COMMENTARY

Oncologists: Burned Out -- or Burned?

Bruce D. Cheson, MD

Disclosures

March 24, 2014

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Hello. This is Bruce Cheson from Georgetown University Hospital, the Lombardi Comprehensive Cancer Center, in Washington, DC, speaking to you for Medscape Hematology.

When I arrived in the office this Monday morning, I had a lot of things to look forward to. I was glad to be here, ready to get something accomplished. Were you glad to be in your office this morning? The issue at hand is oncologist burnout.

When I walked into the office this morning, I pulled out the March 1 issue of the JCO (Journal of Clinical Oncology) and found an article by Shanafelt, from Mayo Clinic, and colleaguesfrom other institutions around the country, examining this question.[1] They used a standardized burnout inventory to survey around 3000 oncologists to learn how many showed evidence of burnout. Respondents in active practice (slightly more than 1000) had a median age of around 52 years, roughly one-third were in academics, around 43% were in private practice, and the rest were other types of practitioners.

Respondents saw an average of 52 patients per week. They seemed to like what they were doing because more than 80% were satisfied with their careers and about 80% with their specialty. Yet 44.7% exhibited one or more features of burnout, including emotional exhaustion and depersonalization. The best predictor of burnout was the number of hours spent in direct patient contact, direct patient care.

The academics did a bit better, perhaps because they were younger and more were women, but other features distinguished the academics from those in private practice. They spent more time supervising physicians in training. They were involved a bit more in administrative activities. They saw half the number of outpatients per week but spent the same amount of time with each patient; on the other hand, they saw more inpatients. Academics had fewer nights and weekends on call but were more likely to spend hours at home on work-related activities. Therefore, compensation packages based solely on volume could have a deleterious effect given these observations.

What keeps me going is the diversity of what I do: the writing, the teaching, the Medscape filming. At Georgetown, we have a bonus package that actually rewards us for some of our non-relative value-related activities so that committee memberships, the number of patients put on clinical trials, publications, speeches, and so on are all counted and given value. I am glad I do what I do and I think the diversity of what I do really helps. If it were merely a question of volume for volume's sake and to make more money for more volume, I can easily see how one could get to burnout.

I hope this paper will lead to more interest in the subject and more activity focused on solving the problem of physician burnout, because it can be a serious problem.

Before you get burned out from listening to me, I will say goodbye for now. This is Bruce Cheson from Georgetown University Hospital and for Medscape Hematology. Until next time, thank you.

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