Hematologists and oncologists are more likely to experience burnout if their compensation model is based solely on clinical productivity, according to the results of a survey conducted by the American Society of Hematology. However, the incorporation of advanced practice providers (APPs) as clinical support staff was associated with lower rates of burnout, particularly among community-based physicians.
The survey was conducted of 631 hematologists and oncologists in 2019 using a validated, single-item burnout instrument. There were 411 complete responses included in the final analysis. Several domains were evaluated using a 5-point Likert scale. The results were published in the journal Blood Advances.
The cohort comprised 36.7% of physicians from academic practices and 63.3% from community-based practices. There were 29.0% of respondents who were female. The majority of respondents in academic practice reported malignant hematology or solid tumor oncology as their clinical focus, whereas the primary focus was solid tumor oncology or a combination of solid tumor oncology and malignant hematology in the community setting. Compensation models differed between academic and community practices, with 51.0% and 32.5% reporting a salary-only or relative value unit (RVU) plus salary model, respectively, in the academic setting and 30.4% RVU only, 35.7% salary-only, 19.6% RVU plus salary, and 14.2% other in the community setting.
There were 74.2% and 50.8% of respondents from academic or community practices, respectively, who reported working often with APPs. In academic practices, physicians reported working with APPs across multiple areas, with the most common including hospital rounds, when performing invasive procedures, and that they manage their own patient panel. In community practices, APPs were most commonly participating in hospital rounds, performing invasive procedures, order chemotherapy, and managing palliative care.
Burnout was reported by 36.5% of the entire cohort, with 12.0% reporting a high level of burnout. Several factors were significantly associated with increased risk of burnout based on a multivariate analysis. There were significantly higher odds of burnout with an RVU-only compensation model (odds ratio [OR], 4.37; 95% CI, 2.00-9.58). This association was sustained when stratified by practice type. Female physicians demonstrated a greater likelihood for burnout overall (OR, 2.56; 95% CI, 1.24-5.28), particularly in the academic setting (OR, 6.84; 95% CI, 1.79-26.15) rather than the community setting (OR, 2.07; 95% CI, 0.84-5.10).
Working with APPs decreased the odds of burnout (OR, 0.40; 95% CI, 0.20-0.80), which was driven primarily by physicians in the community setting (OR, 0.28; 95% CI, 0.12-0.65) compared with the academic setting (OR, 1.21; 95% CI, 0.18-8.12).
A clinical focus of benign hematology was associated with less burnout in the community setting (OR, 0.43; 95% CI, 0.03-0.48), but not the academic setting (OR, 2.46; 95% CI, 0.14-42.85).
Career satisfaction was also evaluated. Overall career satisfaction was similar between practice types, with 68.9% and 64.5% of academic and community physicians, respectively, satisfied (P =.39). Physicians in academic practice reported greater satisfaction with career development opportunities (P =.02) compared with those in a community practice.
In academic practices, both career dissatisfaction (OR, 10.00; 95% CI, 1.65-60.69) and dissatisfaction with work-life balance (OR, 6.83; 95% CI, 1.21-38.58) was more likely among physicians compensated according to an RVU-only model.
In contrast, dissatisfaction with career (OR, 2.98; 95% CI, 1.20-7.44) and work-life balance (OR, 4.35; 95% CI, 2.13-8.88) was significantly associated with high working hours at home. A higher number of working hours overall (OR, 5.12; 95% CI, 1.91-13.72) and 10 years or more in their current job (OR, 2.47; 95% CI, 1.20-5.05) was associated with dissatisfaction with work-life balance.
“Our findings raise a concern about the state of wellness of the hematology/oncology workforce and suggest that compensation systems focused exclusively on clinical productivity in either academic or community practices may be exacerbating physician burnout,” the authors concluded. They added that “increased utilization of APPs in clinical practice may mitigate high burnout, specifically among community hematologist and oncologists.”
Ian Lee A, Masselink LE, De Castro LM, et al. Burnout in US hematologists and oncologists: impact of compensation models and advanced practice provider support. Blood Adv. 2023;7:3058-3068. doi: 10.1182/bloodadvances.2021006140