Burnout in Oncology: Risk, Prevention, and Management for Oncologists

Bridget Koontz, MD

According to Bridget Koontz, MD, how to recognize, manage, and prevent burnout in clinicians is key in continuing down a positive career path.

Burnout is often associated with feelings of extreme pressure, physical and emotional exhaustion, a low sense of professional accomplishment, and more. While there have been some studies evaluating burnout at a training, more are needed for experienced clinicians who have been with their jobs for an extended period.

The prevention of burnout must be proactively addressed at the individual and organization level to feel satisfaction in oneself, improve wellness for clinicians and their careers, and better outcomes for patients.

According to Koontz, United States chief medical officer and deputy global chief medical officer at GenesisCare, a key way to prevent burnout is by managing expectations. She notes that oncologists often set high expectations for themselves, and while that is necessary to move up in their line of work, managing those expectations is of the utmost importance.

One way Koontz does this is by recognizing the difference between the destination and the journey.

“The destination is our goal, our dream, and in the big picture is where one wants to go. The journey, we have to recognize, is not really a straight path. There are always going to be bumps in the road, or detours, or one takes a wrong turn. Sometimes, you end up in a place that was not where you thought you were going to end up. Recognizing that happens, that it happens to everybody, and that it's okay, [is important],” stated Koontz in an interview with Targeted Oncology^TM.

In the interview Koontz discussed burnout and its importance in relation to experts treating patients with cancer.

Targeted Oncology: Can you define burnout and why it is important for clinicians to discuss?

Koontz: How to prevent and manage burnout is [important], specifically, managing expectations, because that's when you think about why people feel symptoms of being burned out. It's often because they feel that the pressure is quite high and they're not achieving things the way that they want, or they feel things aren't going the way that they wanted or thought they would. That is a matter of expectation. Thinking about and being adaptable to how we set our goals, what our goals are, or what expectations people have of us and how we meet them in a way that we're proud of controls both happiness and satisfaction and gives a feeling of wellness in our lives.

What are some of the issues with burnout that doctors have been experiencing?

What's been well studied is burnout in training. There are a lot of components to it, but part of it is the stress of achievement, having high expectations for oneself, as well as feeling that there are certain high bars that you have to meet. Also, [there are] even expectations of family members or others where you expect that they're proud of you that you got this far, and you're trying to meet their expectations in terms of where you go. I also think there's the view of physicians that are just past that training level that have also dealt with burnout. That's again multifactorial, but it might be related to the job not being what they thought, because the environment has changed, they went into private practice, and they just wanted to see patients but turns out that that private practice role that they're in is now a lot of paperwork and business management that they don't know how to do. Or, are they in an academic job and feeling a lot of pressure around succeeding in research, are having trouble doing so, or being successful in that way? It is going to be dependent on the position that experienced physicians are in, but again, it will be heavily around expectations.

For how to manage expectations, 1 is recognize the difference between the destination and the journey. The destination is our goal, our dream, and in the big picture is where one wants to go. The journey, we have to recognize, is not really a straight path. There's always going to be bumps in the road, or detours, or one takes a wrong turn. Sometimes, you end up in a place that was not where you thought you were going to end up. Recognizing that happens and that it happens to everybody, and that it's okay [is important].

How do expectations play a role in burnout?

Warren Buffett has a quote that says, the key to happiness is low expectations. I don't entirely agree with that quote, because most of us physicians have high expectations of ourselves and that's how we got this far.I do think that the key to happiness is adaptable expectations. Recognizing what's possible in the environment you're in, recognizing why your expectation was what it was, what your goal was like, what the key part of that goal was, and while the goal itself may not be achievable in that environment, can you get the same satisfaction, can you get the same core by doing something similar but also achievable? Being able to be self-reflective on the why, and then recognizing there are sometimes barriers or detours can be an opportunity if you're willing to be adaptable and change your plans.

In terms of recognizing, doing that self-reflection and recognizing the need to adapt is not a weakness. Recognizing that there are things that we can change, and we should 100% work to change them if we want to, but there are also things that we can't, and we are not going to be happy trying to change things that are that we have no power to change. Again, being adaptable, recognizing those things you just have to let pass you by, also being good at communicating with others, both for your own expectations and for their expectations, because you can't assume that you know what they expect of you. If you're an academic, you might think that your chair wants you to publish 10 papers a year. It may be that, but maybe the chair doesn't have that expectation, and you need to talk and understand what is and what is flexible there. You may not understand what is expected of you and being able to communicate and have a conversation about, not just what the expectation is, but what's realistic, is needed to come to a commonality.

Regarding the things that can be changed, do you have any ideas for potential solutions?

[A colleague of mine] gave a nice story where she described that her family had moved to Minnesota, and she was still working in Baltimore, and she was commuting. She said that she was in that moment, just trying to survive. She was commuting back and forth, trying to work, trying to keep up with her academic commitments, and trying to spend time with family. It was hard. Her head was down, and she was just working as hard as she could at that. Somebody said to her, you don't have to do this job. There are other jobs out there and you can work somewhere else. She said it was a huge eye opener. In a moment when one is stressed like that and trying to survive, we don't often brainstorm well about whether there's something out of the box that could get us the same level of satisfaction. That same day this person said that she went home and called people in Minnesota and asked if they needed a radiation oncologist?

That is a recognition that when we're stressed, we are in survival mode and our brains are in survival mode. There are a lot of interesting articles around the way we make decisions and the difference between making decisions, cognitive decisions in the cerebral part of our brain vs survival decisions in the central, limbic part of our brain. When I came across this as a physician a couple years ago from a burnout perspective, that made a lot of sense. She, in her moment of survival, wasn't thinking creatively, she wasn't even able to step back objectively and say, why am I doing this? For being able to change the things that you can, the first step is recognizing that you have a choice and that you can try to take that step back and look objectively at what things you have to do and then what things are you actually doing to yourself.