Oncology's Unrecognized Crisis
Oncology's Unrecognized Crisis
Dr Schapira: What did your study identify as the primary stressors in burnout?
Dr Banerjee: Oncologists who have a poor work-life balance are 3.6 times more likely to experience burnout. Other factors were inadequate vacation time and longer time to travel to work. There are a number of other personal factors, including not being in a relationship, living alone, and not having children. Hospital factors that affect burnout include fewer oncologists and higher number of patients seen each week. I think some of these points came through in the US studies as well.
There were not significant differences in burnout between men and women, but looking at the individual components of burnout, interestingly, men were found to have higher depersonalization scores than women (60% vs 45%), and low accomplishment was highest among the 26- to 30-year-olds compared with the 36-40 years group (45% vs 27%).
Dr Schapira: That's fascinating. Did you identify any contributors to burnout that might be attributed to the clinical setting in which they practice?
Dr Banerjee: We have collected data on the hospital type or clinical setting—for example, a university hospital, general hospital, or private hospital. We will be analyzing this. However, given the age range, it will be difficult to make clear conclusions regarding the effect of private hospitals.
We do know that increased workload—caused by higher number of patients per week and fewer oncologists—is a factor for a higher risk for burnout.
Dr Schapira: Oncologists in the United States frequently say that one of the major contributors to burnout is the amount of time they spend on nonclinical work such as paperwork, electronic record documentation, and negotiations with insurance companies. Do those factors apply to European oncologists?
Dr Banerjee: We have collected and need to analyze the survey data on the proportion of time spent on clinical work compared with nonclinical work or research. We may be able to better define the degree to which these factors increase risk for burnout among European young oncologists. I'm sure there will be common factors between Europe and the United States that affect trainees and new specialists who are embarking on their careers. That's why I think it's an international problem that we need to address together.
Dr Schapira: In the recent US survey of oncology fellows, the fellows seemed surprised that they didn't have enough time to stay abreast of new therapeutic developments. There is some speculation that not being able to keep up with the literature might erode their sense of competence and may contribute to a feeling of personal failure. Does that resonate with your experience?
Dr Banerjee: I am a member of the European Young Oncologists' Committee, and I have spoken with many young oncologists about their concerns and problems. What you just outlined is a common theme. From a personal point of view and from exchanges with trainees who I supervise, young oncologists have a need and desire to be at the cutting edge of the latest work, and to deliver high-quality care to their patients.
There is an element of personal expectations among young oncologists, and I think that more senior oncologists in institutions need to recognize that young oncologists need time for personal development.
Dr Schapira: Your study documents varying but dramatic rates of burnout in young oncologists across the regions of Europe. What is the next step in your research?
Dr Banerjee: One of the next things that we need to do is conduct a more detailed survey looking at various factors contributing to burnout, such as debt and other personal stresses. Then we can work to identify whether there are interventions that could remedy burnout. For example, after our presentation of the results of this study, I became aware that one hospital in Belgium engaged with psychologists to work one-on-one with oncologists to identify potential stress factors and give advice. That's a model that we would like to explore further.
Dr Schapira: What did your study identify as the primary stressors in burnout?
Dr Banerjee: Oncologists who have a poor work-life balance are 3.6 times more likely to experience burnout. Other factors were inadequate vacation time and longer time to travel to work. There are a number of other personal factors, including not being in a relationship, living alone, and not having children. Hospital factors that affect burnout include fewer oncologists and higher number of patients seen each week. I think some of these points came through in the US studies as well.
There were not significant differences in burnout between men and women, but looking at the individual components of burnout, interestingly, men were found to have higher depersonalization scores than women (60% vs 45%), and low accomplishment was highest among the 26- to 30-year-olds compared with the 36-40 years group (45% vs 27%).
Dr Schapira: That's fascinating. Did you identify any contributors to burnout that might be attributed to the clinical setting in which they practice?
Dr Banerjee: We have collected data on the hospital type or clinical setting—for example, a university hospital, general hospital, or private hospital. We will be analyzing this. However, given the age range, it will be difficult to make clear conclusions regarding the effect of private hospitals.
We do know that increased workload—caused by higher number of patients per week and fewer oncologists—is a factor for a higher risk for burnout.
Dr Schapira: Oncologists in the United States frequently say that one of the major contributors to burnout is the amount of time they spend on nonclinical work such as paperwork, electronic record documentation, and negotiations with insurance companies. Do those factors apply to European oncologists?
Dr Banerjee: We have collected and need to analyze the survey data on the proportion of time spent on clinical work compared with nonclinical work or research. We may be able to better define the degree to which these factors increase risk for burnout among European young oncologists. I'm sure there will be common factors between Europe and the United States that affect trainees and new specialists who are embarking on their careers. That's why I think it's an international problem that we need to address together.
On Edge About Slipping Off the Cutting Edge
Dr Schapira: In the recent US survey of oncology fellows, the fellows seemed surprised that they didn't have enough time to stay abreast of new therapeutic developments. There is some speculation that not being able to keep up with the literature might erode their sense of competence and may contribute to a feeling of personal failure. Does that resonate with your experience?
Dr Banerjee: I am a member of the European Young Oncologists' Committee, and I have spoken with many young oncologists about their concerns and problems. What you just outlined is a common theme. From a personal point of view and from exchanges with trainees who I supervise, young oncologists have a need and desire to be at the cutting edge of the latest work, and to deliver high-quality care to their patients.
There is an element of personal expectations among young oncologists, and I think that more senior oncologists in institutions need to recognize that young oncologists need time for personal development.
Dr Schapira: Your study documents varying but dramatic rates of burnout in young oncologists across the regions of Europe. What is the next step in your research?
Dr Banerjee: One of the next things that we need to do is conduct a more detailed survey looking at various factors contributing to burnout, such as debt and other personal stresses. Then we can work to identify whether there are interventions that could remedy burnout. For example, after our presentation of the results of this study, I became aware that one hospital in Belgium engaged with psychologists to work one-on-one with oncologists to identify potential stress factors and give advice. That's a model that we would like to explore further.
