Burnout is the current reality for many healthcare workers, but physician assistants can sometimes fall under the radar.
Here are some difficulties with burnout PAs are facing, along with some solutions organizations should take advantage of, according to Daytheon Sturges, PA-C, PhD, and Quanté Greenlee, PA-C, PhD, both of the University of Washington School of Medicine in Seattle.
Question: How bad is burnout for physician assistants right now?
Dr. Daytheon Sturges: Across the board, there are a lot of competing interests and duties, especially in the clinical sphere, that require a lot of attention and a lot of emotional toil.
For example, you're addressing patient concerns. Some things you're not able to adequately address because, organizationally, you might may not be able to react as quickly with resources that may be available, [or there are] state laws that are going into effect that prevent you from from practicing at the top of your license or providing the avenues to address social determinants of health, political, commercial determinants of health.
On top of that, too, you have all the organizational duties. For example, the electronic health record — which is honestly, death by 1,000 clicks — that you have to chart and work with these clunky electronic health record platforms that take up a bulk of your time.
Most people spend more time engaged with the health record than they do with actual patients. That's just at the clinical level, but then you factor in, what resources are available? What are the expectations that are set by the organization? Because, again, it takes the organization addressing what the contributors to burnout are, so that people can move beyond burnout or don't experience it at all.
[That's] one of the things that people kind of confuse, too. [They think] that it's an individual thing and it's really not. It's really at the organization level — what's in place that's contributing to PA burnout.
Dr. Quanté Greenlee: One of the things that really points to physician assistants is how much resources are allocated. More than anything organizational buy-in, leadership and supporting their staff, across all healthcare disciplines, has been shown to really determine how bad burnout is.
We look at the healthcare data, and physicians have one of the highest levels of burnout and suicide. But I think as our profession has grown, and PAs have adopted more responsibilities, seen an escalation in our ability to deliver more care — because we're educated to do so and licensed to do so — and PAs have entered more administrative and leadership roles, [it] becomes more stress. As we've seen over COVID, there was a lot of stress on all healthcare providers. [With] PAs being one of the leaders in health care, I think experienced a significant bulk of that as well.
Q: How do you see this negatively impacting healthcare organizations?
DS: People are leaving. People are choosing other careers.
Again, the PA career has become very dynamic. So often, drug companies are wanting to hire PAs [as] medical science liaisons, where you can control your schedule.
You become an expert on a topic, and you go teach people about it. Some go out into academia, but academia contributes to burnout too. [However], people are deciding to prioritize their physical and mental health and [are] choosing different options.
Also, an emotionally exhausted [and] physically exhausted PA can lead to adverse health outcomes, medical mistakes. It's dangerous. Research has not shown us a lot regarding PAs, but [there is an increase of] physician and residents [committing] suicide, especially during this pandemic. So, the negative outcomes not only affect the organization, it trickles down into the health of the individual as well as the health of the community.
QG: PAs increasingly get recognized for our contributions to healthcare and our roles [are] expanding. For those PAs who work in states where it's probably a little bit more restrictive, or they work in organizations that are a little bit more restrictive or don't incorporate PAs into their healthcare team, that also contributes to burnout. PAs know what they can do, they know their education, they know how to best operate. They're tough, they're licensed.
So, when you are in a work environment that doesn't really respect your role in the healthcare team and then your job demands are high, that is a two-fold kind of pressure on that provider. That's why oftentimes PAs are really advocating for expansions of our roles and ways of better contributing to the team — so that we increase the respect of our skill set and are also acknowledged for the role that we contribute.
No matter what your profession is, if you feel like you're working for a place where you're not respected, or you feel like that your opinions or your direction of care doesn't matter, you're going to [become] disengaged from your organization. That can result in disengagement for patient care and PAs becoming really despondent.
Q: What do you feel are the necessary next steps forward to correct this issue?
DS: From an organization standpoint, there has to be an investment in wanting to assess and address burnout. Really moreso prevention. You can't just say one day, "I'm going to end burnout." You first have to understand what the contributors to burnout are. You have to engage with and speak with the people that work in the organization, the PAs, the nurses, the unit clerks, whomever — you need to understand what the issues are, and then prioritize them at different levels.
You can address that through the six domains of the work environment. This comes from [Christina] Maslach and [Michael] Leiter research.
[First is] workload: The workload doesn't match what you were told that you're going to do coming in.
Healthcare astronomically changes from year to year, day to day. So workload control [is another domain]. What type of control do you have in your work environment or to your work schedule? Can I control my day? Or do I show up and I had 10 patients that I scheduled, but now I have 20? What type of level of control do I have in my work environment?
[Next is] reward. For the work that I'm doing, am I being appreciated? Am I being given employee of the month, or at least being recognized for the work that's being done?
[Third is] community. This can be many layers. Like, do I feel included? Do I belong as a part of this team? [This domain extends] to interpersonal interactions. It can be ageism, sexism, racism, all these different things that are occurring in the community in which we are engaged in on the job.
[Fourth is] fairness. Everyone wants to be treated equitably. You want to have the tools you need to be successful. Am I being ignored? Is someone else being propped up at my expense? Am I contributing ideas and someone else is getting the credit?
[Fifth is] values. Are your values aligned with the mission of the organization?
I think that by knowing contributors and rooting them in these six domains with a work environment, you can create with the help of those who are in the organization some type of intervention that is catered specifically to your organization.