Elsevier

Gynecologic Oncology

Volume 143, Issue 2, November 2016, Pages 421-427
Gynecologic Oncology

Review Article
Stress and burnout among gynecologic oncologists: A Society of Gynecologic Oncology Evidence-based Review and Recommendations

https://doi.org/10.1016/j.ygyno.2016.08.319Get rights and content

Highlights

  • There is a high prevalence of burnout among gynecologic oncologists.

  • Physician burnout is associated with significant personal distress.

  • There are practical solutions to reduce physician burnout and promote wellness.

Introduction

Wellness is “a conscious, self-directed and evolving process of achieving full potential” as defined by The National Wellness Institute [1]. While this sounds like an aspiration for every gynecologic oncologist, achieving it requires dedication, effort, and time, resources that many physicians deplete at work. A career in gynecologic oncology can be extremely rewarding, but, it is universally strenuous and demanding. Caring for women with gynecologic cancers (and complex gynecologic problems) requires a significant and continuous commitment from providers which often becomes an all-encompassing mission. Unfortunately, this level of dedication can lead to burnout [2].

Burnout is a mental state defined by any of the following three elements: lack of enthusiasm for work, skepticism and distrust, and a low sense of personal accomplishment. Objectively, burnout can be measured by the Maslach Burnout Inventory, which assesses: emotional exhaustion, depersonalization and low personal accomplishment. The syndrome of burnout is present if at least one of the elements is significantly abnormal [3]. In addition to burnout, physicians may also experience compassion fatigue, also known as vicarious traumatization, which also follows from the stress caused by caring for ill patients. Compassion fatigue and burnout can coexist, but are distinct entities. Burnout is due to stressors related to interaction with the work environment and can include loss of empathy [4], while compassion fatigue is caused by the stress of the bond between the caregiver and the patient; empathy is preserved but caregivers become overwhelmed by the trauma to which they are exposed [5], [6].

Burnout and compassion fatigue are endemic among healthcare providers. It has been estimated that half of all medical students, residents and attending physicians experience burnout, and that physicians suffer more burnout than do other American workers [7], [8], [9]. Conflicting data suggest that primary care physicians on the ‘front line’ experience the lowest job satisfaction and the highest burnout, while the oncology, trauma and surgical literature show that physicians dealing with the most acutely ill patients have a high prevalence of burnout. In a meta-analysis of burnout among healthcare professionals that care for patients with cancer, the prevalence of emotional exhaustion was 36%, depersonalization 34% and low sense of personal accomplishment 25%, with severe involvement in up to 51% of surveyed subjects [10]. Forty percent of surgical oncologists, 35% of medical oncologists and 64% of obstetrician gynecologists were estimated to have symptoms of burnout in specialty specific surveys [11], [12], [13]. While it is to be expected that caring for extremely ill and dying patients is emotionally draining, it is alarming that doing so causes potential harm to the physician as well.

Burnout has been studied among medical oncologists and surgeons; however, there is less data specific to gynecologic oncolxogists [14], [15]. Job satisfaction and work related stress among gynecologic oncologists have been assessed [2], but until recently, burnout was not assessed. Two large, seminal studies, a 2014 survey of 369 members of the Society of Gynecologic Oncologists (SGO) and a 2008 survey of 7900 members of the American College of Surgeons (ACS), established the high prevalence of physician burnout in gynecologic oncologists and surgeons respectively, affecting 32%–40% of responders [16], [17]. Both works are cited throughout this paper and were driving forces motivating the Society of Gynecologic Oncology (SGO) to assemble a Wellness Task Force to address this issue. This paper represents an effort by the Task Force to acknowledge the high rate of burnout in gynecologic oncology as a specialty by bringing the subject forward for discussion, and exploring potential solutions.

Section snippets

Consequences of burnout

It is crucial to address physician burnout as its consequences extend beyond the individual physician and affect the entire profession, patient care, and society in general (Fig. 1).

Causes of physician burnout

The current literature describes a multitude of factors that are associated with, and possible causes of, physician burnout. Because there are only a few studies that specifically assess gynecologic oncologists, much of what we understand must be extrapolated from larger studies of a variety of physician specialties including general surgeons, internists, and oncologists [2], [14], [15]. While each individual study has unique findings, there are common themes among the literature:

Job stress: practicing medicine in the modern era

One of the most important factors associated with physician burnout is job stress. Physicians as a whole, and particularly surgical and medical oncologists, deal with stress as an integral part of their daily work [11]. Caring for patients with cancer and interacting with their families is an emotionally demanding job. Studies have shown that burnout correlates with managing acutely ill patients, and dealing with the issues surrounding death and dying [10]. Among gynecologic oncologists, those

Work-life balance: walking the tight rope

Another key factor contributing to burnout is the challenge of work-life balance. The expectation that physicians be excellent at their job while maintaining a highly functional and rewarding personal life is daunting, and studies have found that difficulty balancing career with family/personal life is a major contributor to burnout [46]. In particular, a sub-analysis of the ACS survey showed that resolving this work-life conflict by prioritizing work over personal time is associated with

Loss of meaning from work

Deriving a sense of meaning from work has been shown to reduce the risk of physician burnout [12]. In a 1997 job satisfaction survey of over 300 physicians, positive relationships with patients and colleagues, and intellectual stimulation, were identified as important components of job fulfillment [54]. More recent studies have confirmed these findings 20 years later. In a survey of internal medicine faculty in a U.S. academic medical center, a majority of respondents (68%) stated that patient

Risk factors for burnout

Risk factors for physician burnout provide some insight vulnerable physician groups, but some controversy remains. Female gender and younger age are consistently cited as risk factors [41]. In a large study of medical oncologists, variables strongly associated with burnout included: younger age, female gender, single relationship status, not having children, greater student loan debt, and greater number of hours spent seeing patients each week. However, on multivariate analysis, only younger

Self-care strategies to promote wellness

While awareness regarding the factors that contribute to physician stress is increasing, few studies address methods for preventing or treating the problem. There is evidence to suggest that self-care strategies, both relating to mental and physical activities, can improve wellbeing [65], [66], [67], [68], [69], [70], [71]. One integrative technique that is gaining in popularity utilizes the cultivation of self-awareness and mindfulness based practices [66], [67], [68]. Krasner et al. reported

Conclusion

The SGO survey highlights the high prevalence of physician burnout and serves as a call to action. It is encouraging that gynecologic oncologists scored highly in their perception of meaning in their work, with 70% of respondents in the SGO survey reporting high levels of personal accomplishment. Most were satisfied with their careers, as indicated by the fact that 89% would enter medicine again, and 61% would encourage their child to enter medicine [16]. The unique aspects of the specialty of

Conflict of interest statement

Dr. Nefertiti duPont sits on the Advisory Board and provides consulting to Genetech. Dr. Premal Thaker provides consulting for Celsion. All other authors have no conflict of interest.

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