Oncologists Warned-Don't Take Burnout Lightly

Andrew Smith
Published: Wednesday, Aug 27, 2014
Dr. Anthony L. Back

Anthony L. Back, MD

In ever-growing body of research confirms what many oncologists have long suspected: the stresses of their profession produce an alarming rate of burnout.

These findings bode ill, not only for the nearly half of all oncologists who suffer symptoms of the condition, but also for cancer victims. Studies show that burnout increases medical errors and shortens patient lives. Worse, it may spur enough early retirements to exacerbate a looming shortage of cancer specialists.

Some employers have begun to experiment with anti-burnout initiatives, but it’s far too early to say what specific top-down policies, if any, can reduce the burnout problem in a cost-effective way.

There are, however, approaches that individual professionals can use to help themselves now while research teams refine their understanding of what causes burnout and what mitigates it.

Taking Burnout Seriously

“The bad news is that a serious problem exists. The good news is that we’re finally taking it seriously. We’re doing more research and, perhaps more importantly, we’re finally paying attention to the research and thinking about how to address burnout,” said Anthony L. Back, MD, a University of Washington oncology professor who is one of the most cited authors on doctor burnout.

Burnout among oncologists in particular has attracted renewed attention of late, thanks to a large survey and analysis that appeared earlier this year in the Journal of Clinical Oncology.1

A research team led by Mayo Clinic professor Tait D. Shanafelt, MD, repeatedly asked 2298 oncologists (whose demographics mirrored those of the profession as a whole) to complete a 60-question survey. More than a third of them (1117) eventually answered all the questions, and nearly half (1490) provided some response.

In some ways, satisfaction levels appeared high. More than 80% of all responders said that if they could start life over and choose any career, they’d choose oncology all over again.

In other ways, however, the picture looked bleak. The survey answers provided by 484 oncologists (44.7% of those who answered the relevant questions) indicated some degree of burnout on the emotional exhaustion and/or the depersonalization domains of the Maslach Burnout Inventory, a widely used questionnaire that provides a standardized measurement of burnout.

Among those who study burnout, those dispiriting numbers came as no surprise. Prior surveys of both individual specialties and physicians as a whole have made similar findings.

Indeed, a 2-year-old national study based on 7288 surveys concluded that a virtually identical percentage of the nation’s total pool of doctors (46%) was suffering from at least some symptoms of burnout.2 A sub-analysis of that study, which was also led by Shanafelt, actually suggested that oncologists suffered significantly less burnout than other doctors, but the tiny number of oncologists in the study limited the strength of that finding.

Affecting Physicians and Patients

Such high burnout rates pose numerous problems for both doctors and their patients.

Even mild cases of burnout can make people miserable, and severe cases often lead to serious health issues that range from anxiety or depression to alcoholism or even to suicide.3,4

Burnout also reduces productivity and increases error rates. One study of surgeons in the United States found a very strong correlation between survey answers that indicated burnout and admissions of significant mistakes in the prior 3 months.5

Every additional point that a surgeon scored on a 33-point scale measuring patient depersonalization (one of the 3 big components of burnout) was associated with an 11% increase in errors reported. Every additional point on a 54-point scale of emotional exhaustion was associated with a 5% increase in errors reported. A longitudinal study of residents found a similar correlation between burnout and/or distress and errors, and that study noted that the burnout preceded the errors.6

Doctor burnout may also lead to—or at least worsen—future shortages of cancer specialists. The American Society of Clinical Oncology predicts that, if current trends continue, demand for oncologists will grow 42% by 2025 but supply will grow by only 28%.

The result, according to the organization, will be a shortage of nearly 1500 oncologists.7

If burnout rates lead to an unexpectedly high number of early retirements, that shortage could be far worse than predicted, and studies consistently show that burnout does lead people to retire early or, in some cases, to switch careers while they are still young.8,9

General research into burnout among all types of American workers suggests that at least part of the problem for oncologists lies not in the specifics of medical work but simply in the increasingly stressful nature of modern life.10 Burnout has been on the rise among nearly every subset of Americans in the past decade.

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