IM Residents Rate Cardiology Low on
Work-Life Balance

Marilynn Larkin

October 17, 2022

Both male and female internal medicine (IM) residents prioritized work-life balance, such as stable working hours and family friendliness, when considering career choices, and cardiology was perceived to fall short in this area, an updated survey revealed.

Originally conducted in 2010, the survey aimed to understand IM residents' professional development preferences and perceptions of cardiology as a specialty. That survey demonstrated a discordance between what residents valued in making a career choice and their perceptions of a career in cardiology.

The discordance remained in 2020, with residents even more likely to report negative perceptions of cardiology than their predecessors.

Compared with residents surveyed in 2010, respondents in 2020 placed higher value on all aspects of work-life balance and of having role models who demonstrated a successful balance. The value change was particularly notable for men.

"While our survey does not elucidate why this is, speculation could be made that this value on work-life balance is generational and prominent in the youngest generations entering all professional fields, not just medicine," lead author Meghan York, MD, of Beth Israel Deaconess Medical Center, Harvard Medical School in Boston told | Medscape Cardiology.

"There is also an interesting trend that dual-career couples are on the rise in the US," she said. "This may reflect that trend, [with] men in medical fields possibly taking on more domestic responsibility and requiring more work flexibility to do that."

Regarding perceptions, she added, cardiology tends to show resident cardiologists who are working in inpatient services with "ballooning and unpredictable hours," rather than those who are working in more time-controlled clinics. Therefore, "their prime exposure to physicians is not truly representative of the career." The study was published online October 12 in JAMA Cardiology.

"Lack of Diversity"

The updated surveys were sent by various means to close to 30,000 residents, and were completed by 840 (mean age, 29; 50%, male; 55%, White). Cardiology was a favored subspecialty choice among men, with 46.5% reporting they were considering it vs 29.7% of women. Women were more likely to report never having considered cardiology as a career choice (37.6%) compared with men (22.3%).

The survey incorporated a 5-point Likert scale of 1 (not important) to 5 (extremely important) for some of the questions.

The most important professional development preferences for respondents were positive role models (4.56), stimulating career (3.81), family friendly (3.78), patient focus (3.70), stable work hours (3.66), female or race friendly (3.33), professional challenges (3.21), and financial benefits (3.20).

The cardiology perception statements with the highest agreement were:

  • Interferes with family life during training (3.93)

  • Having met positive role models or having positive views of cardiovascular disease as a topic (3.85)

  • Reasonable compensation (3.69)

  • Adverse job conditions (3.16)

  • Field lacks diversity (2.90)

Compared with the 2010 survey, the 2020 findings indicated increased importance on work-life balance components for both male and female residents, with a greater change among males.

In addition, 2020 respondents were more likely than their predecessors to report negative perceptions of cardiology, such as too much overnight or weekend call, challenging to have children during fellowship, and lack of diversity.

"The culture of the subspecialty of cardiology has not improved to become significantly more diverse or inclusive, whereas other specialties and subspecialties have, and residents interact with cardiologists frequently and can see that," York noted.

"As women now make up greater than 50% of medical students," she said, "it is reasonable to focus on women in medical school and residency to bring them into the field of cardiology. But as racial and ethnic minority groups are also massively underrepresented in medical school, recruitment into medicine needs to start much earlier, in high school and college.

"Creating and supporting rotations that embed residents in the outpatient cardiology setting and exposure to more longitudinal experiences will provide a more realistic picture of the career," she concluded. 

ACC "at the Forefront"

Commenting on the study for | Medscape Cardiology, Lisa Rose-Jones, MD, chair of the American College of Cardiology (ACC)'s Program Directors and Graduate Medical Educators Section, said, "Work-life balance looks different for each and every individual, but there are some themes that we need to think about. The ACC is really at the forefront of this. They are putting together different work groups to focus on how can we have some innovations?"

ACC is seeking mentors as part of its workforce diversity efforts among African American/Black, Hispanic/LatinX and Women's IM cardiology programs, she noted. Furthermore, on October 13, the organization released its 2022 health policy statement on career flexibility in cardiology, which calls for more leeway for cardiologists to deal with common life events without jeopardizing their careers.  

Rose-Jones, who is director of the Training Program in Cardiovascular Disease at the University of North Carolina School of Medicine in Chapel Hill, said that because both male and female residents placed a high value on work-life balance, "we've got to think about how we can have flexibility in our work hours. That is critically important. Health systems need to be able to accommodate working families that may need to alter traditional 9 to 5 work hours to meet the demands of being a successful cardiologist and also being a parent."

In addition, she said, "We need to have very clear policies at every institution on gender-related and parent-related discrimination. Data show that many female trainees are still being questioned on their family planning. That is absolutely not appropriate. It is none of our business. While we continue to do that, we continue to create stigma in our field."

Like York, she noted generational differences in the doctors who are coming up now. "They've seen burnout firsthand and want to have a well-balanced life that includes medicine, but also life outside of the hospital," Rose-Jones said. "So, those of us in cardiology really need to look deep inside and make changes. We need to be thoughtful about how we can be innovative."

No commercial funding or conflicts of interest were declared.

JAMA Cardiol. Published online October 12. Brief Report

Follow Marilynn Larkin on Twitter:  @MarilynnL.

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