CVICU Faculty Sustainability – Methods to Prevent Burnout and Improve Longevity

Pediatric cardiac intensive care has emerged as a distinct specialty over the last fifty years with significant medical, surgical and technological advancements and increasingly complicated patients. While a career in cardiac intensive care (CIC) offers opportunities for professional fulfillment, the demands of 24/7/365 coverage and stresses associated with caring for highly complex patients and vulnerable families weigh heavily upon those who choose to do this important work. Career longevity remains an under-addressed challenge in CIC.

Our team at Stanford has worked to establish a culture focused on achieving personal and professional success by supporting each other at vulnerable times in our careers and lives. This has helped mitigate the stresses of our work when we are least resilient and is predicated upon three principles: optimize individual and team health, support career longevity, and promote a long-term commitment to the needs of the entire faculty group. We believe that everyone at some point during their careers must attend to their personal needs or those of their loved ones. “Payback” is not expected- rather, we “pay it forward.” We also encourage each other to take advantage of sabbatical time offered by the School of Medicine to support professional development and a break from clinical work.

Periodically we re-examine our clinical coverage structure and introduce changes to address pain-points. For example, recognizing the demands associated with 30-hour shifts, we modified the schedule to offer faculty the option to separate day and night service on weekends. The option to choose one’s own weekend schedule helped create our culture of flexibility. With more women of childbearing age entering the field and our desire to create a supportive work environment for new mothers and fathers, we devised a structured approach to parental leave, including ramping down clinical work prior to leave and an incremental increase upon return. Establishing this policy as an expectation removed the burden of individuals having to negotiate schedule changes. Other divisions have expressed interest, and we are facilitating similar guidelines for the entire Stanford Department of Pediatrics. Recently we have also focused on the late career stage, including ramping down of overnight call with clinical efforts being re-focused on mentorship and other Heart Center roles for senior faculty. Specifically, we have planned for discontinuation of overnight, in-house call after age 62 with the opportunity to taper call responsibilities beginning at age 52.

Our innovative staffing approaches have led to improved faculty retention and reduced burnout. To preserve team culture, staffing should reflect the inevitable reality of individuals needing to attend to their personal needs. Administration must accept that lean staffing in a demanding 24/7/365 coverage environment leads to attrition, burnout, suffering of individuals and their loved ones and simultaneously poor patient care. Retention of our most experienced front-line providers and nurses should be similarly valued. Policies and advocacy from professional organizations like PCICS could solidify these career-prolonging philosophies. With thoughtful staffing models and a supportive culture, CIC can be a life-long, fulfilling career.