Understanding and Combatting Burnout in Hematologist-Oncologists

More than one-third (36.5%) of hematologist-oncologists experience burnout, according to a 2019 survey conducted by the American Society of Hematology. In addition, 12% of the 411 respondents reported a high level of burnout. Female gender was associated with high burnout among academic physicians, frequent use of advanced practice providers was associated with lower burnout among community physicians, and relative value unit–only compensation plans were associated with high burnout in both practice settings.

Blood Cancers Today spoke with Melody Smith, MD, MS, an assistant professor in the Department of Medicine in the Division of Blood & Marrow Transplantation and Cellular Therapy at Stanford Medicine, about the study’s methods, why burnout occurs, and how to reduce it.

Can you please describe the study on burnout in hematologist-oncologists?

The study was led by a working group within the American Society of Hematology. We were the recruitment and retention committee within the American Society of Hematology, and our chair was Alfred Lee, MD, a hematologist at Yale University. At that time, there was a lot of conversation around physician burnout and burnout within the healthcare workforce more broadly. We come into medicine with the objective of taking care of patients, but various aspects of our work can start to cause people to feel overwhelmed and less fulfilled.

We conducted this survey using the Maslach Burnout Inventory Emotional Exhaustion Subscale because it is a validated tool. We sent the survey to practicing hematologists and oncologists. The survey had 27 multiple choice and open-ended questions that assessed the following domains:

• Practice activities
• Practice satisfaction: how satisfied people were with their work environment
• Participation in medical education and mentoring
• Compensation: Did people feel like they were being adequately compensated in their environment based on their workload?
• Practice setting: private practice versus academic setting
• Practitioner demographics

Depending upon different practitioner demographics, there might be different tasks that people may be burdened with—such as serving on committees—that don’t contribute towards their academic advancement or have compensation-related benefits. People may be apt to volunteer for these tasks, but that increasing workload can contribute to burnout.

Additionally, we posited that those who are involved in training and education or work with trainees might have more satisfaction because they are contributing to the development of the next generation.

First, there was a pilot-tested survey with 14 attending physicians to pressure test this survey before sending it out by mail with an option for an online response to a random sample of 2,500 physicians listed within the American Medical Association Masterfile as adult hematologists or oncologists. We sent it out between May and July 2019. Even though the paper was published in 2023, this was before the pandemic. We were thinking about burnout in that snapshot of time as opposed to post pandemic, and any factors that could have contributed to burnout or increasing burnout after or during the pandemic wouldn’t have been taken into consideration because the survey was conducted before that.

How do you think feelings of burnout might have changed from 2019 to now?

During the pandemic, there was a lot of stress from caring for patients who had COVID and concerns about contracting the virus and transmitting it to loved ones. Now, the impact in terms of burnout can show up in different ways. Some people might feel less burnout because of more flexibility around the work environment. Depending on the institution, physicians might be able to do more hybrid work than they did before the pandemic. For example, I know colleagues who said that on days they don’t have to be in clinic, they may be able to work from home or take clinics from home, which was not previously an option. Having more autonomy around your schedule might diminish burnout.

That can provide a little more flexibility around the work environment, and some people thrive in that setting. However, that probably doesn’t alleviate stress for those who have child-rearing responsibilities or have children who are still at home during the day. That probably makes it harder to juggle.

Can you share your personal experience with burnout as a hematologist-oncologist?

When I reflect not only on the time I was working on this paper, but even now, I don’t know that I would ever say that I have gotten to the point of burnout. However, I think burnout is a continuum; there are moments where work feels more intense, busy, and stressful, like there’s constant work to do. I try to evaluate how I’m responding to that and evaluate the equipoise in my life both personally and professionally. When I feel that there’s so many deadlines and can’t catch up despite working constantly, I try to reevaluate how I can recenter and have more equipoise and balance.

I do feel like it’s a constant assessment of where things are, because some seasons are busier than others when there’s a deadline for a paper or conference. As I’ve continued to grow and work as a physician, I’ve realized that there are always going to be deadlines. I try to find some balance in putting parameters around and determining when I’ll work and when I won’t—and not allowing it to become overwhelming. That’s how I try to limit burnout for myself.

Do you have any advice to early-career fellows or medical residents who may experience burnout?

Having activities outside of work that you’re passionate about really helps. This way, you can have things that help to bring different perspectives where you’re not thinking about work.

I love what I do; I feel really privileged to be able to practice medicine and take care of patients. I enjoy coming to work every day. In spite of that, I think it’s also important and healthy to have outside hobbies, whether it’s exercising or enjoying the arts or music. I picked up the oboe a couple of years ago, an instrument I played when I was younger and hadn’t played for years. Music uses a different part of the brain. When I’m playing, I’m not thinking about all the things I need to do. It gives that part of my brain a rest.

For younger trainees—when you’re in training, particularly medical school, residency, or fellowship—it feels like you don’t have any time. But, it’s important to carve out time on the weekends or when you’re not on call to do things you enjoy and bring a sense of balance. As you come out of training into your independent positions, it’s important to try to reestablish those rhythms. I found that to be really helpful.

How can burnout affect career satisfaction and performance?

It can lead to a diminished level of career satisfaction. It makes work start to feel like a drudgery. You aren’t finding the joy in what you do. You’re not finding the passion in what you do. That’s the challenge of burnout, and burnout can arise differently in each individual. At the same level of work or the same work context, one person may feel like they’re thriving, and another person may feel like it’s too much. It can also fluctuate with seasons and stages of life. For example, you can have things going on in your personal life that are impacting your ability to work. Constant self-assessments are important to see where you are, when you need to pull back, and who you can go to for assistance when you’re feeling overwhelmed.

I think a lot of institutions are realizing that there’s so many factors that impact how we as physicians show up at work. Burnout is one factor that a lot of institutions are becoming more mindful of. At my institution, there is a wellness program with various retreats for individuals and couples to talk about management burnout and work-life integration. It’s important that people don’t feel ashamed if they are feeling burned out, but rather give voice to it and seek assistance where needed.

Reference

Lee AI, Masselink LE, De Castro LM, et al. Burnout in US hematologists and oncologists: impact of compensation models and advanced practice provider support. Blood Adv. 2023;7(13):3058-3068. doi:10.1182/bloodadvances.2021006140