Fostering an inclusive and civil climate in cardiology requires systematic action to ensure that positive values are more closely translated into a positive lived experience among the workforce, improved well-being and optimal patient care.”

Consistent performance

Historically, secondary vintages have delivered higher median returns than other private-markets strategies, with significantly lower dispersion across funds’ net IRRs (Exhibit 3). 

Much of that stability stems from the very architecture of the asset class. Features such as accelerated distributions, informational advantages that tilt selection toward stronger assets and managers, as well as diversification across seasoned, partially de-risked holdings act as natural stabilisers. 

The rise of GP-led transactions

Within the secondaries market, GP-led transactions have expanded over recent years, growing from 24% of volumes in 2012 to nearly half today (Exhibit 4). Their rapid growth reflects strong buyer demand and their increased use by sponsors, with rising numbers of leading GPs bringing higher-quality assets to market. 

At a time when IPOs, strategic trade and sponsor-to-sponsor exits have become more constrained, GP-led deals are providing managers with valuable realisation optionality. 

However, their rapid adoption also points to a broader structural evolution, with GP-led deals now serving as a routine mechanism for extending ownership and optimising investment outcomes. These transactions allow GPs to realise further value creation potential by lengthening investment horizons of their best assets and avoiding selling to a competitor.

This shift has made single- and multi-asset transactions a defining feature of today’s opportunity set. Three-quarters of leading GPs have now completed deals, and transaction sizes are trending larger.² Continuation vehicles, in particular, have emerged as the structure of choice, offering sponsors flexibility to extend ownership of prized companies, rebalance portfolios and deliver interim liquidity to LPs. 

For investors, the transactions represent a compelling opportunity within the secondaries market, they provide investors with concentrated stakes in seasoned assets managed by top-tier sponsors. The growing interest in the market is therefore unsurprising. A recent survey indicates that investors now target higher returns from GP-led single-asset transactions (Exhibit 5), underscoring why these are among the most sought-after deals in the secondaries market. 

Conclusion

Secondaries have become a core component of a private-markets allocation, powered by structural demand and enabled by an innovative and dynamic marketplace more than two decades in the making.

Their enduring appeal lies not in cyclical dynamics, but in a durable set of advantages that continue to resonate with investors. This includes a unique combination of strategic flexibility, accelerated distributions, enhanced access and selectivity, consistent returns and the maturing GP-led market.

Record deployment testifies to their growing centrality. With investors requiring greater flexibility, liquidity visibility and diversification, secondaries are playing an increasingly integral role in modern portfolio strategies.

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1 Jefferies, Global Secondary Market Review, July 2025.
2 Jefferies, Global Secondary Market Review, July 2025.