Interventional Cardiologists Unhappy, Burned Out Globally

Interventional cardiologists (ICs) around the world are unhappy and burned out, and their well-being is compromised, a new international survey suggests.

“What surprised me was the magnitude of the findings,” Emmanouil S. Brilakis, MD, PhD of the Minneapolis Heart Institute and Minneapolis Heart Institute Foundation in Minnesota, told theheart.org | Medscape Cardiology.

“I was expecting that some interventionalists would feel burned out, but not that 78% would feel they are working too hard, 64% are emotionally exhausted, and 41% considered quitting their job during the past year.

The survey, conducted in January, also showed that while 69% of respondents were affected by burnout, many were either not seeking mental health support or not willing to share whether they are under treatment.

Overall, 28% of interventional cardiologists were not happy with their life, similar to the 29% reported in the Medscape Cardiologist Lifestyle, Happiness & Burnout Report 2022.

“Many institutions have formed task forces to better understand burnout and recommend solutions, but progress has been slow,” Brilakis said. “Barriers include financial constraints, understaffing, lack of understanding of the root causes of burnout in each practice, and perhaps underappreciation of the consequences of burnout.”

The study was published online June 12 in JACC: Cardiovascular Interventions

Too Much Paperwork

The investigators conducted an international, online survey of IC attending physicians and fellows to assess their psychological well-being. The 78 survey questions prepared by the co-authors were shown to perform similarly to the validated Maslach Burnout Inventory.

A total of 1159 attendings and 192 fellows completed the survey, representing 12% of US IC attendings and 19% of US IC fellows.

Half of attending physicians were from the United States, followed by the European Union (16%). Overall, 37% were from academic institutions; the median age was 41-45 years; 91% were men; and mean clinical work hours per week were 63.

Most (86%) had a partner with whom they lived. Yet most (84%) also felt lonely; 41% considered leaving their job during the past year; and 32% said they were currently considering leaving.  

Compared with the previous year, 12% had increased enthusiasm and 44% had decreased enthusiasm toward work. One third (33%) felt overwhelmed and 20% doubted the significance of their work three or more times a week.

As noted, most (78%) felt they were “working too hard,” were emotionally exhausted (64%), and frustrated by work (58%). Almost one third (30%) considered themselves physically unhealthy.

Unhappiness was highest (33%) among 51- to 60-year-olds, followed by 31- to 40-year-olds (31%); it was lowest (21%) among those over age 60.

Unhappiness was similar between men and women (27% vs 30%) and was highest in North America (30%) and lower in Asia (26%).

Most (69%) respondents said that burnout impacted their life, with very little difference between men and women (68% vs 73%).

Two thirds (67%) said they had somebody they could share their mental health concerns with, yet only 37% reported having access to mental health support if needed through their hospital/practice.

For fellows, the median age was 31-35 years; 88% were men; 42% were from the US and 22% from the European Union. Two thirds were from academic institutions (67%) and the mean clinical work hours were 67 per week.

Two thirds (67%) lived with a partner; half (48%) felt lonely, 29% considered leaving their job in the past year, and 15% were currently considering leaving.

Compared with the previous year, 27% had increased enthusiasm, and 32% had decreased enthusiasm toward work. More than one quarter (29%) felt overwhelmed and 26% doubted the significance of their work three or more times per week.

Attendings rated excessive paperwork requirements, bureaucratic tasks, challenges in equipment acquisition, and excessive government regulations higher (in contributing to burnout) compared with fellows.

Non-US attendings reported insufficient income and challenges with equipment acquisition as significant contributors to their burnout more than their United States counterparts.

Fellows rated insufficient income as the most significant contributor to burnout.

Their main coping mechanisms were talking with family/friends (at 6.8 rated on a scale of 0-10), watching movies (6.4), and listening/playing music (6.0).

Attendings were more likely to use exercise as a coping skill, and fellows were more likely to cope by watching movies/series, sleeping, and eating junk food.

Asked what hospitals and practices can do to reduce burnout and improve well-being, attendings suggested removing rules/regulations that do not contribute to patient care, such as reforming prior authorization (mean rating, 8.1), better administrative support (8.0), and professional growth opportunities (7.9).

Non-US attendings more often requested growth opportunities, increased compensation, availability of better hospital food, better hospital infrastructure, streamlined access to equipment, better on-call rooms, and access to mental health professionals to improve their wellbeing.

Overall, fellows were more likely than attendings to request professional growth opportunities and were more likely to ask for availability of better food in the hospital, and better on-call rooms.

Reforms Needed

Laxmi Mehta, MD, chief well-being leader, faculty director of the Gabbe Health and Well-Being Program, and professor of medicine at The Ohio State University Wexner Medical Center in Columbus, noted, “The burnout rates are much higher than our previously reported American College of Cardiology data, which found burnout rates at about 27%; however, that survey was conducted pre-pandemic,” she said. Mehta was the lead author of that 2019 report.

She told theheart.org | Medscape Cardiology that she would have liked to see more breakdowns by gender, and whether there was an association between burnout and the number of procedures performed.

“Nevertheless,” she said, “the rates are very high for burnout, stress, and dissatisfaction, as well as mental health issues. Almost one half of the IC attendings considered leaving their job, which is also seen in other surveys, and is concerning given the projected shortages in the workforce.”

Changes need to be made in the profession of medicine as a whole, she said, though that is unlikely to happen any time soon. “Optimizing workflows and improving the work culture requires not only time, but also collaboration between administration and clinicians, along with an intent and strategic plan focused on well-being of the organization.”

With regard to prior authorization, she said, “medical organizations are advocating for reform at the state and national level. If meaningful reforms can occur, that can reduce some of the bureaucracy. However, there is much more [bureaucracy] in medicine.”

With respect to mental health, she added, “there is a lot that needs to be done to reduce the stigma of seeking help. Many physicians don’t seek help due to the shame, lack of time and potential impact it can have on hospital credentialing and state medical licensing. Medical organizations and individuals are advocating for reforms in this space, as well, to normalize mental health.”

The Minneapolis Heart Institute Foundation’s Science Center for Coronary Artery Disease helped support this research project. Brilakis, study co-authors, and Mehta report no relevant financial relationships.

JACC: Cardiovasc. Interv. Published online June 12, 2023. Abstract

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