Physicians who treat sickle cell disease face some of the most complex and resource-intensive treatments in medicine, and national surveys show significantly higher levels of physician burnout, raising concerns about workforce sustainability and patient care.
study: Burnout among physicians trained in hematology-oncology with a focus on sickle cell disease: A national cross-sectional study. Image credit: Monika Wisniewska/Shutterstock.com
Approximately half of U.S. physicians experience burnout, threatening the quality of care and personal fulfillment. Among U.S. hematology-oncology physicians, those who specialize in sickle cell disease (SCD) are more likely to experience burnout, according to a study published today. Blood Advances. The authors identify lower pride in work and lower frequency of recreational activities as important factors associated with this difference that may help explain it.
Investigating burnout among sickle cell specialists
Burnout is a combination of “emotional exhaustion, dehumanization, and feelings of helplessness and lack of accomplishment.” Physician burnout is a major problem as it causes physician turnover, increases in medical errors, and decreased productivity. These doctors have low patient satisfaction, high absenteeism rates, and strain the health care system.
Factors that protect against burnout include grit and resilience. Grit refers to perseverance and passion to achieve long-term goals despite obstacles. Resilience refers to the ability to positively adapt to stress and change. Physicians generally have a higher level of grit and resilience than the overall U.S. workforce, which obscures the high rates of burnout in this profession.
Hematology-oncology is a demanding medical specialty that involves the care of patients with serious and often complex blood disorders and cancers. Burnout rates in this region are as high as 45 percent. The authors note that burnout, particularly among hematology-oncology physicians specializing in SCD, has not been well described in the literature.
SCD is a genetic disorder associated with severe health needs, high risk of complications and premature death, poor quality of life, and few treatment options. Therefore, caring for SCD involves constant challenges and the use of multiple resources. However, in many facilities, only one or two physicians are available to care for this demanding patient population, especially adult SCD patients. This can cause significant cognitive and emotional burden on these physicians.
The current study is part of several programs initiated by the American Society of Hematology (ASH) to increase the number of physicians trained in SCD.
Measuring burnout, resilience, grit, and career factors
Researchers conducted a national survey of U.S.-based hematology-oncology physicians. Physicians identified themselves as SCD or non-SCD caregivers. Additionally, four dimensions were assessed: burnout, grit, resilience, and career characteristics. They also self-reported other factors that contribute to their health, such as sleep and recreation.
SCD professionals report significantly higher levels of burnout than their peers
The median age of SCD and non-SCD physicians was 45 and 43 years, respectively. Black physicians made up 24% of SCD physicians compared to 4% of non-SCD physicians. Physicians specializing in SCD were more likely to experience burnout than non-SCD physicians: 60% and 44%, respectively. This was despite having similar grit and resilience.
Both groups worked similar hours. However, SCD physicians were less likely to participate in recreation, with 51% reporting engaging in recreational activities only once a week compared to 27% of non-SCD physicians. Similarly, SCD physicians were much less likely to participate in recreational activities more than once per week compared to non-SCD physicians.
Only 47% of SCD physicians reported being proud of their work, much lower than the 65% reported by non-SCD physicians. Approximately 36% earned more than $350,000 annually compared to 60% of non-SCD physicians. This was despite the fact that they had been practicing for longer (over 5 years) and worked similar hours per week (over 50 hours per week).
Physicians with SCD were much more likely (89%) to work primarily in academic medical centers as clinicians, clinician educators, or clinician scientists. More SCD physicians worked as managers or leaders (36%) compared to 16% of non-SCD physicians.
Factors associated with higher burnout among SCD physicians included less recreation and lower pride in work. Participants who rarely engaged in recreation were seven times more likely to experience burnout than those who participated in recreational activities “occasionally.” Similarly, people who had minimal entertainment were four times more likely to experience burnout. In adjusted analyses, lower frequency of recreation and lower pride in work helped explain much of the observed differences in burnout between SCD and non-SCD physicians.
Exploratory subgroup analyzes suggested that differences in the composition and racial representation of pediatric practices did not fully explain the burnout gap, but these analyzes were insufficient for formal statistical tests.
This may suggest that SCD physicians often assume multiple professional responsibilities, serving as clinicians, educators, administrators, community leaders, SCD advocates, and researchers, which may increase their cognitive workload and reduce the time available for recreational activities.
Some non-SCD physicians may feel anxious about managing SCD patients and may place a disproportionate share of responsibility for complex care on SCD physicians. Funding and structural deficiencies can reduce staff numbers and available resources, adding to these pressures.
The authors also comment, citing prior literature, that SCD patients have historically experienced stigma within the health care system. They say this increases the likelihood that “SCD providers feel alone in their mission to care for people with SCD, and sometimes undervalued due to reduced institutional support.” However, these structural and systematic factors were not directly measured in this study and require further investigation.
Future research is needed to understand which aspects of SCD programs cause burnout among SCD physicians.
strengths and limitations
The sample size of SCD physicians was relatively small. However, the authors suggest that this may reflect a relatively small workforce of physicians in the country focused on SCD care, noting that a previous LISTEN survey identified 53 U.S. physicians who reported being adult hematologists or SCD specialists.
The proportion of SCD physicians was 35%, which is much higher than expected and likely reflects sampling bias, limiting generalizability. Additionally, this study was exploratory and brief, which limited the scope of this study. Future work is needed to delve deeper into the areas of interest captured in this study.
Investigating the organizational causes of burnout
Physicians with SCD are more likely to report burnout than non-SCD physicians, including having less pride in their work and having less time for recreation.
These findings are consistent with the possibility that structural or role-related pressures specific to SCD care, rather than individual physician vulnerabilities, contribute to burnout.
Further research should investigate the infrastructural and institutional factors at play beyond those reported here.
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