This survey included the opinions of 1,740 oncologists working throughout the United States and represents the largest published sampling of U.S. oncologists. This response represented almost 22% of the physicians surveyed in the Network for Medical Communication and Research database of 7,715, which is not as high a response rate as the original study published by Whippen and Canellos in 1991 but is almost twice as high as the more recent study presented at the 2004 ASCO annual meeting (June 5-8, New Orleans, Louisiana). Unlike prior surveys, which used the mail service, our survey relied primarily on electronic media. This difference may account for some of the differences in response rates.
In general, the surveyed population consisted of medical oncologists or hematologist-oncologists who represented equally the major geographic areas in the United States. As expected, most of the respondents spent the majority of their effort on patient care activities. Overall, we identified a rate of perceived burnout of almost 62% among the surveyed population. This rate is very similar to the 56% rate reported by Whippen and Cannellos in 598 physician subscribers to the Journal of Clinical Oncology
in 1991, and substantially higher than the 34% reported in 2004 among 1,299 members of the American Society of Clinical Oncology surveyed in 2002.1,3
Why the most recent rate of burnout reported is relatively low is not clear; however, differences in the demographics of the respondents may provide an explanation. A similar survey of burnout in almost 400 cancer clinicians and palliative care specialists in the United Kingdom published in 1995 found a rate of 28% in this population.8
Presumably, many differences in the stresses impacting care providers in Europe may account for the noted rate differences between the populations, and the relatively lower rate of burnout reported in the United Kingdom may in part explain the recently reported lower rates, because the surveyed population may have included oncologists outside the United States.3
It is interesting to note that the rate of self-assessed burnout appears to be relatively stable since the initial survey performed 14 years prior to the present survey, despite the apparent increased reimbursement concerns and complexity of oncology patient management coupled with the perception in 77% who reported that their signs of burnout were becoming more apparent. As is the case with any survey, there is an inherent selection bias in those electing to complete the survey. This self-selection may bias the results and therefore needs to be considered in drawing definitive conclusions.
The primary reasons that were reported as the perceived cause for burnout were overwork and a lack of time away from the office. These causes were mirrored by the need for more time away from the office, including attendance at professional meetings and fewer patients as the most often stated remedies for the reported physician burnout. Recent reports have identified additional factors that contribute to lower rates of burnout including a “hardy personality,” a greater perception of oneself as being religious, and highly developed communication skills that promote a successful doctor-patient relationship.9,10
Because many of the factors that appeared to be directly related to the reported incidence of burnout could be confounded, we performed a multivariate analysis to identify those factors that retained an independent and significant association with burnout. As shown in , all but a single variable identified by univariate analysis remained significant in the multivariate model. Although the causes of burnout appear to be multifactorial, the most significant associations included the amount of time spent on patient care, lack of time away from the office, and attendance at fewer educational meetings. The peak in burnout appears to occur between 10 and 25 years after completing oncology training. These data suggest that it generally takes about 10 years to develop burnout. The decrease in burnout in physicians with more than 25 years after oncology training presumably reflects individuals who have either successfully developed mechanisms to alleviate burnout or who have changed careers and are therefore no longer represented in the population with more than 25 years of experience. Interestingly, neither the area of the country in which the clinician worked nor the number of partners in an oncology practice was associated with the rate of burnout.
These data support a relatively stable but high rate of perceived burnout in the U.S. oncology community that is attributable primarily to overwork and inadequate time away from the office. This information suggests a need to train more oncologists and to make provisions for increasing both personal time and time spent in educational pursuits through attendance at professional meetings.