MADRID — “Why did I choose this?”
That is the core question a Portuguese oncologist posed from the audience during a session at the European Society for Medical Oncology (ESMO) Annual Meeting 2023 that was dedicated to building a sustainable oncology workforce.
“Ten, twenty years ago, being a doctor was a dream,” she said, but right now doctors are underpaid, under strain, and have very few resources.
This oncologist is hardly alone.
Rates of burnout among oncologists remain alarmingly high, explained session chair Kok Haw Jonathan Lim, MD, PhD.
A survey from ESMO conducted almost a decade ago found that more than 50% of oncologists across Europe, many of whom were early in their careers, reported being burned out.
This, Lim said, “was the starting point,” well before the COVID pandemic struck.
More recently, the pandemic has taken its own toll on the well-being of oncologists. A survey presented at ESMO 2020 revealed that 38% of participants, spanning 101 countries, reported experiencing burnout, and 66% said they were not able to perform their job.
Medscape’s own 2023 Physician Burnout and Depression Report highlighted similar burnout rates, with 53% of US physicians and 52% of oncologists saying they felt burned out, compared with about 42% in 2018, before the pandemic.
The oncology workforce is in crisis in every country, said Lim, from the Cancer Dynamics Lab, the Francis Crick Institute, London, United Kingdom.
Burnout, characterized by emotional exhaustion, depersonalization or feelings of cynicism, and a low sense of personal accomplishment, can result in a poor work-life balance as well as poor mental and physical health. Factors linked to burnout include social isolation, increased workload, reduced quality of work, lack of control over work, and stressful professional experiences.
Together, these factors can affect patient care and further exacerbate staffing issues, Lim said.
Staffing shortages are common. Oncologists often work long hours or on weekends to cover gaps caused by staffing shortages. Recent data revealed that in high-income countries, there are on average 0.65 medical oncologists and 0.25 radiation oncologists per 100 patients — a situation made worse by professionals taking early retirement or leaving medicine during the pandemic.
“We have seen that the shortage of human resources in many countries as well as the increasing workload related to the increasing number of cancers,” as well as patients surviving longer, have increased pressures on the healthcare system, Andrés Cervantes, MD, PhD, president of ESMO, explained in a press conference.
While tackling these oncology workforce problems requires smaller, local changes to a physician’s daily routine, “the real change,” Lim said, lies at an infrastructure level.
In response to this chronic and growing problem, ESMO launched its Resilience Task Force in 2020 to evaluate burnout and well-being. The task force plans to publish a position paper in which it will propose a set of recommendations regarding the psychosocial risks of burnout as well as flexible work patterns, well-being resources, and targeted support.
A panel of experts at the meeting touched on some of these solutions.
Dealing with staff shortages is a must, said Jean-Yves Blay, MD, PhD, during the session. “It’s a simple mathematical equation,” Blay said. “We must increase the number of doctors in medical schools and the number of nurses and healthcare professionals in all schools.” Improving staffing would also help reduce chronic workload issues.
Resilience training should also be incorporated into physician training starting in medical school.Teaching oncologists how to deal with bad news and to cope when patients die is particularly important.
“I was not taught that,” said the oncologist from Portugal. “I had to learn that at my own cost.”
The good news is that it’s possible todevelop resiliency skills over time, said Claire Hardy, PhD, from Lancaster University, UK, who agreed that training programs could be one approach to improve oncologists’ work life.
However, a person’s needs are determined by their institution and personal responsibilities. “No one knows your job better than you,” Hardy said. “No one knows better than you where the inefficiencies are, where the bureaucracy is that could be taken away, or it could be done by somebody whose role it is to sort all that out.”
But having this understanding is not enough. Physician also need to feel “psychological safety to be able to speak out and say that something isn’t working right now or is too much,” or, “I’m spending too much time doing this.”
In other words, oncologists need to be able to set boundaries and say no.
Hardy said this concept “has been around a while, but it’s really gaining momentum,” and being able to discuss these issues in a forum such as the ESMO Congress is a promising start.
Lim has relationships with Janseen and SEOM. No other relevant financial relationships were disclosed.
European Society for Medical Oncology (ESMO) Annual Meeting 2023: Presented October 22, 2023.
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