ACC Survey: COVID Slams Already Weary CV Workforce

Patrice Wendling

May 17, 2021

The COVID-19 pandemic has left most people languishing, a few flourishing, and cardiologists just plain burned out.

A new global survey shows rates of burnout nearly doubled during the peak of the pandemic, with more than one in three cardiovascular professionals, or 38%, reporting being burned out.

Rates increased 48% among American cardiologists (from 27% to 40%) and 110% among their international peers (from 10% to 21%).

The findings are problematic for a field already struggling with an aging workforce, an oft-described "leaky pipeline" of diverse new talent, and pervasive job stress and burnout.

Previous studies show that rates of burnout in 2019 were already up 32% from 2015, study author Laxmi Mehta, MD, director of preventive cardiology and women's cardiovascular health, The Ohio State University, Columbus, said at the American College of Cardiology 2021 Scientific Session (ACC.21).

"The potential long-term psychological effects are real and concerning," she said.

The ACC's Task Force on Clinician Well-Being, which Mehta chairs, commissioned the survey, which was sent in October and November 2020 to 10,019 members, of whom 1288 responded.

"Our prior data has shown, and this one also shows, that people who are burned out are less likely to recommend a career in medicine to someone who comes seeking advice, so that really affects our future pipeline," she told theheart.org | Medscape Cardiology.

But what's striking, she added, is the number of burned out professionals, compared with those without burnout, who reported they're planning in the next 12 months to leave their job (20% vs 10%), reduce clinical hours (31% vs 19%), or retire early (22% vs 9%; P < .001 for all).

At the same time, rates of burnout were up 104% among American fellows in training (from 21% to 43%) and 139% among American cardiovascular team members, including nurses (from 23% to 55%).

These respondents may have less control over their work environments, are younger, and often female, Mehta said. "So you're a caretaker at home, a school teacher at home, as well as still trying to do your job," and "there's also the impact on their education being altered because in some places they were sent remotely."

Burned out professionals reported suffering more disruptive economic consequences (32% vs 19%) and salary cuts (47% vs 39%) and were more likely to provide direct in-person care to patients (61% vs 47%) without having adequate PPE (29% vs 17%).

Previous surveys, Mehta noted, have flagged higher rates of burnout among female and mid-career professionals. Another global ACC survey recently reported that 44% of respondents had experienced a hostile work environment during their career, and that rates were higher among female, Black, and North American cardiologists.

Leadership Makes a Difference

Although the long-simmering issue of burnout was previously brought to a boil by widespread implementation of electronic medical records and performance metrics, leadership during the pandemic looms large today.

Burned out respondents felt that workers' basic, emotional, and safety needs were not well supported by their healthcare organization, Mehta said.

Only 11% of burned out respondents, compared with 32% of those without burnout, felt leadership honored their dedication and sacrifices in a meaningful way.

Burned out cardiology professionals were also less likely to report that their organization's leadership took appropriate steps to protect them (54% vs 67%), provided timely information to keep them informed (49% vs 64%), and prepared them to effectively perform their duties (38% vs 58%).

Only 30% felt their needs and concerns were "listened to and understood" by leadership, compared with 53% of those without burnout.

"Your data points toward institutional leadership being really a key driver of burnout," discussant Jeffrey T. Kuvin, MD, chair of cardiology, Long Island Jewish Medical Center and North Shore University Hospital, New York, said. "I think about this all the time and think this is really key and highlights the importance of the work environment in promoting well-being."

"Certainly, COVID affected institutions differently based on many factors, like where their patients were being treated, the PPE supplies," he said. "What do you think are the take-home points for institutions regarding care providers?"

Mehta replied that "institutions often focus more on the personal resiliency piece in terms of, here's some mental stress reduction, go do yoga, or exercise, or watch this webinar. And I think what the take-home message is for the institutions is to really get a pulse of what your employees are feeling. Because if you don't understand that or walk the walk they walk, it's really hard."

She also urged organizations to tackle systemic issues, change the culture of well-being being viewed simply as wellness without the mental health and spiritual components, and to make it acceptable for cardiology professionals to seek mental health. Resources are available on the ACC Clinician Well-Being Portal.

"We want to really recognize mental health because there is going to be a mental health crisis that is coming — if not already here — and is underdiscussed in medicine."

Limitations of the study are the less-than-ideal 13% response rate, the potential for bias because stressed individuals would be more likely to complete the survey, and that burnout was self-reported and may vary over time and may be further confounded with self-perceived levels prior to the pandemic, Mehta said.

Mehta and Kuvin disclosed no relevant financial relationships.

American College of Cardiology 2021 Scientific Session (ACC.21): Abstract 409-18. Presented May 16, 2021.

Follow Patrice Wendling on Twitter: @pwendl. Follow ACC.21 coverage from theheart.org | Medscape Cardiology on Twitter and Facebook.

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