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Keeping Physician Stress in Check

Burnout for oncology health care providers has been worse in recent years, but not only for physicians — the entire health care system is under more stress.

Fahri Saatcioglu, PhD, and colleagues, whose report was published in the Journal of Clinical Oncology, described it as a “dire situation” with resolutions needed “urgently” to “mitigate the negative consequences of physician burnout.” Both individual and whole-system approaches are needed, wrote Dr. Saatcioglu, a researcher with Oslo University Hospital in Norway who reviewed well-being interventions designed to mitigate physician stress.

When burnout sets in it is marked by emotional exhaustion, depersonalization, and a lack of confidence in one’s ability to do his or her job effectively (often because of lack of support or organizational constraints). It can lead to reduced work efficacy, medical errors, job dissatisfaction, and turnover, Fay J. Hlubocky, PhD, and colleagues, wrote in a report published in the Journal of Clinical Oncology.

During the COVID-19 pandemic, patients postponed doctor visits and procedures. Telemedicine was adopted in place of in-person visits, surgeries were delayed, and oral chemotherapy was prescribed over intravenous therapies, wrote Dr. Hlubocky and colleagues, who addressed the heightened sense of burnout oncologists experienced during the COVID-19 pandemic.

But before the pandemic, oncologists were already overburdened by a system unable to meet the demand for services. And now, because patients delayed doctor visits, more patients are being diagnosed with advanced malignancies.

According to the American Society of Clinical Oncology, the demand for cancer-related services is expected to grow by 40% over the next 6 years. And, by 2025, there will be a shortage of more than 2,200 oncologists in the United States.

Addressing physician burnout can affect the bottom line. According to a report published in Annals of Internal Medicine, physician turnover and reduced clinical hours due to burnout costs the United States $4.6 billion each year.

“It is estimated that 30%-50% of physicians either have burnout symptoms or they experience burnout. A recent study on oncologists in Canada found that symptoms of burnout may reach 73%,” wrote Dr. Saatcioglu and colleagues. “It is clear, for example, that an appropriate workload, resource sufficiency, positive work culture and values, and sufficient social and community support are all very critical for a sustainable and successful health care organization. All of these are also required for the professional satisfaction and well-being of physicians.”

Physician stress has become so serious, that Dr. Saatcioglu and colleagues recommend that hospital administrators “firmly establish the culture of wellness at the workplace” by including physician wellness under the institutional initiatives umbrella. Hospital leadership, they wrote, should strive to mitigate burnout at all levels by addressing issues and adopting strategies for physicians as a workforce and as individuals.

“There is a distinct need to approach the personal needs of the physician as an individual who is experiencing chronic stress that can trigger psychologic symptoms, which further affects not only their own health, family life, etc., but also their clinical performance, quality of the resulting health care, patient satisfaction, and finally the health economy,” the authors wrote.

Some health care organizations have adopted programs and made institutional changes designed to reduce burnout for health care workers. These include online wellness programs both free and paid, but there is little data on the efficacy of these programs.

The review by Dr. Saatcioglu and coauthors included the Online Breath and Meditation Program, a Sudarshan Kriya Yoga (SKY) program of three 90-minute sessions on yoga, effective breathing techniques, and cognitive coping and stressor evaluation strategies that have been effective in helping war veterans, prisoners, patients, and students. The ultimate goal would be to have participants adopt a daily yoga routine. Among 803 health care workers who participated in the program and completed a survey, 85% said they benefited from the program and 94% reported experiencing less stress. And, 81% felt the program would help improve their job performance.

“In the future, we believe that the best place for the individual approaches to physician wellness would be to have them as an integral part of the organizational measures, and ideally, implemented as part of the daily work routine of the physician where the organizational and individual responsibilities would merge,” the authors wrote.

Freelance writer Lorraine L. Janeczko, MPH, contributed to this article.

This article originally appeared on, part of the Medscape Professional Network.

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