Oncologist Burnout: Women Worse Off, Except When…

Nick Mulcahy

November 29, 2016

Female oncologists reported significantly more burnout, grief after patient death, and emotional distress than their male counterparts, according to a new study of 178 Canadian and Israeli oncologists.

The study is published in the December 1 issue of Cancer.

The participating oncologists completed a questionnaire package that included a sociodemographic survey, the General Health Questionnaire, a burnout measure, and the Adult Oncologists Grief Questionnaire.

The researchers found that female oncologists (n = 100), in comparison with male oncologists (n = 78), reported significantly more grief responses to patient death (mean, 47.72 vs mean, 44.53; P = .019) more emotional distress (mean, 12.41 vs mean, 10.64; P < .01), and more burnout (mean, 2.59 vs 1.84; P < .01).

The results are in keeping with many – but not all – studies in this area, say the international team of authors, led by Leeat Granek, PhD, of the Department of Public Health at the Ben Gurion University of the Negev in Israel.

"These findings corroborate previous research that has indicated that female oncologists are at a higher risk of burnout than male oncologists," they write, citing six earlier studies. Two other studies found no sex difference.

In their new analysis, the researchers specifically examined associations between three variables — emotional distress, grief reactions, and burnout — to learn about the interplay between them.

They were especially interested in grief that is related to patient death, which they say is an underappreciated aspect of stress in oncology.

"To our knowledge, to date, the vast majority of interventions for burnout have been individualistic, and almost none have focused on responding to patient death," they say.

To examine the effect of grief reactions and burnout on emotional distress within each sex, regression analyses were computed. In all of the analyses, the researchers controlled for country and past depression by sex.

For both sexes, higher levels of grief reactions were associated with greater emotional distress among those who reported high levels of burnout (P < .001).

"For male and female oncologists who reported high levels of burnout, we also found that they reported more grief reactions and also more emotional distress," lead author Dr Granek commented in an email to Medscape Medical News.

Notably, the researchers also found one scenario in which men fared worse.

They found that for men, but not for women, the association between grief reactions and emotional distress was documented at moderate levels of burnout (P < .001).

The authors attempted to explain the finding: "We speculate that men may be more vulnerable to grief reactions and emotional distress at more moderate levels of burnout because of a medical culture that associates oncology with 'toughness' and emotional detachment."

They further say that a "gendered culture that restricts men's ability to express their emotions openly and thus seek support for their emotional needs" may potentially lead to untreated distress even at moderate levels of burnout.

Dr Granek further commented that "there is an expectation that women are more emotional and sensitive than men. It is certainly true that men and women have different levels of comfort in expressing emotion, but both may be equally affected when patients they care about die."

In an attempt make further sense of the finding about men and moderate levels of burnout, the authors refer to a recent qualitative study (J Palliat Med. 2012;15:1254-1260) of oncologists' experiences of patient death. In that study, male oncologists reported that they did not feel comfortable talking of their emotions related to those deaths because they did not want to appear "vulnerable." On the other hand, female oncologists believed they had multiple sources of social support for their grief reactions.

Possible Explanations for Main Findings

As noted above, the main finding of the study is that female oncologists reported more grief responses to patient death, more emotional distress, and more burnout compared with their male counterparts.

A couple of primary reasons may explain this sex discrepancy, the authors say.

First, in the current study, more women (43%) saw 40 or more patients per week than did men (31%). "Previous research has found that patient load is one causal factor of burnout, and this may be one explanation," they write.

Second, the authors speculate that female oncologists might be at higher risk for burnout because of "the potential competing demands of work and family life."

One factor that is helpful in this area is supportive child care, which reduces career burnout in general among mothers, the authors also say.

Women in the United States who had short maternity leaves and poor child care support experienced significantly more burnout than women in the European Union, where maternity leave and child care are "generous and accessible," the investigators write, citing other research (J Vocational Behav. 2010;77:168-185).

Dr Granek emphasized the negative effect of "cumulative stressors" on oncologists, especially with regard to dealing with patient death.

"Our research indicates that oncologists may be able to cope effectively with patient death when they are not feeling burned out by other aspects of their work. Interventions need to look at the whole picture when trying to help oncologists improve their quality of life at work, and in the process also improve quality of care for patients and their families," she said.

The study was supported by the Israeli Cancer Association. Dr Granek has disclosed no relevant financial relationships.

Cancer. 2016;122:3705-14. Abstract

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick

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