Special Feature
Lifestyle, Stress, and the Gynecologic Oncologist
By David M. Gershenson, MD
It seems as if everyone i know in the field of gynecologic oncology is expressing the opinion that they are working harder and enjoying life less than they did in the past. I have listened to this theme equally from both academic and community practice gynecologic oncologists. Of course, all of us complain to some degree or another about our problems and the frustrations we experience. Isn’t that what accounts, at least partially, for so many in the upper echelons of our society pursuing counseling or psychotherapy? And is it simply routine complaining or is there really something going on that separates us from our parents’ generation?
A recent report on job satisfaction among gynecologic oncologists practicing in the United States sheds some light on this topic.1 The authors surveyed all U.S. gynecologic oncologists who were members of the Society of Gynecologic Oncologists in an effort to compile information on demographics, training, motivating factors, overall professional satisfaction, and the effect of managed care. Of 767 members polled, there were 344 (47%) respondents. Of the respondents, the majority was male (80%), white (86%), married (85%), and board certified (82%). Fifty-seven percent identified themselves as academic, as defined by practicing in either a university setting or in a community hospital training program. Respondents were classified based on the time frame in which they completed their training. The percentage of women steadily increased from 0% prior to 1965 to 30% after 1995. An increasing percentage of gynecologic oncologists have left their initial job within five years—from approximately 30% of those who completed training before 1965 to more than 50% of those who finished between 1986 and 1995. The authors note that the most common explanation for leaving a job was "difficulty with colleagues and/or the department chairperson." The mean number of partners and the mean number of hospitals attended in their current job is also greater for the younger gynecologic oncologists (3.8 vs 2.0, and 3.7 vs 2.5, respectively). All groups before 1995 showed a statistically significant increase in the reported number of hours per week spent personally dealing with insurance company paperwork or phone calls. Forty-eight percent of the respondents reported having been sued, with an average of one lawsuit per individual. Female gynecologic oncologists reported having been sued half as often as male gynecologic oncologists—25% vs. 54%—but this appeared to be related to the higher number of years in practice for the latter. Of academic gynecologic oncologists, the proportion of their salary that depended on clinical productivity increased from 39% in their first job to 66% in their current job.
The authors asked respondents to rank 10 motivational factors in order of importance at the time they were looking for their first jobs and their current jobs and in how they contributed to professional satisfaction once they were in these jobs. In all generations of gynecologic oncologists, four of the following five characteristics were rated as the most important factors in both looking for a job and in contributing to job satisfaction: 1) practice characteristics; 2) potential for professional growth; 3) location; 4) colleagues and/or department chair; and 5) salary. There were no significant differences between male and female respondents. However, gynecologic oncologists in private practice ranked location as their most important factor while academic gynecologic oncologists ranked practice characteristics as the most important factor.
In terms of overall job satisfaction, there were no differences between men and women or between academic and private gynecologic oncologists (all in the range of 4-5 on a scale of 1 to 10). In addition, the average respondent stated that managed care had significantly decreased their job satisfaction and their quality of care.
In a recent article entitled, "The Balanced Life: A Discussion of Stress in Gynecologic Oncology," Leo Lagasse, MD, a much-respected senior member of our discipline, noted that "our subspecialty is one of the four or five highest stress areas in medicine."2 He discussed the practice stresses that we face—death and dying, surgical complication, and specialty overlap—as well as administrative pressures—peer review, malpractice, managed care, and the myriad hospital committees—to name a few. He also underscored the personal stresses in our lives, including family commitments and relationships. For both men and women, balancing our professional lives and our family obligations is a major challenge. As one of my friends recently told me, "There is no longer any down time in my life. Life is always a rush to get to the next commitment or deadline." And I agree; life does seem more frenetic than before. Faxes, e-mail, and cell phones have undoubtedly contributed to this dramatic change in lifestyle. Lagasse encourages us to find a balance in our lives by setting priorities and by de-emphasizing professional gratification (money, power, honors, etc.) and focusing on our personal lives. He also offers other potential options, including support groups, flexible work schedules, shared positions, and fitness programs.
Finding balance in our life and minimizing stress are important and desirable goals for each one of us. And of course, the problems discussed herein are not restricted to the practice of gynecologic oncology, but rather have much broader implications. I do firmly believe that the introduction of the younger generation, particularly women, into our subspecialty has caused all of us to reexamine our priorities. Each one of us will deal with these challenges in different ways, but the overriding message is quite clear—life is considerably more complex than it was for our parents’ generation, and we need to find our own balance.
References
1. O’Meara AT, Averette HE. Gynecol Oncol 2000;76:163-169.
2. Lagasse L. Gynecol Oncol 2000;76:301-304.
According to a recent report on job satisfaction by O’Meara and Averette, female gynecologic oncologists reported being sued half as often as male gynecologic oncologists.
a. True.
b. False.
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