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MARCH 28, 2020 -- Even before the COVID-19 pandemic, more than a third of U.S. cardiologists report being burned out and 58% of these physicians say they plan on leaving their current job, a new survey shows.
"It is important to recognize the personal and professional repercussions of physician burnout," lead author Laxmi Mehta, MD, director of preventive cardiology and women's cardiovascular health at Ohio State University, Columbus, said during an online session of the American College of Cardiology 2020 Scientific Session (ACC.20)/World Congress of Cardiology (WCC).
The new ACC 2019 Well Being Survey was sent to 19,348 ACC members in the fall of 2019 and sought to take a deeper dive into the issue of burnout after the ACC's most recent Professional Life Survey revealed that one in four U.S. cardiologists were burned out in 2015.
While the number of cardiologists who reported feeling stressed fell from 49.5% in 2015 to 43.9% in 2019, the number of cardiologists who reported being burned out increased by 32% from 26.8% to 35.4%, Mehta said.
Among those currently feeling burned out, 23.9% reported having one or more symptoms of burnout, 9.9% had chronic burnout and work frustrations, and 1.6% were "completely burned out" and at the point where they may need to seek help.
Burned-out cardiologists were more likely than those who felt stressed or no burnout to say they may have made a major medical error in the past 3 months (58.3% vs 33.1% and 8.6%; P ≤ .001).
The Usual Suspects
As previously observed, burnout was highest among mid-career cardiologists with 8 to 21 years in practice vs early-career and late-career cardiologists (45.3% vs 35.4% and 31.5%; P ≤ .001) and in women vs men (45.3% vs 33.5%; P ≤ .001). Of the 2025 ACC members who responded, 362 were women.
Several initiatives are underway by the ACC to increase the diversity of cardiology as a specialty, but attention is also needed for mid-career cardiologists, who may not see the "light at the end of the tunnel," as they take on more clinical demands and more administrative roles, Mehta observed.
Not surprising, clocking 60 or more hours per week increased the risk for burnout, compared with working 40 to 59 hours per week or fewer than 40 hours per week (41.5% vs 29.5% and 17.9%; P ≤ .001).
Burned-out cardiologists were also more likely than those who felt stressed or no burnout to report working in a hectic work environment (59.5% vs 32.3% and 14.6%; P ≤ .001) and to have plans to leave their current practice setting (58.1% vs 27.9% and 14.0%; P ≤ .001).
Factors that played a significant role in those plans were the desire to spend more time with family, on-call time, excessive work or relative value unit (RVU) targets, electronic health records, and the pressure to maintain high patient satisfaction scores, Mehta noted.
"Is any of this relatable to decreasing numbers of cardiologists in the U.S., or is there work to try and relate actual work force availability to burnout?" asked session moderator B. Hadley Wilson, MD, executive vice chair of the Sanger Heart & Vascular Institute in Charlotte, North Carolina, and a member of ACC's Board of Trustees, following the presentation.
"It's hard to decipher all of those exact details, but we do know that the cardiology work force tends to be older, so the mid-careers are going to be pulling on a lot more weight in the next few years, so that is a concern," Mehta replied.
A big factor, however, is the excessive work hours put in by all cardiologists, especially the increasing amount of time spent with electronic medical records and administrative tasks, which is "taking away the fun we had in cardiology," she added.
Limitations of the survey include the potential for bias; burnout was self-reported and may vary over time; and the 14% response rate was less than ideal, although the results are consistent with other national surveys, Mehta said.
In the recent Medscape Cardiologist Lifestyle, Happiness & Burnout Report 2020, 29% of respondents reported feeling burnout, 2% depressed, and 15% both burned out and depressed.
The Elephant in the Room
The new findings are "certainly a call to action, but it's hard to avoid the elephant in the room, which is COVID-19," said panelist Sandra Lewis, MD, Legacy Good Samaritan Hospital & Medical Center, Portland, Oregon.
"The implications of burnout are really front-and-center with our colleagues, who are working long hours, have hectic work environments, lack of control, and, more than that, a lack of safety of the work situations that we have worked so hard to achieve, as we run out of protective gear, we don't have masks, as we see our colleagues falling victim to this."
During her presentation, Mehta highlighted the ACC Clinician Well Being Portal and its COVID-19 Hub, but also several self-care strategies to employ, such as relinquishing control during these uncharted waters, revisiting personal strengths and abilities leveraged in other times of uncertainty, and giving yourself a "brain break" by challenging yourself to chat with a colleague for 30 minutes on topics unrelated to COVID-19 and other workplace stressors.
Wilson said the global pandemic only heightens concerns about burnout among cardiologists, which he likened to a "runaway train."
"These are not great signals, I think they're shocking, quite frankly," Wilson told theheart.org | Medscape Cardiology.
"ACC is setting up a task force from the board of trustees to get to work right away and see about ways we can turn this around as quickly as possible and be a voice for the clinicians," he said. "It's not only cardiologists, it's everybody on our cardiovascular care team, including nurses, physician assistants, nurse practitioners, and even pharmacists. Everybody's burning out."