Global action is needed to improve clinician wellbeing, according to four leading cardiovascular health organisations, who have issued a joint paper calling for an increased recognition of the impact of clinician burnout, particularly due to the COVID-19 pandemic. The comments have come jointly from the American College of Cardiology (ACC), the American Heart Association (AHA), the European Society of Cardiology (ESC) and the World Heart Federation (WHF).
“Over the last several decades, there have been significant changes in healthcare with the expansion of technology, regulatory burden and clerical task loads. These developments have come at a cost to the well-being and work-life integration of clinicians,” said Athena Poppas, immediate past president of the ACC and co-author of the joint opinion. “The COVID-19 pandemic has caused additional strain on clinicians through increased patient mortality, personal and family safety concerns, fear of the unknown and increased work demands. The time is now to join with our global healthcare professionals to call for quick action to improve clinician well-being worldwide.”
Clinician well-being is described as experiencing satisfaction and engagement with work, while also having a feeling of professional fulfillment and a sense of meaning in work.
Conversely, burnout is defined as emotional exhaustion, depersonalisation and a sense of low personal accomplishments in a perceived stressful work environment. Burnout is an extremely negative component along the spectrum of clinician wellbeing and can coexist with other mental health conditions (for example, anxiety and depression).
Recent survey data among 2,274 US cardiologists and fellows-in-training reported that more than one-quarter were burned out and almost 50% were stressed. Only 23.7% said that they enjoyed their work. Women reported burnout more frequently compared with men.
Drivers associated with burnout among cardiologists include lack of control over workload, a hectic work environment, misalignment of values and insufficient documentation time. Furthermore, women are underrepresented in cardiology and may have added stressors contributing to burnout such as lack of career promotion, inequalities in income and disparities in mentorship, in addition to working in environments that lack diversity, equity, inclusion and belonging.
“These stressors compound over time, and collectively, they diminish our abilities to provide high-quality patient care and to strengthen and diversify our workforce. In addition, stigma related to mental health care must be eradicated,” said Mitchell Elkind, immediate past president of the AHA. “Our organisations are joined together in this report to ensure that we create a strong and supportive clinician environment—for our personal wellbeing and for our families, loved ones and patients. Wellbeing is essential to achieving personal fulfillment and satisfaction in our work.”
There are serious personal and professional ramifications of clinical burnout. Personal ramifications of burnout consist of higher rates of alcohol abuse, substance use, dysfunctional relationships, depression and suicide. Professional ramifications of clinician burnout include higher rates of medical errors, lower quality of care, decreased patient satisfaction, increased disruptive behaviour and loss of professionalism accompanied by a decreased level of empathy.
“The rising rate of stress and burnout among health professionals rings an alarm bell. As well as serious consequences for the individual, they will impact patient care. The ESC joins other professional societies today to raise a red flag and to urge health care systems to create healthy environments for all those providing patient care,” said Stephan Achenbach, ESC president.
The joint opinion urges healthcare organisations and medical specialty societies to implement strategies to prevent clinician burnout. For healthcare organisations, suggested prevention strategies include:
- Support the psychosocial health of employees and be accountable for a holistic approach
- Create an organisational infrastructure within which clinicians can thrive
- Provide employees with a structure that allows for confidential reporting of mistreatment, as well as destigmatisation of clinician access to mental health resources
For medical specialty societies, suggested prevention strategies include:
- Continue to provide recommendations to healthcare organisations and advocate for meaningful health policy changes
- Develop specialty-specific tools that may improve practice efficiency or clinician knowledge base in a timely and convenient fashion
- Expand initiatives in diversity and inclusion to improve feelings of being valued and belonging
“Even before the COVID-19 pandemic, clinicians were often struggling in existing health systems that did not fully support them,” said Fausto Pinto, president of the WHF. “Strategies to prevent clinician burnout must target the root causes of the problem. Medical societies, as well as civil society foundations, have an important role to play in creating support networks for their members and pushing governments to enact meaningful health policy changes.”
The joint opinion published simultaneously in the flagship journals of all four organizations: Journal of the American College of Cardiology, Circulation, European Heart Journal and Global Heart. The report was led by Chair Laxmi Mehta, professor in the division of cardiovascular medicine, section director of preventive cardiology and women’s cardiovascular health, and vice chair of wellness in the department of internal medicine at The Ohio State University Wexler Medical Center (Columbus, USA).
“As clinicians, we continuously strive for the improved health of our patients and at the same time recognise our own welfare is paramount to them receiving optimal care,” Mehta said. “We will continue to work together and strategize to maintain the well-being of our workforce and keep the joy in cardiovascular medicine.”