Abstract:
The unprecedented scale and severity of the COVID-19 pandemic has exerted significant pressure
on physicians, who as frontline respondents are continually exposed to stressful and demanding
work environments. However, even prior to COVID-19 extensive literature has evidenced physician
burnout to be particularly prevalent amongst oncologists due to the nature of cancer care provision.
Oncologists may therefore face unique adaptive challenges in sustaining service delivery for an
immunocompromised patient population despite the risks posed by the pandemic. Hence, this thesis
aimed to investigate the experiences and well-being of oncology and comparatively general
medicine physicians working at Auckland District Health Board during New Zealand’s first
nationwide COVID-19 lockdown.
The literature reviews identified key work-related factors influencing the experiences and well-being
of oncologists in standard settings and healthcare workers in preceding epidemics and pandemics.
Collectively these included workload and time, work environment and changes, patient engagement
and care, leadership and management, training and supervision, professional development, risk
perception and sources, precautionary measures and PPE, colleagues, work life balance and
personal life impact, a sense of duty and appreciation and stigmatisation. These factors were dual in
nature as they could either elicit positive or induce negative outcomes.
Guided by pragmatic methodology, a mixed methods study was conducted to explore work-related
factors influencing the experiences and well-being of SMOs, RMOs and house officers working in
the medical oncology, radiation oncology, haematology, gynaecological oncology and general
medicine services at Auckland District Health Board during New Zealand’s first nationwide Alert
Level 3 and 4 lockdown. Data was collected through fifty-nine mostly quantitative surveys and
thirteen semi-structured interviews. Quantitative analysis was undertaken using descriptive and
inferential statistics and qualitative analysis using thematic analysis.
The quantitative and qualitative results found the COVID-19 pandemic influenced the working
experiences and well-being of these physicians by enhancing or inhibiting exhibition of work-related
factors already contextual to standard settings, in addition to introducing unique pandemic-related
factors. Physicians who worked in the Cancer and Blood oncology services, who were not senior
medical officers and were parents or caregivers of dependent children were most significantly
impacted. The service finding was unforeseen considering the nature of the specialty does not
traditionally subject oncologists to pandemic-related factors most prominently associated with
adverse psychological outcomes, which are far more characteristic of front lining and infectious
disease specialities like general medicine. Non-senior medical officers were at greater risk of
burnout due to the work expectations and demands associated with their role, compounded with
being subject to greater COVID-19 exposure and infection risk. Parents and caregivers of
dependent children also had significantly more negative pandemic working experiences due to
elevated and intersected demands from both work and family. However, the low case concentration
of COVID-19 in New Zealand as a consequence of both the government and population’s
responses were imperative in enabling relatively favourable service outcomes and working
experiences for all physicians.
Considering the COVID-19 pandemic is an ongoing and dynamic global health threat and the impact
this can have on the physician workforce and service sustainability in the long-term, the findings
present implications for policy and practise. Further research into oncologists’ working experiences
and well-being throughout New Zealand is required to disentangle influential factors contextual to
standard settings and the pandemic, enabling improvement in oncologists’ well-being and ultimately
cancer care delivery.