Societies: Identifying, acting on drivers of burnout crucial to cardiologists’ well-being
Clinician burnout is a multifactorial issue, one found among a large proportion of cardiologists, that requires a multipronged approach to eliminate among health care practitioners, according to a statement on clinician well-being.
The American College of Cardiology, American Heart Association, European Society of Cardiology and the World Heart Federation released a joint opinion statement highlighting the many manifestations of clinician burnout, its primary drivers and ways in which institutions can act to reduce its prevalence among health care workers, particularly cardiologists. It was published in the Journal of the American College of Cardiology, Circulation, the European Heart Journal and Global Heart.
“As clinicians, we strive for improved health for our patients; yet, it is increasingly clear that our own well-being is an essential component of the quadruple aim: to improve population health, enhance patient experience, reduce costs and improve the work life of health care workers,” Cardiology Today Editorial Board Member Laxmi S. Mehta, MD, FACC, FAHA, noninvasive cardiologist and professor of medicine in the division of cardiovascular medicine at The Ohio State University, and colleagues wrote. “Clinician well-being is described as experiencing satisfaction and engagement with work, while also having a feeling of professional fulfillment and a sense of meaning in work.”
Burnout is defined as emotional exhaustion, depersonalization and a sense of low personal accomplishment in a stressful work environment, Mehta and colleagues wrote.
According to the Constitution of the World Health Organization, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Therefore, the authors of the joint opinion statement posited that the absence of burnout may not necessarily represent a state of well-being among physicians. They stated that burnout is an extreme component along the spectrum of clinician well-being and can present concomitant with other common mental health conditions.
Prevalence and characteristics of burnout
“Over the last several decades, there have been significant changes in health care 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,” Athena Poppas, MD, MACC, immediate past president of the ACC, director of the Lifespan Cardiovascular Institute in Providence, Rhode Island, and chief of cardiology and professor of medicine at the Warren Alpert School of Medicine at Brown University, said in a press release. “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 health care professionals to call for quick action to improve clinician well-being worldwide.”
As Healio previously reported, 35.4% of U.S. cardiologists reported feelings of burnout; 43.9% reported feeling stressed; and one-quarter of physicians who reported burnout cited experiencing symptoms such as physical and/or emotional exhaustion, personal sense of lack of accomplishment, and cynicism and detachment.
At the 2017 AHA Scientific Sessions, researchers reported that burnout was also 29% more likely among cardiologists who are women compared with men.
Physicians who reported being burned out were also:
- spending more time in direct clinical practice;
- less satisfied with achieving their professional goals or their desired financial compensation;
- less likely to recommend cardiology as a career; and
- less likely to report feeling valued or treated fairly at work.
Burned out physicians also reported lack of control over workload, a hectic work environment, misalignment of values and insufficient documentation time, according to the statement.
Strategies to prevent burnout
“Health care organizations have predominately focused on the concept of ‘fixing the employee’ with individual-focused programs (self-resiliency and stress management training) as the solution to improving well-being; however, much more effort needs to be tailored to systemic issues that affect the work environment,” Mehta and colleagues wrote. “Intentional refinement of practice environments with highly functioning teams within which clinicians can optimally care for patients enables all team members to find value and purpose in their work and can result in improved outcomes for the health care organization and patients.”
For the support of the psychosocial health of clinicians, the authors recommended institutions adopt the Stanford WellMD model of professional fulfillment. This approach incorporates a culture of wellness, practice efficiency and personal resiliency domains while accounting for the modifiable intrinsic factors such as recognition, trust and meaning in work, and extrinsic factors such as call schedule, compensation and technology.
The authors of the joint statement also recommend the use of an adapted model of Maslow’s hierarchy of needs by Shapiro and colleagues. This model provides a prioritized stepwise to address clinicians’ professional fulfillment. The hierarchy reads as such:
- basic physiological and mental health needs;
- safety and security;
- respect from administrators, colleagues and patients;
- appreciation and interpersonal connection; and
- resources and time to treat patients and practice medicine fully.
According to the statement, hospital credentialing committees should improve inquiries into mental health conditions so to perpetuate neither their underreporting or undertreatment due to clinicians’ fear of the loss of hospital privileges.
“Even before the COVID-19 pandemic, clinicians were often struggling in existing health systems that did not fully support them,” Fausto Pinto, MD, PhD, president of the World Heart Federation, dean of the faculty of medicine at the University of Lisbon and head of the cardiology department at University Hospital Santa Maria/CHLN, Lisbon, Portugal, said in the release. “Strategies to prevent clinician 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 pushing governments to enact meaningful health policy changes.”
References:
- Constitution of the World Health Organization. https://www.who.int/publications/m/item/constitution-of-the-world-health-organization. Accessed July 12, 2021.
- Mehta LS, et al. Circulation. 2021;doi:10.1161/CIRCULATIONAHA.121.055748.
- Mehta LS, et al. Eur Heart J. 2021;doi:10.1093/eurheartj/ehab346.
- Mehta LS, et a. Glob Heart. 2021;doi:10.5334/gh.1067.
- Shapiro DE, et al. Am J Med. 2018;doi:10.1016/j.amjmed.2018.11.028.
- The Stanford Model of Professional Fulfillment. https://wellmd.stanford.edu/about/model-external.html. Accessed July 12, 2021.
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