January 18, 2012

Long before it was applied to people, the term “burnout” appeared in Merriam-Webster’s Dictionary to describe what happened to rockets or jet engines that “ceased to operate,” having used up their fuel.

By the 1970s, the term had been aptly borrowed by psychology researchers who realized that humans, too, can sputter to earth when caught in a cycle of stress so pervasive that it leads to emotional exhaustion, cynicism, depersonalization, and inefficacy.

Oncologists and others in the oncology field are especially at risk, as evidenced in solid studies conducted over the past 20 years. Unfortunately, the problem hasn’t gone away.

Common themes echo through the literature, chalking up burnout in oncology mostly to overwork, insufficient time away for personal or professional pursuits, reimbursement headaches, and, not insignificantly, the emotional toll inherent in the life work of caring for seriously ill, sometimes terminally ill, patients.

The latest news focuses on pediatric oncologists, surveyed by Dr. Michael Roth and associates from Children’s Hospital at Montefiore and Albert Einstein College of Medicine in the Bronx.

In a study published in December (Pediatric Blood & Cancer 2011:57(7);1168-73), they report that 72% of 410 pediatric oncologists were experiencing at least moderate levels of burnout, according to the well-regarded Maslach Burnout Inventory.

For 38% of these respondents, the career crisis was severe, undoubtedly impacting their personal lives, collegial relationships, and the quality of care they were able to provide.

Female pediatric oncologists and those in practice for less than 10 years were disproportionately likely to suffer burnout, while, not surprisingly, physicians who reported satisfaction from their lives outside the hospital and clinic were less at risk. Other protective factors included the availability of an institutional forum for debriefing and services for physicians experiencing burnout.

The findings parallel a long history of studies that point to institutional, as well as personal, factors that either smolder as incendiary promoters of ultimate burnout, or provide emotional nourishment that keeps oncologists mentally healthy, balanced, and satisfied with the important work that they do.

It’s instructive to revisit one of the earliest significant studies of burnout among oncologists, by Whippen and associates published in 1991.

That study found that 63% of 598 oncologists met criteria for burnout, with even higher rates among those in private adult oncology practices and internal medicine settings, as opposed to universities or other institutions (J. of Clinical Oncology 1991:9;1916-20).

Administering palliative or terminal care, reimbursement issues, and a heavy work load were most often endorsed by oncologists as contributing to their burnout; most felt that they had insufficient personal or vacation time.

Sound familiar?

A follow-up survey by the same group in 2004 used additional questions from the Maslach Burnout Inventory and found that more than a third of oncologists qualified for the more stringent criteria for burnout for many of the same reasons.

It seems clear that year in, year out, about 1 in 3 oncologists start their days burdened by the leaden weight of overwork and professional dissatisfaction. Most likely, it shows up in anger or irritation, problematic interpersonal relationships, a lack of focus and precision, and very little joy in life, at work or at home.

Does it sound like you?

Next week, a look at the research and expert opinion on how to identify burnout in yourself, and what to do it you find it, depleting your energy and threatening the life blood of the satisfaction you once found with your career.

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