Paper addresses drivers and impacts of burnout, suggests strategies for cardiovascular workforce improvement
Physician well-being is imperative to providing high-quality patient care; However, physician burnout continues to increase, especially over the past year due to the COVID-19 pandemic.
Four leading cardiovascular organizations, the American College of Cardiology, the American Heart Association, the European Society of Cardiology, and the World Heart Federation, are calling for global action to improve physician well-being in a joint op-ed published in CIRCULATION .
“Over the past few decades, there have been significant changes in healthcare with the expansion of technology, regulatory burden, and the burden of administrative tasks. These developments have come at a cost to physicians’ well-being and work-life integration,” said Athena Poppas, MD, MACC, immediate past president of the American College of Cardiology and co-author of the joint opinion.
“The COVID-19 pandemic has caused additional stress on physicians through increased patient mortality, personal and family safety concerns, fear of the unknown, and increased work demands. Now is the time to join our global health professionals in calling for swift action to improve the well-being of physicians around the world."
Clinician well -being is described as experiencing satisfaction and commitment to work, while also having a sense of professional fulfillment and a sense of meaning at work. In contrast, burnout is defined as emotional exhaustion, depersonalization, and a sense of low personal achievement in a perceived stressful work environment. Burnout is an extremely negative component on the spectrum of clinical well-being and can co-occur with other mental health conditions (e.g., anxiety and depression).
Data from a recent survey of 2,274 U.S. cardiologists and fellows in training reported that more than a quarter were burned out and nearly 50% were stressed. Only 23.7% said they enjoyed their work. Women reported burnout more frequently compared to men.
Factors associated with burnout among cardiologists include lack of control over workload, a hectic work environment, value misalignment, and insufficient documentation time. Additionally, women are underrepresented in cardiology and may have added stressors that contribute to burnout, such as lack of career advancement, income inequalities, and mentoring disparities, in addition to working in environments that lack diversity, equity, inclusion and belonging.
“These stressors compound over time and together diminish our ability to provide high-quality patient care and to strengthen and diversify our workforce. Additionally, the stigma surrounding mental health care must be eradicated,” said Mitchell SV Elkind, MD, MS, FAHA, FAAN, immediate past president of the American Heart Association. “Our organizations are united in this report to ensure that we create a strong and supportive clinical environment, for our personal well-being and for our families, loved ones and patients. Well-being is essential to achieve personal fulfillment and satisfaction in our work.”
There are serious personal and professional ramifications of clinical burnout. The personal ramifications of burnout consist of higher rates of alcohol abuse, substance use, dysfunctional relationships, depression, and suicide. The professional ramifications of clinical burnout include higher rates of medical errors, lower quality of care, decreased patient satisfaction, increased disruptive behavior, and loss of professionalism accompanied by a lower level of empathy.
“The increasing rate of stress and burnout among healthcare professionals sounds an alarm.”
In addition to the serious consequences for the individual, they will affect patient care. The ESC joins other professional societies today in raising a red flag and urging healthcare systems to create healthy environments for all who provide patient care,” said Professor Stephan Achenbach, President of the ESC.
The joint opinion urges healthcare organizations and medical specialty societies to implement strategies to prevent physician burnout. For healthcare organizations, suggested prevention strategies include:
- Support the psychosocial health of employees and be responsible for a holistic approach.
- Create an organizational infrastructure within which physicians can thrive.
- Provide employees with a structure that allows for confidential reporting of mistreatment, as well as destigmatizing clinicians’ access to mental health resources.
For medical specialty societies, suggested prevention strategies include:
- Continue to provide recommendations to healthcare organizations and advocate for significant health policy changes.
- Develop specialty-specific tools that can improve practice efficiency or physician knowledge base in a timely and convenient manner.
- Expand diversity and inclusion initiatives to improve feelings of value and belonging.
“Even before the COVID-19 pandemic, doctors often struggled in existing health systems that did not fully support them,” said Professor Fausto Pinto, president of the World Heart Federation. “Strategies to prevent physician burnout must target the root causes of the problem. Medical societies, as well as civil society foundations, have an important role to play in creating support networks for their members and in pressuring governments to enact significant health policy changes.”
The joint opinion was published simultaneously in the four organizations’ flagship journals: Journal of the American College of Cardiology, Circulation, European Heart Journal, and Global Heart. The report was led by Chair Laxmi S. Mehta, MD, FACC, FAHA, professor in the division of cardiovascular medicine, director of the section of preventive cardiology and women’s cardiovascular health, and vice chair of wellness in the department of internal medicine at The Ohio State. Wexler University Medical Center.
“As physicians, we continually strive to improve the health of our patients while recognizing that our own well-being is paramount to their receiving optimal care,” Mehta said. "We will continue to work together and strategize to maintain the well-being of our workforce and keep the joy in cardiovascular medicine."
