COMMENTARY

No Such Thing as Work-Life Balance

Leticia de Mattos-Arruda, MD; Matthias Preusser, MD; Michiel H. Strijbos, MD, PhD

Disclosures

December 14, 2015

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Michiel H. Strijbos, MD, PhD: Welcome to this edition of Medscape Oncology Insights coming to you from the 2015 European Cancer Congress in Vienna, Austria. I am Michiel Strijbos, consultant medical oncologist in the Department of Medical Oncology at the Klina Hospital in Brasschaat, Belgium.

Burnout is an issue among European young oncologists. What's worse is that a large percentage of young oncologists experience stress and do not talk about it. Today, we'll talk about it and discuss how young oncologists can cope with the challenges of oncology practice. Joining me in this discussion are two colleagues, Dr Leticia de Mattos-Arruda, medical oncologist and visiting scientist at the Cancer Research UK Cambridge Institute in the United Kingdom, and Dr Matthias Preusser, associate professor in the Department of Medicine at the Comprehensive Cancer Center and chair of the central nervous system unit at the University Hospital in Vienna, Austria. Thank you both for coming.

We're all in slightly different clinical situations. I'm in private practice, Leticia is a clinician currently working in the lab, and Matthias is a faculty member. Last year, the European Society for Medical Oncology (ESMO) Young Oncologist Committee (YOC) conducted a large survey[1] and identified several risk factors for the development of burnout. The survey found that a poor work/life balance is a major risk factor for developing burnout. Matthias, can you comment on this from your personal perspective?

Matthias Preusser, MD: I was quite surprised to see such high prevalence of burnout [71% among European young oncologists].[1] It did not exactly match my personal experience, as I find that many of my colleagues seem to enjoy their jobs and manage a work/life balance well. Of course, oncology is a very demanding specialty. If you see patients, have academic responsibilities, conduct clinical trials, and have a small group to supervise—that's my current situation—work can be stressful and hectic, for sure. Some of the issues you take home with you. You have to think about your patients and other responsibilities, but I think it's very important to keep a certain distance, to have your spare time, spend time with your family, do sports, whatever, and try to limit your time at work. Even if there's a lot to do, a lot of deadlines, try to keep a private life also.

Dr Strijbos: Leticia, can you comment as a clinician currently working in the lab? That must have been a big transition for you. Is there a way you cope with your personal life and your private life? Is that different now that you're working in the lab?

Work/Life Choices Are Key to Manageable Life

Leticia de Mattos-Arruda, MD: I'm in a privileged position. I'm in the lab this year, and I'm not seeing patients. I have to enjoy this and take advantage of this position. Right now, I am dedicated full time to my research. Next year, I'm going to return to a clinical setting in a faculty position, and I will go back to seeing patients and doing translational research. I think it's absolutely possible to have a career and still have your personal goals and a well-rounded life. Someone once said that there is no such thing as work/life balance; there are work/life choices. I absolutely agree with that. I think we have to choose to spend time with our family and friends, have hobbies, and take time off and go on holiday.

Dr Strijbos: Matthias, in your current position, you serve as an associate professor. I can imagine that you have younger doctors working on your team. Is there a way for them to talk to anybody in your institution when they feel work is overwhelming them?

Dr Preusser: It depends on the mentor they have. I think it's very important for young people to choose the mentor or the person they work with, so I guess some do it better than others. I don't have a problem managing my own time, but sometimes I have to think about managing the time of others. It's very easy to forward an email to a younger colleague and say, write this book chapter for me or help me with this and this, and then the workload piles up for the younger colleague, and oftentimes they are not in a position to oppose you and say, okay it's enough. I always try to limit the workload I put on the younger people who work with me.

Dr Strijbos: Leticia, are you supervising anybody in the lab, or are you still being supervised?

Dr de Mattos-Arruda: Both. I'm in an intermediate position. I have my own project, and we have an international collaboration with Barcelona.

Dr Strijbos: If you feel that your mentors are overly demanding of you, expecting stuff that you just physically cannot complete at a certain time, is there a way for you to address that?

Dr de Mattos-Arruda: I have been very lucky with my mentors; I have connected to wonderful mentors that recognize my drive. I think they understand how hard we work and what we want to accomplish. They also want us to have some time off because it's important to get out of the lab, to have some time for renewal, some time to think, and then to come back to the lab with clear ideas. Our performance improves this way. This can save lots of stress and exhaustion and prevent burnout.

Dr Preusser: Michiel, you work in private practice. I imagine you see a lot of patients. How do you cope with work/life balance?

Dr Strijbos: It was difficult at first because my main task is seeing patients, both outpatients, clinic patients, and hospitalized patients. I know for a fact that if I only see patients for the next 30 years, then I would definitely be a victim of burnout. What I try to do is remain involved in teaching and clinical trials. We don't do phase 1 trials, but we do phase 2, 3, and 4 trials. I'm a principal investigator for several of those trials. I also like to do stuff like the ESMO YOC Committee, trying to seek distraction outside of the hospital. I think that's crucial.

Dr Preusser: I agree with you that contributing to educational activities and research helps a lot to cope with everyday clinic life.

Dr Strijbos: Absolutely. Leticia, any comments on that?

Dr de Mattos-Arruda: I think I have a special comment for us women. For new mothers and women with families, I think that's absolutely important. As women, we want to do everything. We have a family, we have kids, and we have our work in the clinic; sometimes we have research. Some colleagues get exhausted, and they don't know what to do. I think they have to realize that they cannot do everything. They have to stop and do the best that they can in specific tasks.

Dr Strijbos: I think an issue that we also need to address when we discuss burnout is to acknowledge it. We now have the survey. Matthias, you commented that you have some doubts or maybe want to comment on the high prevalence of burnout reported.

Is Selection Bias a Factor in the High Prevalence of Burnout?

Dr Preusser: The reported prevalence of burnout among oncologists was 71%. Among oncologists reporting burnout, about 700 persons or 80% were under 40 years old. I was surprised, as I said, by this high number. I think it is an issue that we have to be aware of. But perhaps selection bias may be responsible for this high number. I would expect that somebody with a burnout issue would be more likely to fill out such a survey and to complain, and maybe even exaggerate to some extent just to tell the world that there is a problem. I think the prevalence of burnout in real life, at least in my experience, is a little bit lower. But I agree with you that we need to acknowledge it and need to take care of it.

Dr de Mattos-Arruda: I think the next step is to create preventive programs to help young oncologists deal with exhaustion and burnout.

Dr Strijbos: Leticia, you're currently working as a research scientist in Europe, but originally you're from Brazil. I can imagine that the work ethic and the organization of work is different in Brazil when compared with the United Kingdom. But I can also imagine that it must be very hard for you working in Europe while your family is thousands of miles away.

Dr de Mattos-Arruda: Absolutely. I did my education in Brazil and spent a year as a junior doctor in private practice, and then I moved to Europe. One of the things that I feel most is to be far away from my family; and this, in the beginning, caused a little imbalance in my life. I cannot see my family every week. I can see them only once every 6 months. I have to create mechanisms to try to cope with this.

Dr Strijbos: Matthias, you have been elected as the next chair of the ESMO YOC. I'm also aware that you are very active in the neuro-oncology department. You're an associate professor, so that obviously comes with teaching responsibilities. That seems like a lot of work in a lot of different areas. When do you say "no" to new responsibilities?

Dr Preusser: That's a very good question and a difficult one to answer. You have to decide on a case-by-case basis with other requests that you get. I try to have very clear priorities—what I want to do and what I don't want to do. Of course, there are sometimes things that you cannot decline, but then I try to agree on concrete and realistic deadlines.

Dr Strijbos: Leticia, how does this apply to your current situation? I know you're also very active in breast cancer, you have your research tasks, and we all know that you're very enthusiastic to move up in the oncology world, but when is enough really enough for you?

Dr de Mattos-Arruda: I think that when I have a challenge or problem, I always try to have the big picture in my mind to try to separate the small stuff from the important things. And I do not lose perspective. I cannot accept all tasks that come to me, all collaborations that are asked, but I try to prioritize. I try to select what is interesting for my institution and what is interesting for me.

Dr Strijbos: Leticia and Matthias, thank you very much for your insights. It's been a very interesting discussion. Thank you for joining us in this edition of Medscape Oncology Insights. This is Michiel Strijbos, reporting from the 2015 European Cancer Congress.

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