Rosenthal, Eric T.
The results of an American Society of Clinical Oncology survey of medical oncologists in the United States dealing with their satisfaction with “work-life balance” and their plans for retirement are contrary to some earlier assumptions—findings that an accompanying editorial called “startling.”
Both articles are now available online ahead of print in the Journal of Clinical Oncology. The survey (doi: 10.1200/JCO.2013.53.4560) by Tait D. Shanafelt, MD, Director of the Department of Medicine Program on Physician Well-being at the Mayo Clinic, and colleagues found that the satisfaction was lower than that for all other medical subspecialists and that this dissatisfaction had a strong relationship with plans to cut back hours and leave current practices. This situation will likely adversely affect the pending oncologist shortage expected by 2020, the researchers said.
The accompanying editorial by Rebecca S. Guest, MD, MPH, and Dean F. Bajorin, MD—titled “Take Care of Yourself: We Need You” (doi: 10.1200/JCO.2013.54.5319)—noted that oncologists' determination to provide the highest standards of care for their patients “should similarly apply to oncologists themselves, personally as well as professionally.”
Asked for his opinion, ASCO Chief Medical Officer Richard L. Schilsky, MD, said that the survey results were not completely surprising and showed that many medical oncologists, although highly satisfied with their career choice, are less so with their work environments and are overwhelmed by, for example, the paperwork generated by regulatory requirements.
He said that now that there is a pretty clear description of the problems, ASCO and the overall oncology community have to focus on finding solutions, including providing tools to help with business operations, being more sensitive about the workplace environment, and working hard to introduce better payment models.
The survey was sent to 2,998 medical oncologists—with an equal number of men and women evenly distributed by years in practice—between October 2012 and March 2013. About half (1,490) responded, with about two-thirds (1,117) completing full-length studies, and evaluation of work-life balance and career plans focused on the 1,058 who had not yet retired. Slightly more than half (51.6%) were women, and the average respondent was 52 years old.
Only one third of the oncologists (345) said they were satisfied; more than one-quarter (270) indicated the likelihood of reducing their clinical work hours within the next year; and about one-third (351) said they intended to leave their current positions within two years. The reasons cited for cutbacks were to spend more time with family or to pursue administrative or leadership opportunities.
The study found that about 45 percent of oncologists experienced symptoms of burnout, including emotional exhaustion or depersonalization, and more than one-quarter (273) said they planned to retire by age 64, with more than 20 percent planning retirement before age 60.
The reasons cited for seeking an earlier retirement included declining Medicare and private insurance reimbursements and the introduction of electronic medical records; reasons for postponing retirement included continuing to enjoy work and decreased retirement accounts.
The researchers noted that other studies have ranked medical oncologists seventh out of 41 medical subspecialties in the number of hours worked, and that these long-hour expectations can lead to conflicts between personal and professional responsibilities.
Shanafelt and his coauthors found that women oncologists and those devoting more time to patient care were less likely to be satisfied, and that satisfaction with work-life balance and burnout were considered the strongest reasons for reducing clinical work hours or leaving current positions.
The editorial noted that while women constitute about 24 percent of oncologists today, they occupy about half of current oncology fellowships. In addition, ASCO's 2007 workforce study (OT 4/10/07 issue) that projected a shortage of medical oncologists by 2020 to meet the growing demand for cancer care in the United States had suggested that one way of dealing with the crisis would be for half of oncologists to delay retiring for five years, a solution that the work-life balance study showed to be unlikely.
In an interview, Dean Bajorin, MD, Co-chair (with Michael Goldstein, MD) of ASCO's Workforce Advisory Group, said he was personally taken by surprise by the new study's findings, especially since the earlier workforce study had proposed that oncologists work longer to meet the increasing patient care demands around the country. That proposal, though, he noted, was not based on any data at the time.
He said that many oncologists go into the field in the first place because they love patient care and that the extra time required for paperwork and other administrative duties is now serving as a deterrent, causing many to rethink a better balance between work and family.
“Burnout is not a singular event. It is an oversimplified impression of what's happening, including physical and emotional exhaustion and depersonalization. Burnout is a multifaceted concept, and is both preventable and reversible though programs dealing with physician resilience.”
Bajorin, a member of Memorial Sloan Kettering Cancer Center and Professor of Medicine at Weill Medical College of Cornell University, added that such resiliency programs may be available at some academic centers but not necessarily in the community, which is important to recognize first and then look at what types of programs can be introduced elsewhere.
He noted that an Education Session dealing with burnout is planned for ASCO's Annual Meeting (“Burnout in Health Care Professionals: Improving the Care You Provide by Caring for Your Mental and Physical Well-being”), but that interventions for burnout have to date not been well studied.
“We need to identify and develop better tools to address the work-life balance and modify the workplace, and ASCO is now developing strategies to address these issues with far more detail,” he said.
The study's senior author, William J. Gradishar, MD, a former chair of ASCO's Professional Development Committee and Director of the Maggie Daley Center for Women's Cancer Care and Director of Breast Medical Oncology at Northwestern Memorial Hospital/Northwestern University, noted that although there has not been a well-done survey of this kind of medical oncologists in quite a while, he didn't think the results were surprising at all: “I see my colleagues every day and although many still find oncology interesting, attractive, and intellectually challenging and are happy with their career choice, the actual aspects of doing the job have become less satisfying.”
One important take-home message of the study, he added, is “If you're feeling burned out, then you're not alone. There are many factors that contribute to that, and satisfaction requires the balance of work with other life pursuits.”
The nature of the job has changed, and elements other than patient care are taking more and more time, he continued. “This is not directly addressed in the survey, but there is a change in expectations for physicians coming out of training now compared with years ago, and there is more of an emphasis on a better work-home balance.”
He said that in the works is a companion study looking at the work-life balance of oncology fellows, so that those in training will be better prepared for the reality that awaits them.