What’s Moral Distress Got to Do With It? How to Avoid Burnout and Optimize Patient Care

Abstract

Burnout, estimated to affect between 40-80% of healthcare professionals, is a complex issue encompassing emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment. The Stanford Model of Professional Fulfillment considers both individual and system-level factors with three main elements of efficiency of practice, personal resilience, and culture of wellness. Dr. Finkelstein’s alternate model for burnout reimagines the Stanford Model with three main factors contributing to burnout: inevitable suffering, moral distress, and “extra junk.” In Dr. Finkelstein’s alternate model, inevitable suffering arises from the emotional toll of providing patient care. While interventions like coaching, therapy, and mindfulness are beneficial, they must be offered genuinely, not as profit-driven schemes. “Extra junk” refers to administrative burdens that take away from patient care. Some initiatives aim to alleviate these burdens, but their effectiveness needs critical evaluation. Finally, moral distress occurs when external constraints hinder an individual’s ethical actions. Burnout affects not just individual professionals but also the entire healthcare system, leading to early retirements, lower quality care, and worsening health outcomes. Recognizing this, the US Surgeon General has outlined an approach to address burnout that requires cultural changes at all levels of the healthcare ecosystem. Healthcare professionals are resilient, and part of the solution lies in individual recognition of burnout, work-life balance, and finding joy in work. However, larger cultural shifts towards justice and equity, both within healthcare and broader society, are needed. This includes prioritizing workforce diversity, humane sick and maternity leave policies, and reducing unnecessary administrative burdens. Academic institutions also have a role in promoting mentorship, recognizing the contributions of underrepresented groups, and supporting burnout research. Addressing burnout effectively requires a comprehensive approach that considers individual and system-level factors, advocating for systemic reforms, and prioritizing justice and equity within the healthcare ecosystem.