Abstract
Svetlana Chamoun, MD, PhD, Fellow of the American College of Cardiology (FACC) and a Diplomat of the American Board of Lifestyle Medicine (DipABLM) is passionate about helping health care professionals prevent and address burnout and optimize their health. Dr. Chamoun is also the Founder and CEO of CardioSeeds LLC, an organization dedicated to helping people address the root causes of burnout, restore health and improve systemic challenges in the workplace. In this column she talks about the staggering facts of burnout, how this can be addressed and her journey to realizing the importance of the role of lifestyle medicine.
According to the Medscape National Physician Burnout and Suicide Report in 2022, 42% to 47% of physicians have fallen into burnout's grip. In certain specialties such as emergency medicine and critical care, the prevalence is at 60%. It's a bit lower than during the COVID-19 pandemic itself, but still the numbers are too high, and the ramifications extend far beyond exhaustion. Burnout is a silent catalyst for deteriorating mental and physical health. About 400 U.S. physicians commit suicide every year—more than any other profession, including the military. Burnout creates a sinister web of depression, anxiety, and instigates problems such as cardiovascular disease and a weakened immune system.
As a founding chair of the Work-Life Balance and Cardiovascular Health subcommittee at the ACLM, I often talk and write about the direct effects of job stressors and burnout and the increased incidences of coronary heart disease and sudden cardiac death. A term actually came from Japan. It's called Karoshi, which means death by overwork in Japanese. In the 1970s, there was an oil crisis in Japan and people were working 110 and more hours per week and had sudden cardiac deaths from myocardial infarctions and strokes. In addition to sudden cardiac death, coronary disease, myocardial infarctions and strokes, burnout causes hypertension, hyperlipidemia, obesity because of the changes in appetite, and atrial fibrillation. Some of these conditions are further driven by unhealthy lifestyle choices such as excess alcohol consumption and poor sleep among health care professionals.
So, all of those are paramount physiologic and psychologic consequences. But it also trickles down to patient care. The quality of patient care suffers, and the risks of medical errors escalate and patient satisfaction plummets. Patient outcomes can take a turn for the worse instead of for the better. As we are seeing, there is also an unprecedented turnover among health care professionals. Staffing challenges escalate costs for the health care system. It was estimated that $16 billion is spent in the United States annually on replacing physicians that left the profession. This also breaks the continuity of care for patients.
Confronting and managing burnout demands a robust, multifaceted strategy that embraces individual, group and organizational approaches. The role of a Chief Wellness Officer is a great one to make a lasting impact. But even without that, I believe that doctors can work with their administrators to help with reforms in their workplaces and with leading the change.
If we look at the books of Dr. Tait Shanafelt, who is the Chief Wellness Officer at Stanford Health, he writes that the strategy that addresses the core needs of health care professionals is a threefold process. It involves mitigating the drivers of burnout or decreasing negativity, cultivating a culture of wellness and leadership behavior that nurtures professional wellbeing or increased positivity and involves the individual and organizational resilience.
Beyond the realms of self-care and work-life balance, several key actions can be undertaken in that regard. For instance, establishing and nurturing organizational culture and building what we call the “esprit de corps” or spirit among the collective group of providers. We need to prioritize and instill a culture that cherishes wellbeing and professional fulfillment, not just profits, and of course, we need to maximize efficiency of work. This is very important because teams sometimes are so inefficient that it creates incredible frustration in all the team members. It is extremely important to promote leadership engagement. We must advocate for team-based care, because we know that teams work better than individuals that work in silos, and building networks for peer support and member mentorship is the key. People are afraid to confront the immediate excessive workload policies at their workplaces, but I strongly recommend that they don't hesitate and get involved, otherwise nothing will change.
Investing in education and training is where everything starts, and we must enable our trainees and young health care professionals with knowledge and tools to change the physician culture in the health care system and the workplaces. There are already many toolkits that were put together by various organizations. The American Medical Association created the STEPS Forward Academy. They have online toolkits that are free and accessible for everyone. They have step-by-step guidance workbooks and how to eliminate unnecessary work processes at every health care organization.
I also recommend wonderful books that one must read while addressing burnout, whether it's personal or professional at the workplace. Dr. Tait Shanafelt and Dr. Stephen Swensen, who is the former Medical Director of Leadership and Organization at the Mayo Clinic, wrote a wonderful book that is on my desk now, called Strategies to Reduce Burnout: 12 Actions to Create the Ideal Workplace. There is a wealth of information available about how to proceed for our physicians who really want to step up to the plate and do this. At CardioSeeds, my organization, we also have a wealth of knowledge and tools to make the workplace better. Burnout is such a strong adversary that requires a nuanced response. It can be complex. But if we act together, we have the power to overcome.
Despite the fact that lots of trainees had burnout and stress, I thrived during my fellowship. I loved it and had big plans for the future. However, life had a different plan for me, and I started having back pain after standing for long procedures. I was fortunate enough to have mentors at the program who saw my talents other than interventional cardiology, and they gently guided me towards the field of cardiovascular imaging.
When I embraced this change, I was invited to transfer to the newly established cardiovascular imaging fellowship at Temple University Hospital in Philadelphia, a decision I cherished. In the following two decades, I alternated between the clinical arena, teaching residents and fellows, and cardiac safety for clinical trials. While juggling home responsibilities with two teenage kids and a busy work schedule, I experienced burnout on my first job. One evening, my husband, who is also a cardiologist, handed me a brochure and said, “I think you'll be interested in this.” The brochure detailed the annual meeting of the ACLM. Little did I know that the simple act of attending this conference would pivot the course of my life. I attended the conference and soon after, became a board-certified lifestyle medicine physician and a health and wellness coach. This marked a new chapter in my life and career, where I was not just a physician but a wellness advocate. I began with harnessing the power of the lifestyle medicine pillars to enhance my own mental and physical wellbeing, and to create a healthier work-life balance.
In 2020, this chaotic period in our world happened, marked by the devastating effects of the pandemic. This deeply affected the workplace around me, and my family members and friends who were working as cardiologists and intensivists on the front lines of addressing COVID. So as a board-certified lifestyle medicine physician, I knew that lifestyle alterations could not only prevent but treat and even reverse up to 85% of all of the Western world's chronic diseases, including cardiometabolic issues, cancer and inflammatory conditions—those very conditions that caused the bulk of COVID complications and deaths.
It was during that crisis that I realized the potential of lifestyle medicine to not only prevent chronic diseases but also so many deaths and disabilities related to COVID. Lifestyle medicine is tragically underutilized and underfunded in our country. There is a need for a monumental shift, if we are to prevent our health care system from spiraling into collapse during future pandemics.
Then an epiphany came to me. The burnout that plagued >80% of the health care workers during the COVID-19 pandemic didn't need to happen had the health care leaders made the right choices. I realized, very clearly, the current health care model was unsustainable. It was hovering on the edge of collapse and needed significant reform. Armed with my knowledge of lifestyle medicine, I was struck by the need to contribute to this monumental change. So I felt a newfound purpose in my professional and personal life.
At that moment, I actually made a drastic career change. I bid farewell to my corporate cardiology career and started my own venture, CardioSeeds, with a mission to provide lifestyle interventions and behavioral coaching, aimed at reducing cardiovascular risk and mitigating burnout through the pillars of lifestyle medicine. We also educate our patients and colleagues, including trainees about the virtues of lifestyle medicine and to advocate for our health care workforce.
I also became very active with the ACLM, taking the role of the co-chair for the Cardiology Member Interest Group and then became a founding chair of the Work-Life Balance and Cardiovascular Health subcommittee. This work gives me a platform to speak about the issues related to health care provider burnout, the role of chronic stress and burnout in the pathophysiology of cardiovascular disease. I also provide information and solutions to my colleagues and patients through speaking engagements, Grand Rounds, roundtables, and other means.
So my journey started, as you see, with cardiology, took a detour through cardiovascular imaging and then led me to the path of lifestyle medicine. Throughout all of this, the common thread was the desire to make a difference and to foster public health and wellbeing of health care professionals.
At CardioSeeds, we created a toolkit. Our toolkit is simple yet diverse and powerful. It includes lifestyle interventions, behavioral coaching, and creativity. We offer burnout mitigation strategies to not only our patients, but also to health care providers and administrators. We created a four-week long course that's called RECLAIM by CardioSeeds. RECLAIM stands as a beacon of health restoration and offers a practical and affordable solution for everyone who needs primary and secondary cardiovascular prevention, burnout reduction, advocacy, and even inspiration and career guidance.
We focus on lifestyle interventions, nurturing creativity, and behavioral coaching, which really serves as a life raft for our patients and clients because it makes them self-sustainable and self-reliant. We firmly believe in the power of information dissemination, so we launched the CardioSeeds Podcast along with a YouTube channel.
I volunteer my time to educate patients' families and health care providers about lifestyle medicine and burnout. We work alongside professional societies such as ACLM, using our collective voice to champion and revamp our health care system.
Education is the key in lifestyle medicine. I also believe in the magic of what I call edutainment, where learning and fun come together. I am in the process of creating a line of educational games that spotlight health lifestyles and teamwork. They are interactive games where health care professionals at workplace and families with kids as young as four years old, at home, can learn, engage, and grow together. At CardioSeeds, we educate, advocate, and create. We sow the seeds for healthier and happier families and workplaces.
Practicing holistic care and understanding that physical health is linked closely with mental and emotional wellbeing is important. Learning lifestyle medicine and practicing lifestyle medicine modifications, and offering not only programs at medical schools and the schools of nursing, but also continuing education for lifestyle medicine is essential. It's important because it's proven that those health care professionals who practice lifestyle medicine, not only have better patient outcomes but they also feel happier, more accomplished and engaged.
To Contact Dr. Svetlana Chamoun
Svetlana Chamoun, MD, PhD, FACC, DipABLM
Founder and CEO, CardioSeeds LLC, Bala Cynwyd, PA
Fellow of the American College of Cardiology and a Diplomat of the American Board of Lifestyle Medicine
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Mindfulness and resilience training are essential. In terms of work-life balance, we must stress the importance of personal time, hobbies, relaxation and social connection. We need to encourage patients too, to find the balance between their health management and other aspects of life.
As far as practical solutions, there are multiple. A group of my colleagues and I at the ACLM are publishing an article in Mayo Clinic Proceedings, highlighting the pillars of lifestyle medicine that reduce major adverse cardiovascular events and measure adverse events in general such as diabetes, high blood pressure related deaths and heart attacks, etc.
There are integrative therapies and techniques that are very simple, and there's evidence based research behind them. For example, transcendental meditation reduces the incidence of myocardial infarction, etc. Yoga and breathing techniques can help lower blood pressure and heart rate, and create an aura of mindfulness where a person can better connect to themselves and to the current situation and their mind slows down. Progressive muscle relaxation can be used to improve the quality of sleep and reduce blood pressure and heart rate, and as mentioned mindfulness meditation helps in many ways. So those are very simple therapies or techniques, and they can be done practically anywhere, at any time of the day or night, to reduce stress, and through reducing stress, we can reduce the risk of cardiovascular events.
I encourage clinicians to learn about lifestyle medicine, connect to ACLM, become an ACLM member, learn about the practice of ACLM lifestyle medicine interventions for yourself and patients. Empower patients, guide them towards better health and foster their engagement. At work, champion a team-based approach. In conclusion, never forget that in your quest to deliver the best care for your patients, your health and wellbeing are the flagships that you have to always keep in mind.▪