Cancer Surgeons’ Distress and Well-being, I: The Tension Between a Culture of Productivity and the Need for Self-Care

Abstract

Background

Burnout is a prevalent and important occupational hazard among surgical oncologists. The well-being or distress experienced can have a significant effect on clinicians and their families, the quality of care provided to patients, and the success of the health care organization.

Methods

We aimed to measure the prevalence of burnout, psychiatric morbidity, and quality of life using standardized measures; characterize associated features; and ascertain the surgical faculty’s views on potential interventions and obstacles to change. Additional questions about service commitment to well-being, use of annual leave, and attitudes about weekend surgical practice were constructed to guide future targeted interventions.

Results

Among the 72 surgeons who responded (response rate of 73%), we found that 42% of surgeons reported burnout and 27% psychiatric levels of distress, while 30% used alcohol and 13% used sleep medications as a possible means to cope. Only one third of surgeons reported high quality of life across physical, emotional, spiritual, and intellectual domains.

Discussion

Compared to general surgical practices, cancer surgeons achieved more personal fulfillment and made less use of distancing methods to cope with their patients. Institutional culture contributes to the nonuse of available annual leave, attitudes about weekend operating schedules, and missed opportunities for the leadership to attend to surgeons’ well-being.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397–422.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Kash KM, et al. Stress and burnout in oncology. Oncology (Williston Park). 2000;14:1621–33.

    CAS  Google Scholar 

  3. 3.

    Elit L, et al. Society of Gynecologic Oncology Canada. Job satisfaction, stress, and burnout among Canadian gynecologic oncologists. Gynecol Oncol. 2004;94:134–9.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Grunfeld E, et al. Job stress and job satisfaction of cancer care workers. Psychooncology. 2005;14:61–9.

    PubMed  Article  Google Scholar 

  5. 5.

    Grunfeld E, et al. Cancer care workers in Ontario: prevalence of burnout, job stress and job satisfaction. CMAJ. 2000;163:166–9.

    PubMed  CAS  Google Scholar 

  6. 6.

    Ramirez AJ, et al. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer. 1995;71:1263–9.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Shanafelt TD, et al. The well-being and personal wellness promotion strategies of medical oncologists in the North Central Cancer Treatment Group. Oncology. 2005;68:23–32.

    PubMed  Article  Google Scholar 

  8. 8.

    Taylor C, et al. Changes in mental health of UK hospital consultants since the mid-1990s. Lancet. 2005;366(9487):742–4.

    PubMed  Article  Google Scholar 

  9. 9.

    Ramirez AJ, et al. Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet. 1996;347(9003):724–8.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Shanafelt TD, et al. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250:463–71.

    PubMed  Google Scholar 

  11. 11.

    Campbell DA Jr, et al. Burnout among American surgeons. Surgery. 2001;130:696–702.

    PubMed  Article  Google Scholar 

  12. 12.

    Kuerer HM, et al. Career satisfaction, practice patterns and burnout among surgical oncologists: report on the quality of life of members of the Society of Surgical Oncology. Ann Surg Oncol. 2007;14:3043–53.

    PubMed  Article  Google Scholar 

  13. 13.

    Shanafelt TD, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251:995–1000.

    PubMed  Article  Google Scholar 

  14. 14.

    Maslach C, Jackson S. The Maslach Burnout Inventory. Palo Alto, CA: Consulting Psychologists Press; 1981.

    Google Scholar 

  15. 15.

    Rafferty JP, et al. Validity of the Maslach Burnout Inventory for family practice physicians. J Clin Psychol. 1986;42:488–92.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Lee RT, Ashforth BE. A meta-analytic examination of the correlates of the three dimensions of job burnout. J Appl Psychol. 1996;81:123–33.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Goldberg DP, Williams P. A user’s guide to the General Health Questionnaire. Nelson, Windsor: NFER; 1988.

    Google Scholar 

  18. 18.

    Graham J, Ramirez A. Improving the working lives of cancer clinicians. Eur J Cancer Care (Engl). 2002;11:188–92.

    Article  CAS  Google Scholar 

  19. 19.

    Locke DE, et al. Validation of single-item linear analog scale assessment of quality of life in neuro-oncology patients. J Pain Symptom Manage. 2007;34:628–38.

    PubMed  Article  Google Scholar 

  20. 20.

    Babor TF, et al. AUDIT: The Alcohol Use Disorders Identification Test—guidelines for use in primary care. 2nd ed. Geneva: World Health Organization; 2001.

  21. 21.

    Kearney MK, et al. Self-care of physicians caring for patients at the end of life: “Being connected…a key to my survival.” JAMA. 2009;301:1155–64.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Guest R, et al. Cancer surgeons’ distress and wellbeing, II: modifiable factors and the potential for organizational interventions. Ann Surg Oncol. In press.

  23. 23.

    Bylund CL, et al. The implementation and assessment of a comprehensive communication skills training curriculum for oncologists. Psychooncology. 2010;19:583–93.

    PubMed  Google Scholar 

  24. 24.

    Fallowfield L. Can we improve the professional and personal fulfillment of doctors in cancer medicine? Br J Cancer. 1995;71:1132–3.

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001;286:3007–14.

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714–21.

    PubMed  Article  Google Scholar 

Download references

Acknowledgment

This publication acknowledges grant NCI P30 CA08748, which provides partial support for the Behavioral Research Methods Core used in conducting this investigation. Marwan Shouery and Ethan Basch developed the Web-based survey distribution as part of the Memorial Sloan-Kettering Core Facility for Online Research Tools (“Webcore’)

Author information

Affiliations

Authors

Corresponding author

Correspondence to Rebecca S. Guest MD, MPH.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Guest, R.S., Baser, R., Li, Y. et al. Cancer Surgeons’ Distress and Well-being, I: The Tension Between a Culture of Productivity and the Need for Self-Care. Ann Surg Oncol 18, 1229–1235 (2011). https://doi.org/10.1245/s10434-011-1622-6

Download citation

Keywords

  • Emotional Exhaustion
  • Psychiatric Morbidity
  • Personal Distress
  • Workplace Culture
  • Annual Leave