종양혈액내과 R4 김태영 /prof. 백선경

SCOPE OF THE PROBLEM Oncologists - evaluate and diagnosis complex problems - devise and administer individualized treatment - critical support to life-threatening illnesses Scientific advances - improved patient outcomes, better palliation - compassionate interactions with patients - opportunities for oncologist’s professional life

SCOPE OF THE PROBLEM Oncologists - constantly faced with life & death decisions - demanding & stressful areas of medicine - frequent exposure to death & suffering has the potential to depression, cynicism, futility - increased productivity requirements, reduced autonomy, growing regulations

SCOPE OF THE PROBLEM Burnout - syndrome characterized by a loss of enthusiasm for work (emotional exhaustion) feelings of cynicism (depersonalization) loss of perspective that work is meaningful - medical oncologists 25% to 35% radiation oncologists 38% surgical oncologists 28% to 36%

SCOPE OF THE PROBLEM medical students 50% many chronic anxiety, poor mental QOL majority of young physicians experience burnout (before the completion of residency/fellowship) more than 50%

CAUSES excess workload, inefficiency, loss of autonomy, lack of meaning in work productivity targets set by practice administrators production is measured in minute detail US physician 50 hrs/wk Medical oncologists 63 hrs/wk (7/41, + 7 hrs /wk)

CAUSES in a multivariate analysis (US surgeons, n=8000) - total hours worked per week - experiencing a work-home conflict, the last 3wks - how the work-home conflict was resolved  the three strongest predictors of burnout - partner’s career and child-rearing responsibilities - 7.4% of US physicians/YR,nearly all by 65 years medical oncologists (approximately 9% per year)

CAUSES being sued for malpractice in the last 24 months - burnout (OR, 1.39 P<.001) - depression (OR, 1.49; P<.001) - suicidal ideation (OR, 1.64; P<.001) delivering bad news to patients or dealing with the stress of administrative tasks Ramirez et al : rate of burnout oncologists who felt inadequately trained in cancer communication skills (30% v 17%P <.004) in office management (34% v 22%,; P <.05).

PROFESSIONAL CONSEQUENCES OF BURNOUT personal distress erode empathy, altruistic views other studies : a high QOL enhance empathy national study of more than 16,000IM residents - test scores for burned out second-year residents equivalent the knowledge scores of interns national study of 8,000 US surgeons - surgeons a major medical error in the last 3m strong-dose response relationship with burnout

PROFESSIONAL CONSEQUENCES OF BURNOUT Mayo Clinic Study (errors lead to distress; distress leads to errors) each 1-point change on burnout scales => 6% to 10% increase an error over the 3 months physician’s personal health => patient satisfaction the accuracy of Medicare billing confidence in their physician adherence to physician’s recommendations.

PERSONAL CONSEQUENCES OF BURNOUT physicians having alcohol abuse Vs general adult US population (10% to 15% v 8%) surgeons with burnout have a 25% increased risk of having an alcohol problem 300 to 400 physicians commit suicide/year 11.2% US medical students had considered suicide the last year (general US population (6.9%) burnout -suicidal ideation-medical error in the last 3 months

SOLUTIONS approximately 12% to 27% of burned out will recover the following 12 months promote short-term wellness, cultivate habits of promote resilience of a career Northwestern University - formal teaching in behavioral change (eg, exercise, nutrition, sleep, study/work habits, mental/emotional health) - 50% of the initial 343 achieved their goal - approximately 4/5 felt healthier after project

SOLUTIONS find meaning in work, a philosophy of work-life balance, focus on the important things in life discussing stressful aspects of work with colleagues => increased burnout training physicians in mindfulness based meditation and techniques to improve self-awareness the absence of distress/burnout ≠ achieving a high degree of life satisfaction

SOLUTIONS relationships with patients and others the intellectual stimulation of practice at least 20% effort to most personally rewarding (intellectual challenge, counseling & interaction) concerted effort to address characteristics in the organizational culture and environment additional studies are required - evaluating well-designed organizational interventions using objective metrics

SOLUTIONS periodic screening or monitoring for burnout providing brief and reliable self-assessment tools => give physicians personal feedback promote a nonpunitive culture => promotes help seeking => provides resources for physicians who request support

CONCLUSIONS Burnout is common among medical oncologists Burnout profound personal and professional consequences Additional studies of organizational approaches are needed.