Burnout symptoms among hematology professionals: An EHA survey

Abstract

Burnout, a work-related syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, has reached epidemic levels in medicine, posing significant threats to healthcare providers, patients, and systems.^1-3 Associated with reduced empathy, impaired judgment, and compromised patient safety,^{4, 5} burnout is generally driven by excessive workload, inefficient processes, administrative burden, and work–home conflict, alongside personal factors like neglect of self-care.^{6, 7} Younger and female physicians report higher burnout rates, with women experiencing more emotional exhaustion and men greater depersonalization.⁸ In high-stress specialties like oncology, nearly 45% of US oncologists report burnout, with long clinical hours and caseloads as dominant predictors.¹ Hematology professionals face similar pressures, managing life-threatening diseases while balancing clinical and research roles.⁹ However, dedicated studies on burnout in hematologists remain scarce.¹⁰ To address this gap, the European Hematology Association (EHA) launched the Burnout Survey Initiative in 2024, with the goal of assessing and characterizing the prevalence and key drivers of burnout within the hematology community. Using a validated instrument, the survey sought to quantify the burden of burnout in this population and to explore both personal and work-related factors associated with its occurrence. Ultimately, our aim was to generate hematology-specific insights that could inform targeted well-being interventions for professionals in the field.

We conducted a cross-sectional survey of EHA members between September and October 2024, targeting hematology professionals worldwide, including clinical hematologists, laboratory hematologists, researchers, and trainees. The survey, disseminated by the EHA Membership Matters Center via email to 7890 members, was anonymous and voluntary, with 14,065 email communications sent, including reminders, to improve response rates. The questionnaire, accessible online from September 10 to October 31, 2024, collected no personally identifiable information, ensuring confidentiality. Burnout was assessed using the Maslach Burnout Inventory-General Survey (MBI-GS), a validated tool measuring emotional exhaustion, depersonalization, and personal accomplishment. Burnout was defined as emotional exhaustion ≥27 and/or depersonalization ≥10; low personal accomplishment when <34.^{1, 11} The survey included MBI-GS items, demographics (age, gender, and country), and professional characteristics (role, experience, workload, and patient contact). Participants with incomplete MBI-GS or demographic data were excluded. Descriptive statistics characterized the sample and burnout prevalence. Univariate associations used chi-square, Fisher's exact, t-tests, or Mann–Whitney U tests. Multivariable logistic regression identified independent predictors of burnout and low personal accomplishment, using a stepwise approach, finally adjusting for age, gender, profession, academic level, working hours, and patient contact. Challenges impacting well-being were analyzed in a separate model. Country-level variations were explored for countries with ≥10 respondents, with a subgroup analysis for those ≤34 years. All analyses used R version 4.3, with P < 0.05 considered significant.

Of 1843 respondents, 62% were female, and most were aged 25–54 years, with 32% aged 35–44. Participants worked in university hospitals (57%) or general hospitals (19%), spanning 43 countries, primarily Italy (13%), Spain (10%), the United Kingdom (8.8%), Germany (7.4%), and France (6.9%). Clinical hematologists comprised 67%, followed by researchers (9.4%) and biomedical scientists (4.6%). Nearly half had >15 years' experience (41%), and 20% had no academic affiliation. Most participants were involved in direct patient care on a daily basis (58%), while 18% indicated that they did not see patients at all. Daytime shift-work was the predominant work schedule (91%); however, substantial proportions also worked evenings (19%), nights (23%), weekends (40%), or participated in regular on-call duties (31%). Regarding workload, over 80% worked ≥40 h/week (35% 40–49 h, 33% 50–59 h, and 18% ≥60 h).

Burnout was present in 50% of respondents (high emotional exhaustion and/or depersonalization). Mean emotional exhaustion was 24 (SD 14), with 42% scoring ≥27; 43% felt “worn out” several times weekly, and 27% reported feeling emotionally exhausted several times a week or daily. Mean depersonalization was 8 (SD 7), with 34% scoring ≥10; 18% felt “emotionally harder” frequently, and 16% reported increased callousness. Notably, among 29 countries/regions with at least 10 respondents, burnout prevalence showed marked variability (Figure 1). The lowest rates were observed in the Netherlands (23%) and in Denmark (24%), whereas the highest were reported in Bulgaria (82%), Cyprus (70%), Portugal (67%), Ireland (65%), and Greece (63%). Among young professionals (≤34 years), rates of severe burnout were particularly elevated in the Czech Republic (82%) and Greece (81%). Notably, burnout rates among young professionals were considerably higher than the national averages observed in the full sample, even in countries known to have less burnout (e.g., the Netherlands: 62% among young vs. 23% overall). Low personal accomplishment (score < 34) affected 66%, with a mean personal accomplishment score of 28 (SD 10). However, 44% reported positively influencing others weekly, and 36% felt energetic weekly. Low personal accomplishment was prevalent, affecting >90% of young respondents in Greece and >75% in Portugal, Spain, Italy, and the United Kingdom.

Multivariable logistic regression identified predictors of burnout (Figure 2): female gender (adjusted odds ratio [aOR] 1.36; 95% CI [1.05–1.76]), working 40–59 h/week (aOR 1.84; 95% CI [1.24–2.75]), ≥60 h/week (aOR 2.95; 95% CI [1.84–4.77]), and daily patient contact (1.77 [1.33–2.36]). Younger age increased risk (aOR 0.35; 95% CI [0.23–0.52] for ≥55 years vs. <35 years), whereas senior academic positions were protective (aOR 0.62; 95% CI [0.41–0.93]). Among laboratory professions, burnout was higher in biomedical scientists (50%) and biologists (46%) than lab permanent staff (25.6%). Key challenges associated with burnout included lack of control and autonomy (aOR 2.52; 95% CI [1.81–3.53]), lack of support (aOR 2.36; 95% CI [1.77–3.17]), poor management (aOR 1.73; 95% CI [1.29–2.32]), work–life imbalance (aOR 1.97; 95% CI [1.46–2.67]), emotional demands (aOR 1.61; 95% CI [1.16–2.22]), inadequate staffing (aOR 1.62; 95% CI [1.22–2.15]), high patient volume (aOR 1.54; 95% CI [1.12–2.12]), and intense workloads (aOR 1.51; 95% CI [1.09–2.09]). A post hoc analysis comparing low-burnout countries (Denmark, the Netherlands) to high-burnout ones (Bulgaria, Cyprus, and Greece) showed higher workloads (50.9% vs. 25.0%), understaffing (57.7% vs. 26.3%), and lack of support (46.4% vs. 18.4%) in the latter. Low personal accomplishment predictors included female gender (aOR 1.48; 95% CI [1.14–1.92]), younger age (aOR 0.32; 95% CI [0.21–0.49] for ≥55 years), and lack of senior academic position (aOR 0.59; 95% CI [0.39–0.90]). Unlike burnout, daily patient contact showed no association (aOR 0.98; 95% CI [0.73–1.31]) with low personal accomplishment, but laboratory hematologists had higher odds (aOR 1.87; 95% CI [1.04–3.52]).

This study, the first large-scale evaluation of burnout among European hematology professionals, reveals a high prevalence, with 50% experiencing burnout and 66% low personal accomplishment, aligning with oncology findings.^{1, 12} Younger professionals, women, and those with daily patient contact or long hours were most affected, whereas senior academic roles were protective.

A key contribution of this study is the distinction between predictors of burnout and low personal accomplishment, underscoring the multifaceted nature of professional distress. While certain factors such as female gender, younger age, and junior academic status were associated with both outcomes, others were outcome-specific. Daily patient contact, for instance, was a strong predictor of burnout but showed no relationship with low personal accomplishment, suggesting that the emotionally taxing nature of clinical care may be offset by a sense of professional fulfillment due to recognition (by patients and families). Conversely, laboratory hematologists had higher odds of low personal accomplishment, potentially reflecting reduced patient interaction, limited recognition, or fewer opportunities for professional growth. Although this category is mixed, the rate of low personal accomplishment did not differ across laboratory-related professions.

Evidently, early-career hematologists face workload imbalance, uncertainty, and insufficient structural support, compounding emotional strain. On top of that, women (62% of respondents) may encounter disproportionate patient communication demands, domestic responsibilities, and workplace inequities like discrimination or limited leadership opportunities.⁸ Fortunately, there are multiple ways to overcome these difficulties. Mentorship programs can support younger professionals by fostering career guidance and resilience, while peer support networks and recognition programs can mitigate isolation for laboratory hematologists. For women, schedule flexibility, equitable leadership pathways, and initiatives to address bias are critical to reducing burnout and enhancing fulfillment.

Beyond tailored interventions, exhaustion and professional satisfaction may only be resolved when systemic factors are efficiently addressed. In our study, lack of control, lack of support, and effective management were the strongest burnout drivers, echoing US studies framing burnout as a structural issue.^13-15 Systemic reforms, including optimized staffing, supportive leadership, and mentorship, are critical to enhance psychological safety.¹³

Our study has several strengths, including a large, diverse sample of hematology professionals, use of a validated burnout measure (MBI-GS), and the inclusion of multilevel analyses. Nonetheless, limitations include a limited number of observed characteristics (e.g., ethnicity, sexuality, and disability were not described) and the possibility of response bias, particularly if individuals experiencing higher distress were more likely to respond. Last but not least, our cross-sectional design lacks longitudinal insight. The question of how burnout trajectories evolve over a career is critical. The observed protective effect of older age and senior academic roles might reflect either a selection effect—where those most affected by burnout leave clinical roles—or a natural adaptation to workplace demands over time. However, as West et al. emphasize, resilience levels among physicians are generally high, even in those experiencing burnout.¹⁵ This suggests that while personal coping mechanisms may improve over time, structural workplace factors remain the primary contributors to burnout.

In conclusion, this first large-scale European study demonstrates that burnout in hematology is common and driven by modifiable systemic factors, not individual failings. The systemic nature of burnout is evident. Therefore, professional societies and healthcare systems must prioritize safer work frameworks, with effective limits on working hours, and develop tailored interventions for younger professionals and women. We urge a shift from expecting clinicians to “cope better” to implementing organizational reforms, ensuring high-quality care for patients with hematologic diseases.

Côme Bommier: Conceptualization; methodology; software; data curation; formal analysis; visualization; investigation; validation; writing—review and editing; writing—original draft. Adela Perolla: Conceptualization; methodology; writing—review and editing. Ana Zelić Kerep: Conceptualization; methodology; writing—review and editing. Ruxandra Irimia: Conceptualization; methodology; writing—review and editing; project administration. Nikolia Iatrou: Conceptualization; methodology; project administration; funding acquisition; resources. Elizabeth Macintyre: Conceptualization; methodology; investigation; funding acquisition; writing—review and editing; supervision. Nuno Borges: Conceptualization; methodology; supervision; project administration; funding acquisition; writing—review and editing.

The authors declare no conflicts of interest.

The study was reviewed under EHA Membership Matters' internal research governance procedures, which are designed to assess ethical risks in line with professional research standards. This protocol was categorized as exempt from full ethical review for the following reasons: participation was entirely voluntary, no personally identifiable information was collected, and the design posed minimal risk and involved no intervention. Membership Matters' practitioners are all members of the Market Research Society (MRS) and conduct research in full compliance with stringent professional codes of conduct—particularly around participant confidentiality, informed consent, and data protection.

The survey was entirely sponsored by the European Hematology Association (EHA). EHA Engagement department also covered the APCs.