The Mental Health of Cardiology Fellows in Training

Pursuing a career in cardiology demands diligence, sacrifice, and perseverance. As trainees transition from residency to cardiology or advanced fellowships, these sacrifices—personal, familial, and financial—become more pronounced, typically lasting 3 to 5 years, until the big day of becoming an attending physician arrives. Yet during this journey, the impact on mental health often goes unrecognized, despite its profound importance. Data from the recent British Junior Cardiologists’ Association survey revealed that 76% of trainees reported burnout, with depression affecting 25% and clinically significant anxiety affecting 18%.¹ These statistics underscore the mental health challenges many trainees face and the critical need to prioritize support within training programs.

The demanding nature of a career in cardiology often requires working at least 10 hours a day. Although this work is rewarding, it can create an imbalance between personal and professional life, even for physicians who manage tasks efficiently. Being an efficient clinician does not necessarily ensure balance, however; rather, achieving balance requires a proactive approach to personal well-being.

Early signs of mental health struggles may be masked by traits that fellows take pride in, such as resilience, determination, and passion. It is crucial to recognize subtle changes in behavior that family, friends, mentors, or the fellows themselves notice. Addressing these signs early can prevent them from escalating, reinforcing that maintaining optimal mental health is as critical to personal well-being as it is to clinical performance and focus.

Taken together, these observations indicate that burnout in fellowship is multifaceted, with self-care often side-lined because of numerous challenges, including time management; stigma; and external factors such as personal relationships, financial stress, genetics, and environmental influences. A qualitative analysis conducted in the Pediatric Cardiology Fellowship Program at Boston Children’s Hospital revealed that trainees often identified failure or disappointment (78%), challenges in balancing personal life (74%), and emotional exhaustion (61%) as substantial fears.² These concerns illustrate how personal and professional pressures play a role in the complex nature of burnout during fellowship.

Beyond these stressors, systemic challenges—such as billing and the demands of being on call, often every fifth day or at least 1 weekend per month—further compound burnout. The financial strain of accumulating debt throughout medical training adds another layer of stress, particularly for fellows who are balancing loan payments with the cost of living. For some, challenges such as gender disparities and discrimination in the workplace exacerbate these difficulties, highlighting the need for an inclusive environment in fellowship programs.

Recognizing these challenges, trainees must prioritize proactive strategies for maintaining balance, such as dedicating time to family, hobbies, or rest. Seeking mental health therapy may also be a necessary and impactful step. Ignoring signs of mental health struggles would be akin to disregarding an elevated glycated hemoglobin level or an abnormal cardiac stress test result, yet within the medical profession, addressing mental health can feel less straightforward. Health care workers have historically faced irrational stigma for seeking therapy for mental health concerns. Concerns about judgment from peers or supervisors and perceptions of weakness often deter trainees from seeking help, creating barriers to accessing care. Programs can address these challenges by emphasizing confidentiality and fostering trust among trainees.

Fortunately, with the increasing efforts of the Accreditation Council for Graduate Medical Education to ensure trainees’ wellness, outdated attitudes toward mental health therapy have steadily been declining. Many programs now require annual lectures on mental health and sleep deprivation and provide confidential mental health services for their employees. Finding the right mental health specialist involves more than just expertise; it requires a meaningful connection, essential for effective care. Recognizing this need, some programs partner with specialists to address challenges such as burnout, “imposter syndrome,” and the pressures of managing clinical duties alongside personal responsibilities. In 2017, a large academic medical center introduced a mental health program for trainees designed to eliminate common barriers to care, such as concerns about cost, privacy, and session limits, while offering flexible delivery options.³ Over 4 years, the program saw substantial engagement, with a 2.2-fold increase in trainees accessing services and a 2.4-fold rise in total visits, emphasizing the importance of accessible and well-structured mental health resources for trainees.³

Even with access to mental health resources, however, stress often peaks at key transition points. Such transitions include the beginning of fellowship training, when inexperience and new responsibilities feel over-whelming, and the transition to life as an attending physician, when clinical and administrative expectations are amplified. Gradual stress accumulation from external factors such as family obligations and financial strain further compounds these challenges. Identifying specific stressors and seeking support early can prevent feelings of imbalance or emotional exhaustion from escalating. Taking advantage of structured resources and peer support can help trainees navigate these transitions more effectively and maintain their well-being.

Nurturing mental health is not just about coping with stress; it is essential for sustaining a rewarding long-term career in medicine and achieving personal and professional growth. Balancing the demands and pressures of cardiology fellowship is a shared experience that underscores the importance of a strong support system. A variety of resources, including confidential counseling services and peer support programs, are available to help manage internal struggles and build resilience. Embracing these resources can make a meaningful difference in navigating fellowship and laying the foundation for a fulfilling career in medicine.