Take Care of Yourself: We Need You

The health and well-being of oncologists is crucial to ensuring patients’ access to clinicians who can provide optimal medical care. The article accompanying this editorial presents the results of a large, national survey examining professional satisfaction among working US oncologists. With an eye toward the projected shortage of US medical oncologists by 2020, Shanafelt et al characterize the state of the specialty today, improving our understanding of the prevalence and impact of work-life conflict, burnout, and career satisfaction on an oncologist’s work and retirement plans. This study is part of a growing body of research supporting the ethos that cancer care providers need a proper balance of work-life time commitment and sustenance in the face of growing demands for cancer care. The results of this survey are startling. Only one-third of oncologists were satisfied with work-life balance, lower than all 24 medical specialties. Their analysis identified an approximately 5% decrease in the likelihood of being satisfied with work-life balance with each additional hour worked per week. Medical oncology is a highly demanding profession so we should not be surprised by these results. A separate study reported that 40% of oncologists work greater than 60 hours per week. In a tracking survey analyzing 41 specialties, medical oncologists ranked fifth in the annual number of work hours—more than general surgery, urology, and obstetrics and gynecology—surgical specialties considered very demanding in terms of work hours. The response to this workload demand is predictable and understandable— dissatisfaction with work-life balance and burnout in this study were the strongest predictors of oncologists’ intent to reduce clinical work hours and leave their current position; 42% cited spending more time with family as the primary reason they are considering reducing clinical work hours. These data imply that our future oncology workforce may be more vulnerable than previously expected, and, that work-life balance and burnout may profoundly affect the supply of cancer care. The American Society of Clinical Oncology (ASCO) workforce study projected an acute shortage of oncologists by 2020 to meet the growing US demand for cancer care. One suggested scenario was for 50% of oncologists to delay retirement for 5 years in order to increase the supply of cancer care. That proposed strategy may be overly optimistic; the study by Shanafelt et al reported that the majority of oncologists (54%) plan to retire at age 65 or earlier, 21% before age 60. The observation that women were “markedly less likely to be satisfied” with work-life balance, confirming other studies, could add additional supply challenges because the proportion of women oncologists in the workforce is rapidly increasing. Women represent only 24% of oncologists in the present workforce yet constitute 50% in oncology fellowship training. Young trainees may also be particularly susceptible to the stressors that result in burnout, irrespective of gender. Work-life balance and lifestyle are important to the younger generation, impacting medical students’ choice of specialty. The older generation, a crucial source of expert patient care, professional mentorship and leadership, may be affected by personal and spousal health, existential questions about mortality, and financial and identity issues as retirement nears. Collectively, these observations imply that our nation’s future cancer care needs may be in peril if we ignore or insufficiently address stress-related symptoms and burnout in our caregivers. It is reassuring that this study identified providing care to patients with cancer as immensely rewarding. They report that the single most common reason oncologists were planning to retire later than previously planned was that they “enjoyed their work too much to retire,” with work enjoyment notably outweighing financial considerations. Kearney et al describe these rewards well—“feelings of satisfaction and gratitude . . . meaningful caregiver-patient relationships; inner selfreflection, connection with peers, family, and community; and a heightened sense of spirituality.” Medical oncologists have much in common with their surgical oncology colleagues, including tremendous responsibility, immense devotion to patients, and a tendency to put personal life behind careers. Not surprisingly, the oncologists’ profile of average burnout, high career satisfaction, and low satisfaction with work-life balance is similar to surgeons. No matter how rewarding the professional life of our caregivers, compromised work-life balance can take its toll on medical and surgical oncologists. The irony is that the coping mechanism that many of us rely on (working harder/longer) can become counter-productive if the self-sacrifice leads to overwhelming fatigue, burnout, or early retirement of the caregiver. Skeptics may consider a physician’s work-life conflict and burnout to be trivial concerns juxtaposed to the immense challenges of patients struggling with cancer. To the contrary, burnout is an important and prevalent condition, not only causing distress to individual providers, but also, adversely impacting the quality of patient care and the costs of care. For example, the rate of major medical errors reported by American surgeons has been reported to be related to burnout symptoms, and a doctor’s distress and lack of self-care can adversely impact the quality of care provided to patients. JOURNAL OF CLINICAL ONCOLOGY E D I T O R I A L VOLUME 32 NUMBER 11 APRIL 1