Author + information
- Akshay Khandelwal, MD, FACC, Chair, ACC Board of Governors∗ (, )
- Laxmi Mehta, MD, FACC, Chair, BOG Task Force on Member Wellness,
- Scott Lilly, MD, FACC, Chair, ACC Membership Workgroup on Wellness and
- Poonam Velagapudi, MD, FACC, BOG Task Force on Member Wellness and ACC Membership Workgroup on Wellness
- ↵∗Address for correspondence:
Akshay Khandelwal, MD, FACC, ACC Trustee and Chair, ACC Board of Governors, 2400 N Street NW, Washington DC 20037.
“So, while I knew what burnout was, I never thought it would happen to me. Even-keeled and rarely stressed out, I perhaps thought I was superwoman and nothing could break me. Burnout carries a stigma as a sign of weakness and since I am not weak, I think my young helper mind couldn't reconcile how burnout could come knocking at my door.”
―Jenn Bruer (1)
Burnout is a syndrome characterized by depersonalization (i.e., cynicism), emotional exhaustion (i.e., fatigue), and a low sense of personal accomplishment while in a perceived stressful environment (2). The prevalence of burnout is higher while satisfaction with work-life integration is lower among physicians compared with the general U.S. working population (3). Burnout can have deleterious effects on the personal and professional lives of clinicians, including alcohol/substance abuse, depression, broken relationships, low quality of care, decreased patient satisfaction, and increased staff turnover, resulting in a substantial negative financial impact on the health system (2).
As a result of the “moral injury” (4) experienced by health care workers, the “triple aim” (lower costs, better patient experience, better outcomes) has been expanded to the “quadruple aim” with the addition of clinician wellness (5). Initiatives to improve clinician wellness need to incorporate resiliency, but equally if not more important, is the necessity to address systemic issues that improve clinician efficiency while reducing unnecessary administrative burdens.
Burnout Among Cardiologists
To characterize burnout among cardiologists, the American College of Cardiology (ACC) included questions specific to burnout and its drivers in the third Professional Life Survey. This study showed that approximately 27% of U.S. cardiologists are burned out, while almost 50% of cardiologists report being stressed with less energy. Burnout rates were higher among women compared with men and among mid-career versus other cardiology career levels. Burned-out cardiologists were more likely to report dissatisfaction with family life, professional achievements, and financial compensation compared with those who were not burned out. Additionally, cardiologists experiencing burnout were less likely to report being treated fairly at work or feeling valued compared with their peers. Lack of control over workload, hectic work environment, misalignment of values, and insufficient documentation time were independently associated with higher rates of burnout (6).
The ACC recognizes the importance of clinician wellness, and as a result the Board of Trustees has incorporated an initiative to improve clinician wellness in its 2020 to 2023 Strategic Plan (7). The following text lists current activities under way within the College.
Membership Work Group on Wellness
In an effort to improve overall physician wellness, the ACC established a Wellness Workgroup in early 2019 within the Membership Committee. Progress within this group has been quick—the charge was drafted and approved and regular communications commenced after ACC’s 2019 Annual Scientific Session (ACC.19). The Wellness Workgroup has collected and cataloged information across all ACC committees regarding current wellness initiatives.
The Wellness Workgroup also drafted and distributed a survey to the ACC membership regarding wellness in an effort to define the incidence and correlates of burnout. We received more than 2,500 responses—an incredible demonstration of how important this issue is to ACC members. The results of this survey are being analyzed and will be presented to the Board of Trustees in January 2019. A shorter, portable version of the survey has also been approved for use in chapters and sections to enable ACC governors, committee and council chairs, and members to take a deeper dive into the issue within identified member subsets.
An online Clinician Well-Being Portal has also been developed on the ACC’s website where you can only track the progress of the ACC’s Wellness Initiative and access resources created within Advocacy, Diversity and Inclusion, and the Board of Governors (BOG) that are salient to cardiovascular professionals and their peers (8).
BOG Task Force on Wellness
In partnership with the Membership Workgroup on Wellness, the BOG Task Force on Wellness was created in the spring of 2019. Its members comprise current and former ACC chapter governors, members of the Early Career Council (ECC), and Cardiovascular Team State Liaisons. The aim of this task force is to elevate the importance of clinician wellness within ACC chapters, provide strategies to incorporate wellness into the professional and personal lives of ACC members, increase awareness of burnout prevalence and the drivers of the burnout among members, and to engage clinicians to advocate for clinician well-being.
A survey of chapters was conducted in May 2019 to gauge current initiatives as well as comments about how the ACC could help its chapters advance well-being and wellness activities. Responses ranged from sharing chapter best practices, to the desire for easy-to-implement resources, as well as toolkits to destigmatize clinician well-being. Because the ECC had already begun work on a chapter toolkit for early career physicians, the BOG task force collaborated with the ECC to create a toolkit with resources to bring wellness solutions to a broader audience of members, including fellows-in-training, cardiologists, and cardiovascular care team members. The toolkit consists of slides on ACC wellness initiatives to incorporate into chapter meetings and a detailed document with resources for wellness. This comprehensive document provides a background on physician burnout, with tools modeled on previous recommendations from the ECC to prevent burnout and promote wellness, and ideas for chapter-level activities and member-level strategies.
In addition, the task force also plans to post case examples regarding best practices for wellness on the American College of Cardiology website. It will share other examples through the Cardiology magazine and newsletters, collectively trying to elevate the visibility of wellness among cardiovascular professionals. The task force will also work to create bidirectional communication with advocacy teams at the state and national levels on initiatives that improve practice efficiency and/or reduce the administrative burden for cardiovascular professionals. Infographics on wellness for use in the office setting will also be created. Ultimately, the task force plans to leverage social media to spread the word on wellness and post short videos of members’ experiences in this realm. The BOG formally adopted the task force recommendations in early November 2019, and is in the process of actualizing these resources.
These are some of the current tactics that the College is employing to tackle burnout and promote clinician wellness. We will need to work together via a multifaceted approach if we are to be successful. A recent opinion piece proposed 6 systematic changes that may translate into improved wellness (9). Below, we have expanded these areas by describing next steps for the ACC, and importantly for each member to absorb, not just for our own health, but also for the health of the organizations in which we work.
• Create positive work environments: Our cardiovascular and administrative leaders in our practices, hospitals, and institutions need to recognize the role clinician wellness can play in not just combating burnout, but also improving patient care and satisfaction. Innovative models of care delivery that are not just financially sustainable but also functionally sustainable, designed with clinician wellness in mind, need to be discussed, developed, and promulgated; this work has already begun within MedAxiom, an ACC company, and with conversations at ACC’s Cardiovascular Summit.
• Create positive learning environments: Wellness is a growing focus within our cardiovascular fellowships and cardiovascular care team training programs that needs further development and actualization. The ACC has taken a leading role in continuing that education for its members at various chapter meetings and the Annual Scientific Session; we must reach out to our less engaged colleagues and administrators and enlighten them on the science and substance of wellness.
• Reduce administrative burden: Many clinicians note that it is not time spent in clinical care that creates burnout, but rather the unnecessary administrative work that often accompanies it. As emphasized in the just-concluded Legislative Conference, the ACC must continue to advocate for prior authorization reform and reduction of other administrative burdens from payers that threaten members’ well-being.
• Enable technology solutions: The ACC is committed to championing the digital transformation of aligned technologies, including electronic health records reforms and interoperability, which will improve clinical wellness at the point of care. As cardiovascular content experts, the College recognizes that we need to embrace digital transformation ourselves to allow for the seamless integration, dissemination, and application of knowledge, as well as easier integration of data into our NCDR that allows for immediate, actionable intelligence.
• Provide support to clinicians and students: By increasing our relevance as the cardiovascular professional home, we create a safety net of interpersonal connections that address and improve member mental health. It is incumbent on each one of us to work within our home practices and hospitals to create new culture, infrastructure, and solutions to support our mental, emotional, and physical well-being.
• Invest in research: By responding to the ACC’s member well-being survey, you will not only assess your own level of wellness, but also contribute to our understanding of wellness within our cardiovascular community that can be tracked over time. To promote wellness, we must advocate for continued investments in state and federal agencies to fund the necessary research.
As the concept of clinician wellness has gained traction across the house of medicine, the ACC has undertaken extensive efforts to identify the sources of burnout, and to establish meaningful interventions that address this for cardiovascular professionals. These efforts are broad-based and have been prioritized by ACC leadership. Although many of the successes in this space may emanate from strategy sharing or partnerships with other medical societies, the wellness initiative within the ACC represents the only one focused specifically on cardiovascular professionals, and represents a major financial, cognitive, and effort-based investment for all ACC members.
|Special thanks to the BOG Wellness Task Force members:|
|Laxmi Mehta, MD, FACC (Chair)|
|Craig Beavers, PharmD, FACC (Task Force CV Team Liaison)|
|Jason Cole, MD, FACC|
|Sanjay Gandhi, MBBS, FACC|
|Dan Friedman, MD, FACC|
|Jeff Marshall, MD, FACC|
|Andy Miller, MD, FACC|
|Pranav Patel, MD, FACC|
|David Perloff, MD, FACC|
|Beth Quick-Andrews, CAE (Task Force Chapter Executive Liaison)|
|Chad Teeters, MD, FACC|
|Ed Toggart, MD, FACC|
|David Wohns, MD, FACC|
|Poonam Velagapudi, MD, FACC|
|Stephanie Mitchell (ACC staff)|
|Marthea Wilson (ACC staff)|
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