A Toxic Mixture: Burnout in Oncology Pharmacy

“Today, pharmacists have practice authorities that go way beyond dispensing,” writes Scott Knoer, MS, PharmD, FASHP, in recognition of American Pharmacists Month in October. The CEO of the American Pharmacists Association, Dr. Knoer writes in his blog, “We’re diagnosing, preventing, and treating COVID-19; helping Americans stay up-to-date on all their routine vaccinations; and delivering care in new ways, such as telehealth.”

The accumulation and expansion of these tasks have been magnified during COVID-19, resulting in growing burnout among pharmacists. This is exacerbated by pharmacy workforce shortages across the country. “Patients may aggressively challenge the professional judgment of pharmacists and other pharmacy personnel,” adds Dr. Knoer. “A toxic mixture of vaccine misinformation and disinformation fuels distrust. Keeping up-to-date with the rapidly evolving vaccine guidance from government authorities can be difficult.”

What Is Burnout?

The International Classification of Diseases 11th Revision (ICD-11) definition of burnout is “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” It is characterized by feelings of energy depletion or exhaustion, increased mental distance from one’s job, feelings of negativism or cynicism related to one's job, and reduced professional efficacy. The extent of the burnout being reported by today’s pharmacists is the topic of a recent study published in HOPA News (Hematology/Oncology Pharmacy Association).

Allison P. Golbach, PharmD, BCPS, a clinical oncology pharmacist at the University of Kansas Health System, authored the study, in which she describes the results of a survey sent to more than 3,000 pharmacists. Of those, 550 surveys were scored for burnout. Dr. Golbach notes that the consequences of the burnout suffered by oncology pharmacists in particular can be dire, as “even small errors in hematology/oncology pharmacy, such as a miscalculation of body surface area or missing a decimal point, could result in significant morbidity or even mortality for patients.”

The study found that an eye-opening 61.8% of hematology/oncology pharmacists experienced high levels of burnout based on their emotional exhaustion and depersonalization scores on the Maslach Burnout Inventory (MBI). Importantly, Dr. Golbach notes that the survey also found that pharmacists registering high burnout were more likely than those without high burnout “to report concern for having made a major medication error in the past three months.” In stressing the significance of this finding, Dr. Golbach states that, given the high-risk medications oncology pharmacists regularly dispense, the consequences of such errors can be significant, even lethal.

Of course, burned out staff often leave their job, if not their profession entirely. Of the pharmacists surveyed by Dr. Goldbach and her team, nearly 27% with high levels of burnout reported their intention to leave their current positions within the next two years. Of those without high burnout, approximately 8% reported an intention to leave.

Targeted Wellness

What can we do with this information? Of the pharmacists surveyed by Dr. Golbach, nearly 63% of those with high burnout said they would benefit from a wellness program. However, approximately 30% were unaware of any program available to them. While workplace programs and tools that combat burnout should be an obvious first step, equally important is advertising such resources and enabling pharmacists to easily access and use them—in a way that does not add to their already-packed schedules.

Identifying the pharmacists most at risk for burnout can help practices and programs target their resources to those most in need of them. Dr. Golbach’s survey found that pharmacists working more hours and those with more administrative responsibilities were more likely to experience burnout. Seeking to ameliorate their stress is a good first step. Dr. Golbach writes, “By starting with those experiencing the most burnout, resources and programs that are initiated [will] trickle down to those who are experiencing less severe burnout as well.”

ACCC Wellness Tools

Krista Nelson, MSW, LCSW, OSW-C, FAOSW, is ACCC’s 2021-2022 president. Each year, ACCC invites its president to select a theme for their tenure that addresses a timely issue in cancer care. By choosing “Real-World Lessons from COVID-19: Driving Oncology Care Forward,” Nelson is focusing on health equity, supportive care services, and professional well-being and resilience. Recognizing that oncology professionals have experienced extraordinary challenges and stressors during the past year and a half, Nelson is creating a free online mindfulness meditation series that can help listeners manage their stress levels and improve their social, emotional, physical, and mental health.

Nelson has also recorded a series of mini podcasts on several wellness issues, including Coping with Pandemic Grief,  Staff Resiliency During COVID-19, and COVID-19 Self-Care. Her blogs include Oncology Social Workers Promote Self-Care in the Workplace and Why Social Workers Are Essential. See more resources on the ACCC President’s Theme 2021-2022 page.