Physician Assistants Also Feel Post-Pandemic Burnout

NASHVILLE, Tenn. -- Nearly a third of board-certified physician assistants (PAs) said they experienced burnout in the past 3 years, according to a national cross-sectional analysis.

Looking at over 111,000 PAs who worked in at least one clinical position, 30.6% self-reported at least one symptom of burnout, found Andrzej Kozikowski, PhD, of the National Commission on Certification of Physician Assistants in Georgia, and colleagues.

These burnout symptoms were also linked with clinicians saying they intended to leave their principal clinical position, with 8% saying they were planning their exit within the next 12 months, according to a poster presented at Psych Congress 2023.

"Understanding and addressing burnout among clinicians is of critical importance," Kozikowski told MedPage Today. "Employers should provide clinicians with resources to properly care for themselves and their patients."

Certain factors emerged as either protective or predictive of PAs experiencing burnout. Not surprisingly, working more hours was by far the strongest predictor of burnout among these clinicians (all P<0.001):

• Working 51-60 hours/week vs 30 or fewer: adjusted OR 2.36
• Working 60+ hours/week vs 30 or fewer: aOR 2.24
• Working 41-50 hours/week vs 30 or fewer: aOR 1.71
• Working 31-40 hours/week vs 30 or fewer: aOR 1.20

Similarly, PAs who managed a higher volume of patients each week were significantly more likely to experience at least one symptom of burnout. On top of that, PAs also were more likely to experience burnout if they worked in a community health center or urgent care compared with a hospital; worked in critical care medicine or emergency medicine versus primary care; were older than age 35; and worked in New England, Mountain, or the Pacific Census Division versus the South Atlantic. Those that spent 6 or more hours per week on call were also more likely to have burnout.

On the other hand, Kozikowski's group found several factors that were significantly protective against PA burnout. The strongest protective factors of all had to do with specialization -- specifically those who worked in surgery, dermatology, ob/gyn, occupational medicine, or pediatrics were far less likely to experience burnout compared with those working in primary care. Those that worked in office-based private practices or other practice settings compared with hospitals were also less likely to burnout.

Interesting, PAs who worked in two or more clinical positions were 34% less likely to experience burnout than those who only worked one position. "We expected that having a second clinical position would be linked with a higher likelihood of burnout," said Kozikowski, who said this was a particularly surprising finding. "We will further explore this finding in a future study."

PAs who were Asian or Black were also less likely to experience burnout than white PAs. Also, male PAs were 38% less likely to experience burnout than female PAs.

Data for the analysis came from the National Commission on Certification of Physician Assistants on 111,726 PAs who worked at least one clinical position. Burnout was measured with one item rating burnout symptoms on a 5-point scale at the end of 2021.

"Many studies showed that burnout among physicians and nurses was increasing and exasperated by the COVID-19 pandemic," said Kozikowski, "However, the research was mixed regarding PAs."

"The PA profession has a unique attribute: PAs can change specialties due to their generalist medical education and certification," he explained. "This versatility enables PAs to practice in a wide range of medical and surgical specialties, transitioning from areas of less need to those of high demand throughout their careers. We wanted to assess burnout levels among PAs to determine if this adaptability was protective -- particularly while PAs faced numerous challenges caused by the pandemic."

In terms of how this relates to burnout among physicians, Kozikowski pointed out that pandemic-era studies indicated a wide range of burnout prevalence among this group, some studies suggesting 15% all the way up to 90% of these practitioners are burnt-out. A 2022 Survey of America's Physicians from the nonprofit Physicians Foundation found 60% of physicians said they often feel burnout out compared with 40% before the pandemic. The prevalence of physicians with self-harm thoughts also rose post-pandemic.

"This [range] could be due to the different ways burnout was assessed and the focus of each study being on physicians in different specialties," he said. "In our study, there were also differences in burnout by the types of specialties PAs practiced. For example, PAs practicing in critical care medicine were more likely to report at least one burnout symptom than PAs in primary care."

"Health systems should implement evidence-based programs to recognize and address burnout among clinicians," advised Kozikowski.

Comment