Satisfaction With Work-Life Balance Among U.S. Oncologists Lower Than Other Medical Specialties, Survey Says
The American Society of Clinical Oncology (ASCO) conducted a survey of U.S. oncologists between October 2012 and March 2013, evaluating satisfaction with work-life balance and career plans. The findings, reported in the Journal of Clinical Oncology by Shanafelt et al, indicate that most are not satisfied with their work-life balance.
Study Details
A total of 2,998 oncologists were invited to complete the survey, which consisted of 60 questions. Of these, 1,490 (49.7%) returned surveys, and 1,117 (37.3%) completed the full survey. The study analyzed the work-life balance and career plans of the 1,058 (35.3%) respondents who were not yet retired.
Responders had a median age of 52 years, 51.6% were women, 85.9% were married, and 85.8% had children; they had been in practice for a median of 19.5 years, worked an average of 57.4 hours per week, and were on call a median of 1 night per week. Among 1,050 responders providing information on practice setting, 45.9% were in private practice, 35.9% were in academic practice, 1.9% worked at a veterans’ hospital, 3.0% worked for industry, and 13.3% worked in other settings. The mean fatigue score was 5.7 (scale 0–10, with a lower score indicating greater fatigue).
Satisfaction Rate
In response to the statement, “My work schedule leaves me enough time for my personal/family life,” 14.1% of oncologists were neutral, 33.4% agreed or strongly agreed, and 52.4% disagreed or strongly disagreed. The proportion who disagreed or strongly disagreed was higher than the 36.9% reporting dissatisfaction in a recent national survey of > 7,000 U.S. physicians from all specialties that used an identical instrument, and the proportion who reported satisfaction would rank lower than all 24 specialties included in the national study.
Factors significantly associated with dissatisfaction included female vs male sex (25.7% vs 41.6% satisfied, P < .001), having youngest child aged < 22 years (37.6% vs 50.6%, P < .001), and being in private and academic practice vs other settings (26.3% and 32.0% vs 52.2%, P < .001 for trend).
Significantly less satisfaction was also expressed by those who devoted more time to patient care (19.2% satisfied for 51%–75% of time devoted to patient care and 31.0% for 76%–100% compared with 36.1% for 26%–50%, 58.9% for 1%–25%, and 71.7% for 0%; P < .001 for trend), those who focused their practice on a specific type of cancer (27.4% vs 37.2% of those who did not, P = .0013), and those who worked more hours per week (eg, 22.7% for 60–69 hours vs 75.9% for < 40 hours, P < .001 for trend), spent more weekends rounding in the hospital (eg, 22.0% for 9–12 weekends vs 62.2% for 0 weekends, P < .001 for trend), and had night call (eg, 27.8% for 1 night per week vs 49.3% for 0 nights, P < .001 for trend).
Fewer oncologists compensated with pure incentive (32.5%) or salary plus bonus (30.7%) expressed satisfaction than did those receiving salary only (38.8%), although the difference was only borderline significant (P =.06).
Factors Predictive of Dissatisfaction
On multivariate analysis adjusting for personal and professional characteristics, female oncologists (odds ratio [OR] = 0.443, P < .001), oncologists who were burned out (OR = 0.329, P < .001), and those with high fatigue scores (OR = 0.489, P < .001) were significantly less likely to be satisfied with work-life balance. Each additional hour worked per week was associated with an approximate 5% decrease in satisfaction (P < .001), and each hour per week spent on patient care was associated with an approximate 3% decrease (P < .0012) independent of total work hours.
Career Plans
A total of 26.5% of oncologists reported moderate or higher likelihood of reducing clinical work hours in the next 12 months, and 34.3% indicated moderate or higher likelihood of leaving their current position within 24 months. On multivariate analysis, burnout (OR = 2.151, P < .001) and dissatisfaction with work-life balance (OR = 1.667, P = .0144) were associated with intent to reduce clinical work hours in the next 12 months; similarly, both burnout (OR = 2.170, P < .001) and dissatisfaction with work-life balance (OR = 1.526, P = .0285) were associated with intent to leave current practice in the next 24 months.
A total of 28.5% of oncologists planned to retire before 65 years of age. Among the 19.1% indicating that they planned to retire earlier than previously planned, the most common reasons were declining Medicare reimbursement for clinical care (14.4%), declining private insurance reimbursement for clinical care (12.6%), and introduction of electronic medical records (11.1%). Among the 32.1% who indicated that they planned to retire later than previously planned, the most common reasons were that they enjoyed their work too much to retire (26.7%), the current state of the economy (20.7%), and decline in value of retirement account in recent years (18.2%).
The investigators concluded, “Satisfaction with [work-life balance] among US oncologists seems lower than for other medical specialties. Dissatisfaction with [work-life balance] shows a strong relationship with plans to reduce hours and leave current practice. Given the pending US oncologist shortage, additional studies exploring interactions among [work-life balance], burnout, and career satisfaction and their impact on career and retirement plans are warranted.”
Tait Shanafelt, MD, of the Mayo Clinic, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by ASCO, the American College of Surgeons Oncology Group, and Mayo Clinic Department of Medicine Program on Physician Well-Being. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
