Studies have shown that oncologists are leaving the workforce at increasing rates in association with career dissatisfaction and growing workloads and patient care hours.
According to a 2023 survey by the American Society of Clinical Oncology (ASCO), 21% of active oncologists reported that it was “likely” or “definite” that they would leave their current practice within 2 years or reduce their clinical work hours in the next 12 months, compared with 16% of oncologists surveyed in 2013 (P=0.009). Almost half (42%) of retired oncologists had retired 2 to 4 years earlier than planned, and 56% of oncologists left their clinical practice to pursue nonclinical roles at a median age of 58 for reasons such as a lack of satisfaction with clinical practice and a desire for more work flexibility.1
Why are these percentages climbing? According to Eric P. Winer, MD, of Yale Cancer Center, and colleagues, high clinical expectations and administrative, research, and teaching responsibilities can contribute to clinician burnout and decreased satisfaction.2 In 2023, a total of 68% of oncologists reported an increase in hours spent on administrative work, 57% reported an increase in total work hours, and 49% reported an increase in patient care hours.1
In early 2025, ASCO released a statement outlining strategies for academic medical centers to change their policies and expectations to support oncologists and their professional fulfillment. These include establishing reasonable workloads, providing resources for oncologists to conduct research, and applying support and opportunities fairly and equitably to oncologists of all races, ethnicities, and genders.2
“Overall, improved career satisfaction is likely to result in retention of oncologists in the workforce,” wrote Dr. Winer and colleagues.2 “This is critical to support high-quality patient care, educate the next generation of cancer-focused professionals, and accelerate research discovering effective strategies for cancer prevention, diagnosis, and treatment.”
Establishing Reasonable Workloads and Increasing Clinical Support
Administrative responsibilities such as documentation requirements can limit time for clinical care and place a greater burden on the clinician, according to Dr. Winer and colleagues. Therefore, ASCO proposes establishing reasonable clinical workloads for academic medical oncologists.2
The amount of clinical support an institution provides, such as personnel and technical tools, plays a role in “defining the clinical workload that is appropriate for an academic medical oncologist,” the authors explained. The amount of clinical support also differs among institutions and for oncologists in the same institution.2
Electronic Health Records
Studies have shown that although electronic health records (EHRs) are an indispensable tool in cancer institutions, they are also time-consuming and contribute to oncologists’ stress.2 In fact, 47% of oncologists identified EHRs as a major work stressor.1
According to the 2021 National Electronic Health Records Survey, 88.2% of office-based physicians in the US have adopted EHR systems.3
“The problem is how we use electronic records, what it does to the way we work, and the amount of time and effort it takes,” Clifford A. Hudis, MD, CEO of ASCO, told Blood Cancers Today, reflecting on his own experience as a former breast cancer clinician in an academic medical center.
In Dr. Hudis’ experience, the shift from paper-based records to EHRs has increased the time requirements for patient documentation, which may also decrease the number of patients oncologists see in a day.
“At the beginning of my career, I would go to clinic with a paper chart rack and see 25 to 35 patients per day. As I talked to the patient, I would document what needed to be documented,” he explained. “Fast forward decades later, and a routine experience for an oncologist is seeing 18 to 25 patients per day, then logging back onto the EHR for 1, 2, or 3 hours in the evening to finish documentation.”
“Every aspect of the model has been stretched in the wrong direction, placing a greater productivity burden on the physician while reducing their actual productivity,” Dr. Hudis continued. “There are certainly still systems and practices where, with adequate support, people have been able to maintain volumes. But even there, that means hiring more people such as scribes.”
Advanced Practice Providers
As the ASCO team notes, many tasks can be performed by other members of a cancer care team such as nurses, advanced practice providers (APPs), pharmacists, social workers, and nutritionists rather than medical oncologists.2
According to a 2024 survey, 42.1% of APPs and 29.3% of physicians reported burnout, and more than 50% of physicians felt that working with APPs had reduced their burnout.4
Ariela Marshall, MD, an associate professor of Medicine in the Division of Hematology, Oncology, and Transplantation at the University of Minnesota, and lead author of the study, outlined her experience working with APPs as a hematologist-oncologist.
“Both at my current and immediate prior institution, we have had an APP specifically dedicated to our inpatient consult setting, which allows them to accumulate over time the very specialized knowledge necessary for these complex inpatient consults,” Dr. Marshall told Blood Cancers Today. “Eventually, the APPs are able to see and evaluate patients independently (as a fellow would) before staffing with the attending. APPs are also able to do bone marrow biopsies, which is a significant improvement in time and workflow for a busy consult service. Additionally, having an APP on the team has created a sense of stability and continuity because attendings and fellows are frequently rotating on and off service, and the APP is the single person who is there on a consistent basis.”
According to Dr. Marshall, APPs can help contribute to reduced clinician burnout in several ways. For example, APPs seeing patients for follow-up visits or chemotherapy teaching visits in the outpatient setting can allow clinicians to spend more time on “complex and intellectually challenging visits” such as new diagnoses and change of plans for disease progression. Similarly, in the inpatient setting, APPs carrying out and billing simple visits can also allow clinicians to see new patients for consults or admissions.
“The opportunity to work with APPs is a sign that the institution as a whole is invested in hiring the personnel needed to support patient care at an adequate level,” she added.
However, it is important to note that association is not evidence of causation, Dr. Marshall said.
“In studies we have observed that physicians who work more with APPs have reported lower burnout but that this is not yet directly attributable to APP support,” she explained.
Research Support for All Oncologists
ASCO also recommends that academic medical centers support the development of careers in research for early career medical oncologists, while establishing standard durations and metrics for achieving research goals.2
“Neither institutions nor oncologists should view protected research time as flexible hours that can be used for administrative or clinical work rather than pursuing scholarly work,” wrote Dr. Winer and colleagues.2 “Rather, clinical research productivity should be regularly monitored.”
The authors also highlighted disparities among women and underrepresented groups in obtaining research funding, time for research and professional growth, and leadership roles at academic institutions.2
According to a 2019 report by the Association of American Medical Colleges, 63.9% of medical school faculty were White, and 58.6% were male. Among active physicians, 56.2% were White and 64.1% were male.5
To create and maintain a diverse and inclusive workforce, ASCO urges academic medical centers to develop and apply career advancement and leadership opportunities fairly and equitably for all academic medical oncologists. “Adopting evidence-based practices to eliminate stigma and discrimination experienced in the workplace will help academic medical centers address these disparities,” the authors wrote.2
The Complexity of Burnout
Dr. Hudis hopes that ASCO’s strategic plan can stimulate conversation about oncologists’ expectations and performance, as well as the challenges of burnout. However, he also warns of potential bias in studies measuring burnout.
“There has always been burnout. I think the problem is real, but there is a risk of either observer bias or awareness bias,” he said. “Is burnout truly worse today than it was X years ago? Our sense, subjectively and qualitatively, is that it is worse. But in a world that likes data and evidence and numbers, we may or may not have an accurate assessment.”
Similar to Dr. Marshall, Dr. Hudis noted that studies on burnout rely on associations rather than causes.
“You can’t do the kind of study that would, in a definitive way, prove that the reason for our current challenges is either broadly burnout or narrowly some specific component of burnout,” he said. “The best we can do is ask people for their recall and to project into the future about their career plans. In all those cases, you do get a fairly consistent association between reports of burnout and either dissatisfaction or plans to make career changes.”
Despite these limitations, Dr. Hudis hopes that ASCO’s strategic plan can help cultivate supportive clinical and research environments for oncologists, while ultimately nurturing clinical research that patients can participate in.
“Career satisfaction for academic oncologists is a critical resource for the whole world, because it is that group of people who not only deliver patient care to varying degrees but also conduct both basic and translational and clinical research,” he said. “They serve as the seed of future oncologists. No matter where you are becoming an oncologist, you’re being trained by an academic oncologist—somebody who’s dedicated their life to education or research.”
Read more: Understanding and Combatting Burnout in Hematologist-Oncologists
References
- Schenkel C, et al. JCO Oncol Pract. 2023;19(11)42-42.doi:10.1200/OP.2023.19.11_suppl.42
- Winer EP, et al. J Clin Oncol. doi:10.1200/JCO-24-02246
- Centers for Disease Control and Prevention. Accessed April 24, 2025. https://www.cdc.gov/nchs/nehrs/results/index.html#cdc_generic_section_1-2021
- Marshall AL, et al. Blood Adv. 2024;8(5):1179-1189. doi:10.1182/bloodadvances.2023011927
- Association of American Medical Colleges (AAMC). Accessed May 8, 2025. https://www.aamc.org/media/38266/download?attachment
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