Recognizing and Managing Physician Burnout in Oncology

A new ASCO survey attempts to understand why physicians experience burnout more often than other professionals.


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Caring for patients with cancer can be extremely rewarding, but also one of the most demanding and stressful areas of medicine.

—Tait D. Shanafelt, MD, and Lotte Dyrbye, MD

Although job burnout occurs in all professions, it is more common among physicians, according to a study published recently in Archives of Internal Medicine.1 Physicians on the front line of care, such as those working in emergency rooms or in family medicine, experience the highest rates of burnout.

The research, led by Tait D. Shanafelt, MD, Director of the Mayo Clinic Department of Medicine Program on Physician Well-being, compared 6,179 practicing physicians ages 29 to 65 with a probability-based sample of 3,422 U.S. workers of the same age group in other fields. Of the nearly 7,300 physicians who answered questions about their work/life balance, 45.8% reported at least one symptom of serious burnout, such as emotional exhaustion (loss of enthusiasm for work) or depersonalization (high degree of cynicism).

Findings in Oncologists

An earlier article coauthored by Dr. Shanafelt and Lotte Dyrbye, MD, in the Journal of Clinical Oncology (JCO)2 reviewed the problem of burnout among all oncology specialties. According to the article, studies show the prevalence of burnout is between 25% and 35% among medical oncologists, between 28% and 36% among surgical oncologists, and 38% among radiation oncologists.

The authors acknowledged that caring for patients with cancer can be extremely rewarding. However, they wrote, “caring for patients with cancer can be one of the most demanding and stressful areas of medicine.”

They noted that the constant life-and-death decisions oncologists must make, administration of therapies that have high levels of toxicity, limited ability to prolong life for many patients, a median of 63-hour work weeks, increasing productivity requirements, the constant bombardment of new information and new regulations, loss of autonomy, and a reduced work/life balance all take a physical and mental toll that can lead to depression, damaged relationships, alcohol abuse, and suicide.

The suicide rate among physicians is higher than other professionals—approximately 300 to 400 physicians commit suicide each year, according to the JCO article. That number “equates to the entire graduating class of three to four U.S. medical schools.” In addition to the personal distress, feelings of burnout can also lead to more medical errors and is one of the leading reasons physicians decide to leave their current practice or retire early.

“Burnout is a manpower issue because if more people decide not to specialize in oncology or if you are losing oncologists from burnout, you end up with an aging population and fewer oncologists [to treat them when they get cancer],” said Carolyn D. Runowicz, MD, Member, ASCO Board of Directors, and Executive Associate Dean for Academic Affairs and Professor of Obstetrics and Gynecology at Florida International University, Herbert Wertheim College of Medicine, Miami.

Physician Wellness Survey

Whether symptoms of burnout among oncologists are more prevalent now than in the past is not known, but the problem is becoming an increasing concern for the medical profession. Thus, ASCO is collaborating with Dr. Shanafelt to conduct a Physician Wellness survey of 3,000 medical oncologists and 1,500 oncology fellows. The survey of medical oncologists is focused on their professional activities, level of work satisfaction, and compensation. The survey of oncology fellows focuses on their career intention after completing training and quality-of-life issues. The surveys were mailed in October, and the results are expected to be published in spring 2013.

“We decided to initially focus on medical oncologists rather than radiation oncologists and surgical oncologists because medical oncologists are a more homogeneous group of individuals,” said Michael P. Kosty, MD, Director of the Scripps Green Cancer Center in La Jolla, California, and a member of ASCO’s Workforce Advisory Group. He represents that group on the Society’s Physician Wellness Steering Committee. “We also wanted to survey fellows in training to see how, as they transition to different points in their career, their perceptions of their career evolve and when burnout first starts to occur. We’re also looking at what work situations seem to lead to burnout with a higher degree of frequency and, conversely, whether there are work situations that reduce the likelihood of somebody developing physician burnout.”

The goals of the survey, said Dr. Kosty, are to get a clearer understanding of the causes of oncologist burnout and of why some oncologists are more susceptible to the problem than others. In addition, the group seeks to define strategies to mitigate or prevent burnout.

“We think we have an idea based on older surveys on burnout and from surveys looking at surgeons with burnout that the problem is not uncommon, but we are trying to quantify the phenomenon. Then I think we can present the data to our membership and say, ‘these are the risk factors’—whether it is the amount of time the oncologist has been in practice or, more likely, the amount of job satisfaction. And then we hope to say, ‘these are the medical practice situations that are less likely to result in burnout, and here are strategies that long-time practitioners without burnout have used to try to mitigate the problem,’” said Dr. Kosty. ■

Disclosure: Drs. Shanafelt, Runowicz, and Kosty reported no potential conflicts of interest.

References

1. Shanafelt TD, Boone S, Tan L, et al: Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 172(18):1-9, 2012.

2. Shanafelt T, Dyrbye L: Oncologist burnout: Causes, consequences, and responses; J Clin Oncol 30:1235-1241, 2012.

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