For many residents entering their fellowship training, burnout has become an unfortunate and, sometimes, unavoidable reality. The cardiology specialty presents its own unique challenges apart from those experienced in internal medicine residency – stressors that can leave even the most confident individual needing more time to unwind and regroup. Physicians suffering from burnout are less likely to deliver compassionate care, becoming desensitized to patient care as work-related stress increases. With burnout also comes emotional exhaustion and less feeling of accomplishment, making for a less productive workplace and reduced patient satisfaction, according to a recent post on the Health Affairs Blog1. Julie B. Damp, MD, FACC, chair of the Cardiovascular Training Section (learn more about Damp on page 21), states that “burnout during residency and fellowship has significant implications related to patient care and long term career satisfaction and productivity. We know that it is prevalent at all levels of medical training and practice.” Current research shows that more than half of internal medicine residents report experiencing burnout, and approximately 350 physicians die by suicide each year – one of the highest rates compared to other professions. Just last fall, Time magazine reported that the demands on physicians are only expected to grow as the shortage of physicians in the U.S. reaches an estimated 90,000 physicians by 20252. In addition to several thousand dollars of medical school debt and long hours spent with a high volume of patients, cardiology fellows face the added demands of working in one of the most competitive fields in medicine. In terms of patient care, cardiologists newer to the field are also now tasked with higher demands for primary prevention, tackling the number one killer in the U.S. – cardiovascular disease. "Transitioning from senior resident to cardiovascular fellow can be challenging and may often be complicated by burnout, which is not uncommon in the first year of fellowship,” states Konstantinos Siontis, MD, a fellow in training (FIT) at the University of Michigan in the division of cardiovascular medicine. “Adjusting to a new environment and a new institution, keeping up with a hectic clinical schedule, and the heightened level of expectations and responsibilities can all impact a trainee's morale.” A recent FIT and Early Career Page by Oral A. Waldo, MD, an FIT at the Mayo Clinic, published in the Journal of the American College of Cardiology (JACC), recommends the “three R’s” – relaxation, reflection and regrouping – as a strategy to avoiding burnout during fellowship. “Cardiology FITs are so keen to increase their productivity and attain new heights in the profession that they frequently forget to take time to replenish themselves,” states Waldo. “There is no doubt – it is best to avoid burnout rather than [to deal] with it.” Siontis adds that, “while there is no specific recipe for preventing and dealing with burnout, my fellowship program has taken deliberate steps in that direction by ensuring a balance between clinical service duties and education, organizing frequent social events for the fellows and by providing support on a personal level when needed. Outside of the work environment, dedicating quality time for family and friends has also been key in preventing burnout." Michael W. Cullen, MD, FACC, a member of the Early Career Section Leadership Council and past chair of the FIT Section, echoes these words of advice. “Fellowship can be a difficult time, and it’s easy to burnout,” he said. “Maintaining connections with both peers at work, old friends outside of work, and close family members is probably the most important way to limit burnout.” In addition to finding time to step away from the stress of fellowship, FITs experiencing burnout should also look to their training programs and their respective directors for help. As Martin E. Goldman, MD, FACC, writes in his response to Waldo’s JACC article, reflecting on the rewards of a career in cardiology will provide balance to the stress that comes with it. “Although cardiology is uniquely stressful, the field is also distinctly gratifying in its ability to intervene and immediately reverse a patient’s terminal illness,” he explains. Cullen expands upon the rewards of cardiology, stating that “despite the amount of work we’re doing in fellowship, we all gain satisfaction from parts of our job, whether it’s seeing patients with certain clinical conditions, completing research projects or cultivating professional interactions. Identifying those things that spark your inner passions and pursuing them with vigor will be incredibly important to limiting burnout, not only in fellowship, but also in your future career.” According to Damp, educators should be aware of burnout and be proactive in addressing it in their training programs. “First, we can educate our fellows about burnout and its signs,” she explains. “We can also make modifications that can decrease the risk of burnout such as ensuring appropriate workload levels, providing mentoring, addressing work environment stressors, and providing trainees with some input and control in their work environment. Training programs can also emphasize individual wellness and provide support when necessary to help individual fellows achieve this.” Citations: 1. Shin, Andrew. “Make the Clinician Burnout Epidemic a National Priority.” Health Affairs Blog. 21 April 2016. Web. 27 April 2016. 2. Oaklander, Mandy. “Doctors on Life Support.” Time. 7 Sept. 2015: 44-50. Print. The following resources are available for medical residents and FITs looking for more information on avoiding or managing burnout: • The 3 “Rs”—Relax, Reflect, and Regroup: Avoiding Burnout During Cardiology Fellowship J Am Coll Cardiol. 2015;66(11):1303-1306. Doi:10.1016/j.jacc.2015.07.054 • Physician and Medical Student Depression and Suicide Prevention, AFSP.org • American Medical Association Steps Forward Initiative, StepsForward.org Learn more about the Fellows in Training Section at ACC.org/FIT.
Published by American College of Cardiology. View All Articles.