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Being a young radiation oncologist in Poland: results of a multi-institutional survey

Being a young radiation oncologist in Poland: results of a multi-institutional survey In 2018, Polish Society of Radiation Oncology formed a young section (yPTRO), dedicated to radiation oncologists under the age of 40. To evaluate their current situation, an anonymous, nationwide, online survey was carried out. Thirty-two-item-based questionnaire investigated young radiation oncologists’ perception of employment, workload, education, malpractice lawsuits, scientific research, and board exam. A total of 44 physicians responded to the questionnaire, yielding a response rate of 25%. Results of the survey identified the main problematic areas. In general, young radiation oncologists in Poland are overloaded with bureaucracy. They complain on spending too much time at work and lack work-life balance. The risk of being sued for medical error is threatening two-thirds of responders in everyday work. Compensation is not satisfying for nearly half of the survey participants. Nearly all young radiation oncologists continue education and participate in national and international educational events. Forty-eight percent of responders do scientific research alongside clinical work. However, the perception of young radiation oncologists on the board exam is alarming and requires further discussion. Fifty-five percent of the survey participants think that current form of the exam is not appropriate. Hopefully, 75% of physicians feel fairly evaluated. The presented report is the first of its kind in Poland. Issues mentioned in our questionnaire will help newly formed yPTRO to develop strategic priorities for the upcoming years. . . . . Keywords Radiation oncology Young specialists Education Employment Survey Introduction Radiation oncology (RO) is a rarely chosen medical specialty with a relatively low number of specialists worldwide. It re- mains unknown for both general public and other medical * Ewa Pawlowska professionals. Thus, the leading international RO societies, ewa.pawlowska@gumed.edu.pl namely the European Society for Radiotherapy and Oncology (ESTRO) and the American Society for Radiation Department of Oncology and Radiotherapy, Faculty of Medicine, Oncology (ASTRO), play an essential role in creating a sense Medical University of Gdansk, Gdansk, Poland of community and supporting members from all over the Department of Biostatistics and Translational Medicine, Medical world. Societies provide standards of education and practice University of Lodz, Lodz, Poland in radiotherapy, organize courses and meetings, and facilitate Department of Radiation Oncology, Medical University of Lodz, research in RO [1]. In 2018, ESTRO published the results of Lodz, Poland an online survey for RO professionals under 40 years on na- Postgraduate School of Molecular Medicine, Medical University of tional education systems. They received 463 questionnaires. Warsaw, Warsaw, Poland Unfortunately, only few professionals from Poland responded Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria [2]. Taking into consideration that in 2018 there were 592 Sklodowska-Curie National Research Institute of Oncology, radiation oncologists in Poland and according to the data in Warsaw, Poland 6 the Polish national physicians’ registry, 176 of them were 40- Brachytherapy Department, Greater Poland Cancer Center, and-younger, such underrepresentation is worrisome [3, 4]. Poznan, Poland 7 The same year, Polish Society of Radiation Oncology Maria Sklodowska-Curie National Research Institute of Oncology (PTRO) formed a young section (yPTRO) for RO specialists Gliwice Branch, Gliwice, Poland J Canc Educ (2022) 37:1614–1620 1615 and trainees under the age of 40. Such sections are popular Results among National Societies, e.g., AIRO Giovani (Italy), SYROG (Spain), SFjRO (France), or yDEGRO (Germany) A summary of answers to all single-choice-questions is avail- [5–8]. They address the special needs of young physi- able in Supplementary Materials - Table S1 cians for employment, education, and research. Moreover, young sections monitor feedback on stan- dards for training and board certification. Participants Thefirst andonly nationalsurveyon ROtrainingin Poland was performed in 2007 [9]. In 2018, yPTRO A total of 44 yROS responded to the survey, yielding a re- decided to conduct two surveys to evaluate the situation sponse rate of 25%. Twenty-five (57%) yROS provided the of young radiation oncologists in Poland. The first one name of an employer reporting 14 cancer centers (Table 1). was dedicated to RO trainees (results were published in All but one declared working in the public healthcare system. 2020 by Napieralska et al. [10]). In 2018, there were 47 radiotherapy departments in Poland Hence, we present the results of the second survey on the [3]. There were no data on the number of yROS working in present situation of young RO specialists (yROS) in Poland. each department. Employment and salary Methods In Poland physicians who work in hospitals have two main Survey design types of work arrangements, namely regular employment or self-employment with an independent contract with a medical An anonymous survey was designed by the yPTRO. Six vol- unit. unteers (radiation oncology trainees and young specialists Twenty-three (52%) yROS worked as employees and 18 from five radiation oncology departments) prepared a sam- (41%) were independent contractors. The others (7%) had pling plan, evaluated and revised questions through a series both types of work arrangements. Thirty-five (80%) yROS of remote discussions. The format was consequently modified declared being satisfied with the current type of employment; according to suggestions until it reached unanimous approval. however, only 24 (55%) responders could freely choose it. The unvalidated questionnaire was self-designed using Satisfaction rate was lower among self-contractors (78%) than Google Forms (available at https://docs.google.com/forms/). employees (87%) and those with both types of employment It comprised of 30-single-choice questions, each with a box (100%). Eight (18%) yROS, who were not satisfied with the for comments, one multiple-choice question, and one rating type of employment, complained about the salary (employees) question (the translated version of the survey is attached as a and lack of social benefits (independent contractors). supplementary material). Percentages were calculated using Forty-one (93%) yROS did not experience problems with returned questionnaires. Results were divided into six sec- finding a job after board certification. Nevertheless, the ma- tions: (1) employment and salary, (2) workload, (3) education, jority of yROS (n=37, 84%) continued work at the department (4) malpractice lawsuits, (5) scientific research, and (6) board providing their RO training. exam. Participants were not required to answer all questions. Forty-two (95%) yROS responded to the question about general job satisfaction. The vast majority (n=32, 76%) were Survey distribution satisfied with the working conditions. None of the contractors complained compared to over 35% unsatisfied employees and The survey was launched on 17th October 2018. Invitations 1 unsatisfied person with both types of employment. Negative were sent via email and across social media (Facebook® plat- comments mentioned a necessity to choose work-life balance form) to yROS. To increase the number of responses, individ- and a limited number of radiotherapy departments in their ual invitations, and reminders, as well as emails to RO depart- neighborhood. ments, were sent over the data collection period, which closed Twenty-three (52%) yROS worked at two or more on 9th November 2018. RO trainees were excluded. places, mainly due to financial reasons (n=13, 57%). Personal interests were the second reason for having Statistical analysis more than one job (n=7, 30%). Thirty-five (80%) yROS worked as radiation oncologists in The survey results were mostly descriptive. The comparative the gap between finishing training and taking board exams. statistics were limited because of the relatively small sample Only eight physicians (18%) did not have this opportunity. size. Calculations were done using Microsoft Excel®. Twenty-six (59%) yROS were satisfied with their salaries. 1616 J Canc Educ (2022) 37:1614–1620 Table 1 List of oncological centers represented by the survey participants Name of the oncological center Voivodeship Number of respondents Greater Poland Cancer Center Greater Poland 8 Amethyst Radiotherapy Center in Cracow Lesser Poland 1 Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Cracow Branch Lesser Poland 1 N. Copernicus Memorial Hospital, Lodz, Poland Lodz province 1 Lower Silesian Oncology Center Legnica Branch Lower Silesian 1 Center of Oncology of the Lublin Region St. Jana z Dukli Lublin province 1 Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Warsaw Masovian 2 Bialystok Oncology Centre Podlaskie 1 Gdynia Oncology Centre of the Polish Red Cross Maritime Hospital in Gdynia Pomeranian 1 University Clinical Centre in Gdansk Pomeranian 1 Beskid Oncology Center Silesian 1 Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch Silesian 3 Subcarpathian Oncology Center Subcarpathian 2 Holy Cross Cancer Center Holy Cross province 1 Not indicated 19 Total 44 Workload Fourteen (32%) yROS declared that administrative re- sponsibilities take from 26 to 50% of daily time. Most of yROS (n=24, 55%) spent at work approximately 40 h Seven (16%) yROS spent on it less than a quarter of per week. Fifteen (34%) yROS declared longer working time, their working time. It means that more than 50% of the around 50 h a week. The others declared working part-time or survey participants spent more than half a day on non- up to 30 h per week. Twenty-four (55%) yROS had night clinical tasks. Such a workload with paperwork was shifts at their departments. frustrating for 35 (88%) yROS. Only four (10%) Despite that declared weekly working hours were not yROS claimed that the number of administrative tasks alarming and corresponded to the typical 8-h working is reasonable. day, and 26 responders (59%) wrote that, in their opin- ion, they spend too much time at work. Twenty-four (56%) yROS noticed the negative impact of work on Education their private lives (Fig. 1). To assess yROS’ workload, we asked about the number of Forty-three (98%) yROS participated in national and/or inter- new admissions per week. Twenty-seven (61%) yROS national educational events; however, most of them (n=33, consulted five to ten new patients per week. Thirteen (30%) 75%) experienced difficulties with accessing such events yROS declared admitting less than five patients per week, (Fig. 2). Fifteen (34%) yROS considered the number of while the others (9%) consulted 11 to 15 new patients per attended courses as satisfactory. week. More than half of yROS (n=26, 59%) thought that their Thirty-five (80%) yROS got financial support for educa- workload is optimal. Ten (23%) responders stated that the tional events, mainly from pharmaceutical companies (n=31, number of new patients is too high. Only six (14%) yROS 74%), their hospital (n=15, 36%), and/or cancer societies complained about having too few patients. Half of the yROS (n=9, 21%). (n=22, 51%) declared having no impact on the number of The length of educational leave per year was enough in the weekly admissions. In turn, 21 (49%) yROS could decide on opinion of 13 (30%) and insufficient for 17 (39%) yROS. the number of new patients per week. Thirteen (30%) yROS working as independent contractors According to the survey results, yROS were declared no educational leave privilege. overloaded with administrative tasks. Most of the Twenty-six (59%) yROS felt confident with the ac- yROS (n=21, 48%) spent 51–75% of daily time on quired level of clinical knowledge. All survey partici- these responsibilities. Two yROS declared that paper- pants declared having the possibility to seek for work consumes 76–100% of their working hours. advice/consult within their department. J Canc Educ (2022) 37:1614–1620 1617 Fig. 1 Workload. a Average number of working hours per 26 week. b In your opinion, do you 54.5 % spend too much time at work? c Does job negatively influence your life? 34.1 % 6.8 % 4.5 % up to 30 h up to 40 h up to 50 h part-time workers bc n = 26, n = 24, 59.1 % 55.8 % n = 18, n = 19, 40.9% 44.2% Yes No Yes No Malpractice lawsuits The board exam was considered to be tough. Participants were asked to assess its difficulty from 1 (very easy) to 10 Thirty (68%) yROS claimed that the risk of being sued for (very tough). Median value from 43 responses was 8 (inter- medical errors is on their mind in everyday work. Fourteen quartile range: 7–10). The answers are presented in Fig. 3. (32%) yROS declared that the threat of malpractice lawsuits does not affect their work. Discussion Scientific research To the best of our knowledge, this is the first nationwide Nearly half (n=21, 48%) of yROS declared doing scientific survey providing a comprehensive overview of the situation research alongside with clinical work. For 20 (49%) yROS, of Polish yROS. Previously, in 2007, the survey conducted among RO specialists addressed a different group of partici- the clinical work overload negatively impacted their research. pants and was reported only as a short letter [9]. Issues men- tioned in our questionnaire will help newly formed yPTRO to Board exam develop strategic priorities for the upcoming years. Results of our study identify some problem areas. On the Twenty-four (55%) yROS thought that the form of the board one hand, most yROS are satisfied with the place of work and exam was not reliable, in contrary to 20 (45%) who were form of employment. Moreover, working hours declared by satisfied with it. However, most of yROS (n=33, 75%) respondents corresponded to the typical 8-h working day. claimed that they were fairly evaluated on their exam. Nine Polish yROS spend less hours weekly at work than their yROS (20%) considered the board exam as not valid. German colleagues. They also less often participate in night Number of responders 1618 J Canc Educ (2022) 37:1614–1620 72.7 % 63.6 % 20 15 10 20.5 % 22.7 % 6.8 % 4.5 % 2.3 % 2.3 % 2.3 % 2.3 % Yes No From time to time Only partial cd None 1 Hospital (only when presenting author) 1 n = 29, 65.9% Compensation arrangements 1 Cancer societies 9 n = 15, 34.1 % Hospital Pharmaceutical companies 0 5 10 15 20 25 30 35 Yes No No of responses Fig. 2 Education. a Can you attend national/international educational events? b Do you get financial support for participation in educational events? c Do you think that the number of educational events you attend is optimal? d Sources of reimbursement shifts [8]. On the other hand, the proportion of yROS achieving more than 50% of participants. Identification of complaining about lack of work-life balance is striking, underlying causes needs more in-depth investigation. yROS are overloaded with bureaucracy that causes frustration in 88% of them. Such imbalance between administrative tasks and clinical duties may cause burnout syndrome. However, 25.6 % data about its prevalence among yROS are scarce. Ciammella et al. conducted an online survey among Italian yROS and 20.9 % identified factors significantly influencing the risk of develop- 18.6 % ing the syndrome such as working position, number of years 16.3 % of practice, work hours per week, lack of cooperation in the team, lack of opportunities for personal development, and uncertainties on the working perspectives [11]. Up to now, there are no data on the frequency of burnout syndrome 7.0 % 7.0 % among Polish RO specialists and further research on this topic is warranted. Nevertheless, many initiatives can be imple- 2.3 % 2.3 % mented as preventive strategies, some of them at the local 0 % 0 % 123456789 10 level (such as task restructuring, work evaluation and super- Grade vision, and management support) [12]. As yPTRO, we plan to organize courses enhancing job competencies, improving Fig. 3 Difficulty of the board exam (1 = very easy and 10 = very tough) Yes Yes, with some limitations Yes, limited due to the workload Yes, without financial support Only national No Number of participants Number of participants Number of participants J Canc Educ (2022) 37:1614–1620 1619 coping skills, and managing negative emotions. Moreover, as problem fellowships in polish departments, allowing for a national society, we plan to monitor by repeatable surveys self-development, gaining experience, accelerating imple- the prevalence of the burnout syndrome among our members. mentation of new RO techniques across the country and en- Paperwork overload may be related to the fear of malprac- hancing a sense of community. Moreover, we are preparing to tice lawsuits raised by the two-third of yROS. In Poland, the start an educational platform with free online courses and employment of medical secretaries is still infrequent. Thus, webinars on statistics or clinical trials in radiation oncology. the whole paperwork must be done by a physician. It results One of our goals is to implement a program of financial sup- in sacrificing expert skills, knowledge, and time that could be port for young specialists not only for participation in educa- used for patient care. However, it is a nationwide problem that tional events but also for research. requires general legislative reforms to be implemented by the Board exam was not the main topic of our survey and men- government. Hopefully, there are some initiatives helping tioned in only three questions. However, results are not encourag- physicians to deal with the risk of malpractice lawsuits. ing and should be discussed with PTRO and Polish National Regional medical councils in each voivodeship organize med- Consultant in RO. Despite the fact that 75% of survey participants ical law courses and offer free of charge legal assistance for its believe to be fairly evaluated on their board exam, more than half members. Moreover, RO trainees during residency are obliged of physicians think that its current form is not appropriate. to take part in a dedicated medical law course. This study’s limitations include a low response rate (25%) that Another issue for further discussion is salary. Again, there might introduce ascertainment bias. It reduces the representative- are no data on salaries of Polish radiation oncologists, but 41% ness of the sample and the possibility of generalizing the survey of yROS were dissatisfied with work compensation in our results. One of the reasons of such a low response rate may be the survey. This is in line with the results of an ASTRO study in lack of a database of Polish yROS. Due to the General Data which satisfaction with salary among American RO special- Protection Regulation, it is not possible to acquire such data from ists reached mean score 6.3 (scale 1–10, 1 = very dissatisfied physician registries. Interestingly, the yPTRO survey on RO and 10 = very satisfied) [13]. Consequently, the low salary trainees achieved a response rate of 68% [10]. Comparison to was the most common reason for having a second job. other national surveys among yROS is difficult as most of them Problem with unsatisfactory work compensation is rather enrolled both trainees and young specialists [8, 15]. According to complex, and solving it is beyond yPTRO; however, Best the literature, online surveys tend to achieve even lower response et al. identified business and financial management as one of rates than received 25% [16]. The reason of low responsiveness the perceived gaps in the transition to practice in radiation of yROS could be explained by the workload and lack of time oncology. As a solution, they suggest formal and informal [17]. Such unwillingness of Polish yROS to participate in sur- teaching, mentorship, and educational resources [14]. Up to veys was present in the largest European survey conducted by ESTRO [2]. This problem requires particular attention and ac- now, there are no courses dedicated yROS on to the topic of financial management. We plan to fill this gap by preparing tions taken by both yPTRO and PTRO. What can be done from webinars or online courses accessible to all yROS. our perspective is creating an updated database of yROS contain- Another important area of discussion is education and per- ing all important information, e.g., department, age, and mailing sonal development. RO is a rapidly developing specialty, and address allowing for direct contact for future studies and surveys. keeping up to date with knowledge is essential. Every year, Another weakness could be the lack of survey validation; ESTRO and ASTRO organize various educational events, however, such validated tools do not exist. courses, and congresses. Moreover, there are dozens of inter- national and national oncological meetings. Almost all yROS (98%) declared taking part in educational events. However, for the three-fourth of them, participation in such activities Conclusions was limited by extra conditions. This may explain why 66% of yROS are not satisfied with the number of courses they yROS in Poland face many problems in their everyday work could attend. Hopefully, most of yROS get financial support and need support in keeping a work-life balance. Further, for postgraduate education that might be crucial in the case of nationwide questionnaires on burnout syndrome and salaries insufficient salary. Another obstacle in self-development may are warranted. yPTRO will represent both RO trainees and be the limited access to the educational leave, considered as yROS in discussions on identified issues. scarce by 39% of yROS. All this, taken together, gives us a possible reason for uncertainty of 36% yROS about Supplementary Information The online version contains supplementary possessing the knowledge sufficient for work. As yPTRO, material available at https://doi.org/10.1007/s13187-021-01998-0. we observe a lack of courses and educational events dedicated to yROS. To fill this gap, since 2018, we are working on a Author contribution All authors contributed to the study conception and design. Data collection was performed by Ewa Pawlowska. Material mentoring program with short, focused on prespecified 1620 J Canc Educ (2022) 37:1614–1620 preparation and data analysis were performed by Ewa Pawlowska and 6. Grupojovenseor (2012) Meeting for young researchers. In: Bartosz Tomasik. The first draft of the manuscript was written by Ewa SYROG. http://grupojovenseor.blogspot.com/. Accessed Pawlowska, and all authors commented on previous versions of the man- Nov 2020 uscript. All authors read and approved the final manuscript. 7. Bibault J-E, Fumagalli I, Diaz O et al (2012) The French Society of Young Radiation Oncologists: history, goals and perspective. Rep Pract Oncol Radiother 17:255–258. https://doi.org/10.1016/j.rpor. Data availability Data and material are available upon Reviewer or Editor 2012.07.006 request. 8. Dietzel CT, Jablonska K, Niyazi M et al (2018) Quality of training in radiation oncology in Germany: where do we stand?: results from Code availability Not applicable a 2016/2017 survey performed by the working group “young DEGRO” of the German society of radiation oncology (DEGRO). Declarations Strahlenther Onkol 194:293–302. https://doi.org/10.1007/s00066- 017-1250-6 9. Niemiec M, Kepka L, Maciejewski B et al (2009) Radiation oncol- Competing interests The authors declare no competing interests. ogy training in Poland: results of a national survey (2007). Clin Oncol 21:74–75. https://doi.org/10.1016/j.clon.2008.10.008 Open Access This article is licensed under a Creative Commons 10. Napieralska A, Tomasik B, Spałek M et al (2020) Radiation oncol- Attribution 4.0 International License, which permits use, sharing, adap- ogy training in Poland: multi-institutional survey. J Cancer Educ. tation, distribution and reproduction in any medium or format, as long as https://doi.org/10.1007/s13187-020-01702-8 you give appropriate credit to the original author(s) and the source, pro- 11. Ciammella P, Bari BD, Fiorentino A et al (2013) The vide a link to the Creative Commons licence, and indicate if changes were “BUONGIORNO” project: burnout syndrome among young made. The images or other third party material in this article are included Italian radiation oncologists. Cancer Investig 31:522–528. https:// in the article's Creative Commons licence, unless indicated otherwise in a doi.org/10.3109/07357907.2013.830735 credit line to the material. If material is not included in the article's 12. Franco P, Tesio V, Bertholet J et al (2020) Professional quality of Creative Commons licence and your intended use is not permitted by life and burnout amongst radiation oncologists: the impact of statutory regulation or exceeds the permitted use, you will need to obtain alexithymia and empathy. Radiother Oncol 147:162–168. https:// permission directly from the copyright holder. To view a copy of this doi.org/10.1016/j.radonc.2020.05.017 licence, visit http://creativecommons.org/licenses/by/4.0/. 13. Pohar S, Fung CY, Hopkins S et al (2013) American Society for Radiation Oncology (ASTRO) 2012 workforce study: the radiation oncologists’ and residents’ perspectives. Int J Radiat Oncol Biol Phys 87:1135–1140. https://doi.org/10.1016/j.ijrobp.2013.08.038 References 14. Best LR, Sengupta A, Murphy RJL et al (2019) Transition to prac- tice in radiation oncology: mind the gap. Radiother Oncol 138:126– 1. Overgaard J, Baumann M (2020) Four decades with ESTRO. 131. https://doi.org/10.1016/j.radonc.2019.06.012 Radiother Oncol 142:1–5. https://doi.org/10.1016/j.radonc.2020. 15. Franco P, Ciammella P, Peruzzo Cornetto A et al (2013) The 01.001 STYRO 2011 project: a survey on perceived quality of training 2. Bibault J-E, Franco P, Borst GR et al (2018) Learning radiation among young Italian radiation oncologists. Med Oncol 30:729. oncology in Europe: results of the ESTRO multidisciplinary sur- https://doi.org/10.1007/s12032-013-0729-y vey. Clin Transl Radiat Oncol 9:61–67. https://doi.org/10.1016/j. 16. Nulty DD (2008) The adequacy of response rates to online and ctro.2018.02.001 paper surveys: what can be done? Assess Eval High Educ 33: 3. Składowski K (2019) Raport na temat stanu radioterapii w Polsce 301–314. https://doi.org/10.1080/02602930701293231 na dzień 31.12.2018 r. http://kkro.io.gliwice.pl/. Accessed 17. Cunningham CT, Quan H, Hemmelgarn B et al (2015) Exploring Nov 2020 physician specialist response rates to web-based surveys. BMC 4. Polish National Physicians Registry http://rejestr.nil.org.pl/xml/nil/ Med Res Methodol 15:32. https://doi.org/10.1186/s12874-015- rejlek/hurtd. Accessed Sept 2020 0016-z 5. Filippi AR, Alongi F, Ciammella P et al (2012) A strategy for young members within national radiation oncology societies: the Italian experience (AIRO Giovani group). Rep Pract Oncol Publisher’sNote Springer Nature remains neutral with regard to jurisdic- Radiother 17:259–261. https://doi.org/10.1016/j.rpor.2012.07.011 tional claims in published maps and institutional affiliations. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Cancer Education Springer Journals

Being a young radiation oncologist in Poland: results of a multi-institutional survey

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Abstract

In 2018, Polish Society of Radiation Oncology formed a young section (yPTRO), dedicated to radiation oncologists under the age of 40. To evaluate their current situation, an anonymous, nationwide, online survey was carried out. Thirty-two-item-based questionnaire investigated young radiation oncologists’ perception of employment, workload, education, malpractice lawsuits, scientific research, and board exam. A total of 44 physicians responded to the questionnaire, yielding a response rate of 25%. Results of the survey identified the main problematic areas. In general, young radiation oncologists in Poland are overloaded with bureaucracy. They complain on spending too much time at work and lack work-life balance. The risk of being sued for medical error is threatening two-thirds of responders in everyday work. Compensation is not satisfying for nearly half of the survey participants. Nearly all young radiation oncologists continue education and participate in national and international educational events. Forty-eight percent of responders do scientific research alongside clinical work. However, the perception of young radiation oncologists on the board exam is alarming and requires further discussion. Fifty-five percent of the survey participants think that current form of the exam is not appropriate. Hopefully, 75% of physicians feel fairly evaluated. The presented report is the first of its kind in Poland. Issues mentioned in our questionnaire will help newly formed yPTRO to develop strategic priorities for the upcoming years. . . . . Keywords Radiation oncology Young specialists Education Employment Survey Introduction Radiation oncology (RO) is a rarely chosen medical specialty with a relatively low number of specialists worldwide. It re- mains unknown for both general public and other medical * Ewa Pawlowska professionals. Thus, the leading international RO societies, ewa.pawlowska@gumed.edu.pl namely the European Society for Radiotherapy and Oncology (ESTRO) and the American Society for Radiation Department of Oncology and Radiotherapy, Faculty of Medicine, Oncology (ASTRO), play an essential role in creating a sense Medical University of Gdansk, Gdansk, Poland of community and supporting members from all over the Department of Biostatistics and Translational Medicine, Medical world. Societies provide standards of education and practice University of Lodz, Lodz, Poland in radiotherapy, organize courses and meetings, and facilitate Department of Radiation Oncology, Medical University of Lodz, research in RO [1]. In 2018, ESTRO published the results of Lodz, Poland an online survey for RO professionals under 40 years on na- Postgraduate School of Molecular Medicine, Medical University of tional education systems. They received 463 questionnaires. Warsaw, Warsaw, Poland Unfortunately, only few professionals from Poland responded Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria [2]. Taking into consideration that in 2018 there were 592 Sklodowska-Curie National Research Institute of Oncology, radiation oncologists in Poland and according to the data in Warsaw, Poland 6 the Polish national physicians’ registry, 176 of them were 40- Brachytherapy Department, Greater Poland Cancer Center, and-younger, such underrepresentation is worrisome [3, 4]. Poznan, Poland 7 The same year, Polish Society of Radiation Oncology Maria Sklodowska-Curie National Research Institute of Oncology (PTRO) formed a young section (yPTRO) for RO specialists Gliwice Branch, Gliwice, Poland J Canc Educ (2022) 37:1614–1620 1615 and trainees under the age of 40. Such sections are popular Results among National Societies, e.g., AIRO Giovani (Italy), SYROG (Spain), SFjRO (France), or yDEGRO (Germany) A summary of answers to all single-choice-questions is avail- [5–8]. They address the special needs of young physi- able in Supplementary Materials - Table S1 cians for employment, education, and research. Moreover, young sections monitor feedback on stan- dards for training and board certification. Participants Thefirst andonly nationalsurveyon ROtrainingin Poland was performed in 2007 [9]. In 2018, yPTRO A total of 44 yROS responded to the survey, yielding a re- decided to conduct two surveys to evaluate the situation sponse rate of 25%. Twenty-five (57%) yROS provided the of young radiation oncologists in Poland. The first one name of an employer reporting 14 cancer centers (Table 1). was dedicated to RO trainees (results were published in All but one declared working in the public healthcare system. 2020 by Napieralska et al. [10]). In 2018, there were 47 radiotherapy departments in Poland Hence, we present the results of the second survey on the [3]. There were no data on the number of yROS working in present situation of young RO specialists (yROS) in Poland. each department. Employment and salary Methods In Poland physicians who work in hospitals have two main Survey design types of work arrangements, namely regular employment or self-employment with an independent contract with a medical An anonymous survey was designed by the yPTRO. Six vol- unit. unteers (radiation oncology trainees and young specialists Twenty-three (52%) yROS worked as employees and 18 from five radiation oncology departments) prepared a sam- (41%) were independent contractors. The others (7%) had pling plan, evaluated and revised questions through a series both types of work arrangements. Thirty-five (80%) yROS of remote discussions. The format was consequently modified declared being satisfied with the current type of employment; according to suggestions until it reached unanimous approval. however, only 24 (55%) responders could freely choose it. The unvalidated questionnaire was self-designed using Satisfaction rate was lower among self-contractors (78%) than Google Forms (available at https://docs.google.com/forms/). employees (87%) and those with both types of employment It comprised of 30-single-choice questions, each with a box (100%). Eight (18%) yROS, who were not satisfied with the for comments, one multiple-choice question, and one rating type of employment, complained about the salary (employees) question (the translated version of the survey is attached as a and lack of social benefits (independent contractors). supplementary material). Percentages were calculated using Forty-one (93%) yROS did not experience problems with returned questionnaires. Results were divided into six sec- finding a job after board certification. Nevertheless, the ma- tions: (1) employment and salary, (2) workload, (3) education, jority of yROS (n=37, 84%) continued work at the department (4) malpractice lawsuits, (5) scientific research, and (6) board providing their RO training. exam. Participants were not required to answer all questions. Forty-two (95%) yROS responded to the question about general job satisfaction. The vast majority (n=32, 76%) were Survey distribution satisfied with the working conditions. None of the contractors complained compared to over 35% unsatisfied employees and The survey was launched on 17th October 2018. Invitations 1 unsatisfied person with both types of employment. Negative were sent via email and across social media (Facebook® plat- comments mentioned a necessity to choose work-life balance form) to yROS. To increase the number of responses, individ- and a limited number of radiotherapy departments in their ual invitations, and reminders, as well as emails to RO depart- neighborhood. ments, were sent over the data collection period, which closed Twenty-three (52%) yROS worked at two or more on 9th November 2018. RO trainees were excluded. places, mainly due to financial reasons (n=13, 57%). Personal interests were the second reason for having Statistical analysis more than one job (n=7, 30%). Thirty-five (80%) yROS worked as radiation oncologists in The survey results were mostly descriptive. The comparative the gap between finishing training and taking board exams. statistics were limited because of the relatively small sample Only eight physicians (18%) did not have this opportunity. size. Calculations were done using Microsoft Excel®. Twenty-six (59%) yROS were satisfied with their salaries. 1616 J Canc Educ (2022) 37:1614–1620 Table 1 List of oncological centers represented by the survey participants Name of the oncological center Voivodeship Number of respondents Greater Poland Cancer Center Greater Poland 8 Amethyst Radiotherapy Center in Cracow Lesser Poland 1 Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Cracow Branch Lesser Poland 1 N. Copernicus Memorial Hospital, Lodz, Poland Lodz province 1 Lower Silesian Oncology Center Legnica Branch Lower Silesian 1 Center of Oncology of the Lublin Region St. Jana z Dukli Lublin province 1 Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Warsaw Masovian 2 Bialystok Oncology Centre Podlaskie 1 Gdynia Oncology Centre of the Polish Red Cross Maritime Hospital in Gdynia Pomeranian 1 University Clinical Centre in Gdansk Pomeranian 1 Beskid Oncology Center Silesian 1 Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch Silesian 3 Subcarpathian Oncology Center Subcarpathian 2 Holy Cross Cancer Center Holy Cross province 1 Not indicated 19 Total 44 Workload Fourteen (32%) yROS declared that administrative re- sponsibilities take from 26 to 50% of daily time. Most of yROS (n=24, 55%) spent at work approximately 40 h Seven (16%) yROS spent on it less than a quarter of per week. Fifteen (34%) yROS declared longer working time, their working time. It means that more than 50% of the around 50 h a week. The others declared working part-time or survey participants spent more than half a day on non- up to 30 h per week. Twenty-four (55%) yROS had night clinical tasks. Such a workload with paperwork was shifts at their departments. frustrating for 35 (88%) yROS. Only four (10%) Despite that declared weekly working hours were not yROS claimed that the number of administrative tasks alarming and corresponded to the typical 8-h working is reasonable. day, and 26 responders (59%) wrote that, in their opin- ion, they spend too much time at work. Twenty-four (56%) yROS noticed the negative impact of work on Education their private lives (Fig. 1). To assess yROS’ workload, we asked about the number of Forty-three (98%) yROS participated in national and/or inter- new admissions per week. Twenty-seven (61%) yROS national educational events; however, most of them (n=33, consulted five to ten new patients per week. Thirteen (30%) 75%) experienced difficulties with accessing such events yROS declared admitting less than five patients per week, (Fig. 2). Fifteen (34%) yROS considered the number of while the others (9%) consulted 11 to 15 new patients per attended courses as satisfactory. week. More than half of yROS (n=26, 59%) thought that their Thirty-five (80%) yROS got financial support for educa- workload is optimal. Ten (23%) responders stated that the tional events, mainly from pharmaceutical companies (n=31, number of new patients is too high. Only six (14%) yROS 74%), their hospital (n=15, 36%), and/or cancer societies complained about having too few patients. Half of the yROS (n=9, 21%). (n=22, 51%) declared having no impact on the number of The length of educational leave per year was enough in the weekly admissions. In turn, 21 (49%) yROS could decide on opinion of 13 (30%) and insufficient for 17 (39%) yROS. the number of new patients per week. Thirteen (30%) yROS working as independent contractors According to the survey results, yROS were declared no educational leave privilege. overloaded with administrative tasks. Most of the Twenty-six (59%) yROS felt confident with the ac- yROS (n=21, 48%) spent 51–75% of daily time on quired level of clinical knowledge. All survey partici- these responsibilities. Two yROS declared that paper- pants declared having the possibility to seek for work consumes 76–100% of their working hours. advice/consult within their department. J Canc Educ (2022) 37:1614–1620 1617 Fig. 1 Workload. a Average number of working hours per 26 week. b In your opinion, do you 54.5 % spend too much time at work? c Does job negatively influence your life? 34.1 % 6.8 % 4.5 % up to 30 h up to 40 h up to 50 h part-time workers bc n = 26, n = 24, 59.1 % 55.8 % n = 18, n = 19, 40.9% 44.2% Yes No Yes No Malpractice lawsuits The board exam was considered to be tough. Participants were asked to assess its difficulty from 1 (very easy) to 10 Thirty (68%) yROS claimed that the risk of being sued for (very tough). Median value from 43 responses was 8 (inter- medical errors is on their mind in everyday work. Fourteen quartile range: 7–10). The answers are presented in Fig. 3. (32%) yROS declared that the threat of malpractice lawsuits does not affect their work. Discussion Scientific research To the best of our knowledge, this is the first nationwide Nearly half (n=21, 48%) of yROS declared doing scientific survey providing a comprehensive overview of the situation research alongside with clinical work. For 20 (49%) yROS, of Polish yROS. Previously, in 2007, the survey conducted among RO specialists addressed a different group of partici- the clinical work overload negatively impacted their research. pants and was reported only as a short letter [9]. Issues men- tioned in our questionnaire will help newly formed yPTRO to Board exam develop strategic priorities for the upcoming years. Results of our study identify some problem areas. On the Twenty-four (55%) yROS thought that the form of the board one hand, most yROS are satisfied with the place of work and exam was not reliable, in contrary to 20 (45%) who were form of employment. Moreover, working hours declared by satisfied with it. However, most of yROS (n=33, 75%) respondents corresponded to the typical 8-h working day. claimed that they were fairly evaluated on their exam. Nine Polish yROS spend less hours weekly at work than their yROS (20%) considered the board exam as not valid. German colleagues. They also less often participate in night Number of responders 1618 J Canc Educ (2022) 37:1614–1620 72.7 % 63.6 % 20 15 10 20.5 % 22.7 % 6.8 % 4.5 % 2.3 % 2.3 % 2.3 % 2.3 % Yes No From time to time Only partial cd None 1 Hospital (only when presenting author) 1 n = 29, 65.9% Compensation arrangements 1 Cancer societies 9 n = 15, 34.1 % Hospital Pharmaceutical companies 0 5 10 15 20 25 30 35 Yes No No of responses Fig. 2 Education. a Can you attend national/international educational events? b Do you get financial support for participation in educational events? c Do you think that the number of educational events you attend is optimal? d Sources of reimbursement shifts [8]. On the other hand, the proportion of yROS achieving more than 50% of participants. Identification of complaining about lack of work-life balance is striking, underlying causes needs more in-depth investigation. yROS are overloaded with bureaucracy that causes frustration in 88% of them. Such imbalance between administrative tasks and clinical duties may cause burnout syndrome. However, 25.6 % data about its prevalence among yROS are scarce. Ciammella et al. conducted an online survey among Italian yROS and 20.9 % identified factors significantly influencing the risk of develop- 18.6 % ing the syndrome such as working position, number of years 16.3 % of practice, work hours per week, lack of cooperation in the team, lack of opportunities for personal development, and uncertainties on the working perspectives [11]. Up to now, there are no data on the frequency of burnout syndrome 7.0 % 7.0 % among Polish RO specialists and further research on this topic is warranted. Nevertheless, many initiatives can be imple- 2.3 % 2.3 % mented as preventive strategies, some of them at the local 0 % 0 % 123456789 10 level (such as task restructuring, work evaluation and super- Grade vision, and management support) [12]. As yPTRO, we plan to organize courses enhancing job competencies, improving Fig. 3 Difficulty of the board exam (1 = very easy and 10 = very tough) Yes Yes, with some limitations Yes, limited due to the workload Yes, without financial support Only national No Number of participants Number of participants Number of participants J Canc Educ (2022) 37:1614–1620 1619 coping skills, and managing negative emotions. Moreover, as problem fellowships in polish departments, allowing for a national society, we plan to monitor by repeatable surveys self-development, gaining experience, accelerating imple- the prevalence of the burnout syndrome among our members. mentation of new RO techniques across the country and en- Paperwork overload may be related to the fear of malprac- hancing a sense of community. Moreover, we are preparing to tice lawsuits raised by the two-third of yROS. In Poland, the start an educational platform with free online courses and employment of medical secretaries is still infrequent. Thus, webinars on statistics or clinical trials in radiation oncology. the whole paperwork must be done by a physician. It results One of our goals is to implement a program of financial sup- in sacrificing expert skills, knowledge, and time that could be port for young specialists not only for participation in educa- used for patient care. However, it is a nationwide problem that tional events but also for research. requires general legislative reforms to be implemented by the Board exam was not the main topic of our survey and men- government. Hopefully, there are some initiatives helping tioned in only three questions. However, results are not encourag- physicians to deal with the risk of malpractice lawsuits. ing and should be discussed with PTRO and Polish National Regional medical councils in each voivodeship organize med- Consultant in RO. Despite the fact that 75% of survey participants ical law courses and offer free of charge legal assistance for its believe to be fairly evaluated on their board exam, more than half members. Moreover, RO trainees during residency are obliged of physicians think that its current form is not appropriate. to take part in a dedicated medical law course. This study’s limitations include a low response rate (25%) that Another issue for further discussion is salary. Again, there might introduce ascertainment bias. It reduces the representative- are no data on salaries of Polish radiation oncologists, but 41% ness of the sample and the possibility of generalizing the survey of yROS were dissatisfied with work compensation in our results. One of the reasons of such a low response rate may be the survey. This is in line with the results of an ASTRO study in lack of a database of Polish yROS. Due to the General Data which satisfaction with salary among American RO special- Protection Regulation, it is not possible to acquire such data from ists reached mean score 6.3 (scale 1–10, 1 = very dissatisfied physician registries. Interestingly, the yPTRO survey on RO and 10 = very satisfied) [13]. Consequently, the low salary trainees achieved a response rate of 68% [10]. Comparison to was the most common reason for having a second job. other national surveys among yROS is difficult as most of them Problem with unsatisfactory work compensation is rather enrolled both trainees and young specialists [8, 15]. According to complex, and solving it is beyond yPTRO; however, Best the literature, online surveys tend to achieve even lower response et al. identified business and financial management as one of rates than received 25% [16]. The reason of low responsiveness the perceived gaps in the transition to practice in radiation of yROS could be explained by the workload and lack of time oncology. As a solution, they suggest formal and informal [17]. Such unwillingness of Polish yROS to participate in sur- teaching, mentorship, and educational resources [14]. Up to veys was present in the largest European survey conducted by ESTRO [2]. This problem requires particular attention and ac- now, there are no courses dedicated yROS on to the topic of financial management. We plan to fill this gap by preparing tions taken by both yPTRO and PTRO. What can be done from webinars or online courses accessible to all yROS. our perspective is creating an updated database of yROS contain- Another important area of discussion is education and per- ing all important information, e.g., department, age, and mailing sonal development. RO is a rapidly developing specialty, and address allowing for direct contact for future studies and surveys. keeping up to date with knowledge is essential. Every year, Another weakness could be the lack of survey validation; ESTRO and ASTRO organize various educational events, however, such validated tools do not exist. courses, and congresses. Moreover, there are dozens of inter- national and national oncological meetings. Almost all yROS (98%) declared taking part in educational events. However, for the three-fourth of them, participation in such activities Conclusions was limited by extra conditions. This may explain why 66% of yROS are not satisfied with the number of courses they yROS in Poland face many problems in their everyday work could attend. Hopefully, most of yROS get financial support and need support in keeping a work-life balance. Further, for postgraduate education that might be crucial in the case of nationwide questionnaires on burnout syndrome and salaries insufficient salary. Another obstacle in self-development may are warranted. yPTRO will represent both RO trainees and be the limited access to the educational leave, considered as yROS in discussions on identified issues. scarce by 39% of yROS. All this, taken together, gives us a possible reason for uncertainty of 36% yROS about Supplementary Information The online version contains supplementary possessing the knowledge sufficient for work. As yPTRO, material available at https://doi.org/10.1007/s13187-021-01998-0. we observe a lack of courses and educational events dedicated to yROS. To fill this gap, since 2018, we are working on a Author contribution All authors contributed to the study conception and design. Data collection was performed by Ewa Pawlowska. Material mentoring program with short, focused on prespecified 1620 J Canc Educ (2022) 37:1614–1620 preparation and data analysis were performed by Ewa Pawlowska and 6. Grupojovenseor (2012) Meeting for young researchers. In: Bartosz Tomasik. The first draft of the manuscript was written by Ewa SYROG. http://grupojovenseor.blogspot.com/. Accessed Pawlowska, and all authors commented on previous versions of the man- Nov 2020 uscript. All authors read and approved the final manuscript. 7. Bibault J-E, Fumagalli I, Diaz O et al (2012) The French Society of Young Radiation Oncologists: history, goals and perspective. 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Journal

Journal of Cancer EducationSpringer Journals

Published: Dec 1, 2022

Keywords: Radiation oncology; Young specialists; Education; Employment; Survey

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