Physicians routinely advise their patients on the importance of reducing psychological stress and taking time to relax, and cardiologists have a unique understanding of the link between stress and heart health in particular.1 However, they may find it difficult to follow their own advice, despite the critical need for downtime and high levels of physician burnout.
Among cardiologists, some findings indicate higher rates of burnout compared with other specialties,2 although results on this point have been mixed overall. Survey-based studies have also found that nearly one-half of cardiologists in the United States reported high levels of job stress,3 and more than one-quarter of cardiologists worldwide reported the presence of a mental health condition.4
In addition to the potential value of vacation time for reducing professional burnout, multiple studies have linked adequate vacation time with improvements in various health measures and outcomes, including well-being, heart rate variability, sleep quality,5 incidence of metabolic syndrome,6 and mortality risk.7
One study showed that, even among individuals who diligently engaged in healthy lifestyle behaviors as part of a 5-year cardiovascular risk reduction intervention, those who took shorter vacation time each year had a substantially higher 30-year mortality risk compared with those who took longer vacation time annually (hazard ratio, 1.37; 95% CI, 1.03-1.83; P =.03).7
Taken together, these findings make a strong case for prioritizing personal time off for physicians.
To discuss benefits, barriers, and solutions regarding vacation time for cardiologists, we interviewed Laxmi Mehta, MD, cardiologist and professor, Chief Wellbeing Liaison, faculty director of the Gabbe Health and Wellbeing Program, and director of preventative cardiology and women’s cardiovascular health at The Ohio State University Wexner Medical Center in Columbus; and Amanda D. McCormick, MD, pediatric cardiologist and assistant professor of pediatrics, pediatric heart failure, and cardiac transplantation at the University of Michigan Medical School in Ann Arbor.
Both physicians have co-authored papers pertaining to professional burnout in cardiology,3,8,9 and Dr Mehta was an author of the study on mental health conditions among cardiologists.4
Why is it important for clinicians – and cardiologists in particular – to take an adequate amount of vacation or personal time throughout the year?
Dr Mehta: Burnout rates are higher while work-life integration is lower among physicians compared to the general US working population. The chronic stress and high workloads are taxing, and physicians—just like our patients—need to rest and recharge. Taking time off is an essential component of our physical and mental health and may help reduce burnout. When physicians return from vacation they are rested and have improved performance and productivity.
Dr McCormick: It is well-recognized that employees from all fields benefit from time away from work, and this is no different for clinicians, of course. In particular, clinicians benefit both from being away from the demands of their practice and from the benefits of resilience-building [that comes] from the enjoyment of time away, whether that is time with loved ones, travel, or for other personal enjoyment.
Specific to cardiologists and other high-acuity specialties, vacation may affect 2 specific components of burnout – allowing reprieve from emotional exhaustion and decreasing depersonalization.
What are some of the barriers that may discourage or prevent physicians from taking time off?
Dr Mehta: Some barriers that physicians face are lack of coverage while away, organizational rules on vacation, and compensation models which de-incentivize time away from work.
Dr McCormick: Unfortunately, taking time off can be challenging for physicians. Some contributors may be the need to cancel or find coverage for patient responsibilities or loss of wages for physicians who are on hourly or relative value unite-based compensation models. For physicians in highly specialized careers where there may not be other physicians with their niche, coverage can be a huge challenge.
In addition to these practical things, even for physicians who take time away it may be challenging in the era of email, text message, and the electronic health record (EHR) to actually be “away,” as technology permits communication even when clinicians are on vacation.
What measures are needed on the practice or institutional level to enable and encourage physicians to take adequate personal time?
Dr Mehta: Organizational culture needs to support and encourage physicians and their teams to take vacation time. Furthermore, adequate staffing and coverage are needed as well as compensation models that more appropriately adjust for time off.
Dr McCormick: Institutions and practices need to set the expectation that vacation is a requirement, not an option. The culture of everyone taking vacation promotes marginalized groups, including early career faculty and potentially those from underrepresented minorities, from feeling like they need to be constantly available to promote their careers.
Additionally, the culture of being truly “unavailable”— away from text, email, portal, and EHR during time off – must come from the top down. Further, there should be explicit expectations for what coverage is needed during time away.
What are recommendations for cardiologists to help them prioritize taking adequate personal time?
Dr Mehta: Cardiologists need to recognize that self-care and vacation time are important, and they should ensure that vacation time is adequately accounted for in their contracts. In addition, we need to recognize the importance of time off, advocate for it, and be intentional in using our time off.
It is also important to recognize that vacation time doesn’t mean you need to stress about planning an exotic trip. Just being at home or wherever you like, doing things that you enjoy or spending time with family and friends, is critical recharging time. Self-care is not selfish – it is essential to being the best person and cardiologist that we can be.
Dr McCormick: Coping with a high-demand, high-acuity field like cardiology is a learned skill that we should be teaching in training. Residents and fellows should be taught to be intentional about their vacation time, as time away often requires significant planning ahead. They should also be taught to distance themselves from clinical demands while away.
Finally, for most practices, time away is a matter of reciprocity—if one partner is away, the other partners cover, and vice versa. Having a mindset of coverage for clinical demands for the good of the team, so that in turn you can take time away when planned, improves the whole team’s burnout and resilience.
- Santosa A, Rosengren A, Ramasundarahettige C, et al. Psychosocial risk factors and cardiovascular disease and death in a population-based cohort from 21 low-, middle-, and high-income countries. JAMA Netw Open. Published online December 15, 2021. doi:10.1001/jamanetworkopen.2021.38920
- Patel RK, Sweeney MD, Baker CSR, et al. If not now, when? Enhancing cardiologists’ psychological well-being as a COVID-19 gain. Heart. Published online January 8, 2021. doi:10.1136/heartjnl-2020-318852
- Mehta LS, Lewis SJ, Duvernoy CS, et al; on behalf of the American College of Cardiology Women in Cardiology Leadership Council. Burnout and career satisfaction among U.S. cardiologists. J Am Coll Cardiol. Published online June 24, 2019. doi:10.1016/j.jacc.2019.04.031
- Sharma G, Rao SJ, Douglas PS, et al. Prevalence and professional impact of mental health conditions among cardiologists. J Am Coll Cardiol. Published online 28, 2022. doi:10.1016/j.jacc.2022.11.025
- Hübner M, Lechleitner P, Neumayr G. Effects of a one-week vacation with various activity programs on well-being, heart rate variability, and sleep quality in healthy vacationers-an open comparative study. BMC Public Health. Published online December 27, 2022. doi:10.1186/s12889-022-14838-7
- Hruska B, Pressman SD, Bendinskas K, Gump BB. Vacation frequency is associated with metabolic syndrome and symptoms. Psychol Health. Published online June 17, 2020. doi:10.1080/08870446.2019.1628962
- Strandberg TE, Räikkönen K, Salomaa V, et al. Increased mortality despite successful multifactorial cardiovascular risk reduction in healthy men: 40-Year follow-up of the Helsinki Businessmen Study Intervention Trial. J Nutr Health Aging. Published online September 12, 2018. doi:10.1007/s12603-018-1099-0
- McCormick AD, Lim HM, Strohacker CM, et al. Paediatric cardiology training: burnout, fulfilment, and fears. Cardiol Young. Published online January 24, 2023. doi:10.1017/S1047951123000148
- Mehta LS, Murphy DJ Jr. Strategies to prevent burnout in the cardiovascular health-care workforce. Nat Rev Cardiol. Published online April 16, 2021. doi:10.1038/s41569-021-00553-0
This article originally appeared on The Cardiology Advisor