Building civility, respect and inclusion into the cardiology workplace is essential, especially in an era where burnout is so high, a speaker said at the National Lipid Association Scientific Sessions.

Cardiology Today Editorial Board Member Laxmi Mehta, MD, FACC, FAHA, FNLA, professor of medicine, vice chair of wellness in the department of internal medicine and section director of preventive cardiology and women’s cardiovascular health at The Ohio State University, gave a presentation on how to define and identify physician burnout, how to relate contributors to burnout with discrimination and how to respond to microaggressions.

Dealing with burnout

The signs of burnout include physical and emotional exhaustion manifested in chronic fatigue, insomnia, impaired concentration, reduced attention span, increased illness, loss of appetite, anxiety and depression; cynicism and detachment manifested in loss of enjoyment, pessimism, isolation and detachment; and ineffectiveness manifested in apathy, hopelessness, irritability, lack of productivity and poor performance, Mehta said.

In a 2019 American College of Cardiology survey, the prevalence of burnout among cardiologists was 26.8%, with 49.5% identifying themselves as stressed and only 23.7% saying they enjoyed work, she said.

Compared with those without burnout, those with it were less likely to be married, to feel satisfied with family life, to say they feel treated fairly at their job or valued in their profession and to say they feel their contributions matter, and more likely to say their family responsibilities hinder their ability to work, to be less satisfied with achieving professional goals, to be less satisfied with their financial compensation, to report experiencing discrimination and to recommend cardiology as a career, she said.

In a 2021 paper published in the Journal of the American College of Cardiology, 29% of cardiologists reported experiencing emotional harassment, 4% reported experiencing sexual harassment and 30% reported experiencing discrimination, while 79% reported adverse effects on professional activities as a result of these issues, Mehta said.

Addressing uncivil workplace behaviors

The four main components of uncivil workplace behaviors are bias, discrimination, bullying and harassment (BDBH), Mehta said, noting that components of programs that have successfully reduced them include subject-matter expertise; structures, resources and funds dedicated to addressing those issues; a strategic plan with comprehensive assessments; and organizational and leadership commitment to reducing BDBH.

“Individuals should ensure freedom from BDBH in their own personal behaviors and actions and assist others by practicing allyship and upstander behaviors, and by supporting institutional efforts,” Mehta said. “Individuals should work toward establishing a culture and climate of respect, including elimination of harassment and bullying. The workforce must have, and be able to use, the necessary skills and tools to achieve those goals.”

Moreover, she said, organizations should incorporate assessments of respect and civility into performance reviews, rewarding those who have worked toward reducing BDBH, should have robust training programs about BDBH and should have mechanisms for confidential reporting and investigation of incidents without retribution.

“The framework for a just culture matches the level of response to the degree of the behavioral problem,” she said.

Handling microaggressions

Microaggressions are common in the cardiology workplace, are often caused by implicit bias and “may have the same negative effect on individuals as overt racism and sexism,” Mehta said during the presentation.

“Microaggressions are more prevalent in environments where BDBH is also prevalent and where workforce diversity and inclusivity are low,” she said. “Long-term strategies for reducing microaggressions must include increasing organizational diversity, equity, inclusion and belonging.”

She said the best way to respond to microaggressions is to use the ACTION framework, which stands for Ask clarifying questions, Curiosity instead of judgment, Tell the facts you observed, Intention vs. impact, Own your thoughts/share your reactions and Next steps.

“For professional fulfillment, assessment is key,” she said. “Burnout is the metric and well-being is the goal. Cardiovascular organizations and individuals are responsible for ensuring a safe, supportive and respectful workplace environment.”