What Contributes to Burnout Among Hematologists, and What Can We Do About It?

Burnout has become increasingly prevalent among both practicing and training physicians. Physician burnout — described by Dr. Colin P. West and colleagues as a “work-related syndrome involving emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment” — has been associated with negative impacts on patient care, physician wellness and safety, and sustainability of health care systems.¹ 

Within hematology/oncology, the impacts of burnout have been observed in all aspects of our profession spanning patient age (adult and pediatric), level of training (attending physician and resident), scope of practice (physicians and advanced practice providers [APPs] such as nurse practitioners), and geography (United States and Canada).^2–4  This has been exacerbated by the COVID-19 pandemic, which has led to an increasing strain on health human resources. There is an urgent need to understand and address the individual and system factors that contribute to physician burnout. In the present study, Dr. Alfred I. Lee and colleagues examined the extent to which compensation models and support from APPs affect physician burnout.

The authors conducted a practice survey of hematologists and oncologists from the American Medical Association Physician Masterfile in 2019. Burnout was measured using a single-item burnout instrument from the Physician Work life Study (participants rated level of burnout on a 5-category ordinal scale, with “high burnout” defined as score ≥ 4). They were also asked to rate various domains on a five-point Likert scale including career satisfaction, work-life balance, work hours, APP support, academic activities (mentorship, research involvement), and compensation models (“relative value unit [RVU] –only compensation” or “RVU + salary compensation”). Weighted logistic regression was used to explore associations between job characteristics and likelihood of reporting high levels of burnout, in both academic and community settings.

Among 411 respondents, 37 percent were in academic and 63 percent were in community practices. Twenty-nine percent were female, 50 percent had been in practice for less than 10 years, and 27 percent were younger than 40 years. Within academic practice, clinical focus on classical hematology, malignant hematology, and solid tumors was 16 percent, 36 percent, and 38 percent, respectively, and within community practice, 6 percent, 4 percent, and 42 percent, respectively. A greater proportion of academic practitioners worked frequently with nurse practitioners (74%) compared with those in community practice (51%). Among all survey respondents, 22 percent were paid by an RVU-only compensation plan, while 24 percent were paid with a mixture of RVU-based plus salary; 12 percent reported other arrangements including profit sharing and shareholder agreements.

Among all respondents, 37 percent reported having burnout, while 12 percent experienced high burnout (4% feeling they would need to seek professional help). Less than half reported being satisfied with their work-life balance. In logistic regression models, RVU-only compensation was associated positively with high burnout, both in academic and community practices (stronger association with academic practices). Female gender was also associated with high burnout, particularly in academic settings. Working often with nurse practitioners and age younger than 40 years were inversely associated with high burnout, particularly in community settings.

These findings suggest that compensation models that reward clinical productivity cause deepening of physician burnout, a trend also borne out in a 2012-2013 survey of American Society of Clinical Oncology members.⁵  The authors note that this is particularly significant as academic institutions shift toward hiring more clinically oriented faculty for academic appointments. This association was stronger for those in academic practices, which may speak to the difficulties in balancing academic commitments with maintaining a degree of clinical work for sufficient compensation. While working with APPs did reduce the likelihood of high burnout, this association was most strong for those in community practice, which may again reflect the varied nonclinical responsibilities of academic medicine. Of note, hematology/oncology nurse practitioners were also reported to have high levels of emotional exhaustion or burnout, with one small study suggesting as many as 20 percent expressing an intent to leave their jobs or the nursing profession entirely.³  This speaks to the need to engage nonphysician colleagues while being mindful of their workload and priorities. Finally, female gender was found to be an independent predictor of high burnout, particularly among academic hematologists and oncologists. This gender association has been reported previously, and the authors posit multiple possible reasons including differences in income, age, promotion, and mentorship.^6,7