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The Cost of Caring - Balancing Provider Stress and Reward


Last month’s article on patient trust touched on the importance of provider wellbeing in establishing and maintaining those trusting relationships. This month, we want to further home in on provider wellbeing and look at it as the foundation of improved outcomes for the patient, the provider, the practice, and the system as a whole.

I have the great opportunity to facilitate trainings nation-wide around compassion resilience in the health and human services sector and one of my favorite activities to engage in with teams relates to systems drivers of fatigue. It pulls us away from the common focus we so often place on self-care and highlights the reality that if staff continue to enter into work environments and systems that do not support their wellbeing, that drain their ability to show up as their best selves, self-care efforts are unlikely to be effective.

When introducing discussions and activities around systems drivers of fatigue (and resilience), I sometimes find it helpful to start by thinking about the stressors and rewards that are both inherent in caring for patients and clients as well as those that are external to caregiving.

Inherent Rewards & Stresses: The very nature of providing care to others who may be suffering is simultaneously satisfying and draining. It is a source of both rewards and stress which are inextricably connected, meaning you cannot remove one without changing the nature of the provider role.

External Rewards & Stresses: These rewards and stressors arise outside of providing care for patients, they are not connected to some reward with a deeper meaning, and they make many healthcare professionals say, “I did not sign up for this.” Often, this type of stress is related to financial and regulatory aspects of healthcare, such as documentation and electronic health records, as well as poor management, a toxic culture, and disruptive peer behavior.

Take a moment to think about the inherent and external rewards and stressors in your own work. The table below (from Mylod, 2017) lists some common sources of rewards and stressors within the healthcare field. Consider which are present in your work and whether the related statements resonate with you. Ask yourself:



Sources of reward & stress

Sample diagnostic statements (Agreement indicates reward; disagreement indicates stress)










Sources of reward & stress

Sample diagnostic statements (Agreement indicates reward; disagreement indicates stress)









Source: Mylod, 2017

Examining rewards and stressors is a great way to get teams to think about the system drivers of fatigue (and resilience) that are unique to their own context and culture. Teams can build on this through discussions around where on the spectrum they perceive the locus of control falls for each of these aspects of their work and how they may act on those they can control or loosen their focus and attention on those they cannot.

Written by Katie Ebinger, MPH, MSW - Facilitator, Advancement & Healthcare Transformation, HealthTeamWorks



      WISE, Rogers Behavioral Health, & Katie Ebinger. (n.d.). Compassion Resilience Toolkit for Health and Human Services Leaders and Staff: Systems Drivers of Compassion Fatigue. Available at

     Mylod, D. (2017). One way to prevent physician burnout. Harvard Business Review. Available at