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Is burnout a well-recognized issue among physicians?
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Burnout deserves attention
The potential for burnout in hematology/oncology is high. A lot of us go into the field because we want to spend time getting to know and help our patients. When we have less and less time to spend with patients, it becomes a source of frustration for us as well as for the patient.
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There should definitely be more awareness of potential burnout among hematologists and oncologists. We need to be leading healthy and well-balanced lives to be able to tell our patients to do the same thing. That means taking time to meet our own personal needs and to rejuvenate, whether it is through hobbies, friendships, vacations or spiritual practices.
There is no question that you can only give what you have. If you are not feeling well, psychologically or mentally, you cannot give as much to your patients. We also need to be good role models for our trainees, and we can’t do that if we’re not taking care of ourselves and trying to prevent burnout. We need to try to separate work from personal life, to develop hobbies and to do creative work. We give so much energy to our patients; we need to replenish that energy through our personal activities.
There definitely should be more awareness of burnout in institutions. There is a high level of awareness in some institutions, but there should be a higher level of awareness at every institution. Some institutions are very sensitive to their physicians. We found in our review of the literature, for example, that hematologists and oncologists in the university setting are better protected against burnout than those in private practice because they rotate service responsibilities and provide cross coverage for each other. However, all hospitals need to be sensitive to the human needs of human beings, including their doctors. They should be generous with providing time off for rejuvenation and learning experiences and hiring enough staff so that no one person has to do the work of more than one. They don’t need to go beyond that. We do not want hospitals to become invasive in preventing burnout, and there may be a fine line between providing enough and providing too much.
Paulette Mehta, MD, MPH, is a Professor of Hematology/Oncology and Associate Director of the Hematology/Oncology fellowship program at the University of Arkansas for Medical Sciences, and a Staff Hematologist/Oncologist at the Central Arkansas Veterans Health Care System in Little Rock.
Burnout exists, but hard to define
This issue has been given quite a bit of attention from the professional societies. There have been sessions on this topic at ASCO meetings for many years.
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Do oncologists themselves pay enough attention to it? I’m not sure. In most studies on burnout, a fairly high number of oncologists have answered that they have had a burnout or feel like they’re having burnout. It is a prevalent problem, but even if the oncologists identify problems with burnout, I am not sure how much they actually deal with it.
Oncologists tend to have heavy patient loads and tend to be very busy people who don’t slow down. They should have an exit strategy so that when they start to feel burned out they have a strategy to wind down or back out or change jobs. For most physicians, it’s difficult to slow practice down when they have a lot of patients dependent upon them.
Burnout often sneaks up on people, and it is hard to recognize whether they are truly burning out or if they are just having a bad few weeks. One of the signs of burnout is distancing yourself from patients. But are you doing that as a healthy coping mechanism to set boundaries? Or are you truly burning out?
For physicians to recognize it, there would almost need to be a specific medical model with signs, symptoms, data and ways to treat it. There are not enough concrete strategies to help them cope with burnout, and seeing a counselor or psychiatrist is associated with a stigma that many want to avoid.
Physicians would benefit from talking to each other when they are having bad days. Talk to your colleagues when you’re having a difficult week with patients, like when you have a disproportionate number of patients relapse or die.
The best thing for institutions to do is provide their physicians with more help, such as nursing help or help with the ton of regulatory paperwork. Most oncologists are in this job to help patients. The way to help the oncologists is to give them help with the paperwork and administrative tasks that probably contribute to burnout more than anything. This gives the physician time to do the part of the job they love: helping their patients. Also, asking our palliative care colleagues to share the care of our folks helps a lot, as we know their symptoms will be treated expertly and end-of-life concerns addressed. It isn’t that we do not like to do those things as well, but it gives us more time for cancer treatment, and they have tremendous expertise in those areas.
Laurie Lyckholm, MD, is an Associate Professor of Hematology/Oncology and Palliative Medicine, and Fellowship Program Director at the Massey Cancer Center at Virginia Commonwealth University.