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Leadership, camaraderie required to overcome, prevent physician burnout
The burnout rate among oncologists has reached an all-time high, with various surveys showing incidence exceeds 50%.
Many hematology/oncology centers have prioritized efforts to identify and address burnout, Anthony Back, MD, professor of medicine in the division of oncology at University of Washington, told HemOnc Today.
“Clinical leaders at cancer centers are becoming increasingly concerned with the level of burning out and feel it has reached a tipping point where they need to address it,” Back said.
Greater workloads — compounded by increasing documentation and administrative demands — and the dramatic increase in drug approvals, which requires clinicians to invest considerable time to learn about each agent so they can determine which treatments are most appropriate for their patients, likely are key factors, Back said.
The nature of the specialty also has contributed to increased burnout prevalence in oncology, according to Ethan Basch, MD, MSc, director of UNC Lineberger Cancer Outcomes Research Program.
“In many cases, it is the inability to cure the disease, as well as handling the toxicity of various treatments,” Basch told HemOnc Today. “The toxicity of some treatments we have are worse than the disease itself and can lead an oncologist to feel repeatedly helpless.”
Experts who participated in an NEJM Catalyst live web event called for leadership to work toward finding the camaraderie and joy in medicine again, giving physicians a vaccine for burnout.
“If you look at the fundamental drivers of professional burnout, one of the drivers is moral distress and values dissonance,” Stephen Swensen, MD, MMM, FACR, medical director of professionalism and peer support at Intermountain Healthcare, said in his keynote speech. “If we work in systems that promote the rendering of care that we wouldn’t choose for ourselves, that creates moral distress and values dissonance and professional burnout. Not only is it good for patients to put their interests first, it’s good for us.”
Patients ask three primary things of their physicians, Swensen said:
- Care about me;
- Care for each other; and
- Put my interests first.
“You can’t give what you don’t have,” Swensen said. “If we don’t have empathy, if we are emotionally exhausted, if we are socially isolated, then our patients suffer for that. Even if we get the mechanics of care right, we don’t get the relationship right.”
Steven Strongwater, MD, president and CEO of Atrius Health, put the responsibility for this dissonance on the workflow and expectations placed upon physicians.
“We have fallen down in the workflow and the work itself. The model needs to change,” Strongwater said.
Many physicians work the 18 to 21 hours per day that they feel is required, and they do not have the time or bandwidth to push for change, panelists said.
“There are very few individual physicians than can actually impact the current state. They are employees. They do not control the resources,” Strongwater said. “It’s wonderful that we’re having this conversation ... but, unless leadership walks away and says I am committed to finding solutions ... and committed at the very least to ongoing measurement and reporting to their boards in the same way we report patient satisfaction scores, we will never get ahead of this. It is fundamentally the role of leadership to take on this challenge.”
Swensen described camaraderie as “one of the most important vaccines for burnout.”
That requires physicians, nurse practitioners, physician assistants, managers and other members of the team to respect and trust each other.
He described the ideal environment: “There’s meaning and purpose. They’re connected and they have a system that makes the right thing to do for patients the easy thing to do, so that the care they’re giving is the care they want.”
Healio.com has reported extensively on the causes and consequences of physician burnout over the past few months. These reports will offer insights into how others throughout the medical field have dealt with this issue, and the strategies they have implemented to overcome it.
- This HemOnc Today cover story explains the risk factors for and consequences of burnout among members of hematology/oncology care teams, how this can affect quality of care, and the interventions that may help prevent burnout at the individual and institutional levels. Read more.
- This edition of Point/Counter explores whether fostering resilience and wellness to reduce physician burnout is a personal responsibility or a system responsibility. Read more.
- Acknowledging stress, accepting help and addressing fatigue are useful strategies for clinicians facing burnout, according to recommendations published in Obstetrics and Gynecology Clinics of North America. “Burnout is physical or mental collapse that is caused by overwork or stress and all physicians are at risk,” Roger P. Smith, MD, assistant dean for graduate medical education and professor in the department of integrated medical science at Florida Atlantic University’s Charles E. Schmidt College of Medicine, said in a press release. “Professional burnout is not new, but what is new is the wider recognition of the alarming rates of burnout. Physicians in general have burnout rates that are twice the rate of working adults.” Read more.
- Burnout rates continue to increase, with no apparent end to the trend. However, this blog post suggests the onset of burnout is not inevitable, and that emotional depletion can be sidestepped. The answer lies in the power of decision. Read more.
- AMA delegates adopted a new policy designed to improve medical student and physician access to mental health care. Read more.
- By using mindfulness, clinicians and mental health professionals can establish a compassionate attitude, increase empathy for patients, improve their ability to serve patients and decrease burnout, according to Seema Desai, MD, of NYU School of Medicine. In this video, Desai illustrates ways in which the clinician or trainee can integrate mindfulness into their practice. Read more.
Disclosures: The researchers report no relevant financial disclosures.