Global action is needed to improve clinician well-being and reduce burnout, both of which are and will be crucial for providing high-quality patient care, four major cardiology organizations from around the world said in a joint statement published July 13 in their flagship journals.
“Over the last several decades, there have been significant changes in healthcare with the expansion of technology, regulatory burden, and clerical task loads. These developments have come at a cost to the well-being and work-life integration of clinicians,” co-author Athena Poppas, MD, Brown University, Providence, Rhode Island, observed in a press release issued with the document from the American College of Cardiology (ACC), the American Heart Association (AHA), the European Society of Cardiology (ESC) and the World Heart Federation (WHF)
“The COVID-19 pandemic has caused additional strain on clinicians through increased patient mortality, personal and family safety concerns, fear of the unknown, and increased work demands. The time is now to join with our global healthcare professionals to call for quick action to improve clinician well-being worldwide,” said Poppas, ACC immediate past president, in the announcement.
As described in the document, hallmarks of clinician well-being include satisfaction and engagement with work coupled with a feeling of professional fulfilment and a sense of meaning in work. In contrast, it notes, burnout includes emotional exhaustion, depersonalization, and a sense of low personal accomplishment in a stressful work environment.
In a recent survey of more than 2200 US cardiologists and fellows-in-training, the statement says, 1 in 4 reported feeling burned out, nearly half said they were stressed, and only about 24% said they enjoyed their work. Women reported burnout more often than men.
Alarm Bells
Lack of control over workload, a hectic work environment, misalignment of values, and insufficient documentation time are key drivers of burnout among cardiologists, observes the statement. Women may experience added stressors contributing to burnout because of their underrepresentation in cardiology, a lack of career promotion, inequalities in income, and disparities in mentorship, in addition to “working in environments that lack diversity, equity, inclusion, and belonging.”
“These stressors compound over time, and collectively they diminish our abilities to provide high-quality patient care and to strengthen and diversify our workforce. In addition, stigma related to mental health care must be eradicated,” Mitchell S.V. Elkind, MD, immediate past president of the AHA, observed in the press release.
“Our organizations are joined together in this report to ensure that we create a strong and supportive clinician environment — for our personal well-being and for our families, loved ones, and patients. Well-being is essential to achieving personal fulfilment and satisfaction in our work,” said Elkind, of Columbia University Vagelos College of Physicians and Surgeons, New York City.
Burnout may have a number of personal and professional ramifications, the statement notes. They include higher rates of alcohol and substance use, dysfunctional relationships, depression and suicide.
Professionally, they can include “higher rates of medical errors, lower quality of care, decreased patient satisfaction, increased disruptive behavior, and loss of professionalism accompanied by a decreased level of empathy.”
“The rising rate of stress and burnout among health professionals rings an alarm bell,” and will have serious consequences for individuals as well as patient care, ESC president Stephan Achenbach, MD, says in the press release.
“The ESC joins other professional societies today to raise a red flag and to urge health care systems to create healthy environments for all those providing patient care.” said Achenbach, of the University of Erlangen, Germany.
Keeping Joy in Cardiovascular Medicine
The joint statement urges health care organizations to implement strategies to prevent clinician burnout. They can include supporting the psychosocial health of employees and being accountable for a holistic approach; creating an organizational infrastructure within which clinicians can thrive; and providing employees “with a structure to allow for confidential reporting of mistreatment and also to destigmatize clinicians’ access to mental health resources.”
Medical societies, the document declares, can also have a role to play in providing recommendations to healthcare organizations and advocating for meaningful health policy changes; developing specialty-specific tools for improving practice efficiency or clinician knowledge base; and expanding initiatives in diversity and inclusion to improve feelings of being valued and belonging.
“Even before the COVID-19 pandemic, clinicians were often struggling in existing health systems that did not fully support them,” WHF president Fausto J. Pinto, MD, says in the statement.
“Strategies to prevent clinician burnout must target the root causes of the problem,” said Pinto, of the University of Lisbon, Portugal. “Medical societies, as well as civil society foundations, have an important role to play in creating support networks for their members and pushing governments to enact meaningful health policy changes.”
“As clinicians, we continuously strive for the improved health of our patients and at the same time recognize our own welfare is paramount to them receiving optimal care,” observes writing group chair Laxmi S. Mehta, MD, director of preventive cardiology and women’s cardiovascular health at Ohio State University, Columbus, in the statement.
“We will continue to work together and strategize to maintain the well-being of our workforce and keep the joy in cardiovascular medicine,” she adds.
The joint statement was published simultaneously in the Journal of the American College of Cardiology , Circulation, European Heart Journal , and Global Heart .
J Am Coll Cardiol. Published online July 13, 2021. Full text
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