In this study, we assessed the prevalence of burnout among oncologists and its possible relation to different sociodemographic factors. Using stringent diagnostic criteria according to the OLBI, more than 43.8% of participating German oncologists showed increased exhaustion rates as a sign of burnout. Though this prevalence is lower than the rate of burnout-affected physicians in other disciplines, such as emergency medicine, general internal medicine and neurology (Shanafelt et al., 2012; Peter Chernoff, Adedokun, O’Sullivan, et al., 2019), our data reflect a public health crisis with a huge negative impact on patient care, physicians’ health and healthcare organizations and systems (reviewed by West, Dyrbye, & Shanafelt, 2018).
The analysis of different healthcare systems showed broad variations regarding the prevalence of burnout among oncologists: Using different diagnostic criteria, even higher rates of burnout were reported in a survey among oncologists in the US (Allegra, Hall, & Yothers, 2005) or Korea (Lee, Maeng, Kim, & Kim, 2020), whereas a recent survey involving Italian oncologists has only shown a burnout rate of 10.5% (Cheli, Zagonel, Oliani, Blasi, & Fioretto, 2021).
In this survey, burnout was significantly associated with age and professional experience, with a higher prevalence observed among younger physicians. These data are in line with published results emphasizing the higher risk of burnout among younger physicians at a lower hierarchical level (e.g. residents) (Shanafelt et al., 2012). In contrast, a higher age was associated with a lower prevalence of burnout in this survey, as shown in other surveys involving oncologists in different countries (Alacacioglu, Yavuzsen, Dirioz, Oztop, & Yilmaz, 2009; Shanafelt et al., 2014). Higher weekly working hours, higher rates of emotional labor and more alternating shifts, including night or weekend work, might contribute to this increased prevalence (Panagopoulou, Montgomery, & Benos, 2006). Furthermore, working in an inpatient setting and being confronted daily with severely sick patients in an advanced stage of disease might be additional cofactors. Furthermore, the double burden of managing family life and professional career can cause role conflicts as an additional risk factor for burnout (Linzer et al., 2001; Cheli et al., 2021). Interventions to promote the mental health of oncology workers should address these issues. Several authors (Blanchard et al., 2010; Roth et al., 2011; Shanafelt et al., 2014; Cheli et al., 2021) have proposed a higher prevalence of burnout in female physicians, whereas we and other groups (Wang et al., 2014) could not confirm this observation. However, the number of female physicians participating in this survey was low to draw any conclusions on gender-specific differences.
The decrease in the rate of burnout with advanced age and professional experience probably reflects the capability of physicians to deal with professional requirements and stressors; alternatively, physicians might not work anymore in professional patient care. Moreover, the high level professional role associated with social and financial benefit might be a protective factor against burnout (Cheli et al., 2021).
The work setting of physicians may have a strong impact on professional satisfaction: In contrast to data from the US with higher burnout rates among physicians working in their own private practices than those working in academic medical centers or other practices (Dyrbye et al., 2011; Dyrbye et al., 2013), this survey showed a lower prevalence of exhaustion in self-employed physicians. Given that healthcare systems in Germany are different from those in the US, it can be assumed that physicians in outpatient oncological practices are less confronted with stress factors, such as rotating-shift work or night work. Furthermore, self-employment might allow a better control of the workload leading to less stress and a higher professional satisfaction (Williams et al., 2002). Furthermore, in our cohort, oncologists in outpatient practices tended to be older; thus, the reduced rate of exhaustion might also be attributed to the higher age and the higher grade of experience. Physicians’ psychological burden has a strong impact on medical care. In a comprehensive systematic review in 2016, Hall et al. (2016) have reported a high level of evidence for relations between self-reported medical errors and psychological burden. A possible explanation for this relationship is the emergence of cognitive limitations. These findings stress the importance of physicians’ health to ensure quality patient care.
Though the rate of exhaustion was high in this survey, the rates of disengagement were lower than expected with a mean value of 1.65 and less than 10% showing a high rate of disengagement. This prevalence is lower than the prevalence of disengagement of physicians in other disciplines, such as emergency medicine (P. Chernoff, Adedokun, O'Sullivan, McManus, & Payne, 2019) or medical staff in general. These findings imply high demands of physicians to fulfill job requirements despite imminent or actual overburdening in daily work.
Strengths and limitations
This study is the first to examine two dimensions of burnout in a German sample of oncologists. We had the opportunity to reach several oncologists through the cooperation with the AIO. Even though the response rate was below 10%, we could reach a large group with a wide range of professional experiences.
However, this survey has several limitations. First, the number of physicians that responded was limited; physicians with a higher symptom load might have reported at a higher frequency, leading to an overestimation of the prevalence of burnout, though the prevalence of burnout reported here is in line with data published. Second, since the participants were members of a professional society, the work demands, and job characteristics might not reflect clinical routine in Germany. Third, since this survey was conducted in summer 2020 after the first peak of the coronavirus disease 2019 (COVID-19) pandemic, additional stressors associated with this might have influenced the results of this survey. In contrast, during the survey running, the incidence rates of COVID-19 were low in Germany with only few major structural issues occurring in hospitals. The main limitation of this study is related to its cross-sectional design, which does not allow either temporal or causal inferences. Further investigations with consecutive measurements are required to obtain a more detailed understanding of burnout among oncologists.