Burnout soars among US oncologists over past decade
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Oncologists in the U.S. reported a worsening of burnout and lower satisfaction with work-life balance over the last decade, according to a study presented at ASCO Quality Care Symposium.
The findings, presented by Caroline Schenkel, MSc, manager of research analysis and publications for ASCO, emphasized the need for policies and organization-level interventions that provide additional support for administrative and patient care duties. Notably, the survey identified administrative and operational issues — such as staffing, electronic health-related concerns and payer policy challenges — as the top workplace stressors, rather than emotional burdens linked to patient death and suffering or the COVID-19 pandemic.
“The issue of oncologist burnout is a major concern in the oncology community due to its implications for the well-being of individual clinicians and the sustainability of the oncology care workforce,” Schenkel told Healio. “Accurately characterizing and appropriately addressing the issue has been a priority of the American Society of Clinical Oncology and it’s board-appointed volunteer Well-Being Task Force for several years.”
‘Serious implications’
In the study, Schenkel and colleagues sent a 36-item REDCap survey to 5,892 U.S.-based physician members of ASCO. Several ASCO channels distributed the survey, which included two questions from the Maslach Burnout Inventory (MBI), from February to March 2023.
The researchers compared the responses with findings from a 2013 survey study conducted by Tait Shanafelt, MD, and colleagues published in Journal of Clinical Oncology. They defined burnout as having high levels of emotional exhaustion and/or depersonalization. The 2023 survey study assessed factors potentially associated with burnout, such as age, race and caregiver responsibilities. Additionally, the current study asked about major stressors at work, as well as aspects of oncology practice that gave respondents joy.
A total of 410 oncologists responded to the survey, and the researchers included responses from 328 oncologists in active clinical practice in the analysis. The study population had a median age of 47 years and consisted of 52% women, 55% white clinicians and 85% married/partnered oncologists. Sixty-eight percent reported having caregiving responsibilities, parental or otherwise, and 64% reported working at an academic institution.
Compared with a 29% rate of high emotional exhaustion on the single MBI-EE questionnaire item in 2013, 57% of clinicians in the 2023 survey reported high emotional exhaustion. Rates of depersonalization, characterized as having “become more callous toward people” since taking the job, also increased from 13% in 2013 to 34% in 2023.
Notably, a higher proportion of clinicians showed one or more symptoms of burnout in 2023 vs. those surveyed in 2013 (59% vs. 34%).
The report also found increases in factors associated with burnout, such as fatigue and work-life balance, Schenkel said.
“Average levels of fatigue increased over the decade, and the percentage of respondents who were satisfied with work-life integration fell from 35% to 24%,” she said. “These findings about diminished well-being have serious implications for clinicians, care teams and patients.”
Factors linked to burnout
The 2023 study also identified demographic factors associated with higher rates of burnout.
Compared with clinicians without caregiving responsibilities, those with caregiving responsibilities demonstrated higher rates of burnout (47% vs. 65%). Individuals under age 50 years demonstrated a higher prevalence of depersonalization vs. those aged 50 years or older (39% vs. 24%). Clinicians who identified as non-white had higher rates of emotional exhaustion compared with oncologists who identified as white only (63% vs. 52%).
“We also saw an association between burnout and reporting a high likelihood of reducing clinical care hours in the next 12 months, or leaving current practice in the next 2 years,” Schenkel said.
Although Schenkel found the increased rate of burnout among oncology physicians unsurprising, some of the top workplace stressors contributing to burnout had not necessarily been expected.
“In 2023, 93% of respondents selected an administrative or operational issue — such as staffing levels, the use of electronic records, or payer policies and interactions like prior authorization — as one of their top two professional stressors,” Schenkel said. “That figure is markedly higher than the 38% who reported that the emotional burden related to patient death and suffering, interpersonal reactions with colleagues or challenges with patients and caregivers, or the COVID-19 pandemic were among their top two stressors.”
Targeting system-level pressures
The study went on to reveal that for many oncologists, the patient-facing aspects of the job are among their greatest sources of joy.
“Most respondents (63%) identified speaking with and advising patients about diagnosis and treatment as one of their top two sources of joy at work,” Schenkel told Healio. “Despite some differences by work setting in respondents’ rankings of top stressors and factors with the potential to improve work, oncologists working at both academic centers and nonacademic sites ranked these patient interactions as a top source of joy.”
Schenkel pointed out that based on the 2023 survey responses, efforts to improve burnout may be most effective at the organizational and administrative levels, rather than at the level of the individual oncologist.
“Survey respondents ranked ‘wellness/burnout resources’ lowest on the list of top factors with potential to improve work,” she said. “This finding suggests that, rather than attempt to mitigate burnout one clinician at a time, future interventions should be targeted at organization and system-level pressures. To retain joy in the practice of oncology, solutions should strive to preserve time for oncologists to have meaningful interactions with patients.”
References:
- Schenkel C, et al. Abstract 1. Presented at: ASCO Quality Care Symposium. Oct. 27-28, Boston.
- Shanafelt TD, et al. J Clin Oncol. 2014;doi:10.1200/JCO.2013.51.8480.
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