Burnout in end-of-life care

When it comes to burnout, are we blaming the victim?

In research by Dr. Arif Kamal, Chief Medical Officer of Acclivity Health, palliative care physician shortages are predicted to send patient-to-provider ratios skyrocketing in the coming decade —1:808, to be exact. The reasoning? Dr. Kamal and his team found that one-third of palliative care clinicians are burned out, and two in five are 56 years of age or older. There are about 7,600 physicians board-certified in palliative care. That number is not increasing, meaning as burnout mounts and physicians age, there are no new providers waiting to take their place.

Robin Stawasz, Program Development Executive at Acclivity Health, says the impact of burnout is ubiquitous across the health care industry, and damaging to patients and care quality.

“Burnout impacts the majority of providers in most health care fields. It causes the loss of highly valuable professionals, which creates a chain reaction of poor outcomes, including patient death, high provider suicide rates, and increased costs,” she said.

While more and more health systems and private practices are making efforts to prevent or alleviate burnout, Stawasz’s experience tells her that focusing on burnout is more of a Band-Aid than a true solution.

“It’s like focusing on the symptoms of the disease, not the cause,” she explained. “Burnout sufferers are often told to change their behaviors, practice more self-care, or find a better work-life balance. In doing so, we’re blaming the victim for not coping well rather than holding the perpetrator of the damage accountable, which is what will create positive change.”

But what exactly is the root cause, the “perpetrator”, of burnout? Moral distress and moral injury rank high on the list for most providers. These issues can arise even more frequently in hospice and palliative care settings where a patient’s or family’s decision may not match a provider’s opinion, and loss can occur more frequently. 

“Moral distress is the emotional response to being constrained from acting on deeply held beliefs. It causes a sense of compromising one’s professional integrity. For example, if a provider sees what should happen but cannot make it happen or is prevented from taking action in some way,” said Stawasz. 

Moral injury is similar in nature — Stawasz describes it as an emotional, physical, or spiritual blow felt after failing to prevent or witnessing something that conflicts with a provider’s deeply held beliefs or expectations. 

“Leaders of health care organizations have to remove their focus from the sufferers and refocus on the situation causing suffering,” she said. “We have to acknowledge that some systems are set up to make money, not to help patients, and that not being able to offer the level of care providers want to offer – due to time restrictions or administrative tasks – hurts, too.”

So, how can hospice and palliative care organizations take care of their providers moving forward?

“Drive to outcomes, not volume,” said Stawasz. “Allow clinicians to determine what care should be delivered and how, not payers. It’s also worthwhile to invest in a universal patient data system to break down barriers and use data to proactively inform care decisions. This sets up your providers for success and minimizes the chance of all the previously mentioned risk factors.”

Dr. Kamal agrees that attacking the root of burnout is the only way to prevent it and incentivize new providers to come on board.

“For this to work, a practice has to be much more efficient. With strained resources, a palliative care physician can reasonably see 15 to 20 patients a day at most,” he says. “If they’re seeing people who don’t really need their help, they’re wasting that time when they could see the patients with the most need. Data helps you draw that line. Platforms like Acclivity’s help you hone in and decide, ‘Let’s draw the line at the 90th percentile so we don’t end up seeing patients who could be better served by another specialist, or miss patients who absolutely should be seen by palliative care.’”

If you have any questions about how a data-driven platform can prevent burnout in your organization, please feel free to email us at info@acclivityhealth.com.