• Cardiovascular Disease Fellowship Program Directors Report High Stress and Burnout Rates – Survey

    17% are considering quitting in 2022

    Stress and burnout remain common issues among directors of cardiovascular disease fellowship programs, particularly for women, early-career directors and those in charge of larger, university-based programs, a survey has found.

    Notably, 17% of program directors reported a high likelihood they would resign next year, with the most common reason being that their tasks were becoming “overwhelming.”

    The third annual Cardiovascular Diseases Fellowship Program Directors Survey was published Monday online, ahead of the Oct. 26 issue of the Journal of the American College of Cardiology.

    The researchers – led by Mayo Clinic’s Michael W. Cullen, MD – called for more efforts to mitigate dissatisfaction, stress and burnout among these experts.

    Physician burnout is a common and growing phenomenon affecting upwards of 50% by some measures, the researchers said, citing data showing burnout rates of 27% to 46% in cardiologists specifically. The issue is critical not only for the sufferer, but also for patients and the healthcare system as a whole, they warned.

    Despite the growing problem, data on burnout among U.S. cardiologists remain limited, they said, adding that even less is known about the well-being of directors in cardiology fellowship programs.

    The 34-question survey – open between May 19 and July 16, 2020 – contained eight questions specifically focused on cardiovascular program director burnout, with the rest addressing demographic information on trainees and leadership.

    Program directors from 141 of the 247 eligible programs (57% response rate) completed the survey, the majority of whom were male (78%), white (59%) and from university-based programs (54%), after which 41% were from community programs. The median duration in their current position was 5 years, and most directors were either associate or full professors (68%).

    Although the respondents largely said they had job satisfaction as program director (80%) – with 96% identifying interactions with fellows as a driver of their satisfaction – 45% said they feel a “great deal of stress” from their job.

    A further 21% reported some symptoms of burnout, while only 36% reported enjoyment of their job without stress or burnout, with more men and late-career directors giving this response. .

    Of the 45% who agreed they felt a great deal of stress from their job, 18% strongly agreed with the statement. Rates of strong agreement were higher in women than men (23% vs. 16%, respectively), as well as in early versus mid and late career directors (24% vs. 20% vs. 9%, respectively).

    The directors of large programs were also more strongly associated with feeling great stress than those for medium and small programs (25% vs. 21% vs. 8%, respectively), as were directors for university programs compared to community-based counterparts (21% vs. 12%, respectively).

    Men more commonly felt they had adequate support from leadership than women directors (45% vs. 29%, respectively), as did those in later careers compared to mid and earlier career directors (56% vs. 35% vs. 35%, respectively).

    Those in smaller and medium programs also said they felt more supported than those in large programs (50% vs. 40% vs. 33%, respectively), while community-based directors felt better supported by leadership than university directors (50% vs. 36%, respectively).

    Similar patterns were seen regarding adequate administrative report.

    “Reports of stress related to the PD role were common,” the researchers concluded. “Many PDs did not report sufficient time for their PD responsibilities.”

    They added that: “Concerns regarding limited administrative support and burdensome regulatory requirements unique to fellowship PDs remain.”

    In an accompanying editorial, Jeffrey T. Kuvin, MD, Zucker School of Medicine at Hofstra/Northwell Health, and Jonathan Halperin, MD, Mount Sinai Medical Center, stressed that the role of program director is critical to trainees, departments, hospitals and “the entire profession of cardiology.”

    “We must remember that [program directors] are ultimately responsible for educating the next generation of cardiologists,” they stressed, warning that: “Burnout is present, real, and must be addressed, perhaps with a different approach to that provided for general cardiologists.”

    The editorialists went on to insist that helping directors to keep up with demands will require “constant analysis to provide support, dedicated time, effort, and funding to limit burnout and ensure stability in training programs,” urging that an effective and committed workforce of program directors is “the best chance we have to develop outstanding cardiology clinicians and leaders of the future.”


    Cullen MW, Damp JB, Soukoulis V. Burnout and Well-Being Among Cardiology Fellowship Program Directors. J Am Coll Cardiol 2021;78:1717-1726.

    Kuvin JT, Halperin J. Cardiology Fellowship Program Director Wellness: The Future Depends on it. J Am Coll Cardiol 2021;78:1727-1729.

    Image Credit: wutzkoh – stock.adobe.com

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