Heart Societies Issue Joint Opinion on Improving Clinician Well-Being Worldwide

July 13, 2021—Four leading cardiovascular organizations—American College of Cardiology (ACC), American Heart Association (AHA), European Society of Cardiology (ESC), and World Heart Federation (WHF)—announced the publication of a call for global action to improve clinician well-being in a joint opinion paper.

The societies advised that clinician well-being is imperative to providing high-quality patient care. However, clinician burnout continues to increase, especially over the last year because of the COVID-19 pandemic.

Writing group Chair Laxmi S. Mehta, MD, et al—Mitchell S.V. Elkind, MD, AHA immediate Past President; Professor Stephan Achenbach, MD, ESC President; Professor Fausto J. Pinto, MD, WHF President; and Athena Poppas, MD, ACC immediate Past President—published the paper in the societies’ respective journals: Journal of the American College of Cardiology, Circulation, European Heart Journal, and Global Heart.

As summarized in the societies’ announcement, 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.

The paper describes clinician well-being 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).

The society press release stated that recent survey data among 2,274 United States cardiologists and fellows-in-training reported that more than one-quarter were burned out and approximately 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.

Additionally, 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.

There are serious personal and professional ramifications of clinical burnout:

• Personal ramifications of burnout include 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.

Dr. Mehta, Chair of the writing committee, commented in the announcement, “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. We will continue to work together and strategize to maintain the well-being of our workforce and keep the joy in cardiovascular medicine.” Dr. Mehta is 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 in Columbus, Ohio.