Battling Burnout

Matthew Matasar, MD is a medical oncologist specializing in lymphoma and is chief of the Division of Blood Disorders at Rutgers Cancer Institute of New Jersey and RWJBarnabas Health.

I find myself thinking a lot about burnout these days, and I know I’m not alone. At a meeting before the holidays, I heard friends and colleagues use all manner of colorful language describing their own mental states. “Flash fried,” “crispy critter,” “scorched,” and “stick a fork in me, I’m done!” come to mind. But this is – as my kids might say – funny/not funny and belies a very real problem that we individually and collectively face in medicine and even more starkly in hematology. Burnout is our reality as a profession, and we are failing at addressing it.

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Certainly, our understanding of burnout is far more than pre-holiday anecdotes. There’s no shortage of data describing the problem, and clearly, it’s not a new problem. Tait Shanafelt, MD, and colleagues led a national survey almost a decade ago, finding that 45% of responding oncologists in the U.S. reported emotional exhaustion or depersonalization symptoms related to burnout.¹

Maybe I should take a beat here and clarify what I mean by burnout. Far more than just being fatigued and ready for a vacation or long weekend, burnout is really a syndrome with three pieces: physical or emotional exhaustion, cynicism and disengagement, and sense of a lack of meaningful accomplishment. Any of that resonate with you or with what you’re seeing around you? You’re not alone.

To be clear, burnout matters. It’s far more than dissatisfaction or restlessness. Burnout leads to a whole host of problems, both professional and personal. Examples include early retirement (a real problem for our profession, as anyone who’s read forecasts of physician shortages can attest) or quitting medicine to work in other fields (look at the number of not just senior physicians, but mid-career and junior docs leaving the practice of medicine for jobs in pharma, consulting, or the like). Worse yet, burned-out physicians who try to tough it out can find themselves in a state of moral distress, trying to remain committed to treatments that they sense are useless, working in hospitals or clinics they feel are misaligned with personal values, all while caring for patients they find increasingly hard to connect with.

So. Burnout is pervasive, depleting our ranks, and harming those who persist. Where do we go from here? A lot of fuss is made over promotion of personal resilience – or, in the language of psychologist Angela Duckworth, PhD, “grit.” All of this, frankly, misses the mark and smacks of blaming the victim.

We’re not burned out because of a lack of personal resilience, even though resilience, that quality of being able to emerge from challenges strengthened rather than diminished, is certainly valuable. We’re burned out because of all the external factors that drive burnout. Overwork. Increased administrative burden, exacerbated by the thrall of the electronic medical record. A diminution of autonomy over our daily lives – to wit, surveys such as one by M.W. Steffen, M.D., and colleagues² have shown how hard it is for physicians to even see our own physicians! Pressure from leadership to prioritize productivity over achievement, let alone innovation.

And thus, our answers must begin to focus on addressing these underlying factors. Responsibility falls first and foremost on those with leadership roles, from leading a clinic team to leading a health system. And, as with our most sophisticated targeted therapies, we need interventions that specifically address underlying dysfunction while minimizing off-target effects.

I propose focusing on three concrete solutions:

1. We can promote a culture of gratitude for the service of our colleagues, focusing on more effective and committed mentorship and sponsorship. This must be done in the context of an individual physicians’ goals, interests, and passions. And we must find ways to nurture and cultivate – take advantage of, even! – these passions, even when they may not directly translate into RVUs (relative value units).
2. We must establish cultures of caring, in which we make clear the expectation of self-care for ourselves and our colleagues, from receiving our own health care to participating fully in key moments outside of our professional responsibilities.
3. We must refocus our professional metrics not around productivity but around sustainability. Yes, health care economics are increasingly fraught, and a sustainable health care enterprise clearly requires health care revenue generation. But sustainability must be assessed at the departmental, team, and individual levels. A more holistic assessment of the sustainability of a team or individual’s work is required and must replace the more brittle measure of individual or collective financial value. This will require honest conversations and, ultimately, a rebalancing of effort.

This is hard but necessary work, and we owe it to ourselves, each other, our teams, and our patients not to shrink from it.

Matthew Matasar, MD
Associate Editor

References

1. Shanafelt TD, Gradishar WJ, Kosty M, et al. Burnout and career satisfaction among US oncologists. J Clin Oncol. 2014;32(7):678-686.
2. Steffen MW, Hagen PT, Benkhadra K, Molella RG, Newcomb RD, Murad MH. A survey of physicians’ perceptions of their health care needs. Occupat Med (London). 2015;65(1):49-53.

The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.

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