Q&A: Tackling issues at the organizational level key to mitigate burnout in oncology
Burnout in the field of oncology continues to increase and experts in the field suggest that organizational interventions could be most effective at combatting the issue, according to a review published in JCO Oncology Practice.
There is a significant need for strategies that ensure professional wellness goals focus on the development of organizational policies, cultures and best practices that create healthy work environments, according to Kaitlyn Lapen, MD, resident in the department of radiation oncology at Memorial Sloan Kettering Cancer Center, and colleagues.
Healio spoke with Lapen about what is already known about burnout in oncology and what still needs to be examined, the lived experiences of the oncology workforce in terms of work-life balance, and the policies that she and colleagues recommend to help address the issue once and for all.
Healio: What prompted this paper?
Lapen: During a town hall session at the ASCO Annual Meeting back in 2023, results were presented of a survey conducted by the State of Cancer Care in America board that regularly conducts surveys to assess burnout and workplace happiness among oncologists. The results showed burnout had increased significantly in the past decade, which wasn’t surprising after the pandemic and how things have changed in oncology. That town hall was the impetus for this paper.
Healio: What is already known about burnout in oncology, what still needs to be examined and why?
Lapen: The ASCO survey included about 330 oncologists and showed that the rates of burnout were nearly 60% — oncologists were reporting at least one symptom of burnout in 2023 vs. 34% in 2013, so quite a significant increase. The rates of emotional exhaustion and depersonalization were also significantly high at 57% — those numbers are concerning.
What we didn’t really know about were some of the main causes of burnout in this group. The survey examined some of the main factors oncologists attributed to burnout, including short staffing within the clinics as well as issues with electronic health records. Payer policies, interactions with insurance companies, and the burden of preauthorization on oncologists were also noted. We now know what the problems are and know burnout is a problem, but we don’t know what the solution is. In my experience, there is a growing population of patients and an increasing pressure for clinicians to see more patients, but there is only so much time and it can be difficult to allocate effectively and I don’t see that going away anytime soon.
Healio: What are the lived experiences of what the oncology workforce is facing in terms of work-life balance?
Lapen: I’m a resident and still in training. I am not currently burned out, but burnout is a big topic of conversation among my colleagues. Residency, in general, is tough.
In the past several years, there has been a lot of effort to try to make things better for us, such as limiting work hours and mandatory sessions on wellness and fatigue mitigation.
At the end of the day, we all want to work reasonable hours and feel more supported in our work. It’s hard because we are in an environment where we are trying to learn but there is this pressure to keep up with clinic and see patients, especially in the field of oncology. There is this sense of urgency that we feel a lot in oncology, and oftentimes if there’s a patient who is present and requests to be seen, we will overbook our clinic to see that patient, because while it’s not always medically urgent, how do we turn away someone with cancer who is present and anxious? It’s difficult to find the balance between protecting ourselves as clinicians but also doing what feels empathetically correct for our patients. That is something that I find very challenging, and I don’t know if there’s a solution for that.
Healio: What are the specific policies you and colleagues identified in the paper?
Lapen: Rather than tackling burnout at the individual level, we looked at the types of things that organizations can do at their level to help mitigate burnout, which are not novel but are things we pulled from other sources and other efforts to promote wellness.
The first is eliminating low-value work. A lot of that is looking at EHRs and how we can reduce burdens there. At my center, we just switched EHRs and it’s been a challenge, because we went from a system that was designed overtime to meet our needs, and now we’re starting from scratch and having to re-personalize our EHR system. There are so many clicks, and even just waiting for a chart to open or a document to load can really slow you down. Looking at workflow elements like that and coming up with ways to improve that is important.
Another suggestion is restructuring teams to efficiently complete work. We have a physician and then there’s typically a nurse, as well as other individuals in the clinic — how can we go about making sure everything’s done efficiently? Is there a way to give clinicians autonomy in their scheduling, whether that be via telehealth, or being able to dictate how many days of clinic they want per week and the structure of those clinic days?
We also suggested promoting psychological safety in the workplace, reducing any sort of stressors related to workplace discrimination and having a zero-tolerance policy for that.
Identifying individual practice stressors is also important — a lot of which relates to speaking with clinicians and understanding what they find to be the most stressful aspects of their workflow, and how the organization can help alleviate that.
Finally, fostering community within the organization — creating a forum in which people can raise these issues and feel as though they’re being heard. Being able to foster a network of support within organizations can make a difference in terms of mentorship or just being able to have colleagues that you’re able to vent and discuss issues with is helpful.
Healio: What should women in oncology now do with this information?
Lapen: As a woman in oncology myself, I am still struggling to find a good work-life balance. I have felt burnout during several stages of my training thus far, and it may sound cliche but making a conscious effort to stay balanced and find time for family, friends, your own interests and your own hobbies is so important.
It is easy to lose sight of those things in our field, and especially in training, because it can feel like it’s all-consuming. I oftentimes have to remind myself that even though oncology can feel like more than just a typical job, it is still just a job, and we can’t lose sight of all the other important aspects of life.
Healio: What’s next?
Lapen: ASCO’s State of Cancer Care in America continually evaluates challenges that face the workforce, and I was fortunate to be invited to help comment and write up this paper. This is something that they will continue to evaluate, and the more data that we gather the better. It is reassuring to see this data and know that we are not alone, and hope that it can motivate change. In terms of the solution and what’s next, it seems as though it must come from the organizational level and those who are higher-up.
References:
- Lapen K, et al. JCO Oncol Pract. 2025;doi:10.1200/OP.24.00199.
- Schenkel C, et al. JCO Oncol Adv. 2025;doi:10.1200/OA.24.00010.
For more information:
Kaitlyn Lapen, MD, can be reached at lapenk@mskcc.org.
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