Oncology Experts Weigh in on Burnout and Managing Work/Life Balance

"Certain things can make a big difference. They’re as simple as making sure that people are paid the same for what they’re doing, [giving] parents get parental leave regardless of their gender, and [having] secure vacation policies and coverage so that you can take time off to truly unplug and not just try to go away a little bit but check your inbox all the time," according to Tara Sanft, MD.

Physician burnout has affected most healthcare providers but up until the pandemic, it was never so prominently discussed compared with most recent years. In a study conducted by the Mayo Clinic, in 2021, 62.8% of participants reported having at least 1 manifestation of burnout vs 38.2% in 2020.¹

The American Medical Association has described physician burnout as being made up of 3 key components: emotional exhaustion, depersonalization, and feeling of decreased personal achievement.² Although it has been suggested to keep a look out for these signs, clinicians are still trying to find ways to mitigate burnout before these symptoms arise.

In a Tweet created by Amer Zeiden, MBBS, MHS, an associate professor of Internal Medicine, and director of Early Therapeutics Research, Hematology at Yale School of Medicine, queried as to how his colleagues work to best reduce burnout.³ Several of the replies from other oncologists/hematologists suggested having hobbies, spending time with their families, and exercising as potential ways to manage work-related stress.

Another piece of advice came from Narjust Florez, MD, who commented, “I deleted email from my phone.” CancerNetwork^® reached out to Florez, a physician and an associate director of the Cancer Care Equity Program at Dana-Farber Cancer Institute, as well as a faculty member at Harvard Medical School, to further speak about her methods for managing stress and preventing burnout.

Creating Distance Between Work and Life in Oncology

During the interview, CancerNetwork^® asked about her practice of not answering emails after work hours, and whether it has created any positive impact in her life and helped to reduce burnout.

“I emailed everybody, like the nurses [and] coordinators, saying, ‘I’m not checking email after 6 pm and eliminated my email from my phone.’ I was making sure that people knew about this. The expectations were clear.”

Florez went on to discuss that part of maintaining this boundary and not making oneself accessible all the time can be viewed as lazy. She said that within the different generations, setting and maintaining boundaries can be viewed differently.

“The younger generation is called lazy because we have boundaries,” she stated. “Burnout is not only about that, but also about understanding other people’s boundaries, and not making them feel guilty about it.”

Tara Sanft, MD, an associate professor of Medicine, chief Patient Experience Officer, and medical director of the Survivorship Clinic at Yale School of Medicine, also spoke with CancerNetwork^®, about factors that play into burnout and guidelines that have been created for clinicians experiencing it.

Sanft believes that the first way to address burnout is in the workplace. She notes that within each clinic or department, teams must work together to communicate needs, with burnout being reduced by this communication. While the workplace is a good place to start in identifying burnout, Sanft recommends taking a step back to examine how everyone can implement changes into their daily lives to help alleviate any symptoms they may be experiencing.

In a Letter to Readers that was published in the journal ONCOLOGY^®, co-editor-in-chief, Julie Vose, MD, MBA, highlighted the increased administrative burden regarding electronic medical records that are hard to navigate, and a lack of organizational infrastructure.

Vose is the division chief, and a Neumann M. and Mildred E Harriss professor in the Division of Hematology and Oncology and the University of Nebraska Medical Center.

In the letter, she reviewed data that were collected between 2011 and 2017 on changes in burnout and satisfaction in work-life balance conducted at the Mayo Clinic. It was determined that the aforementioned variables have led to physicians taking an additional 28 hours per month to complete these tasks during nights or weekends. The study has also highlighted that the rate at which messages are answered, patient interactions, and productivity scores now define what it means to be a “good doctor.”¹

In her letter, she also points out that being female, not having a partner, or being of younger age can more significantly impact burnout.

The Role Gender Plays in Physician Burnout

There is evidence to suggest that burnout impacts certain groups differently. According to a study published in The New England Journal of Medicine, female physicians were more likely to spend more time providing direct patient care per day and per year compared with men. Despite this, women were found to accumulate less revenue and had a lower volume of visits per year vs their male counterparts.⁴

Findings from the study indicated that in 2017, female physicians generated 10.9% less revenue or –$39,143.20 (95% CI, –$53,523.00 to –$24,763.40), and had 10.8% or –330.5 (95% CI, –406.6 to –254.3) fewer visits, and over 2.6% or –5.3 (95% CI, –7.7 to –3.0) fewer clinical days than their male counterparts. The investigators adjusted for age, academic degree, specialty, and number of sessions worked per week.

Data from the study also indicated that female radiation oncologists were billed for fewer lucrative procedures than their male colleagues.

Additionally, when an adjustment was made for physician, patients, and visit characteristics, female physicians acquired equal revenue compared with men but spent 15.7% (95% CI, 2.1-2.6) more time with patients.

“[Women are more likely to] have more patients, spend time with more patients, but then when it comes to success, we are measuring a higher standard [compared with men] and we have 4 times more responsibility,” Florez said, based on her own experiences and that of her colleagues in the workplace.

COVID-19’s Impact on Burnout in the Cancer Space

When asked why burnout is becoming more prevalent again like it was during the pandemic, Florez responded that nothing was learned from the pandemic. When it wasn’t physically possible to be in person, emails and Zoom meetings were put in place instead of face-to-face interaction, she said. During that time, Florez indicated that it helped her and her colleagues to better communicate with one another. However, as the world is beginning to transition into a post-pandemic era, these virtual strategies have not gone away.

Florez’s primary concern with pandemic-era communication strategies is the availability and access to the provider. With technology, there was an expectation created among patients and colleagues that clinicians can be reached at any time, and an immediate answer is expected. She emphasizes that there are no barriers between work and personal life, which only further increases burnout. During the height of the pandemic, oncologists continued to treat patients at an increased pace. Even though a new normal has been established following the height of the COVID-19 pandemic, expectations that were set for clinicians in the last few years have not loosened, according to Florez.

“Many of us were deployed for COVID floors,” she said. “We were outside our scope. There hasn’t been a moment to stop to rest after everything that happened with the pandemic. The new technology is being used against us now. The boundaries [between] home and work don’t exist anymore. [We are asked], ‘If you were available during the pandemic, why can’t you be available now?’ There is more urgency, and there’s more emails. We didn’t learn anything.”

Sanft had a similar viewpoint, stating that burnout from the pandemic has never truly gone away. While Florez and many of her colleagues were deployed to COVID-19 floors, Sanft experienced a bit of a reprieve. She was able to use that time when quarantined at home to unplug a bit, which led her to not experience burnout as severely as others she works with.

However, Sanft noted that her colleagues who specialized in critical care or infectious disease remained at the frontlines, and were not able to have a reprieve during lockdown to reflect.

“During the lockdown, the oncology community maybe had a little bit of a breather for a moment, although we never stopped caring for patients, maybe we weren’t as hectic [as other departments during the pandemic],” she said.

Overall, there has not been a major change in the way burnout has been handled over the last 3 years, Sanft indicated. She feels as though there aren’t many concrete solutions on reducing burnout that are being implemented at either industry or policy levels.

Strategies to Mitigate Burnout

Although burnout is not a new concept, identifying strategies to mitigate and manage workplace stress and find work-life balance have been few and far between. When asked, Sanft, Florez, and Vose each described the strategies for managing and mitigating burnout that have worked well for them.

In the Letter to Readers, Vose wrote that diminishing burnout needs to begin with the clinician. That includes exercising, a healthy diet, and getting rest. She also discusses reducing unnecessary stress and finding enjoyable non-work activities. However, responsibility also falls on institutions to begin modifying the workplace to reduce stress and burnout.

For the overall medical community, a roadmap was created by the Surgeon General that addresses burnout and outlines how to build a healthy work environment.⁵

Some solutions offered in these guidelines include protecting the health and safety of all workers, eliminating negative repercussions for seeking mental health care, reducing administrative and other workplace burdens, and transforming organizational cultures to prioritize health workers’ wellbeing to show that they are valued.

The first step to alleviating burnout can begin by allowing clinician's voice’s to be heard, showing how they are valued, and building in policy to assess how clinicians are coping with current workloads.

Sanft believes that there are a few strategies institutions can implement to begin making a change.

“Certain things can make a big difference,” she said. “They’re as simple as making sure that people are paid the same for what they’re doing, [giving] parents get parental leave regardless of their gender, and [having] secure vacation policies and coverage so that you can take time off to truly unplug and not just try to go away a little bit but check your inbox all the time.”

Florez’s perspective on mitigating burnout relies more on understanding coworkers, and how everyone is in the same situation.

“The number one thing is to give each other grace,” she emphasized. “That’s my number one rule: give each other grace and remove shame [and guilt] from resting. We need to train the next generation so that they don’t feel guilty for resting. We need to learn from the new generation. I love learning from my medical students because they do have clear boundaries, and that is something that has helped me in prioritizing and being okay with being behind sometimes.”

References

1. Shanafelt TD, West CP, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVID-19 pandemic. Mayo Clin Proc. 2022;97(12):2248-2258. doi:10.1016/j.mayocp.2022.09.002
2. American Medical Association. What is physician burnout? Updated February 16, 2023. Accessed May 19, 2023. https://bit.ly/3oi9N9U
3. @Dr_AmerZeidan. What is your best trick to reduce burnout? February 9, 2023. Accessed May 19, 2023. https://bit.ly/3MCLxbP
4. Ganguli I, Sheridan B, Gray J, Chernew M, Rosenthal MB, Neprash H. Physician work hours and the gender pay gap - evidence from primary care. N Engl J Med. 2020;383(14):1349-1357. doi:10.1056/NEJMsa2013804
5. The U.S Surgeon General’s Advisory on Building a Thriving Health Workforce. Addressing Health Worker Burnout. 2022. Accessed May 19, 2023. https://bit.ly/42QGL09