title: Strategies for avoiding burnout in hospice and palliative medicine: peer advice for physicians on achieving longevity and fulfillment.
abstract: BACKGROUND
  Hospice and palliative medicine (HPM) is now an American Board of Medical Specialties-recognized subspecialty, and many physicians are choosing it as a career. There is little written about recognition and prevention of burnout or physician self-care in this challenging and ever-evolving field.
  
  
  METHODS
  We conducted a qualitative online survey of 40 HPM physicians practicing in the United States and asked them to comment on their strategies for avoiding burnout and finding fulfillment in palliative medicine. Responses were coded into thematic classes by commonalities.
  
  
  RESULTS
  Thirty of 40 HPM physicians (19 males, 11 females) surveyed responded in full. Each listed between 1 to 7 strategies (median 4 per respondent) they felt to be important in preventing burnout that were placed in 1 of 13 thematic classes. Physical well-being was the most common strategy reported (60%), followed by professional relationships (57%), taking a transcendental perspective (43%), talking with others (43%), hobbies (40%), clinical variety (37%), personal relationships (37%), and personal boundaries (37%). "Time away" from work (27%), passion for one's work (20%), realistic expectations and use of humor and laughter (13% each), and remembering patients (10%) were cited less frequently.
  
  
  CONCLUSIONS
  HPM physicians report using a variety of strategies to promote their personal well-being suggesting a diversified portfolio of wellness strategies is needed to deal with the challenges of palliative care medicine. Additional studies are needed to help HPM recognize burnout in their practices and among their colleagues, and to determine how to help future HPM physicians develop individualized strategies to promote personal wellness and resilience.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. swetz.keith@mayo.edu
authors.forename: Keith M
authors.initials: KM
authors.lastname: Swetz
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Harrington
authors.forename: Robin K
authors.initials: RK
authors.lastname: Matsuyama
authors.forename: Tait D
authors.initials: TD
authors.lastname: Shanafelt
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Lyckholm
mesh_terms: D000223:Adaptation, Psychological; D002055:Burnout, Professional / Q000517:prevention & control*; D003625:Data Collection; D005260:Female; D006304:Health Status; D017051:Hospice Care; D006801:Humans; D020407:Internet; D007588:Job Satisfaction; D008297:Male; D010166:Palliative Care; D010379:Peer Group; D036301:Qualitative Research; D013315:Stress, Psychological; D013997:Time Factors