One in Four US Cardiologists Burned Out, Run Down

Patrice Wendling

June 26, 2019

A concerning 27% of American cardiologists report being burned out and another 49.5% cite being under stress and having less energy in the American College of Cardiology's third Professional Life Survey.

Burnout appears to peak among mid-career cardiologists with 8 to 21 years in practice, compared with fellows in training, early-career, and late-career cardiologists (39% vs 10%, 23%, and 28%; P ≤ .01).

Neither cardiovascular subspecialty nor practice setting had an impact on burnout.

"We need to address some of the work environment issues that impact burnout. It's more than just a resiliency issue," study author Laxmi Mehta, MD, director of the women's cardiovascular health program at Ohio State University in Columbus, told theheart.org | Medscape Cardiology.

The transition to electronic medical records (EMRs) is often singled out as one of the biggest drivers of physician burnout. Research suggests that for every 1 hour of time spent directly dealing with patients, physicians are spending 2 additional hours on desk work and EMRs, with another 1 to 2 hours of computer work at night, often referred to as 'pajama time.'

The survey reflects that bureaucratic burden. Three-fourths (72%) of cardiologists with burnout reported documentation time pressures and 57% reported increased EMR use at home.

The survey was published in the July 2 issue of the Journal of the American College of Cardiology and was completed by 2313 American cardiologists. Results on professional satisfaction and workplace discrimination were previously reported.

The new findings focus on 10 additional questions from the validated Mini-Z burnout survey completed by 2274 cardiologists and fellows in training, of whom 953 were women.

Overall, women reported burnout more frequently than men (31% vs 24%; P ≤ .001). A deeper dive into these data is expected later this year, said Mehta, who notably juggled this interview while on holiday in Yellowstone National Park.

Is the Tide Turning?

"Despite the fact there's some very, very concerning things, the one thing that is heartening is that this survey was actually better than most of the others that we've seen in terms of the rates of burnout including cardiologists. Usually you're seeing rates in the forty to fifty zone," cardiologist John P. Erwin, MD, chair of internal medicine at Baylor Scott & White Medical Center, Temple, Texas, told theheart.org | Medscape Cardiology.

Indeed, 43% of cardiologists reported being burned out in the 2019 Medscape report on cardiologist lifestyle, happiness, and burnout. The investigators note it does not use a validated measure of burnout and is a convenience sample, but also acknowledge that others have reported that about 44% of physicians are experiencing burnout.

"It is unclear why the prevalence of burnout in the current study of cardiologists is lower than prior reports of other specialties but may be attributable to the burnout assessment tool used, cardiologists' resilience, and/or unique elements of the field/practice of cardiology that may be more protective than those found in other disciplines," they write.

By its nature, cardiology is a high-stress environment, observed Erwin. "We tend to self-select out for those people who get a little bit of an adrenaline rush from that stress but trying to remain in the 'EU' stress zone is very important and for us to be mindful of when we're getting to the edge of those zones. And that takes people looking out for one another."

When he first started working, Erwin said physicians spent at least 30 minutes in the cafeteria and discussed interesting cases or bemoaned the bad things that may have happened. "That's actually therapy," he said. "Nowadays that doesn't happen. If you don't have patients scheduled over the noon hour or other procedures, in general people are spending that time on the computer trying to get their notes or correspondence caught up."

In the survey, burnout took a toll on career satisfaction. Cardiologists reporting burnout were more likely to report feeling less satisfied with achieving professional goals (43% vs 18%), their level of advancement (75% vs 65%), and financial compensation (49% vs 32%). They were also less likely than those without burnout to recommend cardiology as a career (44% vs 20%; all P ≤ .001).

Several factors were independently associated with a higher rate of burnout in multivariate analyses. They include:

  • No control over workload (odds ratio [OR], 2.03; P  ≤ .001)

  • Hectic work environment (OR, 1.90; P  ≤ .001)

  • Misalignment of values (OR, 1.65; P  ≤ .001)

  • Family responsibilities hindering professional work (OR, 1.47; P = .002)

  • Intent to renegotiate for support staff (OR, 1.68; P = .009)

  • Insufficient documentation time (OR, 1.40; P = .011)

The American College of Cardiology has efforts underway to try to address burnout and their members needs, Mehta noted.

"We're looking at developing chapter tool kits at the state level, where chapters can incorporate wellness into their annual meetings; just having Powerpoint slides, developing info graphics for members," she said. "And we're going to start gauging our members to figure out who's doing what in terms of best practices to improve wellness among our members."

Erwin said his institution is trying to address burnout through multiple avenues, including systemic changes, a "physician rejuvenate" program, and even contracting with combat-tested military officers to, among other things, use dedicated time to debrief from stressful situations. On an individual level, physicians also need to prioritize the time for ongoing self-evaluation about their professional and personal lives.

Rather than using the term work–life balance, "I've tried to stress to people that we should really look at it as a work–life harmony," he said. "We have to be able to be mindful enough to know when the medical demands on us require more than what our family needs or what we need individually for ourselves. But then we also have to realize that part of that harmony is that there are other times when you clearly have to put the focus on your family and your own personal well-being. I think we get it completely out of harmony very frequently in medicine, and especially in cardiology.

"I've used the word mindful a lot but it's important to be aware of the situation and what's going on and to be able to counteract that," Erwin said. "It actually is an active process in doing so and shouldn't be something that's just left over."

The authors report no relationships relevant to the study. Erwin reports serving as a reviewer for the study.

J Am Coll Cardiol. 2019;73:3345-3348. Abstract

Follow Patrice Wendling on Twitter: @pwendl. For more from theheart.org | Medscape Cardiology, join us on Twitter and Facebook.

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