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From Burnout to Resilience: Building Capacity to Thrive at 

Work 

Arif Kamal MD, MBA, MHS@arifkamalmd

www.resilientclinician.org

Disclosures

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Objectives

• Learners will be able to describe the current prevalence and predictors of burnout in palliative care

• Learners will understand the personal and systems‐related contributors to burnout

• Learners will identify practical techniques to build resilience

“I just don’t know how much longer I can do this….”

-a palliative care clinician you know

“…staying til 8 every night”

“…seeing another 30-year old patient dying of melanoma”

“…talking to the daughter from California (again)”

“…convincing my colleagues that I don’t take away hope”

“…being the only one around who canfacilitate a family meeting”

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Definitions

• Working at a job you can’t be successful at

05

101520253035404550

Professional Burnout %

Professional Burnout

Presented by Arif Kamal MD:

Shanafelt JCO 2013Shanafelt Arch Int Med 2012

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What’s happening in medicine

• asymmetrical rewards, when mistakes are highlighted far out of proportion to successes;

• loss of autonomy, for example when clinicians cannot exercise judgment about how much time a particular patient and family need; and

• cognitive scarcity, which occurs when clinicians must continually manage their time under conditions of high complexity.

Hospice and palliative may be different:1. “Being there’’ vs. “fixing”2. Unique core values 3. Focus on sacred life transition4. Empowering patients & families,

supporting choices5. Requires unique worker qualities6. Uniqueness of (hospice) work climate7. Opportunity for personal growth8. “Hospice enchantment”

DiTullio M. et al. Am J Hospice Pall Med. 1999

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Burnout Question

% who said “Once a week”

% who said “Few times per week”

% who said “Everyday

“I feel used up at the end of the workday”

14% 19% 7%

“I feel I’m working too hard on my job”

11% 22% 13%

“I feel frustrated with my job”

13% 20% 8%

Presented by Arif Kamal MD:

Burnout Severity

0

10

20

30

40

50

60

70

80

90

100

EE DP Overall MD/DO Non-MD

Low Moderate High

Presented by Arif Kamal MD:

62% 60%*67%*

*P<0.01

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Multivariate risks of burnout

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

Leaving>50%

Work >50h Workweekends

>4colleagues

MD/DO >50 y/o

Presented by Arif Kamal MD:

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The Burnout Crisis in PC

0

10

20

30

40

50

60

70

Allphysicians

Oncologyfellows

Radiationoncologists

Surgicaloncologists

Medicaloncologists

PalliativeCare

Professional Burnout %

Arif.kamal@duke.edu@arifkamalmd

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Resilience:

The capacity to meet challenges, recover from difficulties, & thrive at 

work; built from skills, not reflective of traits

Sustainability depends on improving 2 areas 

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Individual skills

Workplace factors 

Enabling control

Structuring rewards

Building community

Promoting fairness

Recognizing values

Calibrating workload

Working from strengths

Tracking activation

Healthy boundaries

Regulating emotions

Recognizing distortions

Reasonable expectations

Finding meaning

Commitment to long term

Six Areas of Work‐life

• Enabling Control

• Structuring Rewards

• Building Community

• Promoting Fairness

• Recognizing Values

• Calibrating Workload

Maslach C, Schaufeli WB, & Leiter 2001

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Enabling Control

• Insufficient control over resources needed

• Can also be too high a level of responsibility

• Related to the inefficacy aspect of burnout

• Control of time

Approaches

• Late start clinician each dayMaslach C, Schaufeli WB, & Leiter 2011

Structuring Rewards

• Financial Reward

• Appreciation

• Recognition

• Intrinsic Reward

Approaches

• “Shout outs” at division meetingMaslach C, Schaufeli WB, & Leiter 2001

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Building Community

• Sense of positive connection with others in the workplace

• Most destructive to community is chronic and unresolved conflict

Approaches

• Training for giving feedback in the workplace

Maslach C, Schaufeli WB, & Leiter 2001

Promoting Fairness

• Perceived fairness = respect and self worth

• Fairness of workload, pay, evaluations, promotions

Approaches 

• Rotations for “high value weeks” Maslach C, Schaufeli WB, & Leiter 2001

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Recognizing Values

• Doing something one considers unethical

• Mismatch between personal aspirations & that of organization

• Discrepancy between mission statement and actual practice.

Approaches

• Team exercise to develop core values and mission statement

• Annual evaluations based on division core values

Maslach C, Schaufeli WB, & Leiter 2001

Calibrating Workload

• Excessive work

• Wrong kind of work

• Most often related to the exhaustion aspect of burnout

Approaches

• Part time work options, program development time

Maslach C, Schaufeli WB, & Leiter 2001

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What’s a resilience skill?

Is this you?

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1. Working from my strengths2. Tracking my activation3. Finding healthy boundaries4. Regulating my emotions5. Reframing cognitive distortions6. Using reasonable expectations7. Discovering meaning everyday8. Committing to ongoing work

A skills‐based approach

Self Awareness Strategies

Examine your HOOKS• denial, helplessness, anger & fear

related to death and loss• need to be in control• to cure and to save - to “do good”• over-helping and under-helping

behaviors• how personal feelings may contribute

to inappropriate diagnoses or treatment• assumptions about a “good death”• dignity & hope at end of life

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This is what MY mind often looks like!

Raises provider consciousness oftheir inner reality and pf the external reality

Teaches is to develop a kind,objective witnessing attitude

Develops empathy for others

Self compassion helps to protect us against anxietyand promote psychological resiliency

Neff, KD, Kirkpatrick KL,, Rude, SS. Self-compassion and adaptive psychological functioning. J Res Pers. 2006;41:139-154

Mindfulness

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Mindfulness Evidencemindfulness courses and activities help burnout

“Mindfulness practices, including the body scan, mindful movement, walking

meditation and sitting meditation, as well as discussion focusing on the

application of mindfulness at work…resulted in significant improvements in burnout.”

“Participation in a mindful communication program

was associated with…improvements in

well–being and attitudes associated with patient-

centered care.”

JAMA Sept. 23, 2009. Vol. 302 No. 12Association of an Educational Program in Mindful

Communication with Burnout, Empathy, and Attitudes Among Primary Care Physicians.

Krasner, M., Epstein, R.

*Int J Psychiatry Med. 2012;43(2):119-28.A mindfulness course decreases burnout and

improves well-being among healthcare providers. Goodman MJ1, Schorling JB.