Stop Celebrating the Martyrs

The Palliative Lens

Andrew Esch

According to the WHO, globally, only about 14% of individuals who need palliative care currently receive it.

The remaining 86% go without access to these essential pain and symptom management services, which greatly improve the quality of life for patients and their families

However there is a strange thing happening in palliative care.

The house is on fire, and we keep giving awards to the people carrying buckets.

Every conference, every panel discussion, every leadership meeting seems to feature another story about a team that somehow found a way to do more with less.

"We expanded our census."

"We doubled our consult volume."

"We covered three hospitals."

"We built an outpatient clinic with no new FTEs."

"We reduced wait times despite vacancies."

And everyone applauds.

We call it innovation.

We call it resilience.

We call it stewardship.

Sometimes I wonder if we are simply celebrating survival.

Because if we're being honest, much of what we praise in palliative care today would be recognized as a system failure in almost any other field.

Imagine a fire department proudly announcing they now cover twice the territory with half the firefighters.

Imagine an ICU bragging that they eliminated nursing positions and somehow still kept the unit functioning.

Imagine oncology congratulating itself because physicians now see twice as many patients in the same amount of time.

We would immediately recognize the danger.

Yet in palliative care, these stories are often held up as examples of excellence.

The truth is less romantic.

Many of our teams are exhausted.

Many of our programs are understaffed.

Many of our clinicians are carrying emotional and clinical workloads that would have been considered unacceptable a decade ago.

And somewhere along the way we started acting like grateful mission labor.

We became thankful for scraps.

Thankful for permission to exist.

Thankful for incremental growth.

Thankful for being invited into rooms where decisions are made about us instead of by us.

We have become so accustomed to justifying our existence that we rarely stop to ask whether what is being asked of us is reasonable.

The irony is that this is happening at exactly the moment our patients need us most.

Our patients are not routine.

They are not simple.

They are not interchangeable.

They are the sickest, most medically complex, most emotionally overwhelmed patients in healthcare.

They are people receiving devastating diagnoses.

People facing decisions that will shape the remainder of their lives.

People trying to make sense of suffering.

Families trying to hold themselves together while someone they love falls apart.

These conversations take time.

Presence takes time.

Trust takes time.

There is no productivity hack for sitting with a frightened family.

There is no AI solution for helping a patient reconcile hope and reality.

There is no workflow redesign that replaces human connection.

Yet we continue building systems that pretend otherwise.

We celebrate efficiency gains while quietly accepting that clinicians have less time to do the very thing that creates value.

We call it scaling.

Patients experience it as absence.

And perhaps what frustrates me most is how little anger exists around this.

We should be furious.

Not because our jobs are hard.

We knew they would be hard.

We should be furious because the people who need us most are receiving less than they deserve.

We should be furious that workforce shortages have become normalized.

We should be furious that vacancies stay open for months while demand explodes.

We should be furious that clinicians are expected to absorb the difference through personal sacrifice.

We should be furious that "doing more with less" has somehow become a strategic plan.

Less is less.

Less physician time is less physician time.

Less social work is less social work.

Less chaplaincy is less chaplaincy.

Less nursing is less nursing.

Less presence is less presence.

No amount of inspirational language changes the math.

The field that taught healthcare about suffering has become remarkably comfortable suffering itself.

We celebrate the martyr.

We celebrate the workaround.

We celebrate the heroic effort.

What we should be demanding is workforce.

Investment.

Infrastructure.

Growth.

Support.

The answer to rising demand cannot forever be asking exhausted people to run faster.

At some point we have to stop congratulating ourselves for keeping the wheels on and start asking why the vehicle is being driven this way in the first place.

Palliative care was never supposed to be a movement powered by self-sacrifice.

It was supposed to be a commitment to delivering the right care to people facing the hardest moments of their lives.

That mission remains as important as ever.

Which is exactly why we should stop accepting less.

And stop celebrating the fact that we somehow survived it.