My mother, despite being married to and raising two physicians herself, continues to ask when my hours will improve to accommodate my toddler's lifestyle. "You'll be working 9-5 as an attending, right?" Yet, the dreams of a more "normal" work schedule, following years of training and overnight calls, remain elusive as we move closer to the finish-line and become privy to the reality of the demanding schedules of an attending cardiologist. When medical students and residents considering careers in cardiology hear about these realities, they often shy away from the field. Only 20% of cardiology applicants are women, a number that has remained stagnant for over a decade, despite an increase in the proportion of women in internal medicine to almost 50% of matriculants.¹

Yet, this is not just about women. Cardiologists, male and female alike, face high rates of burnout and work one of the highest number of hours worked annually compared to other medical specialties.^2,3 Senior cardiologists, a golden asset to our medical community given decades of experience, often leave the field earlier than desired due to inflexible demands of in-hospital call and limited part-time positions. New parents are faced with choices of missing the most demanding but dependent years of their children's lives vs sacrificing career advancement. Mid-career cardiologists with aging parents may face difficulty in attending to both full-time work and family responsibilities. While the time that we require career flexibility may vary based on our individual circumstances, the need remains a constant truth for our well-being.

The ACC's Health Policy Statement on Career Flexibility in Cardiology, published Oct. 13, 2022 in JACC, is a pivotal and perhaps overdue call for change in the culture of our field. As they state explicitly, workplace flexibility does not necessarily assume a desire for fewer work hours, but rather "autonomy and ability" in alternative setting, type, and schedules of work schedules. We are in an era where eight out of 10 people are working in either hybrid or completely remote work models, a clear cultural change in a world transformed by the pandemic.⁴ In this modern age, the prospect of the traditional full-time, in-person uninterrupted job begins to look bleak to both current and future trainees.

The beauty of this statement, however, is that it offers practical solutions, rather than simply calling attention to the problem. It also acknowledges benefits to patients and health systems, by going beyond the traditional norms of the current hospital environment. What if instead of spending the full day in the echo lab, a cardiologist could work in shorter shifts, extending the availability of imaging for patients and hospital services beyond traditional hours? That physician might gain the benefit of being able to drop their children to school in the morning, help their aging parents with morning tasks, or perhaps just enjoy a morning run, rather than forcing themselves on the treadmill after a full workday in the winter. What if those who choose to work part-time during their child's early demanding toddler years, were unencumbered by the demands of traditional tenure timelines, and had options to "lean in" for promotion during their later years? What if fellowship training shifted away from time-based requirements and towards competency, allowing for more flexibility during the full decade of medical training required for cardiology? What if clinical faculty, working at academic institutions, had the same access to sabbaticals to explore novel interests and provide a break in the typical daily grind of an academic physician?

There are certain demands that the field of medicine makes that are immutable – we need to evaluate our patients in-person, we need to drive their clinical trajectory forward by making day-to-day decisions, we need to diagnose and perform procedures to address cardiac pathology. Yet, there are opportunities in a world that is connected by ever-advancing technology to make our work environments less rigid. It's time that medicine, especially the field of cardiology, caught up to the rest of the workforce – this document tells us both why and how.

1. Mehta, L. S., Fisher, K., Rzeszut, A. K., Lipner, R., Mitchell, S., Dill, M., Acosta, D., Oetgen, W. J., & Douglas, P. S. (2019). Current Demographic Status of Cardiologists in the United States. JAMA cardiology, 4(10), 1029–1033. https://doi.org/10.1001/jamacardio.2019.3247
2. Mehta L.S., Lewis S.J., Duvernoy C.S., et al. "Burnout and career satisfaction among U.S. cardiologists". J Am Coll Cardiol 2019;73:3345-3348
3. Walsh M, Arrighi J, et al. 2022 ACC Health Policy Statement on Career Flexibility in Cardiology. J Am Coll Cardiol. 2022 Nov, 80 (22) 2135–2155.
4. Wigert, B and Agrawal, S. Returning to the Office: The Current, Preferred and Future State of Remote Work. Gallup. August 31, 2022, https://www.gallup.com/workplace/397751/returning-office-current-preferred-future-state-remote-work.aspx.

This article was authored by Mili Mehta, MD, a cardiology fellow at University of Pennsylvania. She will be joining Tufts Medical Center next summer for Advanced Heart Failure and Transplant training. Twitter: @milimehtamd