Physicians who treat sickle cell disease face some of the most complex and resource-intensive care in medicine, and a national survey now shows they experience markedly higher burnout, raising concerns about workforce sustainability and patient care.
Study: Burnout in Sickle Cell Disease-Focused Hematology-Oncology Trained Physicians: A National Cross-Sectional Study. Image credit: Monika Wisniewska/Shutterstock.com
About half of US physicians suffer burnout, jeopardizing healthcare quality and personal fulfilment. Among US hematology-oncology physicians, those specializing in sickle cell disease (SCD) are more likely to experience burnout according to a study published in Blood Advances. The authors identify lower job pride and less frequent recreational activity as key factors associated with, and that may help explain, this difference.
Exploring burnout among sickle cell disease specialists
Burnout refers to a combination of “emotional exhaustion, depersonalization, and a sense of ineffectiveness and lack of accomplishment”. Burnout among physicians is a major problem as it causes them to leave the profession, increases the rate of medical errors, and reduces productivity. Such physicians have lower patient satisfaction rates and higher absenteeism rates, stretching the healthcare 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 adapt positively to stress or change. Physicians in general have higher grit and resilience compared to the whole US workforce, obscurring the high rate of burnout in this profession.
Hematology-oncology is a demanding medical specialty that involves caring for patients with serious and often complex blood disorders and cancers. Burnout rates in this area are as high as 45 %. The authors note that burnout among hematology-oncology physicians specifically focused on SCD has not previously been well described in the literature.
SCD is a genetic condition associated with severe health needs, high risk of complications and premature death, a lower quality of life, and few therapeutic options. SCD care therefore involves constant challenge and the use of multiple resources. Yet many institutions have only one or two physicians to take care of this demanding group of patients, especially adults with SCD. This may cause significant cognitive and emotional strain 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
The researchers conducted a national-level survey of US-based hematology-oncology physicians. The physicians identified themselves as SCD or non-SCD caregivers. In addition, they were assessed for four aspects: burnout, grit, resilience, and career attributes. They also self-reported on other factors like sleep and recreation that contribute to wellbeing.
SCD specialists report significantly higher burnout than peers
The median age of SCD versus non-SCD physicians was 45 and 43 years, respectively. Black physicians constituted 24 % of SCD physicians versus 4 % of non-SCD. SCD-focused physicians were more likely to experience burnout compared to non-SCD physicians, at 60 % versus 44 %, respectively. This was in spite of having similar grit and resilience.
Both groups had similar work hours. However, SCD physicians were less likely to participate in recreation, with 51 % reporting only one recreational activity per week vs 27 % of non-SCD. Similarly, SCD physicians were much less likely to participate in two or more recreational activities per week than non-SCD physicians.
Only 47 % of SCD physicians reported high job pride, far less than the 65 % reported by non-SCD physicians. About 36 % earned >$350,000 a year, compared to 60 % of non-SCD physicians. This was in spite of the fact that they had been practicing longer (>5 years) and worked a similar number of hours per week (>50 hours a week).
SCD physicians were far more likely to work at academic medical centers (89 %), mostly as clinicians, clinician educators or clinician scientists. More SCD physicians worked as administrators or leaders, at 36 %, compared to 16 % of non-SCD physicians.
Factors that were associated with higher burnout rates among SCD physicians included less recreation and lower job pride. Participants with almost no recreation had sevenfold odds of burnout, compared with those who “sometimes” took part in recreational activity. Similarly, those with minimal recreation had fourfold odds of burnout. In adjusted analyses, lower recreation frequency and lower job pride helped account for much of the observed difference in burnout between SCD and non-SCD physicians.
Exploratory subgroup analyses suggested that differences in pediatric practice mix or racial representation did not fully explain the burnout gap, although these analyses were underpowered for formal statistical testing.
This may suggest that SCD physicians often take on multiple professional responsibilities, playing roles such as clinician, educator, administrator, leader in community engagement, SCD advocate and researcher, which may increase cognitive workload and reduce time available for recreational activities.
Some non-SCD physicians may feel less comfortable managing SCD patients, placing a disproportionate share of responsibility for their complex care on the SCD physicians. Funding and structural inadequacies may also compound these pressures by reducing the number of staff and the availability of resources.
The authors also comment, drawing on prior literature, that people with SCD have historically experienced bias within the healthcare system. According to them, this increases the odds that “SCD providers feel alone in their mission to care for those with SCD and at times underappreciated due to decreased institutional support.” However, these structural and systemic factors were not directly measured in this survey and therefore require further investigation.
Future studies are required to understand what 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 this may reflect the relatively small national workforce of physicians focused on SCD care, noting that a prior LISTEN survey identified 53 US physicians who reported being adult hematologists or SCD specialists.
The proportion of SCD physicians was 35 % which is far higher than expected, perhaps reflecting sampling bias and limiting generalizability. Furthermore, the survey was exploratory and brief, limiting the scope of this study. Future work is required to dig deeper into the domains of interest captured in this study.
Examination of institutional causes of burnout
SCD physicians are more likely to report burnout than non-SCD physicians, for multiple reasons including lower job pride and less recreational time.
These findings are consistent with the possibility that structural or role-related pressures specific to SCD care may contribute to burnout, rather than individual physician vulnerability.
Further research should explore infrastructural and institutional factors at work, besides those reported here.
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