‘Burnout is actionable’: 6 organizational strategies to promote wellness among oncologists
Key takeaways:
- Reducing burnout must be an organizational strategy.
- Valuing oncologists’ time is a critical component of this.
Ishwaria M. Subbiah, MD, MS, FASCO, is a third-generation health care professional and second-generation medical oncologist.
“I don’t have a memory where taking care of patients wasn’t a part of [my life],” Subbiah, a medical oncologist and palliative care physician based in Nashville, told Healio.
However, she remembers exactly when her concerns about the mental well-being of oncologists became the focal point of her work.
It occurred about a decade ago. Her father, Chandra Mohan, MD, a nephrologist who practiced in York, Pennsylvania, was having grandfather time with Subbiah’s children.
“Then he came up to me and said, ‘We shouldn’t necessarily encourage the kids to go into medicine,’” Subbiah recalled. “‘They should really look at other things, too.’
“That may seem like an innocuous enough statement for most people just looking at it at the surface,” Subbiah added. “For me, I knew the depth of what that meant. My dad loves medicine. He loves taking care of people. He loves being a doctor. To hear him say that his grandchildren should look elsewhere for their profession was very meaningful. That’s when I knew deep down that health care is in trouble, and the practice and the art of medicine is in trouble.”
Burnout rates among physicians and oncologists have increased significantly over the past several years, with both individual and organizational stressors contributing to exhaustion.
Though many institutions have implemented strategies to improve burnout at an individual level, organizational interventions have proven more effective, Subbiah and colleagues wrote in a paper published in JCO Oncology Practice.
They identified six strategies, including the elimination of low-value work and improving psychological safety, to improve the well-being of medical oncologists from an institutional standpoint.
“Burnout is death by a thousand cuts,” Subbiah said. “There are a thousand individual microtrauma that, by themselves, [are not overly concerning]. But when you aggregate 50 cuts over the course of a workday, suddenly you’re going home and you’re bleeding. That gets compounded day after day. The strategies that we highlight ... are known to [alleviate] that microtrauma on health care professionals across the board.”
Background
Healio has reported on several studies that showed burnout rates are rising across health care.
In the 2024 Survey of America’s Current and Future Physicians, six in 10 respondents reported feelings of burnout, up from four in 10 in 2018.
Researchers observed improvements in feelings of hopelessness and less withdrawing from families and friends, but they categorized those changes as small compared with the bigger picture.
Burnout rates among oncologists increased from 45% in 2013 to 59% in 2023, results of another survey showed.
“The problem is greater among oncologists under the age of 50 than among their older counterparts, which is concerning for the future of the workforce,” Laura A. Levit, JD, a senior director at ASCO’s Center for Research and Analytics, told Healio.
‘A striking realization’
Subbiah and colleagues at ASCO did identify a group of health professionals for whom the prevalence of burnout had, in fact, decreased over the past decade — medical oncology fellows.
Their study, published in January, showed that the proportion of medical oncology fellows who met criteria for burnout declined from 34% in 2013 to 20% in 2023.
When reflecting on the reasons behind this decrease, Subbiah noted the “Aha!” moment was recognizing that, when it came to the workplace experience, fellows have something that practicing physicians and other clinical team members don’t — organizational accountability.
“The hospitals and universities that have fellowship programs are held accountable for the training experience of fellows by the national fellowship accrediting authority,” Subbiah said. “The accrediting body established the basic requirements of fellows’ workplace experience. They have a clear process for safely reporting suspected violations. Moreover, these violations come with consequences that are meaningful to the program, and not just a slap on the wrist. That’s a big difference from clinical practice once you’re out of training. There’s really no entity that ensures organizational accountability for the workplace experience of physicians and clinical team members in practice.
“That was a striking realization,” Subbiah added. “We all know we should eat right, exercise more and stress less, but nobody’s holding us accountable to that. But we renew our driver’s license and our passports. We take out auto insurance for our cars, and it’s because not doing so has consequences that carry weight.”
Recent studies, combined with clinical experience, paint a different picture from the usual narrative that burnout is an individual’s issue, Subbiah said.
“What we see is the drivers of burnout following an 80/20 distribution, with only 20% attributable to individual factors,” Subbiah said.
The majority of factors that affect workplace experience come from beyond the individual, encompassing factors such as specific institutions, the health system, cities, states and the federal environment, she added.
“First and foremost is for organizations to recognize that professional well-being is their lane,” she added. “This is a workplace responsibility.”
Subbiah and colleagues highlighted six areas that organizations should examine to improve oncologists’ well-being:
- eliminating low-value work;
- restructuring teams for efficiency;
- encouraging clinician work-life integration;
- promoting psychological safety in the workplace;
- identifying practice setting stressors; and
- fostering community.
Time must be ‘preserved’
Many of the recommendations revolve around the theme of oncologists’ time.
“We have to get a culture in organizations [that says] the attention of our people in all roles is important,” Subbiah said. “Their cognitive bandwidth is important and needs to be preserved.”
The elimination of low-value work, which significantly involves the electronic health record, could help achieve that.
Clinicians spend about 6 hours of an 8-hour day dealing with it.
“We all recognize the strengths of the EHR,” Subbiah said. “[But] there’s no part of that system that was intuitively designed with the end user in mind. That’s been quantified in multiple studies.”
Subbiah shared the example of ordering follow-up labs. When she used paper charts, it would take her 15 to 30 seconds. With the EHR, it takes 2 to 3 minutes.
It’s a minor annoyance in a vacuum, but those inefficiencies “snowball,” she said.
The EHR is only one piece of the puzzle.
“I do so many tasks that have nothing to do with the actual care of the patients under my purview,” co-author Fumiko Chino, MD, assistant professor in breast radiation oncology at The University of Texas MD Anderson Cancer Center and Healio Women in Oncology Peer Perspective Board member, told Healio.
One institution changed its required password length from 8 to 15 characters and reduced its computer lockout time from about an hour to around 30 minutes, Subbiah said. That could benefit cybersecurity, but it forced employees to sign in two to three times more per day.
Another organization had a pop-up message that had to be closed every time someone signed in.
Subbiah’s mandatory yearly compliance training used to be a one-click attestation. Now it is a 20-minute video.
“I dug into it a little bit to understand [why this change got made]. It was somebody’s grad-school project,” Subbiah said. “They deployed that out to an entire health system. That was it.”
These burdens can be exacerbated through an organization’s structure.
Certain institutions support medical assistants and nurses sharing responsibilities with oncologists, reducing oncologists’ workload. Others do not.
“There are certain clinics where the nurses are empowered, enabled and have a clear escalation path when they get requests from patients, or a long message detailing quite a few symptoms,” Subbiah said. “There are other clinics where every message that comes in, regardless of what it is, is forwarded to the physician.”
“Making sure that everyone is doing what they can do to contribute to the team at the top of their license is so important,” Chino added.
Oncologists can have their time taken through scheduling, as well.
Some clinics and institutions that book evening appointments — 6 p.m. or later — also may require oncologists to come in for a 7 a.m. appointment the next day.
“Everybody has long days, but it’s one thing to have a long day every now and then vs. every day being a long day, every day being what should be an exception,” Subbiah said. “That means that you’re counting on people to take time out of their responsibilities outside of work to meet work expectations. That’s not sustainable.”
Clinicians need to have work-life balance to avoid burnout.
“I believe, naively perhaps, that physicians go into medicine to take care of patients,” Chino said. “Most people I know did; they’re in medicine because they feel a calling to help and to heal. Trying to acknowledge the calling of medicine — and reconcile it with the practical nature of billing and scheduling, throughput and workflows — is challenging because the healthcare system just keep adding more tasks.”
‘Row in unison’
Subbiah and colleagues also emphasized the importance of organizational support.
One area that calls for action at the system level is incivility towards clinicians. Several studies report the rising rates of mistreatment faced by clinical teams from patients and visitors, but many health professionals are left to address these events themselves, Subbiah said.
Organizations need to have systems in place to handle those situations.
“Protecting our workforce is part of any organization’s responsibility,” Subbiah said. “So, when it’s the front desk person, nurse, or doctor who may be on the receiving end of a hostile patient, the victim can’t always be one to address the incivility. There must be processes at the health system’s level as a part of their stated commitment to the workforce.”
Additionally, organizations must have awareness of their own institutional issues that could impact their workforce.
Rural clinics may be in areas with poor bandwidth yet rely on the EHR for care delivery functions, including scheduling appointments. That could cause a higher volume of phone calls patients about their appointments, putting a taskload-related stress on the system.
Community clinics may have a high need for social workers but not adequate staffing.
A clinic may be 50 miles away from the nearest pharmacy. If patients cannot access it, they may require more emergency room visits or overload the messaging systems with symptoms.
Organizations must act as a team to support one another, Subbiah said.
“If one member of the team is hurt on the field, the rest of the team doesn’t say that’s your problem. You need to deal with it,” she said. “It just doesn’t work that way. It’s making sure that the organization sees that we’re all rowing in the same boat. We will get further when we row in unison.”
‘Hope in progress’
Organizations do not need to solve every problem at once to reduce clinician burnout.
“Pick one of the six areas as a starting point for action,” Subbiah said.
High-level executives can ask about employee concerns to get a sense of the most troublesome areas.
“It’s validating the individual cuts, those individual efficiencies that seem like little things that we may all just brush aside,” Subbiah said. “As an organization, those are the places that we want to start reclaiming time.”
It could be implementation of a mentorship program, more telehealth flexibility or several other possibilities Subbiah and colleagues outlined.
It is imperative, though, that organizations take their employees’ complaints and suggestions to heart.
“There’s a study from many years ago that showed you actually do more harm as an organization if you ask for feedback and don’t do anything about it than if you just didn’t ask at all,” Subbiah said.
“Burnout can seem unsurmountable, [but] burnout is actionable,” she added. “We can actually do something about our workplace experience. That ‘something’ can be done in a systematic way driven by the organization and the people within the organization. ... There is truly hope in progress, taking a systematic approach and paying attention to the little things that make our workday a bit more challenging. That’s where the answer lies for us to reclaim more of our time and frankly, our workplace experience.”
In an editorial that accompanied the paper by Subbiah and colleagues, Corey W. Speers, MD, PhD, vice chair in the department of radiation oncology at University Hospitals and member of the developmental therapeutics program at Case Comprehensive Cancer Center, and colleagues emphasized the “urgency” of acting now.
“By integrating these strategies into practice, organizations can foster not only a healthier workforce but also ensure the delivery of high-quality, empathetic care for patients with cancer,” they wrote. “The time for action is now — these insights offer a roadmap for institutions committed to preserving the vitality and excellence of the oncology profession.”
References:
- Lapen K, et al. JCO Oncol Pract. 2025;doi:10.1200/OP.24.00199.
- Speers CW, et al. JCO Oncol Pract. 2025:10.1200/OP-24-01050.
For more information:
Fumiko Chino, MD, can be reached on X (formerly Twitter) @fumikochino or on Bluesky @fumikochino.bsky.social.
Ishwaria Subbiah, MD, MS, FASCO, can be reached at ishwariasubbiah@outlook.com.
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