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What Can we do About Burnout Among Palliative Care Doctors?

By Dianne Halderman, AVP, Clinical Operations, Kindred at Home

Results of a recent study showed that burnout among palliative care physicians – those who focus on pain and symptom relief among patients with various diseases and conditions – is extraordinarily high: over 62 percent. The study, which relied on a survey of over 1,200 hospice and palliative care clinicians, also found that 50 percent of palliative care physicians expect to leave the field in the next 10 years. Severity of the burnout seemed to be affected by younger age, having fewer colleagues and working weekends.

As a hospice nurse who has worked in the field for over 20 years and now serves as Area Vice President of Operations for Kindred at Home, I think it’s important to note that these study findings related to physicians. I am very familiar with the concept of compassion fatigue and burnout among nurses. To see this condition affecting physicians as well is important for every one of us working in the fields of hospice and palliative care, which are not one and the same but share important similarities. Palliative care is not hospice, but in hospice, we are offering palliative care in the last six months of life.

Nurses are often intimately involved with their patients and patients’ families, and for hospice nurses, that familiarity evolves during one of the most difficult times of life. I guess I assumed that physicians – who may have more of an intermittent role in their patients’ lives – might escape unscathed. This study shows otherwise, and when I talked to my own physicians after the results were released, many said they had considered a career in palliative care or medical oncology but resisted for the very reasons the study elucidated.

Armed with these study results, it behooves all of us in the fields of hospice and palliative care to focus our attention on how we can address the precipitating issues that lead to this effect, so that we may prevent well-trained, excellent physicians from leaving the field, an effect that can be detrimental to our patients.

I believe the field of palliative care, so closely related to hospice care, can benefit from some of the lessons we learned early on about compassion fatigue among hospice nurses. We would often notice that nurses would start off doing great, with perfect documentation and productivity, and then about six months down the road, we would see a decline in productivity, they might start being late to meetings, they might appear to be lagging. They were experiencing burnout. At that time, the hospice I worked for implemented a program through which nurses would begin accruing time off the minute they walked through the door. So by the end of their first month at work, for example, they might have 20 hours accumulated. We were mindful that hospice staff needed time away from their jobs in order to refresh themselves.

In my own experience as a young hospice nurse, I remember going to my doctor and telling him I felt tired and irritable. When I told him what I did for work, he said it was probably related to my job. I was confused. I loved my job. He said: “You love your job, but these are the effects of working every day with death and dying. It creeps up on you.”

Palliative care work may be susceptible to burnout because it can be repetitious. You get a patient in, you figure out how to get the patient comfortable, you implement interventions and you send them along. You don’t get to see too much reward or closure.

So what can we do with these findings, to help address these issues before they lead to burnout?

  • Remember that time off is important. Be sure it’s always accruing and be sure as practitioners, we use that time off. Take a long weekend to relax and recharge.
  • Ensure you have all of the information you need to know about your job – education and orientation before you embark on it so you are prepared.
  • Be able to identify what is going to affect you. Develop techniques to de-stress and for those in leadership positions, be cognizant of identifying situations and people at risk for turnover and make sure to support the important components of relaxation and taking time for the caregiver.
By Dianne Halderman, AVP, Clinical Operations, Kindred at Home