How to prevent burnout in cardiologists? A review of the current evidence, gaps and future directions.

Abstract
Burnout is rising in all physicians and cardiologists are not an exemption. Cardiology is a very popular specialty among medical students as it is associated with outstanding training standards and high prestige and income. In this review, we critically summarise the evidence on consequences, causes, and evidence-based interventions for burnout with a view towards recommending the best strategies for promoting wellness in cardiologists. Only a handful of studies have examined burnout specifically in cardiologists. Evidence therefore was mainly extrapolated by larger studies in all physicians and other physician specialties. Burnout in cardiologists has serious negative personal and professional consequences and is associated with suboptimal healthcare outcomes for patients. Burnout in cardiologists is primarily driven by professional and healthcare system demands and inefficiencies such as excessive workload and role complexity, training and certification demands, inefficient compensation models and lack of resources, computerisation and loss of autonomy. Moreover, loss of connectedness with patients, difficulties in balancing work and personal life and overvaluing compulsiveness and perfectionism in medical practice further increase the risk for burnout. Burnout among cardiologists may be best mitigated by organisational strategies complemented by individual stress reduction and reflection techniques under the resilience-based approach. Large-scale strategies are needed to mitigate burnout promote physician wellness as a shared responsibility of healthcare systems and individuals and be committed in creating a new culture in medicine.