Future proofing the palliative care workforce: Why wait for the future?
How can we best future proof the palliative care workforce to overcome foreseeable challenges on the horizon? Clearly, this is a complex question that warrants consideration of multiple factors and input from many stakeholders, including palliative care volunteers. Whilst providing a definitive answer is beyond the scope of this paper, here we discuss but a few pieces in contribution to the larger workforcepuzzle of discourse in the field of palliative care. Broader discussion to advocate for strategic workforce policy is essential and waiting passively for an uncertain future is simply not an option. Careful consideration of workforce issues is not new to palliative care. Indeed, calls for workforce development and future workforce planning to address shortages have been evident within the international literature for quite some time. However, there now appears to be a growing sense of urgency. More recently, studies conducted by the American Academy of Hospice and Palliative Medicine's Workforce Task Force have pointed towards an impending crisis in the form of a 'workforce valley' associated with factors such as burnout, intention to leave palliative care, retirement age demographics, and limitations in specialist training. Future workforce challenges for palliative care are thus foreseeable not only from increased demand associated with population growth and ageing, but also a decrease in supply as a significant proportion of the palliative care workforce retire or otherwise leave this specialty area of practice, with insufficient numbers being trained to cover the shortfall. This is reflected in a projected ratio of one palliative care physician per 26,000 American patients eligible for palliative care in 2030, if significant action is not taken soon. Importantly, these concerns are not isolated to the USA or palliative medicine specialists. Kamal and colleagues conclude that 'potential solutions should address the substantial prevalence of burnout in the field, support increased delivery of foundational palliative care services by non specialty clinicians, and grow the workforce of trained palliative care clinicians through traditional and alternative mechanisms' We now speak to these briefly, in turn. As an occupational phenomenon formally recognised in the World Health Organization's International Classification of Diseases, burnout represents a growing concern. Initiatives to address the prevalence of burnout in the palliative care workforce should not only focus on building resilience to adversity; there is also a need to address organisational barriers to compassion for self and others. Retention of the current workforce could be supported by increased staff support and education about effective self care to promote compassion literacy, building self compassion and emotional intelligence. An increased delivery of general and specialist palliative care services could be supported, in part, by leveraging the relative size of the palliative care nursing workforce. While much of the workforce data has focused on physicians, nurses form the largest component of the palliative care workforce. A systematic review of the international literature suggests that innovations in advanced practice and nurse led models of palliative care can effectively bridge gaps in health care service delivery and improve the patient experience through early palliative care intervention. However, the implementation of nurse led models of care should not be misconstrued as substitution of physicians by advanced practice nurses or nurse practitioners. Growing the workforce of trained palliative care clinicians is vital. How, then, can we promote palliative care as a specialty of choice for health professionals and how can we best welcome and nurture their growth? This endeavour will require positive alternatives to traditional approaches used previously to educate and train junior nurses and doctors. For example, discourse on nurses 'eating their young' and doctors 'teaching by humiliation' have punctuated general nursing and medical education. While positive cases of nurses nurturing their young, and physicians mentoring junior doctors can be found in palliative care, we suggest that pathways into palliative care may, at times, be chequered by
Progress in Palliative Care