Clinician well-being is imperative to providing high-quality patient care, yet clinician burnout continues to increase, especially over the last year due to the COVID-19 pandemic. Four leading cardiovascular organizations - the American College of Cardiology, the American Heart Association, the European Society of Cardiology and the World Heart Federation - are calling for global action to improve clinician well-being in a joint opinion paper published today.
"Over the last several decades, there have been significant changes in health care 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, MD, MACC, immediate past president of the American College of Cardiology 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 health care 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, depersonalization and a sense of low personal accomplishments in a perceived stressful work environment. Burnout is an extremely negative component along the spectrum of clinician well-being and can coexist with other mental health conditions (for example, anxiety and depression).
Recent survey data among 2,274 U.S. 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 under-represented 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 S.V. Elkind, MD, MS, FAHA, FAAN, immediate past president of the American Heart Association. "Our organizations 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. Well-being is essential to achieving personal fulfilment 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 behavior 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 Professor Stephan Achenbach, ESC president.
The joint opinion urges health care organizations and medical specialty societies to implement strategies to prevent clinician burnout. For health care organizations, suggested prevention strategies include:
* Support the psychosocial health of employees and be accountable for a holistic approach. * Create an organizational infrastructure within which clinicians can thrive. * Provide employees with a structure that allows for confidential reporting of mistreatment, as well as destigmatization of clinician access to mental health resources.
For medical specialty societies, suggested prevention strategies include:
* Continue to provide recommendations to health care organizations 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 Prof Fausto Pinto, president of the World Heart Federation. "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 S. Mehta, MD, FACC, FAHA, 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.
"As clinicians, we continuously strive for the improved health of our patients and at the same time recognize 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."
About the American College of Cardiology
The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.
About the American Heart Association
The American Heart Association is a leading force for a world of longer, healthier lives. With nearly a century of lifesaving work, the Dallas-based association is dedicated to ensuring equitable health for all. We are a trustworthy source empowering people to improve their heart health, brain health and well-being. We collaborate with numerous organizations and millions of volunteers to fund innovative research, advocate for stronger public health policies and share lifesaving resources and information. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.
About the European Society of Cardiology (ESC)
The ESC brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people to live longer, healthier lives.
About the World Heart Federation
The World Heart Federation (WHF) unites the cardiovascular community and drives the agenda to reduce the global burden of cardiovascular disease and help people live longer, healthier lives. Together with our Members, we are working to end needless deaths and build global commitment for improved cardiovascular health at the global, regional, national and community levels. We believe in a world where heart health for everyone is a fundamental human right. To learn more, visit worldheart.org.
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Journal of the American College of Cardiology