Many US Cardiologists ‘On the Brink of Burnout’

Cardiologists aren’t immune from the increasing pressures on healthcare professionals, suggest newly published survey results from the American College of Cardiology (ACC). The data provide a glimpse of the burnout that can occur in this environment and offer hints on how to improve understanding and where to seek solutions.

More than a quarter of the US cardiologists (26.8%) who replied to the survey reported feeling burned out and half of the remainder said they felt stressed. Cardiologists in the latter group “are on the brink of burnout,” lead author Laxmi S. Mehta, MD (The Ohio State University, Columbus), told TCTMD.

This is the first time a validated method, in this case the Mini-Z survey, has been used to query cardiologists on these issues. This may be why the rate of burnout was comparatively lower in this survey than what had been seen in more informal polls, where the rate reached as high as 43%, write Mehta and her colleagues in their paper published online ahead of the July 2, 2019, issue of the Journal of the American College of Cardiology.

Burnout also seems to be less common in cardiology than in other branches of medicine, though it’s unclear whether that is due to differences in survey methodology, cardiologists’ temperaments, or other work-related factors. “Clinicians in all fields of medicine are experiencing an increase in burnout; however, the highest rates are apparent in those on the front lines of medicine who spend the most time on direct patient care,” the researchers note.

Whatever the exact rate of burnout is, “it’s still a common issue,” due to a long list of stressors: clerical burden, the feeling of being unappreciated, long work hours, the need to negotiate pay, and the corporatization of medicine, said James A. Goldstein, MD (Beaumont Hospital, Royal Oak, MI). Across surveys, these themes are “all there, they’re all consistent, they’re all additive,” he commented to TCTMD. “The bottom line is that 99-plus percent of people go into medicine because they want to take care of patients and/or teach and do research.”

Systemic Factors Loom Large

As part of the ACC’s 2015 professional life survey, 10,798 cardiologists were asked 10 questions designed to measure emotional symptoms of burnout. For the burnout component, the response rate was 21%.

Mehta and colleagues then divided the participating cardiologists into two groups: no burnout (no burnout or feeling stressed but not burned out) versus burnout (at least one symptom of burnout, constant feeling of burnout, or complete feelings of burnout).

Within the no-burnout group, 23.7% said they enjoyed their work but 49.5% still reported being under stress with less energy. Within the burnout group, on the other hand, 19.2% experienced at least one symptom, 6.4% had chronic symptoms that led to frequent frustration over work, and 1.2% said they were experiencing burnout so completely that they might need outside help.

Had they imposed everything at once, there would have been a rebellion. But we just kept adapting, and now we find our professional lives have changed. James A. Goldstein

Midcareer cardiologists with 8 to 21 years of practice were more likely to report burnout (39%) than were fellows in training (10%), early-career cardiologists (23%), and late-career cardiologists (28%). Subspecialty and practice setting didn’t seem to matter, though burned-out physicians reported spending more of their time in direct clinical practice.

Women were more likely to experience burnout than were men (31% vs 24%). Cardiologists reporting burnout were less apt to be married (79% vs 85%), and they were more likely to say they were dissatisfied with family life (30% vs 10%) and that family responsibilities hindered their professional work (46% vs 29%).

Despite the overall career satisfaction, cardiologists in the burnout group were more likely to report dissatisfaction with achieving career goals (43% vs 18%), their financial compensation (49% vs 32%), and their level of advancement (75% vs 65%). Moreover, they were less likely than the no-burnout group to recommend a career in cardiology (44% vs 20%).

Work environment appeared to play a key role, with burned-out physicians saying they were less likely to be treated fairly, feel valued, or feel that their contributions matter. Discrimination during career or training was more likely, and had a greater impact on activities with colleagues and patients, for cardiologists with versus without burnout.

On multivariate analysis, several factors independently correlated with burnout or lack thereof.

Independent Predictors of Burnout

Both Mehta and Goldstein highlighted the transition from paper charts to electronic medical records (EMRs) as a big factor adversely affecting work-life balance for physicians.

“There are many drivers of burnout, including, but not limited to, unrealistic efficiency/productivity targets, reduced time allocated per patient encounter, increased administrative and professional burdens, and exponential rise in documentation time with EMR. The intense workloads along with loss of autonomy, financial strain, and escalation in negative views toward doctors have resulted in a rise in burnout nationally among physicians,” the researchers observe in their paper.

Goldstein likened the situation to the allegory of putting a frog in cold water then gradually turning up the heat.

“What’s happened in medicine over the past 15 or 20 years and accelerating over the past 10 years, has been this, ‘Well, just one more thing, then just one more thing,’” ranging from the use of EMRs to yearly training in infectious control, fire safety, and sexual harassment to interactions with institutional review boards and HIPAA requirements, he explained. “If it were just one thing, it would be no big deal. It’s just everything piled upon another. And because it’s been insidious and progressive, it’s had an insidious and progressive impact. Had they imposed everything at once, there would have been a rebellion. But we just kept adapting, and now we find our professional lives have changed.”

Still, physicians find joy in their work and cope by coming up with ways to reduce the impact of these day-to-day stressors, Goldstein emphasized. Some of this comes down to an individual’s resilience and flexibility, but on a higher level, cardiologists need to come together. As an example, he cited the activism surrounding the burdensome maintenance of certification requirements instituted a few years back.

The ACC, said Mehta, is actively working to better understand burnout and come up with solutions, such as workflow redesign. It’s more than just resilience, she observed, urging that systemic issues also need to be addressed. Several groups within the ACC are focused on promoting wellness as well as on educating cardiologists about what they can do on a local level. Within the next 6 to 9 months, the ACC will be releasing wellness toolkits that state chapters can share with their members, Mehta said.