Mar 03, 2017
By Suresh S. Ramalingam, MD
Winship Cancer Institute of Emory University
There has never been a better time to be a cancer care provider; with breakthrough discoveries in cancer biology and immunology, a new armamentarium of anticancer therapies is available. Targeted therapies and, more recently, immune checkpoint inhibitors have provided us with new hope to achieve long-term survival, and even a cure, for patients with cancer. The adoption of these innovative advances in clinical practice has re-energized oncologists and increased optimism of improved outcomes for our patients. However, a number of factors that directly influence our daily work are leading to discontent with the job and pose a threat to our overall well-being, ability to provide high-quality patient care, and continued progress in our chosen career path.
A study by Shanafelt and colleagues reported that approximately 35% of oncologists are suffering from burnout. Of greater concern is the fact that nearly 35% of practicing oncologists indicated a high likelihood of leaving their current position within 24 months.1 Approximately 30% plan to retire before they reach age 65. This is of great concern, as the need for high-quality oncology care is projected to increase rapidly over the next decade, and the number of trainees that are graduating each year is not keeping pace with those leaving the workforce. In fact, a substantial subset of fellowship trainees also reported suffering from burnout.2 For all these reasons, promoting physician wellness is a critical and urgent issue that begs for solutions.
The first step is to understand the reasons behind this high rate of burnout. There are limited data on factors driving burnout among oncologists. However, we can all relate to increasing regulatory burden in our daily work lives, interactions with insurance companies, demands on our time to meet patient expectations in the era of Google, and the increasing complexity of our own continuing medical education and recertification needs. Electronic medical records (EMRs), which are critical for physician information sharing and to minimize errors in practice, have also added new challenges for physicians. It is not at all uncommon for physicians to regularly spend personal time after hours to complete electronic records (so-called “pajama time”).
The majority of these problems are not unique to oncologists and apply to health care providers in general. Solutions for addressing these problems are beginning to emerge at multiple levels. ASCO is committed to addressing these critical issues to improve the wellness of its membership. In fact, ASCO has played an important role in conducting the studies that described the scope of oncologist burnout.
In 2014, ASCO’s Leadership Development Program tasked one of its trainee groups to study and explore solutions to promote wellness among its membership. This group interviewed a number of physicians, training program directors, and industry leaders to obtain their perspectives on physician wellness. Based on the knowledge gained, the Leadership Development Program group provided a series of recommendations that include measures to enhance education, research, and evaluation, and, ultimately, to implement steps to promote wellness.
The ASCO Professional Development Committee is also engaged in a number of initiatives to raise awareness and propose potential solutions to the issue of physician burnout. We recently launched a new Physician Wellness blog on ASCOconnection.org. We anticipate that this forum will serve as a medium to promote conversations and best practices to improve physician wellness among ASCO membership. ASCO members are invited to share their personal experiences, lessons learned, and measures that they have undertaken to improve quality of life and maintain a passion for patient care in their own lives.
The committee has also deliberated on various stressors at work—regardless of academic, community, or industry setting—and considered potential ways to ameliorate them. The committee feels that a physician wellness campaign along the lines of Choosing Wisely will go a long way in addressing the problem. Unfortunately, unlike Choosing Wisely, where there are proven ways to improve quality of care, there are no evidence-based approaches to promoting physician wellness.
It is clear that we have to address this issue at both the individual and institutional levels. At an individual level, physicians should take time off at regular intervals to relax and recharge. Even interventions that can be undertaken for brief periods during daily work such as relaxation techniques might be valuable in this regard. (See 'Mind Over Matter' for an introduction to mindful meditation techniques.) At an institutional level, it is important to implement plans to promote physician wellness and reduce burnout. Resources to prevent burnout should be made available to physicians. We also feel that physician work schedules should include sufficient time built in for the completion of medical records. Outpatient clinic templates should be more realistic, considering increasing patient complexity and expectations. Appropriate compensatory days off should be provided following long stretches at work, such as working through weekends and long stints on inpatient service. Although these interventions might not address every problem at every level, the committee is confident that these approaches will initiate dialogue at the institutional level and promote the development of creative solutions.
The Professional Development Committee is also piloting a Resiliency Skills Training Initiative in four selected fellowship programs. The respective program directors will be partnering with social workers at their institutions and will lead eight sessions on resiliency skills. This strategy is based on the notion that resiliency skills can be learned and will result in lifelong benefits, if initiated at the earliest possible time. The lessons learned from this program will greatly facilitate adaptation to a greater number of training programs in the future.
ASCO also plans to develop podcasts and webinars focused on the topic of physician wellness, where professionals at various organizations that have addressed this issue will share insights with the ASCO membership. The importance of working together with other professional organizations to develop best practices cannot be overstated. As a Society, we will have to work together to identify ways to promote physician wellness that will facilitate continued passion for patient care and enhance our ability to continue to provide top-notch care for patients, which is the reason we chose this professional career.
- Shanafelt TD, Gradishar WJ, Kosty M, et al. J Clin Oncol. 2014;32:678-86.
- Shanafelt TD, Raymond M, Horn L, et al. J Clin Oncol. 2014;32:2991-7.
Originally published in 2017 ASCO-SITC Clinical Immuno-Oncology Symposium Daily News; reprinted with permission.