Brief Report| Volume 64, ISSUE 1, e15-e21, July 2022

Frequency and Prediction of Burnout Among Physicians Who Completed Palliative Care Fellowship Training - A 10 Year Survey



      Palliative Care (PC) physicians are vulnerable to burnout given the nature of practice. Reports suggest that burnout frequency is variable across different countries.


      The main objective of our study was to determine knowledge, attitudes and frequency of burnout among Hospice and Palliative Medicine (HPM) Fellowship graduates trained at a comprehensive cancer center.


      We conducted a survey to determine the knowledge, attitudes, and frequency of burnout in former fellows, consisting of the Maslach Burnout Inventory (MBI) and 41 custom questions. Palliative care fellows who trained at a Comprehensive Cancer Center from 2008 to 2018 were included in the survey.


      Eighty-four percent of the 52 eligible physicians completed surveys. Median age was 38 years, with 68% females. Seventy-seven percent practiced PC more than 50% of time. Median practice duration was four years, and 84% were board certified. Most common disease types treated were cancer (89%), cardiac (43%) and pulmonary (43%). Burnout rate was high at 52% (n=20). The median scores for emotional exhaustion were 25.5, depersonalization 9, and personal accomplishment 48. Female gender (P=0.07) and having administration as a component in the job description (P=0.044) were associated with risk of burnout. Clinical care setting, work hours/week, frequency of weekend calls, and size of team were not significantly associated with burnout.


      Burnout among former fellows trained in HPM between 2008 and 2018 is high. More research is needed to develop strategies to better prevent and manage burnout among HPM fellowship trained PC physicians.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pain and Symptom Management
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cordes CL
        • Dougherty TW.
        A review and an integration of research on job burnout.
        Acad Manage Rev. 1993; 18: 621-656
        • Maslach C
        • Jackson SE.
        The measurement of experienced burnout.
        J Occup Behav. 1981; 2: 99-113
        • Maslach C
        • Schaufeli WB
        • Leiter MP.
        Job burnout.
        Annu Rev Psychol. 2001; 52: 397-422
      1. WHO. International classification of disease 11th revision. 2019. Available from

      2. Taking action against clinician burnout: A systems approach to professional well-being.
        The National Academies Press. National Academies of Sciences, Engineering and Medicine Web site., 2019
        • Hynes J
        • Maffoni M
        • Argentero P
        • Giorgi I
        • Giardini A
        Palliative medicine physicians: doomed to burn?.
        BMJ Support Palliat Care. 2019; 9: 45-46
        • Meier DE
        • Beresford L.
        Preventing burnout.
        J Palliat Med. 2006; 9: 1045-1048
        • O'Mahony S
        • Gerhart JI
        • Grosse J
        • Abrams I
        • Levy MM.
        Posttraumatic stress symptoms in palliative care professionals seeking mindfulness training: prevalence and vulnerability.
        Palliat Med. 2016; 30: 189-192
        • O'Mahony S
        • Ziadni M
        • Hoerger M
        • et al.
        Compassion fatigue among palliative care clinicians: findings on personality factors and years of service.
        Am J Hospice palliat care. 2018; 35: 343-347
        • Perez GK
        • Haime V
        • Jackson V
        • et al.
        Promoting resiliency among palliative care clinicians: stressors, coping strategies, and training needs.
        J Palliat Med. 2015; 18: 332-337
        • Ramirez A
        • Addington-Hall J
        • Richards M.
        ABC of palliative care the carers.
        BMJ (Clin res ed). 1998; 316: 208-211
        • Samson T
        • Shvartzman P.
        Association between level of exposure to death and dying and professional quality of life among palliative care workers.
        Palliat Support Care. 2018; 16: 442-451
        • Zambrano SC
        • Chur-Hansen A
        • Crawford GB.
        The experiences, coping mechanisms, and impact of death and dying on palliative medicine specialists.
        Palliat Support Care. 2014; 12: 309-316
      3. Jamieson L, Teasdale E, Richardson A, Ramirez A. The stress of professional caregiving. In: New York: Oxford University Press; 2010.

        • Rushton CH
        • Kaszniak AW
        • Halifax JS.
        A framework for understanding moral distress among palliative care clinicians.
        J Palliat Med. 2013; 16: 1074-1079
        • Downing NL
        • Bates DW
        • Longhurst CA.
        Physician burnout in the electronic health record era: Are we ignoring the real cause?.
        Ann Intern Med. 2018; 169: 50-51
        • Asai M
        • Morita T
        • Akechi T
        • et al.
        Burnout and psychiatric morbidity among physicians engaged in end-of-life care for cancer patients: a cross-sectional nationwide survey in Japan.
        Psycho-oncology. 2007; 16: 421-428
        • Parola V
        • Coelho A
        • Cardoso D
        • Sandgren A
        • Apostolo J.
        Prevalence of burnout in health professionals working in palliative care: a systematic review.
        JBI Database Syst Rev Implement Rep. 2017; 15: 1905-1933
        • Pereira SM
        • Fonseca AM
        • Carvalho AS.
        Burnout in palliative care: a systematic review.
        Nurs Ethics. 2011; 18: 317-326
        • Yoon JD
        • Hunt NB
        • Ravella KC
        • Jun CS
        • Curlin FA.
        Physician burnout and the calling to care for the dying: a national survey.
        Am J Hospice Palliat Care. 2017; 34: 931-937
        • Dyrbye LN
        • West CP
        • Satele D
        • et al.
        Burnout among US medical students, residents, and early career physicians relative to the general US population.
        Acad Med. 2014; 89: 443-451
        • Ercolani G
        • Varani S
        • Peghetti B
        • et al.
        Burnout in home palliative care: What is the role of coping strategies?.
        J Palliat Care. 2020; 35: 46-52
        • Lupu D
        • American Academy of H, Palliative Medicine Workforce Task F
        Estimate of current hospice and palliative medicine physician workforce shortage.
        J Pain Symptom Manage. 2010; 40: 899-911
        • Kamal AH
        • Bull JH
        • Wolf SP
        • et al.
        Prevalence and predictors of burnout among hospice and palliative care clinicians in the U.S.
        J Pain Symptom Manage. 2016; 51: 690-696
        • Dewa CS
        • Loong D
        • Bonato S
        • Thanh NX
        • Jacobs P.
        How does burnout affect physician productivity? A systematic literature review.
        BMC Health Serv Res. 2014; 14: 325
        • Kahill S.
        Symptoms of professional burnout - a review of the empirical-evidence.
        Can Psychol. 1988; 29: 284-297
        • Shanafelt TD
        • Balch CM
        • Bechamps G
        • et al.
        Burnout and medical errors among American surgeons.
        Ann Surg. 2010; 251: 995-1000
        • Shanafelt TD
        • Balch CM
        • Dyrbye L
        • et al.
        Special report: suicidal ideation among American surgeons.
        Arch Surg. 2011; 146: 54-62
        • Maslach C
        • Leiter MP.
        The truth about burnout.
        How organizations cause personal stress and what to do about it. John Wiley & Sons, 2008
        • Schaufeli WB
        • Bakker AB
        • Hoogduin K
        • Schaap C
        • Kladler A.
        on the clinical validity of the maslach burnout inventory and the burnout measure.
        Psychol Health. 2001; 16: 565-582
        • Schutte N
        • Toppinen S
        • Kalimo R
        • Schaufeli W.
        The factorial validity of the Maslach Burnout Inventory-General Survey (MBI-GS) across occupational groups and nations.
        J Occupational Org psychol. 2000; 73: 53-66
        • Reddy SK
        • Yennu S
        • Tanco K
        • et al.
        Frequency of burnout among palliative care physicians participating in a continuing medical education course.
        J Pain Symptom Manage. 2020; 60 (e82): 80-86
        • Kamal AH
        • Bull JH
        • Wolf SP
        • et al.
        Prevalence and predictors of burnout among hospice and palliative care clinicians in the US.
        J Pain Symptom Manage. 2020; 59: e6-e13
        • Shanafelt TD
        • Boone S
        • Tan L
        • et al.
        Burnout and satisfaction with work-life balance among US physicians relative to the general US population.
        Arch Intern Med. 2012; 172: 1377-1385
        • Shanafelt TD
        • Hasan O
        • Dyrbye LN
        • et al.
        Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014.
        in: Paper presented at: Mayo Clinic Proceedings. 2015
        • Maslach C.
        Maslach burnout inventory-human services survey (MBI-HSS).
        MBI Man. 1996; : 192-198
        • Kavalieratos D
        • Siconolfi DE
        • Steinhauser KE
        • et al.
        It is like heart failure it is chronic and it will kill you a qualitative analysis of burnout among hospice and palliative care clinicians.
        J Pain Symptom Manage. 2017; 53 (e901): 901-910
        • Kamau C
        • Medisauskaite A
        • Lopes B.
        Orientations can avert psychosocial risks to palliative staff.
        Psychooncology. 2014; 23: 716-718
        • Dreano-Hartz S
        • Rhondali W
        • Ledoux M
        • et al.
        Burnout among physicians in palliative care: impact of clinical settings.
        Palliat Support Care. 2016; 14: 402-410
        • Dunwoodie DA
        • Auret K.
        Psychological morbidity and burnout in palliative care doctors in Western Australia.
        Intern Med J. 2007; 37: 693-698
        • Koh MY
        • Chong PH
        • Neo PS
        • et al.
        Burnout, psychological morbidity and use of coping mechanisms among palliative care practitioners: a multi-centre cross-sectional study.
        Palliat Med. 2015; 29: 633-642
        • Graham J
        • Ramirez AJ
        • Cull A
        • et al.
        Job stress and satisfaction among palliative physicians.
        Palliat Med. 1996; 10: 185-194
        • Kase SM
        • Waldman ED
        • Weintraub AS.
        A cross-sectional pilot study of compassion fatigue, burnout, and compassion satisfaction in pediatric palliative care providers in the United States.
        Palliat Support Care. 2019; 17: 269-275
        • Kamal AH
        • Wolf SP
        • Troy J
        • et al.
        Policy changes key to promoting sustainability and growth of the specialty palliative care workforce.
        Health Aff. 2019; 38: 910-918
        • Baumrucker SJ.
        Palliative care burnout, and the pursuit of happiness.
        Am J Hospice Palliat Care. 2002; 19: 154-156
        • Back AL
        • Steinhauser KE
        • Kamal AH
        • Jackson VA.
        Building resilience for palliative care clinicians an approach to burnout prevention based on individual skills and workplace factors.
        J Pain Symptom Manage. 2016; 52: 284-291
      4. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Paper presented at Mayo Clinic Proceedings 2017.

        • Shanafelt TD
        • Gorringe G
        • Menaker R
        • et al.
        Impact of organizational leadership on physician burnout and satisfaction.
        Mayo Clin Proc. 2015; 90: 432-440
        • West CP
        • Dyrbye LN
        • Shanafelt TD.
        Physician burnout: contributors, consequences and solutions.
        J Intern Med. 2018; 283: 516-529
        • Awa WL
        • Plaumann M
        • Walter U.
        Burnout prevention: a review of intervention programs.
        Patient Educ Couns. 2010; 78: 184-190
        • Kearney MK
        • Weininger RB
        • Vachon ML
        • Harrison RL
        • Mount BM.
        Self-care of physicians caring for patients at the end of life Being connected a key to my survival.
        Jama. 2009; 301 (E1151): 1155-1164
        • Sanchez-Reilly S
        • Morrison LJ
        • Carey E
        • et al.
        Caring for oneself to care for others: physicians and their self-care.
        J Support Oncol. 2013; 11: 75-81
        • Sanso N
        • Galiana L
        • Oliver A
        • et al.
        Palliative care professionals' inner life: exploring the relationships among awareness, self-care, and compassion satisfaction and fatigue, burnout, and coping with death.
        J Pain Symptom Manage. 2015; 50: 200-207
        • Swan A
        • Azhar A
        • Anderson AE
        • et al.
        Empowering the health and well-being of the palliative care workforce: evaluation of a weekly self-care checklist.
        J Pain Symptom Manage. 2021; 61: 817-823