Systemic Barriers Drive Burnout in Sickle Cell Disease Clinicians – Where Do We Go From Here?

Increased burnout rates among clinicians who treat sickle cell disease (SCD) point to systemic barriers rather than personal-level factors.

A recent study found burnout rates of 60% among hematology-oncology physicians who treat SCD, compared to 43% in those who did not, with no significant difference in grit and resilience reported between groups (P = .046).1

“This is the first study ever conducted specifically on sickle cell providers, and I hope it starts a conversation because burnout can be uncomfortable to talk about, and admitting to it can feel like an admission of weakness or lack of commitment,” Layla Van Doren, MD, MBA, assistant professor of medicine at Yale School of Medicine and a classical hematologist at Smilow Cancer Hospital, said in an interview with HCPLive. It's neither. This is a systemic problem, and that's what this work is helping us understand.”

The cross-sectional, nationwide survey was the first study on burnout, grit, and resilience in sickle cell providers, likewise highlighting disparities among providers who treat SCD, including reduced job pride, distinct from job fulfilment, and decreased recreation time. Study investigators identified that these factors were directly associated with increased burnout, while increased levels mitigated burnout. Additionally, 64% of these providers reported annual earnings of < $350,000 compared to 40% of their colleagues (P = .005). Meanwhile, SCD providers had more years in practice and more often worked in academia or leadership roles (all P < .05).1

Van Doren and Restrepo-Espinosa are currently conducting a follow-up study examining the specific systemic factors driving burnout among sickle cell providers, including institutional infrastructure, compensation equity, emotional exhaustion, compassion fatigue, compassion satisfaction, and moral distress.

HCPLive spoke with investigators Van Doren and Valentina Restrepo-Espinosa, MD, a postdoctoral associate at Yale School of Medicine, about what the findings reveal, and what the field needs to do next.

Catch up with part 1 of our interview, where they discuss background, study design, and key findings.

HCPLive: What does it tell us that sickle cell providers had comparable grit, resilience, and work hours to the control group, but reported lower annual salary, job pride, and recreation time?

Van Doren: The job pride finding was something we discussed at length. I think job pride is distinct from personal fulfillment. Caring for people with sickle cell disease is deeply fulfilling for those of us in this field — it's what keeps us going and why we do it. But job pride is tied to something different: feeling supported at your institution, having the program resources your patients need, feeling that opportunities for career development exist.

The recreation finding was equally striking. Sickle cell providers recreated less per week despite logging the same work hours as the control group. That raises the question of cognitive and emotional load — providers may be going home too mentally and emotionally exhausted to engage in activities outside of work, even when hours on paper look equivalent.

Restrepo: These three findings — lower salary, lower job pride, and less recreation — all point to the environment these physicians are working in. On salary: sickle cell providers in our study had significantly more years of experience than the control group. You'd expect more senior physicians to earn more, especially with equivalent work hours. Instead, they earned less. That speaks directly to how institutions assign value to this work.

If the people and institutions around you don't recognize the value of what you're doing, that filters into how you see yourself professionally. We believe that's part of what's driving lower job pride — not a lack of meaning or commitment, but a lack of institutional recognition.

On recreation: equal work hours should translate roughly to equal time for personal activities. The fact that it doesn't suggests sickle cell providers are leaving work carrying something heavier — mentally and emotionally — that limits their ability to recover. That kind of exhaustion can reinforce and deepen burnout over time.

The broader picture is that sickle cell providers are doing work of tremendous importance — comparable in many ways to oncology, which was our control group — but are not working in an environment that reflects that. They're not feeling valued, and they're not receiving the institutional support they need to sustain themselves professionally or drive the changes they want to see for their patients.

HCPLive: Many physicians treating sickle cell disease reported burnout, and your study points to job pride and recreation as potential mitigating factors. How should the hematology field interpret these findings to improve the culture for these physicians and help address systemic barriers?

Van Doren: I don't think our study, as it stands, produces something immediately actionable — because we still don't have a precise picture of which systemic factors are most responsible. Identifying those is the necessary next step, which is why we're conducting a follow-up study.

Restrepo: We're going very granular into the systemic factors in the follow-up, since this study identified those as likely key. We're examining the institutional infrastructure in which providers work — dedicated nursing, dedicated infusion center space, access to mental health providers, and similar elements. We're also asking providers directly what they find most challenging, whether that's the advocacy burden, fighting insurance, or other specific pressures.

We're asking sickle cell providers whether they feel their institution regards them with appropriate respect, and whether their compensation reflects the work they actually put in, to better understand the job pride and salary findings from this study.

To further examine the recreation finding, we'll be assessing emotional exhaustion using a dedicated validated instrument, as well as compassion fatigue — sometimes referred to as secondary PTSD — which can occur when providers work closely with patients experiencing significant trauma. We'll also assess compassion satisfaction, the sense of reward that comes from helping people through difficult circumstances, and moral distress, which arises when a provider knows the right course of action but is prevented from taking it by external factors such as structural bias, insurance barriers, or lack of institutional resources and support.

Van Doren: This is the first study ever conducted specifically on sickle cell providers, and I hope it starts a conversation because burnout can be uncomfortable to talk about, and admitting to it can feel like an admission of weakness or lack of commitment. It's neither. This is a systemic problem, and that's what this work is helping us understand.

Editor’s Note: Van Doren and Restrepo report no relevant disclosures.

References

1. Restrepo-Espinosa V, Van Doren L. Burnout in Sickle Cell Physicians Linked to Systemic Barriers. Yale School of Medicine. Published online 2026. doi:https://doi.org/10.1182/bloodadvances.2025018338/567099

2. Higher burnout rates among physicians who treat sickle cell disease. EurekAlert! Published March 12, 2026. Accessed March 30, 2026. https://www.eurekalert.org/news-releases/1119293