November 30, 2020
PAs in Oncology Report Burnout and High Satisfaction
Compassion Fatigue Contributes to Emotional Toll
By Eric Tetzlaff, MHS, PA-C, DFAAPA
May 28, 2020
I hear it all too often, “That must be hard … I could never do that … Isn’t it depressing?” My response since entering oncology has often been the same — that it is a privilege to care for patients who are facing life-threatening illnesses. Although challenging at times, the opportunity to participate in and witness the strength of patients and families makes my work meaningful and manageable.
My experience may help explain why, despite high levels of burnout among PAs in oncology, PAs in oncology also report high levels of satisfaction with their career and specialty choice, and few indicate plans to leave oncology. It may also suggest opportunities to help mitigate the risk of burnout for providers in oncology.
Compassion Fatigue and Satisfaction
Compassion fatigue can contribute to provider burnout. But in focusing on the downside of compassion, sometimes we lose sight of its benefits — the positive feelings we derive from patient care, and the pleasure we get from helping others. Importantly, research shows that compassion fatigue and compassion satisfaction are not two sides of the same coin. Many oncologists who experience high levels of compassion fatigue also report experiencing high levels of compassion satisfaction.
To help cope with the demands of caring for patients with terminal illnesses and the potential emotional toll, oncologists cite distancing and balancing emotional boundaries as strategies to minimize or avoid emotional pain when a patient dies. But distancing ourselves from the emotions that accompany losing a patient may have the unintended consequence of diminishing our compassion satisfaction and the meaning we derive from our practice.
I would suggest instead that we lean in to patient care. Rather than distancing ourselves from patients, if we lean in and develop strong personal bonds with patients, we may significantly increase our compassion satisfaction and engagement at work. In doing so, we may maximize the rewards of providing complex care to patients and the relationships that we have with them. It would also not surprise me at all that by leaning in we increase the quality of care we provide and increase patient satisfaction.
Environment or the Individual?
Burnout is largely driven by system-level issues, which should be the primary focus of efforts to decrease provider burnout. To make a meaningful impact on burnout, most strategies should focus on improving the efficiency of providing care and ensure that as PAs, we are working to the top of our education, experience, and training. This approach to reducing the risk of burnout would be broad and impactful for all PAs, regardless of specialty or setting.
To a lesser degree, strategies that focus on the individual can help mitigate the risk of burnout. Unfortunately, focusing on the individual often has the unintended consequence of making them feel as if they caused their burnout and may further decrease engagement at work. One exception may be strategies that help oncologists with the challenge of not only the exposure to death and dying but with grief and sense of failure. For oncologists, assisting them in managing grief after a patient loss, increasing opportunities for them to reflect on their role in providing care, and helping to minimize their perception of failure, may all help decrease compassion fatigue and burnout. Perhaps having this type of support would allow us to better lean in to patient care and increase our compassion satisfaction.
- Tetzlaff, E.D., et al., National Study of Burnout and Career Satisfaction Among Physician Assistants in Oncology: Implications for Team-Based Care. J Oncol Pract, 2018. 14(1): p. e11-e22.
- Laor-Maayany, R., et al., Compassion fatigue among oncologists: the role of grief, sense of failure, and exposure to suffering and death. Support Care Cancer, 2020. 28(4): p. 2025-2031.
- Granek, L., et al., Barriers and facilitators in coping with patient death in clinical oncology. Support Care Cancer, 2016. 24(10): p. 4219-27.
- Medicine, N.A.o., E. National Academies of Sciences, and Medicine, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. 2019, Washington, DC: The National Academies Press. 334.
Eric Tetzlaff, MHS, PA-C, DFAAPA, practices in the Department of Hematology/Oncology at the Fox Chase Cancer Center in Philadelphia, Pennsylvania. Contact Eric at eric[email protected].