Long Hours and Compassion Fatigue Drive Stress for Oncologists

Roxanne Nelson

March 29, 2013

Oncologists tend to be healthy, like to travel to far-off lands, and enjoy reading and a good glass of wine. However, they get stressed out by too many "bureaucratic tasks" and the long hours spent at work. Compassion fatigue is also a key source of stress.

Burnout is a psychologic syndrome characterized by emotional and physical exhaustion caused by excessive and prolonged stress. A recent survey found that burnout is more common among physicians than among other workers in the United States (Arch Intern Med. 2012;172:1377-1385). In fact, 45.8% of physicians reported at least 1 symptom of burnout, defined as loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.

In a survey conducted by Medscape, a similar proportion of respondents — 39.8% — indicated that they were burned out, according to the 2013 Medscape Physician Lifestyle Report.

But the news is a little less discouraging for oncologists. For burnout, oncology is ranked number 13 among the 24 specialties surveyed.

On the 7-point severity scale (where 1 indicates "does not interfere with my life," and 7 indicates "so severe that I am thinking of leaving medicine altogether"), oncologists had a mean score of 3.6. More female than male oncologists reported burnout (56% vs 36%).

Key Drivers of Stress

External stressors play a clear and major role in physician burnout. In a Medscape Roundtable in Primary Care, Roy Poses, MD, from Brown University in Providence, Rhode Island, noted that "most interventions meant to improve burnout have treated it like a psychiatric illness, not a rational response to a badly led, dysfunctional healthcare system."

In the Medscape survey, oncologists reported that the key drivers of stress are the high level of bureaucratic tasks, "spending too many hours at work," and "compassion fatigue." It is not surprising that oncologists and critical care physicians were the only specialists to list compassion fatigue as 1 of their top 3 stressors.

Conversely, oncologists were least affected by "difficult colleagues or staff," a "difficult employer," or a "lack of professional fulfillment."

Age and Good Health

Age also plays a role in the degree of burnout experienced; it appears to peak during midlife. Burnout was reported by 32% of oncologists 46 to 55 years of age, by 29% of those 56 to 65 years of age, and by only 4% of those older than 66 years (which could be related to retirement or reduced work hours).

In general, oncologists enjoy good health, whether or not they reported burnout. On a 7-point physical health scale (where 1 indicates "poor health" and 7 indicates "extremely healthy"), the mean physical health score was 5.3 for those who reported burnout and 5.7 for those who did not.

However, burnout status did appear to affect body weight. Oncologists appear to maintain a healthier weight than their patients, but burned out physicians tended to weigh more. Of oncologists who reported burnout, 49% were overweight or obese; of those who did not, 40% were.

Happiness and Marriage

How happy are oncologists? Not surprisingly, mean scores on the 7-point happiness scale (where 1 indicates "very unhappy" and 7 indicates "very happy") were lower in those who reported burnout than in those who did not (3.8 vs 5.3). This rate matches that of the public at large.

Oncologists who reported burnout and those who did not were happier at home than at work (5.0 vs 5.5).

However, burnout did not seem to affect marital status. As in other physician groups, a large percentage of oncologists are married or live with a domestic partner; rates are similar for those who reported burnout and those who did not (83% vs 81%). In addition, roughly two thirds of all oncologists are still in their first marriage; that number is slightly higher in the burnout group.