COVID-19 Doubled Burnout Rates in Cardiology
The responsibility for change needs to be shared between hospitals, policymakers, and clinicians, says ACC’s president.
The COVID-19 pandemic caused clinician burnout rates to nearly double from prepandemic levels, which were already high due to a variety of factors related to increased administrative work and pressure to put quantity over quality, according to new American College of Cardiology (ACC) survey data.
Last year, Mehta presented results of the 2019 ACC Well-being Study showing a 32% increase in burnout among US physicians from the previous 2015 survey.
ACC President Dipti Itchhaporia, MD (Hoag Memorial Hospital Presbyterian, Newport Beach, CA), told TCTMD that stories of burnout have especially been circulating over the past 14 months, “but to actually see data to support that is always sobering.”
She called the data a “wake-up call” to hospitals, leadership management, and policy makers. “They need to see that there's a disconnect between what they've been thinking and what's reality,” Itchhaporia said. “So, I think it should make us all pause and really consider what do we need to change so that this trend doesn't continue.”
Mehta and colleagues used a Mini Z survey to poll a selection of more than 10,000 ACC members between October and November 2020. Among the 1,288 who replied, 20% identified as having burnout prepandemic, while 38% said they had symptoms of burnout during the peak of the pandemic for their region.
Interestingly, US cardiologists reported higher rates of pre-COVID and peak-COVID burnout (27% vs 40%) than did international cardiologists, who made up a third of the respondents (10% vs 21%). Also, US fellows-in-training (43%) and cardiovascular team members (55%) reported especially high rates of peak-COVID burnout.
Specific pandemic-related situations that led to increased levels of burnout were disruptive economic consequences, salary reductions, inadequate personal protective equipment (PPE), and direct in-person care.
Organizational leadership also seemed to have an effect on burnout rates, with those who felt like their institutions were taking care of their basic, childcare, and emotional needs as well as honoring their dedication in a meaningful way less likely to feel burnout. Likewise, respondents who felt like their organization took meaningful steps to protect them as well as keep them informed, prepared, and listened to also reported less burnout.
Only 14% of burnt out respondents said they felt happy at work, while 31% said they felt worthwhile. Strikingly, only 36% of burnt out respondents said they would recommend a career in medicine, with many of them feeling a strong emotional burden leading them to disconnect with and have less empathy for colleagues and patients.
Significantly more respondents who reported burnout said they plan to leave practice (20% vs 10%), reduce their clinical work hours (31% vs 19%), or retire early (22% vs 9%; P < 0.001 for all).
Mehta stressed that achieving well-being is “a marathon, not a sprint.”
“If we try to rush into everything, we're going to spin our wheels and not make much change,” she said. “It has to be measured and meaningful change. It's hard because it's not something that the ACC can fully own, and it's not that the organization can fully own, and it's not that the physician or nurse practitioner can fully own. We all jointly own it, and so we all jointly need to work together.”
That said, “I don't think that these burnout levels are going to be sustainable in medicine,” Mehta said. “It's not good for the individual, it's not good for the health system, and it's certainly not good for our patients.”
More Than Personal Resiliency
Discussing the study following its presentation, Jeffrey Kuvin, MD (Northwell Health, Manhasset, NY), observed: “Certainly burnout in the cardiovascular workforce, including our fellows, physicians, and the entire care team, has to be recognized and discussed in these kinds of formats. COVID has so heightened the importance of clinician well-being.”
In response to some of Kuvin’s questions, Mehta noted that it’s hard to compare these results to what might be seen in other specialties, given the survey mechanism used, but said she expects similar pandemic-related burnout would be seen among other physician groups: “No doubt about that.” Additionally, she pointed out the 2015 and 2019 ACC surveys showed that women tend to be at greater risk for burnout than men, and that mid-career cardiologists might be at even greater risk than those early in their careers.
“We've done a great job—obviously we could do better—with the trainees, but we have to remember us mid-career people need to take care of ourselves too,” Mehta said.
Kuvin pointed out that institutional leadership appears to be a key determinant of burnout levels. “I think about this all the time, and I think this is really key and highlights the importance of a work environment in promoting well-being. And, certainly, COVID affected institutions differently based on many factors like where the patients were being treated, the PPE supply, etc,” he observed.
The take-home message for institutions, Mehta said, is that instead of focusing on personal resiliency related to exercise or webinars, it’s better to “get a pulse of what your employees are feeling, because if you don't understand that and you don't walk the walk that they walk, then it's really hard. . . . Healthcare organizations really need to be working on the issues that are in the work environment, but most important is changing the culture of well-being, as well.”
It should make us all pause and really consider what do we need to change so that this trend doesn't continue. Dipti Itchhaporia
Itchhaporia agreed. “The conversation has been occurring, but I think for some people, the whole conversation was all about chair yoga and not necessarily about something that can affect not just clinician wellness. It can really affect patient outcomes,” she said. “For us to really think broadly about what it is that we can do at a system level that can help with mitigation strategies, I think that it behooves all health systems and hospitals and managers and leadership to really think about what is at the core of all of this and to sort of try to figure out what the best way forward is.”
This includes recognizing the importance of mental health as well, Mehta stressed. “There is going to be a mental health crisis that is coming, if not already here and underdiscussed within medicine. Hospitals and organizations need to really work on changing the culture and working on the systemic things and then making it acceptable to seek mental help.”
For those currently feeling burnt out, Itchhaporia said there are more resources to for them than there have ever been. She encouraged cardiologists to reach out to the ACC and their individual health system for help, and if the latter is not engaged in this issue to speak up and encourage greater involvement. “Each of us is a leader and we all need to go be a leader within that space if it's something that's important to us and start those conversations at our local level,” she said.
Mehta LS. Impact of COVID-19 on the global cardiovascular workforce: the ACC 2020 Well Being Study. Presented at: ACC 2021. May 16, 2021.
- Mehta and Itchhaporia report no relevant conflicts of interest.