DALLAS-Nearly half of breast cancer surgeons reported signs of professional "burnout," and almost 60 percent do not find their work fulfilling, according to a survey of members of the American Society of Breast Surgeons (ASbcS), released at the group's 20th anniversary meeting (Abstract 581898).
Jennifer Q. Zhang, MD, a research fellow in surgery at Beth Israel Deaconess Medical Center, presented a summary of responses from 660 breast cancer surgeons asked to answer 39 personal questions reflecting demographic characteristics, practice patterns, and elements of the Professional Fulfillment Index.
"We found that 41 percent of breast surgeons had burnout, and 57.5 percent said they did not have professional fulfillment," she said. Professional fulfillment was rated as a score of 3.0 or greater, and the presence of overall burnout was set at 1.33 or greater. "Despite reporting exhaustion at work, breast surgeons still felt very engaged with their patients and found their work to be quite meaningful."
"Our data suggest that specific clinical practice conditions largely influence rates of burnout and professional fulfillment," added her colleague, senior author Ted A. James, MD, Associate Professor of Surgery and Chief of Breast Surgical Oncology at Beth Israel.
"The risk factors identified in our analysis may be useful in identifying breast surgeons who are particularly at higher risk for burnout, and designing targeted interventions focused on the clinical practice environment to promote professional sustainability."
Surgeons working longer hours each week were more likely to have symptoms of burnout, while increasing years of practice was negatively associated with burnout symptoms.
"Physician burnout is a well-recognized problem in health care that negatively impacts physician well-being and decreases the quality of patient care," said James. "Rates of professional burnout in breast surgery are not well-defined, and we wanted to better understand the degree of burnout in surgeons and identify factors that may influence burnout and professional fulfillment."
Research Findings
Of the 2,568 surveys delivered, 708 were initiated and 660 were completed. The survey was both anonymous and blinded to interpreters. The mean age of surgeons was 51.5 years, 68.6 percent were female, 86.4 percent were in a partnered relationship, and mean years in practice was 18.5 years.
The majority of respondents worked between 40 and 60 hours per week, and surgeons spent an average of 80 percent of work hours on patient care and 64.8 percent had a full-time breast surgery practice.
Just over half (51.7%) of the responding oncologists were in a private practice and 44.3 percent practiced in a population of 500,001 or greater. Overall, 270 (41.3%) had evidence of burnout and 379 (57.5%) did not have professional fulfillment.
Multivariable analysis showed that years in practice was negatively associated with burnout, while working 60 or more hours per week was positively associated with burnout. The number of years in practice was also positively correlated with professional fulfillment, and spending less than 50 percent of practice dedicated to breast surgery was negatively associated with fulfillment.
"We believe that organization and system-level efforts are needed to reduce physician burnout, including increasing administrative support, reducing regulations for medical documentation, allowing surgeons more control over their work and schedule, and finding ways to increase time spent on the most meaningful aspects of patient care," Zhang said.
"Our data suggest that specific clinical practice conditions largely influence rates of burnout and professional fulfillment. The risk factors identified in our analysis may be useful in identifying breast surgeons who are particularly at higher risk for burnout, and designing targeted interventions focused on the clinical practice environment to promote professional sustainability."
Commentary/Other Research
"The high rate of burnout in breast surgeons surprised me," said Henry M. Kuerer, MD, PhD, Professor and Executive Director of Breast Programs at MD Anderson Cancer Center.
"On an individual and organizational basis, we have to be courageous in facing and managing burnout to prevent loss of highly specialized professionals and ensure that our patients get the best care they deserve," he noted.
Part of the issue with breast surgeons, he noted, is the very high volume of demands made upon them, coupled with maintaining compassion for each patient "through extreme emotional upheaval and fear of the unknown."
The rates appear to have doubled since Kuerer and his colleagues published a similar survey of ASbrS members in 2007, when 28 percent of breast oncology surgeons showed signs of burnout (Ann Surg Oncol 2007;14(11):3043-3053). In that survey, they too found that it was more common among respondents age 50 years or younger.
Other factors associated with a higher risk of burnout, they found at that time, were devoting less than 25 percent of time to research and lower physical quality-of-life scores. More than half of the respondents worked more than 60 hours per week, while 24 percent performed more than 10 surgeries each week. Even so, 79 percent of those surveyed stated that they would become a surgical oncologist again given the choice.
A systematic review and meta-analysis of burnout prevalence in oncologists, published in 2016, found that of 4,876 surgical oncologists included in 17 published studies, 32 percent had high burnout scores, while other national surveys have found a 45 percent burnout rate among oncologists (J Am Coll Surg 2016:222(6):1230-1239).
Results from a 2017 survey across medical specialties found that more than 50 percent of physicians met criteria for burnout, a lower rate than the general U.S. working population (Mayo Clin Proc 2019; doi:http://doi.org/10.1016/jmayocp.2018.10.023). However, in many subspecialties, the burnout rate was well over 50 percent, significantly more than among the general working population.
Kurt Samson is a contributing writer.