Oncology's Unrecognized Crisis
Editor's Note: Burnout among young oncologists is not confined to the United States. An important survey of European oncologists presented during the 2014 annual congress of the European Society for Medical Oncology (ESMO) reported a burnout rate of 71% among European young oncologists. In Central Europe, the rate was substantially higher. On behalf of Medscape, Lidia Schapira, MD, associate professor at Harvard Medical School, spoke to the lead study author, Susana Banerjee, MD, PhD, consultant medical oncologist andresearch lead of the Gynaecology Unit at The Royal Marsden NHS Foundation Trust, to discuss the crisis of oncology burnout and what can be done about it.
Dr Schapira: At the 2014 ESMO Congress,you presented findings of a study of burnout among European young oncologists. The reported burnout rate was an astonishing 71%. Were you surprised by that?
Dr Banerjee: I was surprised by the extent of the regional differences in burnout rates across Europe. In Northern Europe and the British Isles, the burnout rate is probably more in keeping with some of the work from the United States—around 50%. The highest rates of burnout were 84% in Central Europe, with Western Europe, Eastern Europe, Southwestern, and Southeastern Europe in between.
When comparing Central Europe with Eastern Europe in a multivariate analysis, there's an almost threefold increase in burnout. European region was an independent factor along with good work-life balance and adequate vacation time. Seeing these differences in burnout rates, we need to find out what the real factors are in European regions that make oncologists living in one area or another more susceptible to burnout.
Yes, 71% is a high rate, reflecting the potential extent of the problem.
Dr Schapira: How do you define "young" oncologists?
Dr Banerjee: Young oncologists are aged 40 or less. This includes oncologists in training as well as oncologists, like me, who have been fully trained and have their own practice. Basically, 52% of the respondents were trainees and the remainder had completed training. The majority of responses—some 83%—were from medical oncologists. This is most likely a reflection of the survey being distributed through ESMO, which targets medical oncologists. But respondents included radiation oncologists and surgical oncologists. There was a mix.
Dr Schapira: I assume that the definition of burnout is the same that has been used previously, but can you define it for us?
Dr Banerjee: We used the Maslach Burnout Inventory, which is the most widely used tool as a measure of burnout. The MBI looks at the three main components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. In our study, we defined burnout as high scores over relevant thresholds of all three parameters; some studies have looked at two parameters.
Dr Schapira: With reports of such high burnout rates, do young oncologists ask for help or at least speak up about their situation?
Dr Banerjee: Among young oncologists in practice, we asked how many times they had asked for support during training and after training to see whether there had been any changes. What was surprising to me was the number of oncologists who did not ask for support for stress or burnout. Over 70% never asked, either in training or after training. That's one of the problems: Oncologists aren't seeking help. Some 74% actually reported that they had no access to support services for doctors, which was perhaps more of a concern.
Editor's Note: Burnout among young oncologists is not confined to the United States. An important survey of European oncologists presented during the 2014 annual congress of the European Society for Medical Oncology (ESMO) reported a burnout rate of 71% among European young oncologists. In Central Europe, the rate was substantially higher. On behalf of Medscape, Lidia Schapira, MD, associate professor at Harvard Medical School, spoke to the lead study author, Susana Banerjee, MD, PhD, consultant medical oncologist andresearch lead of the Gynaecology Unit at The Royal Marsden NHS Foundation Trust, to discuss the crisis of oncology burnout and what can be done about it.
Dr Schapira: At the 2014 ESMO Congress,you presented findings of a study of burnout among European young oncologists. The reported burnout rate was an astonishing 71%. Were you surprised by that?
Dr Banerjee: I was surprised by the extent of the regional differences in burnout rates across Europe. In Northern Europe and the British Isles, the burnout rate is probably more in keeping with some of the work from the United States—around 50%. The highest rates of burnout were 84% in Central Europe, with Western Europe, Eastern Europe, Southwestern, and Southeastern Europe in between.
When comparing Central Europe with Eastern Europe in a multivariate analysis, there's an almost threefold increase in burnout. European region was an independent factor along with good work-life balance and adequate vacation time. Seeing these differences in burnout rates, we need to find out what the real factors are in European regions that make oncologists living in one area or another more susceptible to burnout.
Yes, 71% is a high rate, reflecting the potential extent of the problem.
Dr Schapira: How do you define "young" oncologists?
Dr Banerjee: Young oncologists are aged 40 or less. This includes oncologists in training as well as oncologists, like me, who have been fully trained and have their own practice. Basically, 52% of the respondents were trainees and the remainder had completed training. The majority of responses—some 83%—were from medical oncologists. This is most likely a reflection of the survey being distributed through ESMO, which targets medical oncologists. But respondents included radiation oncologists and surgical oncologists. There was a mix.
Dr Schapira: I assume that the definition of burnout is the same that has been used previously, but can you define it for us?
Dr Banerjee: We used the Maslach Burnout Inventory, which is the most widely used tool as a measure of burnout. The MBI looks at the three main components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. In our study, we defined burnout as high scores over relevant thresholds of all three parameters; some studies have looked at two parameters.
Stressed but Staying Quiet About It
Dr Schapira: With reports of such high burnout rates, do young oncologists ask for help or at least speak up about their situation?
Dr Banerjee: Among young oncologists in practice, we asked how many times they had asked for support during training and after training to see whether there had been any changes. What was surprising to me was the number of oncologists who did not ask for support for stress or burnout. Over 70% never asked, either in training or after training. That's one of the problems: Oncologists aren't seeking help. Some 74% actually reported that they had no access to support services for doctors, which was perhaps more of a concern.