Feature | ACC Survey: Burnout Rates Double For Cardiology Clinicians Amid COVID-19

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The COVID-19 pandemic has taken a significant toll on cardiovascular clinicians, many of whom provide direct care to patients with or at greater risk of the virus. As a result, the prevalence of burnout among cardiovascular professionals nearly doubled when comparing pre- to peak COVID-19 levels. These are among the findings from ACC's 2020 Well-Being Study presented during ACC.21.

A survey was sent via email in November 2020 to 10,019 cardiologists, fellows in training (FITs) and cardiovascular team members. A total of 1,288 people responded to the survey (456 U.S. and 436 international cardiologists, 128 FITs and 268 cardiovascular team members). Because peaks in COVID-19 disease activity differed by region, questions were structured to ask about feelings of burnout before COVID-19 and during the peak of COVID-19 in their region.

Among those surveyed, burnout increased from 20% to 38% during the peak of the pandemic. Rates of burnout pre- and peak COVID-19 increased across all members of the cardiology care team and was particularly striking among cardiovascular team members, which researchers said may be because they were more likely at the bedside as patients were dying. Among all cardiovascular clinicians – cardiologists, physician assistants, nurse practitioners, nurses, pharmacists and imaging technologists – half provided direct care to patients with COVID-19, and yet one of five reported not having adequate personal protective equipment. Not surprisingly, the rate of burnout was higher in this group.

The survey also revealed that some cardiovascular clinicians are thinking about leaving their jobs, in some cases, because of COVID-19. Plans to reduce clinical work hours in the next year, leave their current practice or retire early were reported by 23%, 13% and 13% of respondents, respectively, and notably higher among those who reported feeling burnt out. For some, COVID-19 is the key influencer for these decisions, with 17% of clinicians planning to reduce their clinical work hours, 12% planning to leave their current practice and 11% planning to retire due to COVID-19.

The survey also revealed financial stressors exacerbated by COVID-19, with 41% of respondents reporting that their salary had been reduced to some degree. Roughly the same percentage of clinicians also reported inadequate health system support during the pandemic related to workers' basic needs, such as food, lodging, transportation, child care and emotional support.

Laxmi S. Mehta, MD, FACC

Cardiology spoke with Laxmi S. Mehta, MD, FACC, the study's lead author and chair of ACC's Task Force on Clinician Well-Being about the survey results. Supporting clinician wellness by providing potential solutions to alleviate some of the job pressures associated with burnout has become a strategic priority for the ACC.

What is your key takeaway from this survey?

Burnout amongst cardiovascular professionals across the globe nearly doubled when comparing pre-pandemic to peak-pandemic times. The highest prevalence of burnout at the peak of the pandemic was amongst cardiovascular team professionals in the U.S. Those who reported being burned out were less likely to report that their basic needs, emotional needs and safety needs were adequately supported by their health care organizations.

What surprised you from the findings?

It was interesting that the prevalence of burnout both at pre- and peak pandemic times were lower among international cardiologists compared with U.S. cardiologists, fellows in training and cardiovascular team members. It is unclear if there was survey bias such that international members who had less exposure to COVID-19 (either by country prevalence or work duty exposure) were more likely to respond to the survey. The COVID-19 pandemic clearly drove up rates of burnout and it has factored into clinicians looking to make changes in their work life, such as reducing clinic hours, leaving their current practice or retiring early. But it seems important that the focus should be on the fact that burnout has been a longstanding issue with substantial rates that cannot be dismissed.

What is needed for institutions to address the issues contributing to burnout overall as well as pandemic-specific issues?

It is important to collaborate with our institutions on the goal of improving the work environment by building the business case for well-being. Clinician well-being is tied with improved patient outcomes and lower costs. Clinician well-being needs to be incorporated into the culture of cardiology and medicine in general.

Recognizing the need for improving workforce care, what are some specific strategies that health care organizations can undertake?

The ACC and AHA just published the Consensus Conference on Professionalism and Ethics Report which includes recommendations for health care organizations to be accountable for the psychosocial health of their workforce and to regularly assess clinician well-being as it is a marker for organizational health. Specific recommendations focused on strategies for improving the efficiency of health information technology – a key factor in clinician burnout – as well as opportunities to improve the well-being of trainees and researchers, and to identify and assist physicians with impaired and disruptive behaviors. Click here to learn more about the report and access the full document.

Please highlight some of the work underway by the ACC's Task Force on Clinician Well-Being to help improve clinician wellness.

The Task Force has developed the Clinician Well-Being Portal (ACC.org/ClinicianWellbeing) and collaborated with others in the College to contribute to the ACC COVID-19 Hub. These websites provide easy access to important well-being resources and information for ACC members. We have also developed webinars on mental health and this past Spring held a series of in-depth conversations with national leaders of well-being in medicine which helped strengthen our formal recommendations to the ACC Board of Trustees. Stay tuned as we work with the Sections, Committees, Work Groups across the College to incorporate the concept of well-being in all aspects of the College's activities.

Resources For Clinician Wellness

The scope of the problem of clinician burnout is becoming clearer. In addition to the new research presented at ACC.21 showing a doubling in burnout rates among cardiovascular clinicians in the last year to 38%, the most current survey from Medscape found that 43% of cardiologists described themselves as "burned out."

A wealth of resources to support clinician wellness and address burnout are available from the ACC, a variety of professional medical groups and private companies at no cost. The number of wellness resources have grown with the increase in burnout and the strategies have evolved to meet new challenges, including the COVID-19 pandemic.

The ACC's Clinician Well-Being Portal provides a range of resources, including pathways related to administrative burden, resources and events, diversity and inclusion, and connecting and discussing. Find it all at ACC.org/ClinicianWellBeing.

"Physicians are critically underestimating how burned out they are and they overestimate their wellness," says Tristan Mueck, DO, assistant medical director at EmPRO, a company offering wellness strategies. The Physician Wellness Index, a short survey developed at the Mayo Clinic, can help clinicians "to take their own temperature to see how they are doing." Click here for the survey.

EmPRO offers a free Physician Care Support program that is building a community for physicians around the world to talk during hour-long Zoom sessions with a group leader. Before the COVID-19 pandemic, EmPRO offered one or two peer support groups a month, and now this has grown to 20 programs a month. EmPRO also offers free mindfulness, writing and narrative programs and is starting new programs targeted to community groups, such as Women in Medicine. Click here to explore these resources.

Other resources for clinician wellness include:

The Physician Support Line (888-409-0141), a free and confidential service comprised of volunteer psychiatrists who provide peer support for physicians. No appointment is necessary, and the line is open seven days a week from 8:00 a.m. to 1:00 a.m. ET. Learn more at PhysicianSupportLine.com.

The American Medical Association's Physician Health website offers health tools and resources for physicians and medical practices plus webinars and articles. Click here to access the site.

The AMA also offers a Burnout Management Tip of the Week by email. The tips are expert-driven insights to help manage burnout as well as ideas to streamline workflow. Click here to sign up.

The Mayo Clinic Program on Physician Well-Being evaluates personal, professional and organizational factors that affect the well-being, satisfaction and productivity of health care professionals. Click here for more.

Hope4Healers is a service that provides free counseling to all health care workers, childcare workers and first responders. Licensed mental health professionals provide counseling on a confidential basis as well as work with clients to identify solutions to the problems they face and competently manage stress. Hope4Healers is a collaboration between the Department of Health and Human Services and The North Carolina Psychological Foundation. Click here for help.

PeerRxMed is a free peer-to-peer program for physicians and other health care workers. It is designed to help them address and prevent burnout by using a buddy system. PeerRx provides prompts and guidance for weekly, monthly and quarterly check-ins. Click here for more info.

Keywords: ACC Publications, Cardiology Magazine, COVID-19, SARS-CoV-2, Pandemics, Physician Executives, Burnout, Professional, Physicians, Mental Health, Mindfulness, Personal Protective Equipment, Physician Assistants, Health Workforce, Nurse Practitioners, Medicine, Self-Help Groups, Emotions, Delivery of Health Care, Medical Informatics


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