Physician Burnout in the Oncology Practice Setting
Orlando, FL—Burnout is a syndrome that includes feeling exhausted, cynical, and ineffective at work. Recognizing the triad of symptoms in the oncology setting is the first step to identifying physician burnout, said Anthony L. Back, MD, Professor, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, at ASCO’s first Oncology Practice Conference in March 2017.
In certain specialties, including oncology, 60% to 70% of physicians would score positive for burnout on a validated questionnaire, said Dr Back. “And because it [burnout] so intimately affects how physicians perform, it’s starting to capture the attention of the public, of medical leaders, and of practice managers,” he said. When physicians reach the burnout stage, they tend to make more errors, medical practices report increased turnover, inpatient mortality is higher, and physicians spend less time interacting directly with patients.
This complicated phenomenon cannot be attributed wholly to the clinician or to the workplace. “If we focus only on physicians, we make it seem like the system is not accountable. But the reality is, there’s also a host of workplace factors affecting clinician burnout,” said Dr Back.
Countering the Burnout Epidemic with Resilience
“Burnout is quite widespread, and what is happening to clinicians is not exactly a secret,” said Dr Back. In the wake of new payment structures, pathways, quality metrics, and management structures to which physicians are expected to adhere, a preponderance of empirical data supports a steady increase in physician burnout, and survey data have demonstrated that practicing physicians have become increasingly less likely to recommend medicine as a profession to their children.
Burnout predicts turnover. One study that involved more than 2500 physicians at the Mayo Clinic showed that burnout scores predicted reduction of work hours during the subsequent 24 months. “These physicians have gotten burned out and basically feel like they have to leave,” noted Dr Back.
However, the discussion around resilience is gaining traction, Dr Back said. Resilience is the ability to take on challenges, bounce back from difficulties, and thrive at work. Studies of physician resilience in the United States have yielded universally low scores, but certain skills and behavior modifications can contribute to resilience in the oncology setting, he said.
Workplaces can foster resilience. Symptoms of burnout decrease when a system optimizes the workload of its physicians, enhances efficiency, enables autonomy, integrates a healthy work–life balance, upholds values, and creates a sense of community.
Good leadership can also positively affect physicians in terms of burnout and satisfaction. The Mayo Clinic study asked approximately 2800 physicians to score their unit leaders on a 60-point scale. The results demonstrated that every 1-point increase in leadership score was associated with a 3% decrease in the likelihood of burnout.
“When leadership and systems are willing to engage in change—to sit down with clinicians and work on matters that affect their day-to-day life—that makes physicians feel like they’re being listened to,” said Dr Back.
Building Resilience Skills
Leaders in oncology should foster the development of individual resilience skills. “Established burnout is very hard to change. At that point, something major needs to change, and that’s usually a change in work,” said Dr Back. “If you want to invest in your workforce and in the physicians who provide the bulk of your care, the idea is to shift to a more upstream approach,” he added.
Resilience skills can prevent physicians from ever reaching burnout. Dr Back and his colleagues performed an exhaustive review of the literature to identify individual skills that were learnable and correlated with individual changes in well-being; they identified several skills, including managing energy, using attention mindfully, finding healthy boundaries, reframing cognitive distortions, calibrating expectations, regulating emotions, and discovering meaning daily.
Dr Back offered practical examples of these resilience skills in the clinical practice setting. For example, saying “I should have done more,” perpetuates the myth of not being good enough and leads to a negative cycle of rumination.
“If this becomes your default response to every bad thing that happens, that’s a cognitive distortion,” he explained. Instead, he encourages physicians to ask themselves, “What would a good friend say about this situation?”
Telling oneself, “They need me, so I’ll stay late,” perpetuates the myth that one should always practice self-sacrifice. Although certain circumstances may call for this behavior, a healthy work–life balance requires flexible boundaries and the protection of other commitments.
“Instead, tell yourself that over time, you will find ways to honor all of your commitments,” he advised. “Look at the situation and respond flexibly. It’s not just about being nice to everyone; it’s about making sure you have the energy to focus on what’s important.”
Physicians should circumvent 2 default behaviors—avoidance and venting. Avoiding negative emotions can build up over time and can lead to intractable conflict, which is precisely the kind of workplace environment that sets physicians up for burnout. Similarly, venting to coworkers is ineffective, strains relationships, and does not improve psychological well-being.
“Empirical data show that using these kinds of techniques can restructure one’s thinking. And we ought to be thinking about clinician well-being in the same breath that we’re talking about patient and family well-being,” said Dr Back.