John Leung

Stress, satisfaction and burnout amongst Australian and New Zealand radiation oncologists

The aim of this study was to determine the self‐reported prevalence of stress, job satisfaction and burnout among radiation oncologists in Australia and New Zealand. A secondary aim was to determine the association between stress and satisfaction parameters with burnout.

Faculty of Radiation Oncology 2010 workforce survey.

Introduction: This paper outlines the key results of the Faculty of Radiation Oncology 2010 workforce survey and compares these results with earlier data.

Faculty of Radiation Oncology 2012 trainee survey: perspectives on choice of specialty training and future work practice preferences.

This paper reports the key findings of the first Faculty of Radiation Oncology survey of trainees dealing with experiences and perceptions on work practices and choice of specialty.

Burnout, stress and satisfaction among Australian and New Zealand radiation oncology trainees.

To evaluate the incidence of burnout among radiation oncology trainees in Australia and New Zealand and the stress and satisfaction factors related to burnout.

Faculty of Radiation Oncology 2014 workforce census.

This paper reports the key findings of the Faculty of Radiation Oncology 2014 workforce census and compares the results with earlier surveys.

Workforce issues in radiation oncology: still a complex issue 10 years on but more so in 2012.

Dear Editor, In 2000, Liz Kenny wrote in her editorial that workforce issues were a ‘vexed and most complex problem’.1 At that time, there was a shortage of training positions. There was also a possible shortage of radiation oncologists if one assumed an optimal utilisation rate of 50–55%. The problem is that the actual utilisation rate is around 38%. Therefore, projections of workforce numbers that appeared realistic back then may not be so now that we have had over 10 years of lower utilisation rates. She also lamented that the ‘capital infrastructure for radiation oncology is inadequate’ and ‘development of services within the private sector remained constrained.’.1 However, many new centres have opened and the private sector has been involved in a number of these, especially Genesis Care. Workforce issues are still prevalent though. The emphasis may be different. Radiation oncology has a small workforce, which means that minor fluctuations can have big implications for the staffing of radiotherapy facilities. The attempt to foretell what the likely nexus between supply and demand of radiation oncologists will be is called workforce modelling. Several groups have been engaged over the years, including the Australian Medical Workforce Advisory Committee (AMWAC) and the Radiation Oncology Reform Implementation Committee (RORIC),2 as well as the Health Workforce Australia (HWA) and the Tasman Health Workforce New Zealand (HWNZ) more recently. The latter two organisations have sections looking at cancer workforce and medical workforce. So why should the College undertake workforce data collection and modelling when there are expert government bodies to do such work? Firstly, because the College is the only organisation that understands radiation oncology in detail and has a genuine interest to promote radiotherapy without a political or a fiscal agenda. Secondly, history tells us that government agencies have failed on many occasions and for different reasons to precipitate workforce issues or to act on them in a timely manner. Let us look more closely at what is happening. The workforce model developed by HWA is too sensitive to be used for modelling future demand and supply in a small specialty.3 Although HWA is open to collaborating with the College and sharing its’ model, it is limited because it is built for specialties with thousands, rather than hundreds of members. The focus of the HWA’s Cancer Workforce Strategy is on ‘innovative workforce models’ and ‘alternative service delivery models rather than supply and demand issues’.4 HWNZ has not gone down the path of detailed modelling. The New Zealand fiscal situation demands a redistribution of existing funds with no new funding forthcoming. The prioritisation of medical specialties by HWNZ at the end of 2011 was an exercise of subjectively ranking medical specialties according to their perceived importance to the health care system. The implication is that a low ranking will mean that registrar funding will be redistributed to the specialties higher on the list. In Australia and New Zealand, the Faculty needed to draw on the results of its’ 2010 Workforce Survey to provide accurate data and to highlight the importance and the vulnerability of radiation oncology. The Faculty has established links with HWA and HWNZ, which will enable us to contribute to their planning processes. The Faculty cannot guarantee that government agencies will adopt our recommendations, but we can influence the process by providing accurate and comprehensive data about our membership and highlighting the implications, if the radiation oncology workforce were to be undermined. It is with this aim in mind that the Faculty had the foresight to reintroduce a regular workforce survey in 2010.5 We can confidently predict certain workforce developments: regional workforce will become an important minority in radiation oncology, bringing with it a unique set of challenges; the increase in cancer incidence will put pressure on all cancer professions; and governments will continue to look for efficiencies and opportunities to minimise costs, particularly through delegation to non-medical health professionals. Also, much has been said about the impact of feminisation, subspecialisation, multi-disciplinary and personalised care, and of generational turnover in the workforce. The Faculty’s role in this area is ‘to act as an authoritative body in matters of public interest in connection with the field of Radiation Oncology’.6 The Faculty’s data collection efforts are paramount to fulfilling this role. As the peak body advancing patient care and the specialty of radiation oncology, the Faculty must have data on the supply of radiation oncologists into the future. In 2010, the Faculty workforce survey achieved a high 76% response rate, which allowed it to have a strong position in discussions with governments. bs_bs_banner Journal of Medical Imaging and Radiation Oncology 56 (2012) 708–709

Employment for radiation oncologists in Australia and New Zealand: Recent graduates survey of experiences and perspectives

This paper reports the key findings of the first survey of recent Radiation Oncology graduates in Australia, New Zealand (ANZ) and Singapore. It explores their experiences in entering the workforce, challenges and perspectives.

Comparative study between 68Ga-prostate-specific membrane antigen positron emission tomography and conventional imaging in the initial staging of prostate cancer

The management of prostate cancer has undergone significant advances since the introduction of 68Ga‐prostate‐specific membrane antigen (68Ga‐PSMA) positron emission tomography (PET) scans. Data on the use of 68Ga‐PSMA PET scans in the setting of biochemical recurrence is widely available. Data on the use of 68Ga‐PSMA PET as an initial staging modality, however, is limited. The aim of this retrospective study was to compare the staging of patients with newly diagnosed prostate cancer between 68Ga‐PSMA PET and current conventional imaging modalities. The potential impact of any change in stage will be analysed.

Are we suffering from burnout and if so what next

In this edition, Michael and Anne Poulsen have written a very interesting and relevant article about burnout. This subject is very topical with many articles appearing in the recent literature. Although the original definition of burnout encompassed high emotional exhaustion and depersonalization with low personal accomplishment, the most common definition now encompasses high emotional exhaustion or depersonalization. There are a number of interesting points to be made. Firstly burnout affects not just radiation oncology trainees, but also specialists and allied professional groups with an incidence of 35–50%. Burnout is important because it not only affects the doctors’ personal lives, but has been shown to affect the effectiveness and safety of doctors as well as patient safety. Secondly, the emphasis now should be on measures to prevent or alleviate burnout. The prevalence of burnout is now well-documented in the recent literature, so further studies on this may not be as important as measures to reduce or prevent it. Indeed, in radiation oncology, there are now studies that have shown burnout prevalence in academic chairs of radiation oncology, residency program directors, radiation oncologists and trainees. This is why Michael Poulsen’s article is important as it is the next step. Its’ focus is specifically on radiation oncology trainees. He has comprehensively made suggestions at the Faculty, organization and individual level. It would seem that most work could be done at the organization or institution level. The suggestions made at the individual level such as adequate sleep, taking holidays, setting time for relaxation, self-awareness, etc., make common sense, but may not be influenced by the profession and may not be adequate when considered in isolation. The College has found it difficult to institute effective measures. Whilst there has been recognition that burnout exists, it has been difficult to take the next step. Ironically, when help was offered to trainees, it was suggested that they were ‘too busy’ to explore this matter further. The College has made its’ members aware by publications in this journal and newsletters. It also has trainee representatives at most College Committees including Faculty Council. However, the next step might be interventional workshops, online educational resources and committees devoting some time to this subject as Poulsen suggests. Indeed, the Poulsens have already demonstrated the effectiveness of a 1-day interventional workshop for radiation oncology professionals. Although this study focused on oncology nurses and radiation therapists, it found that the interventional workshop was more effective than receiving written material alone. The workplace, where the trainee spends most of his or her time would seem the area where effective measures might be considered.

Tony Woo (1970-2017)

Tony was born on 10 March 1970. He graduated from the University of Western Australia in 1993 with his basic medical degree. He obtained his fellowship in 2005. He worked as a radiation oncologist in Canada, Singapore, Adelaide and finally Wagga. An excellent quality Tony displayed was his sheer passion for radiation oncology. There are some who might just get by in the profession, but not Tony. Whether he was advocating for his patients, being involved in a trial or introducing technology, he was very passionate and committed. He always gave his best effort. He was instrumental in introducing intensity-modulated radiation therapy to Adelaide Radiotherapy Centre at a time when few centres in Australia were using it. He never declined or delayed seeing new patients and would make an extraordinary effort into squeezing them in to his busy schedule. He had an excellent knowledge of the current literature in not just one or two areas, but a broad spectrum. Perhaps his greatest strength was his expertise in technology, which was very important in this era of significant technological advances in radiation oncology. His understanding of complex plans was a valuable contribution. Tony was also an interesting man and had a distinctive personality. He had a good sense of humour, wit and could be self-deprecating. He loved learning and spent many hours studying Mandarin. When we compared Mandarin notes, it was obvious that his grasp of the language was superior, but he never let me know it and in fact acted deferentially, revealing another good aspect of his character – humility. He was an avid science fiction fan and in particular loved Star Trek where he interpreted the themes of almost every episode. His love of Asian food led him to being an almost expert reviewer of Chinese restaurants. He was a self-confessed “geek” who loved gadgets from home entertainment systems, computers and smart phones. A measure of a person’s character is not only just in his work achievements but also his other attributes. Tony was a devoted and loving family man. He rang his mother every day no matter where he was or how busy his schedule. He had a strong, stable, loving marriage with his wife Anita and was a much-loved father. He adored his two children Jennifer and Michael. He has died far too young. He will be missed, but not forgotten.