title: Addressing Palliative Care Clinician Burnout in Organizations: A Workforce Necessity, an Ethical Imperative.
abstract: Clinician burnout reduces the capacity for providers and health systems to deliver timely, high quality, patient-centered care and increases the risk that clinicians will leave practice. This is especially problematic in hospice and palliative care: patients are often frail, elderly, vulnerable, and complex; access to care is often outstripped by need; and demand for clinical experts will increase as palliative care further integrates into usual care. Efforts to mitigate and prevent burnout currently focus on individual clinicians. However, analysis of the problem of burnout should be expanded to include both individual- and systems-level factors as well as solutions; comprehensive interventions must address both. As a society, we hold organizations responsible for acting ethically, especially when it relates to deployment and protection of valuable and constrained resources. We should similarly hold organizations responsible for being ethical stewards of the resource of highly trained and talented clinicians through comprehensive programs to address burnout.
authors.affiliation: Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA. Electronic address: krista.harrison@ucsf.edu.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Harrison
authors.affiliation: Division of Hospital Medicine, School of Medicine, University of California, San Francisco, California, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dzeng
authors.affiliation: Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Ritchie
authors.affiliation: Hematology, School of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Tait D
authors.initials: TD
authors.lastname: Shanafelt
authors.affiliation: Duke Cancer Institute, Duke University, Durham, North Carolina, USA.
authors.forename: Arif H
authors.initials: AH
authors.lastname: Kamal
authors.affiliation: Four Seasons Compassion for Life, Flat Rock North Carolina, USA.
authors.forename: Janet H
authors.initials: JH
authors.lastname: Bull
authors.affiliation: General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Jon C
authors.initials: JC
authors.lastname: Tilburt
authors.affiliation: University of Alabama - Birmingham, Birmingham, Alabama, USA; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Swetz
mesh_terms: D002055:Burnout, Professional / Q000209:etiology; D017051:Hospice Care / Q000941:ethics / Q000458:organization & administration; D006801:Humans; D009014:Morals; D010166:Palliative Care / Q000941:ethics / Q000458:organization & administration; D010820:Physicians / Q000523:psychology*; D013597:Systems Analysis
keywords: Burnout; ethics; hospice; moral distress; palliative care