Sarbajit Mukherjee, MBBS
Recalling the emotional exhaustion of his early months on the job, University of Oklahoma oncology fellow Sarbajit Mukherjee, MBBS, wrote an article exhorting colleagues to acknowledge the issue of burnout among oncology fellows.
"The first and most important step toward solving this problem, as with any other problem, is to acknowledge that it exists," Mukherjee wrote in the 2016 Asco Connection story.1
Since the 1970s, when psychologists began publishing research on developing language for occupational burnout, conversation about the phenomenon has grown. Mukherjee's article referenced a study published in 2014 indicating that about 40% of first-year oncology fellows experience burnout.2
The same year, results of another study indicated that 44.7% of practicing oncologists show signs of burnout.3
Citing “a clear need for interventions,” ASCO promised to continue the conversation, primarily by studying and hosting public discussions on the issue.4
But while psychologists have identified many of the causes and effects of burnout, practicalities often complicate the process of fighting it at independent oncology practices, said Robin Zon, MD, of Michiana Hematology Oncology in Elkhart and Mishawaka, Indiana, in a recent interview with Oncology Business ManagementTM
Burnout is often caused by too much work, which can be linked to inadequate staffing, Zon said. Psychologists identify “a persistent imbalance of demands over resources” as a perennial cause of burnout, as a 2008 research paper put it.5
Demand for oncology services is growing. In 2016 an estimated 1.7 million new cases of cancer were diagnosed, up 2% from 2015, according to ASCO. Cancer was the leading cause of death in 22 states in 2016 and is projected to overtake cardiovascular disease as the leading cause of death by 2020, ASCO said.6
“There will be a deficit of oncologists and a surplus of patients. Burnout is part of that whole formula and needs to be paid attention to,” Zon said. Burnout is also often associated with nonproductive work, such as “administrative burden, authorizations, pre-authorizations, notes,” said Linda Bosserman, MD, a medical oncologist at City of Hope in Rancho Cucamonga, California, speaking to OBM
“There’s a potential for increased burnout because of increased regulations. Doctors are starting to do more and more secretarial work just to prove that we’re quality doctors. On top of that, we’re looking at an increased number of cancer patients and survivors, and now we’re dealing with a workforce shortage,” Zon said. “It’s a real concern, because if you’re looking at a shortage already, and doctors are going to have to work harder, what are you going to do?”
What practices can do depends upon the resources available to them, Zon said. Practices can support mitigating strategies such as self-care and an understanding atmosphere regardless of size, but those tactics address burnout’s effects, not its causes.
Larger practices can hire more support staff to take on administrative work, giving oncologists more freedom to focus on patient care, Zon said. If they can afford it, individual oncologists can also try hiring scribes, as she and others at her practice have done.
Overall, “the cultural changes needed to fight burnout are multifaceted. Does a practice have the resources to support the delegation of tasks? Your resources are becoming leaner and leaner, so how are you going to have the resources to hire more people if your reimbursement is going down?” Zon asked.
A Larger Practice Weighs In
Florida Cancer Specialists (FCS), a large network of community practices spread across Florida, has been able to take some of the pressure off its physicians by delegating responsibility for nondoctoring tasks, CEO Bradley Prechtl, MBA, said. For example, he makes a point to hire reimbursement specialists who know the ins and outs of negotiating on drug pricing. Prechtl said he deems this particularly important, considering that drugs are both the biggest expense and the biggest source of revenue for most practices. Prechtl acknowledged that such hires are more difficult at small practices.
This kind of delegation helps put and keep specialists where they’re needed, which improves the bottom line at FCS, Prechtl said. “A small practice would have to be negotiating on drug pricing, which is something that’s highly complex and changes literally daily,” Prechtl said. “Keeping up with all of those contracts is highly complex. You might be managing upward of 80 different contracts, each which can be different by drug.”