Training to be an oncologist can be rough. In the face of long hours, sleep deprivation, and patient suffering, young oncologists may sacrifice hobbies, interests, and even relationships. Many fellows find comfort in reminding themselves that better days are ahead but experts say that they may be setting themselves up for disappointment.

Oncologists who cope by looking to the future may miss opportunities in the present to shape their career to meet their needs.1 “Putting aside one’s personal needs or personal wellness can eventually come back in a negative or unhealthy way that can lead to burnout,” said Charles M. Balch, MD, FACS, professor of surgery in the Division of Surgical Oncology at University of Texas Southwestern Medical School in Dallas, Texas. “A successful medical career at the expense of personal wellbeing is not at all successful.”

One in 3 oncologists will experience significant career burnout—described as emotional exhaustion, depersonalization, and a sense of low personal accomplishment that leads to decreased effectiveness at work.2 Some of its more tragic consequences include broken relationships, substance abuse, and suicide. “Work–home balance is a common denominator of burnout and depression and having a proactive plan for personal wellness is essential if one is to prevent burnout and depression or to mitigate its consequences when it happens,” Dr. Balch said.

For young oncologists, the first step in avoiding burnout is to choose a fulfilling career track—private practice, clinician-educator, translational scientist, or basic scientist—and prepare to manage the stress specific to each (Table 1).2 Each track offers varying clinic duties, intellectual rewards, and potential stressors. Academia presents unique stressors related to balancing research, getting published, and maintaining grant funding. However, private practice, with its heavy clinic schedule and patient exposure, can take a substantial toll on oncologists, and they need to be especially vigilant in protecting their health. Dr. Balch recently published research that found subspecialty surgeons in private practice were more likely to burn out than those in academia.3

Table 1. Work–Life Questions To Ponder
Why did I choose to become a physician?
Why did I choose to become an oncologist?
What do I like most about my job?
What motivates me professionally?
By the end of my career, what 3 things do I hope to have accomplished?

Based on reference 2.

In another recent paper, Laurel J. Lyckholm, MD, and her colleagues suggested oncologists identify professional goals to help them choose their career track and shape it along the way to focus on what is most rewarding to them about that track.2 Oncologists may be able to offset potential burnout by making choices in their career based on the answers to these questions2: Why did I choose to become a physician? Why did I choose to become an oncologist? What do I like most about my job? What motivates me professionally? By the end of my career, what 3 things do I hope to have accomplished? Seeking out mentors who have achieved some sense of balance in their career also may be a great help, Dr. Balch added.

Just as importantly, oncologists should protect their personal well-being and find ways to renew themselves, said Dr. Lyckholm, who is Page Professor of Bioethics and Humanities and fellowship program director in the Division of Hematology/Oncology and Palliative Care at Virginia Commonwealth University School of Medicine in Richmond, Virginia. “Some days will be really hard and you need to find ways to absorb the grief ... whether it is physical activity, writing, talking, praying. Find ways to take small breaks during the day—just 5 minutes to do something pleasant 3 or 4 times a day, read a joke, email a friend, take a short walk, and have a soda or ice cream or something delicious from time to time. Find a space where you work that you can go to. For me, there is a floor of the hospital that has a quiet corridor with windows and a place to sit. It is my sacred space.”

Outside of work, oncologists also must nurture their personal life to prevent burnout (Table 2).2-4 “I heard a great piece of advice once,” Dr. Lyckholm said. “When you are at work with your patient, be entirely there with them. No wife, no husband, no kids—just the patient and [his or her] family. And when you walk in the door at night, you must leave them [patients] behind and be present for your family and friends.” Going on vacation also is a must, she added.

Table 2. Tips To Achieve Work–Life Balance
Choose a career track that fulfills you (private practice, clinician-educator, translational scientist, or basic scientist).
Be vigilant in protecting your health.
Identify professional goals.
Eat well, exercise, and get enough sleep.
Based on references 2-4 and conversations with Charles M. Balch, MD, and Laurel J. Lyckholm, MD.

Eating well, exercising, getting enough sleep, and spending time with family and friends may be advice given by all oncologists and taken by only a few.4 Delegating at work and home can afford you time to include these healthy habits. “If you are spending too many hours at work, think about cutting back and spending money on hiring another registered nurse, nurse practitioner, etc.,” Dr. Lyckholm said. “The money will not be as important as the time. Organize your work around your family, not vice-versa.” At home, hiring household help for laundry, cleaning, and cooking could be worth the time freed up.4 Additionally, living near parents or relatives and finding quality child care can be very helpful for oncologists with growing families.4

In the end, neglecting life at home for career or trying to “do it all” is an unsustainable path. Balance is not easy to find but pursuing it is a worthwhile goal for both physicians and their patients.1-3 “We can’t always control our workplace environment and there is going to be stress,” Dr. Balch said. “It’s a matter of whether we adapt to it in a healthy or an unhealthy way.”

References

     

  1. Shanafelt TD. Finding meaning, balance, and personal satisfaction in the practice of oncology. J Support Oncol. 2005;3(2):157-164.
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  3. Shanafelt T, Chung H, White H, Lyckholm LJ. Shaping your career to maximize personal satisfaction in the practice of oncology. J Clin Oncol. 2006;24(24):4020-4026.
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  5. Balch CM, Shanafelt TD, Sloan JA, Satele DV, Freischlag JA. Distress and career satisfaction among 14 surgical specialties, comparing academic and private practice settings. Ann Surg. 2011;254(4):558-568.
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  7. Chittenden EH, Ritchie CS. Work-life balancing: challenges and strategies. J Palliat Med. 2011;14(7):870-874.
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