More than one-third of physician assistants suffer from burnout, study reports

Reviewed by Emily Henderson, B.Sc.Aug 28 2021

More than one-third of physician assistants (PAs) meet criteria for burnout, suggests a study in the September issue of JAAPA, Journal of the American Academy of PAs (AAPA). The journal is published in the Lippincott portfolio by Wolters Kluwer.

Burnout symptoms are key contributors to both depression and medical errors among PAs, according to the new research by Sarah R. Blackstone, PhD, MPH, of University of Virginia School of Medicine, Charlottesville, and colleagues. They write, "This study provides evidence supporting the need to address burnout in PAs, who continue to be of growing importance in the healthcare system." (At the time the study was performed, Dr. Blackstone was at James Madison University, Harrisonburg, Va.)

Burnout mediates depression's effects on professional outcomes in PAs

In the survey study, 858 PAs completed the Stanford Professional Fulfillment Index, which assesses aspects of burnout (work exhaustion and interpersonal disengagement) along with professional fulfillment. Other assessments included anxiety and depression, information on professional practice as a PA, and experience with medical errors.

Approximately 34 percent of PAs responding to the survey met criteria for burnout. Forty-six percent met criteria for work exhaustion and 30 percent for interpersonal disengagement. But despite these measures of burnout, more than half of PAs (53 percent) reported at least moderate levels of professional fulfillment.

"About six percent of PAs met criteria for depression: a lower rate than previously reported in physicians or in the general population. Thirteen percent had moderate to severe levels of anxiety. About 80 percent of PAs self-reported making at least one medical error during their careers."

Studies in physicians have shown a link between depression and burnout, with both factors negatively affecting performance including medical errors and patient outcomes. The researchers performed a series of "mediation analyses" to explore the interrelationships among burnout, depression, medical errors, and professional fulfillment among PAs.

The results suggested that the burnout symptoms of work exhaustion and interpersonal disengagement "fully mediated" the relationship between depression on the one hand and professional fulfillment on the other. "Burnout plays a stronger role in job satisfaction than symptoms of depression," the researchers write.

Burnout and depression occur at high rates among physicians and other healthcare providers, with important implications for quality of care, patient safety, and retention of qualified professionals. But less is known about burnout and depression among PAs, who play an increasingly important role in providing patient care.

Adding to previous reports, the study finds that "burnout is a growing problem for PAs" – while at the same time showing that most PAs report moderate to high levels of professional fulfillment. "Although depression influences feelings of professional fulfillment, it is mediated by symptoms of burnout, mainly work exhaustion and interpersonal disengagement," Dr. Blackstone and coauthors write. Burnout symptoms also contribute to the risk of medical errors.

The researchers highlight the need for further studies on factors that increase risk and protect against burnout, including factors unique to the PA profession. Dr. Blackstone and colleagues conclude: "Understanding the underpinnings of professional satisfaction may mitigate clinician turnover, which in turn may lead to cost savings for the organization, better resilience and mental health for clinicians, and potentially better patient outcomes."