A career in oncology can be a tremendously fulfilling and a meaningful venture. Oncologists care for the sick, advance medical science, and mentor the next generation of medical professionals. Despite the value and importance of these pursuits, an expanding body of literature reports that physicians are experiencing increased personal distress and decreased satisfaction with the medical practice.1,2
Unlike many other professionals, physicians often experience extreme fatigue and emotional exhaustion at early stages in their careers during medical school and residency. High rates of burnout and poor mental health among physicians can have a profound impact on patients’ quality of care and threatens the sustainability of the health care enterprise.
What is burnout? Burnout is an emotional state seen in many individuals under constant pressure. It can be accompanied by a number of physical and behavioral signs and symptoms, such as exhaustion, perceived clinical ineffectiveness, impaired job performance, and lead to poor health, including hypertension, anxiety, and depression.3,4
The condition has been compared to a worker who has become separated or withdrawn from the original meaning and purpose of his work. Physicians experiencing burnout have been shown to have higher rates of divorce, suicide, job turnover, drug and alcohol abuse, and a shorter life expectancy.3
The risk of burnout increases in individuals who consistently experience work overload and a perceived lack of control. Simendinger et al suggested a three-degree model of burnout.5
The third, or most severe degree, is characterized by major physical and/or psychological breakdown including mental illness, heart attack, and ulcers.5
These individuals find their work unrewarding, believe they are treated unfairly, experience insufficient personal rewards (eg, loss of mentor support and intrinsic satisfaction) and are confronted with conflicting values.Sources of burnout
Several factors such as decreased autonomy, increased administrative tasks and paperwork, less time with patients, and difficulty balancing personal and professional responsibilities can contribute to burnout. Oncologists in academia may face additional stressors such as declining levels of funding to support their scientific research, and changes to the structure of fellowship that have increased their clinical responsibilities and decreased time for traditional academic pursuits such as research and education.6
As a result, physicians may not always have the opportunity to focus on the areas that they view as most personally meaningful.
Interestingly, a study by Einhorn et al found that daily interaction with suffering and dying patients was not the greatest source of stress for oncologists.7
Rather, increased claims documentation requirements (such as those for Medicare) and bureaucratic hassles, which for many resulted in longer working hours, was the greatest concern among oncologists. Board certification may be modestly positively associated with satisfaction,and being a foreign medical graduate may be modestly negatively associated with satisfaction, although this is limited to few studies.8Burnout among oncologists
Although burnout affects many individuals under constant pressure, oncologists in particular are frequently overloaded with the demands of their profession. The stressors of caring for ill patients, responding to the needs and questions of families, and experiencing limited treatment success and the constant loss of patients can exert an emotional toll on oncologists. In a 2003 survey, Allegra et al found that the rate of burnout among oncologists in the U.S. exceeded 60%.9
The seeds of burnout may be sown in residency and fellowship training, during which fatigue and emotional exhaustion are often the norm. By mid-career, the momentum of burnout may be subtly reinforced by the fact that your peers perceive you as a hard worker who places service to others before self-care. As a result, some physicians may deny major negative aspects of their work considering their commitment to become a well-trained medical oncologist.
Fellows coping with the demands of their practice by working harder and longer may experience severe inefficiency, psychological impairment, and poor patient care. Fellows’ expectations are often their greatest source of stress, and few spend time reflecting on themselves or attending to their own needs. Even so, fellows might be reluctant to recognize or talk openly about psychological problems resulting from their professional experiences to avoid having a psychological diagnosis or a “weak fellow” label pinned on themselves. The nature of medical training can reinforce false beliefs in one’s immunity to difficulties and prevent recognition of serious psychological problems.