Simone’s OncOpinion

Career development observations and advice for medical professionals from Dr. Joseph V. Simone.

Wednesday, February 26, 2014

Oncologist Burnout

The issue of physician burnout seems to pop up every few years. Two articles published recently have addressed this topic from very different vantage points:


The first, “Burnout and Career Satisfaction Among US Oncologists,” by Tait D. Shanafelt and colleagues, is in the 1 March 2014 issue of the Journal of Clinical Oncology. The authors contacted 2,998 oncologists; 1,490 returned the surveys, and 1,117 completed full-length surveys. About half were women and slightly more were in private practice compared with those in  academic practice. The measures of burnout were based on the standardized Masiac Burnout Inventory. Overall, 45% had at least one symptom of burnout on the emotional exhaustion or depersonalization categories, slightly higher for those in private practice. Hours per week working in direct patient care were positively correlated with increased burnout. On the other hand, overall career satisfaction was high -- about 82%, slightly lower in private practice.


The remedy suggested is fewer work hours, especially in patient care. However, the common use of “productivity” in both private and academic practices incentivizes oncologists to work more hours and see more patients. This creates a classical double bind, especially since oncologists already work more patient care hours than most other physicians.


A more global approach to the issue of burnout is taken in “Medicine’s Search for Meaning,” by David Bornstein, which appeared in the New York Times (18 Sept. 2013). He begins by saying that the health care system is in crisis -- “We are going bankrupt,. There are too many lawsuits. We practice defensive medicine. We restrict access.” But he says doctors face a more serious problem. Almost 50% of practicing physicians report symptoms of burnout, such as emotional exhaustion, low sense of accomplishment, and detachment. He believes medicine is facing a crisis that is not about money, but about meaning.


Bornstein points out that, “Great doctors don’t just diagnose diseases, prescribe medications and treat patients; they bring the full spectrum of their human capabilities to the compassionate care of others. That is why doctors, upon entering the medical profession, speak noble words like the Oath of Maimonides: ‘May I see in all who suffer only the fellow human being.’”


Nice words, but he says that almost half of medical students suffer from some form of burnout before they even enter residency training. There is convincing evidence that this problem has a negative effect on the quality of care. Dr. Bornstein then introduces the reader to Dr. Rachel Naomi Remen, who is at UCSF. She gives a course called The Healer’s Art, which is now taught in 71 schools in the U.S. and in 7 other countries. The course is very popular because it addresses the difficult issues of gaining the confidence of patients and recognizing the dignity and nobility that should be a part of medical care. It also helps students keep their spirits alive as they go through training.


Burnout can be addressed in practice, but in the current reimbursement environment, only with the prospect of lowering one’s income, and it may be worth every penny lost for longevity and inner peace. But it seems that starting earlier is an even better idea, and action at both opportunities would be a prudent mechanism for avoiding burnout.