Data indicate that medical oncologists, irrespective of where they practice, appear to be at greater risk for burnout than other specialists. Although burnout has been widely studied in academic physicians, community oncologists have not been specifically included in these studies. With community oncologists facing distinct challenges from those of academic physicians and the lack of reports on the impact of electronic health records (EHRs) on this physician group, Ajeet Gajra, MD, FACP, and colleagues conducted a study to assess the issues of work-related stress specific to them, especially addressing the contribution of EHRs as a stressor.
Determining Common Stressors
For a study published in JCO Oncology Practice, Dr. Gajra and colleagues conducted web-based, paid surveys of US community oncologists/hematologists from September to November 2018. “Physicians were asked about frequency of burnout symptoms, drivers of work-related stress, and their perceptions on management of workload,” explains Dr. Gajra. “We developed a set of questions to explore the common stressors in their work lives, as well as questions that would address individual symptoms of burnout. Through our survey design, we were able to circumvent the low response rates in voluntary surveys and essentially achieve a 100% response rate.”
Among survey respondents, 16% felt a substantial amount of stress at work, with most feeling emotionally (85%) and physically (87%) exhausted. A majority also felt lethargic (67%), ineffective (64%), and/or detached (63%). “In a typical workweek, 93% of respondents stated they needed additional time, beyond time allocated to clinical care, to complete work responsibilities,” adds Dr. Gajra. “Of these, 21% needed an extra 7-9 hours, and 17% required more than 10 hours of additional time. Notably, two-thirds attributed moderate to excessive stress to EHR responsibilities,” with 79% working on EHRs outside of clinic hours. Approximately one-third identified changing reimbursement models (33%), interactions with payers (31%), and increasing patient and caregiver demands (31%) as sources of excessive stress. One-third of respondents also reported having considered retiring early or changing their career path to cope.
“It’s important to note that, excluding the ‘never’ and ‘occasionally’ frequencies, the frequency of burnout symptoms was highest for emotional exhaustion (50%), followed by physical exhaustion (44%), cynicism (30%), feeling unaccomplished (27%), and lethargy (23%),” notes Dr. Gajra (Figure). “These rates are rather high and suggest underlying burnout irrespective of whether it is recognized as such by the oncologists.” Physicians provided their perceived magnitude of stress caused by various factors that contributed to their burnout on Likert scales: no added stress, minimal stress added, moderate stress added, significant stress added, and excessive stress added. “Excluding the ‘no stress’ and ‘minimal stress’ categories, the major offenders were: EHR responsibilities (67%), changing reimbursement models (62%), interactions with payers (66%), and increasing demands of patients and caregivers (65%),” says Dr. Gajra. “Notably, keeping up with scientific data and managing complex patients were not perceived to be contributors of excessive stress.”
Despite the frequency of burnout symptoms observed in the study, more than three-quarters of survey respondents stated that their stress was manageable, with 63% reporting an optimal or good workload. “However, the high rates of those who considered retiring early or changing their career path due to increasing demands are a concerning trend when there is already a projected shortage of oncologists,” Dr. Gajra says.
Recognize & Address
Oncologists need to recognize this syndrome in themselves and within their peers, according to Dr. Gajra. “And, if present, we hope they do not try to deny these symptoms given the stigma that has been associated with burnout in the past,” he adds. “Physician burnout is an occupational syndrome that can lead to lower productivity and higher health care costs, as well as increased rates of patient and physician dissatisfaction. If not recognized and addressed by healthcare systems and practices, burnout among oncologists will lead to additional attrition in a stretched workforce by early retirement or change in career path. With timely and unprejudiced recognition, community oncologists can initiate processes to mitigate the factors that are the greatest stressors for them.”
Frequency and Causes of Burnout in US Community Oncologists in the Era of Electronic Health Records