Burnout is a relatively new term coined in 1974 by Herbert Freudenberger. In his book Burnout: The High Cost of High Achievement, he identified symptoms of burnout, suggesting “much had to be attributed to the times we live in, the swift acceleration of change, the depersonalization of neighborhoods, schools, and work situations.”
And change happens quickly in the current healthcare environment. This leaves healthcare professionals at high risk of experiencing burnout.
PA-C burnout can be impacted by several factors. With advancing technology, the PA-C’s work environment is more complex than ever before.
In addition, the physician assistant body of knowledge continues to grow. Stress levels increase as professionals struggle to keep up with new information while dealing with complicated tools designed to make their jobs easier.
Other stressors include changes to regulatory and reimbursement policies, as well as the PA-C’s work environment. A physician assistant must handle all of these while focusing on patient care.
Most of these factors are largely out of the PA’s control, which is a key factor to perceived and real stress and can only accelerate the risk of burnout.
When burnout is left unchecked, it can result in problems with health, happiness, job satisfaction, relationships, and job performance. In order to prevent and treat burnout, it’s important to know what to look for.
The earlier you recognize it, the earlier you can combat it. This is important because some professionals found burnout changed the direction of their careers. That’s why it is necessary to recognize what burnout is, the factors that contribute to it, and its symptoms.
That way, you can make changes and get treatment, should it happen to you. Understanding burnout can also help you put measures in place to prevent it from ever happening.
What is Burnout for Physician Assistants?
The basis for identifying burnout is over 45 years old, but the symptoms remain the same: emotional exhaustion, depersonalization, and a deep sense of a lack of personal accomplishment. The professional and personal consequences can be significant.
When left unaddressed, burnout can lead to dangerous medical errors, low patient satisfaction, and poor patient outcomes, all of which ultimately impact hospital reimbursement. In order to fulfill the *entity’s* mission of patient care and public health, the healthcare system must address PA burnout, and work with PAs to implement effective remedies to address it in the PA profession.
In addition to their work lives, burnout can affect physician assistants’ home lives as well. A lack of energy, emotional exhaustion and depersonalization can lead to emotional distance from friends and family—the very people who can help pull you out of the burnout spiral!
After months and years of emotional exhaustion, some physician assistants end up leaving their practice. And in the current climate, with PA-Cs and other healthcare professionals dealing with COVID-19, the potential for burnout is rising.
COVID-19 and Burnout
The current pandemic increases the risk of burnout in healthcare professionals, including physician assistants. With high rates of patients requiring medical care and dwindling resources, more healthcare professionals are being asked to work longer hours, sometimes without the appropriate personal protection against the virus.
While this is a unique situation, it, unfortunately, is a recurring scenario that plays out every year during flu season. Rising numbers of sick patients and strained resources make it clear that physician assistants and other healthcare professionals must take preventive measures against burnout.
Specialties With High Levels of Burnout
According to the American Academy of Physician Assistants, the average burnout rate for physician assistants in the United States is 32.6% of practicing professionals. Emergency medicine physician assistants have the highest percentage of fulfillment (72.3%) and the highest percentage of burnout (34.5%).
Of all the specialties, pediatric subspecialties have the lowest rate of burnout at 20.2%, followed closely by primary care, internal medicine, and surgical subspecialties. Interestingly, women experienced greater stress and, ultimately, greater burnout.
Additionally, 1 in 8 physician assistants have considered quitting due to stress. In a national study of burnout led by Eric Tetzlaff and Heather Hylton, researchers found, despite high satisfaction levels, one-third of PAs practicing in oncology experienced burnout.
By comparison, the newest survey from Medscape found physician burnout across all specialties averaged 42%, nearly 10% higher than physician assistants. The MD specialties with the highest rate are urology, neurology, nephrology, diabetes and endocrinology, and family medicine. Those rates range from 46% to 54% of those practicing. Just as with physician assistants, women experienced greater physician burnout.
Burnout and PA Career Satisfaction
Burnout has a significant impact and influence on career satisfaction. Chronic stress and burnout are not exclusive to any one member of the healthcare team. Nurse practitioners (NPs), social workers, doctors, physical therapists, and even x-ray technicians may experience added burdens from work that spill over into their home life.
Factors Contributing to Burnout
It’s important to understand the factors that contribute to burnout, as this understanding will help you identify it, should you begin to experience it.
Work Factors
For most physician assistants, their work environment is the root cause of burnout. Unsatisfying work environments can trigger a poor work-life balance, sometimes leading to devastating results. As you take stock of your own life patterns, determine if these factors may be found in your work environment.
Unclear Expectations
Ensure you have a clear understanding of what is and isn’t expected in your role. Misunderstandings and unclear expectations can muddy the water and make the workplace a source of stress.
Activity Extremes
Work is easier when the workload is balanced—neither too much nor too little to do. Unfortunately, the very nature of many PA practices is not predictable, sometimes resulting in activity extremes.
Poor Work-Life Balance
An imbalance between your work and your personal life is often the result of too much work and not enough time at home. If you can’t get work off your mind even after you’ve gone home for the day,, you are essentially still at work, leading to poor work-life balance.
Dysfunctional Workplace
Dysfunction in your work environment increases the potential for arguments and petty disagreements, ultimately increasing your stress.
Lack of Support
This is a factor at work and in your personal life. However, for a physician assistant who is working collaboratively with a physician, a lack of support from the physician can make for some very uncomfortable days.
Personal Factors
As you worked your way through PA school, you’ve likely developed some strategies to cope with your work and personal life. Sometimes these personal traits, which may have driven you to success, can also contribute to burnout.
Self-Criticism
This is a real problem that can have a severe impact on your overall life. Being self-critical may have resulted as a protective strategy, to help rationalize a failure, or as a means of confronting your imperfections. Whatever the reason, self-criticism goes beyond taking responsibility for actions and moves it into the realm of self-destructive behavior.
Poor Coping Strategies
Well-adapted strategies include finding support, relaxation techniques, humor, and physical activity. Sometimes you may be tempted to use maladaptive strategies when they appear to fix the problem in the short-term. These include escaping into solitary activities, overeating, binge drinking, excessive video gaming, and drugs.
Sleep Deprivation
Without an adequate amount of sleep, your body will not have the reserves to cope with a demanding schedule. This can cause emotional upheaval and negatively impact your immune system.
Over-Commitment
The very strategies you used to finish PA school—working long hours, focused determination, and abbreviated leisure time—are what will quickly lead to burnout at work. While many can hold to a grueling school schedule for weeks, or months at a time, it isn’t a schedule that works well indefinitely.
Perfectionism
Perfectionism is not the same as always trying your best. In medicine, others’ lives depend on your decision-making skills, so doing your best all the time is a necessary part of the job. Instead, perfectionism is a shield used to protect against judgment or shame, and it only leads to more stress and anxiety.
Organizational Factors
Organizational factors also contribute to PA-C burnout. And out of all of the factors discussed, these are largely out of the PA’s control, leading to increased stress.
When there is negative leadership, insufficient rewards in the work environment, and limited interpersonal collaboration with supervisors or physicians, it leads to high -stress levels. Ultimately, this contributes to poor work-life balance and burnout.
Negative Leadership
Organizations have cultures defined and supported by leadership. When the leadership supports a negative culture it creates stress in the workplace.
Insufficient Rewards
People require tangible or intangible rewards to feel good about their work and prevent burnout. Money, security, satisfaction, and feeling of making a contribution are needed to help prevent burnout.
Limited Collaboration or Micro-Management
Sometimes burnout is a symptom of the business and not the PA-C. If your supervising physician hovers over your decisions or doesn’t ask for your collaboration in patient care or business decisions, it can feel as if you aren’t trusted and make it difficult to get the job done.
Symptoms of Burn Out
Burnout is a hazard of high achievers because of their “I can do it all” personality. This often leads to chronic stress levels, physical and emotional exhaustion, detachment, and a lack of accomplishment. In other words, a significant lack of well-being.
Burnout symptoms may arise in any of the following four areas:
- Depersonalization: Feeling alienated from work or home activities.
- Physical Symptoms: Bodily ailments such as headaches, chronic intestinal issues, or insomnia.
- Emotional Exhaustion: Feeling drained, unable to cope, and a lack of energy.
- Poor Performance at Work: Experiencing difficulty concentrating and feeling negative about work performance.
10 Questions To Ask Yourself If You Think You’re Burned Out
Identifying the signs of burnout may be challenging. Here are 10 questions to ask yourself if you think you might be burned out. Answer these questions honestly to help identify your stress levels and potential for burnout.
Have you become cynical or critical at work?
Negative emotions are a sign of burnout. You might have feelings of apathy, hopelessness, or an increase in irritability that accompanies burnout. You may feel a general sense that nothing around you is going right and nothing you do matters. As the feelings deepen you may get to a point where you wonder, “what’s the point?”
Do you feel exhausted or have your sleep habits changed?
Exhaustion is a sign you’re burned out. During times of high stress, you may find your sleep habits have changed and you’re either sleeping too much or too little. Both can increase feelings of burnout.
Do you find it hard to concentrate?
Cognitive issues can be a sign of burnout. In the early stages of burnout, you may find that you’re more forgetful than usual, or are struggling with impaired concentration. As burnout continues it may get to the point where it’s difficult to work.
Are you troubled by unexplained headaches, gut problems, or other physical complaints?
Physical ailments are not uncommon when your body is experiencing chronic stress, such as during burnout.
Do you drag yourself to work and have trouble getting started?
Lacking motivation is a sign of burnout. A lack of a sense of personal accomplishment, lack of enthusiasm, and difficulty getting up in the morning are all symptoms typical of burnout.
Do you think about your job, even when you’re not at work?
Obsessing over work is a symptom of burnout. If you’re having difficulty getting work off your mind and thinking about work even when you’re home, it’s a sign you are likely experiencing burnout.
Do you lack the energy to be consistently productive?
Slipping job performance can indicate you’re burned out. Physician assistants may experience a lack of productivity, poor performance, and an increasing number of medical errors.
Have you become irritable or impatient with co-workers, patients, familys, or friends?
An increase in interpersonal problems is a symptom of burnout. Burnout triggers feelings of isolation, detachment, and a general desire to be alone. You may depersonalize situations and feel resistant to socializing with friends or family.
Are you using food, drugs or alcohol to self-medicate?
Poor self-care is an indicator of burnout. As discussed above, unhealthy coping strategies are a part of poor self-care and can include smoking and over-exercising.
Do you lack satisfaction from your achievements?
A decrease in overall satisfaction with life isa big sign of burnout. Burnout may trigger reduced job satisfaction and problems with relationships, and friendships.
If you’re seeking a more clinical evaluation, consider the Maslach Burnout Inventory (MBI), as it uses measures from the World Health Organization’s definition of burnout.
The Maslach Burnout Inventory has several options, so look for the one specific to medical professionals. It will help measure emotional exhaustion, depersonalization, and a low sense of personal accomplishment.
Burnout Treatment for Healthcare Providers
Once the condition is recognized, it’s important to make changes to reduce the effects and get treatment.
Burnout is a cunning thief that robs your community of passionate professionals by stealing their enthusiasm and energy until there’s nothing left. Once you recognize the symptoms, you can take steps to make yourself a positive force once again.
Changing your lifestyle choices takes a little effort, but the results are well worth your energy. Taking a vacation does not change the issues and it only prolongs the problem unless you use this time to reformat your choices before going back to work.
Sleep and nutrition are two of the most important health strategies you can use to prevent and treat burnout.
Eating Habits
Begin by making changes to your eating habits. The food you eat fuels your cells, so seek out healthy, whole foods and ditch the processed, junk foods.
Avoid or eliminate processed sugar and sweets, and avoid foods that affect your mood, such as foods with chemical preservatives, hormones, or trans fats as well as caffeine. Eat more foods with omega-3 fatty acids, such as wild-caught Alaskan salmon, herring, mackerel, or sardines. Animal sources are the only way to get the EPA and DHA necessary for brain health. If you don’t like eating these types of fish, consider a supplement.
Sleeping Habits
Address any sleep issues you might have, and be sure to get plenty of quality sleep each night. Try to keep as much light out of the room as possible; this promotes your melatonin production and helps you sleep more deeply. Stick to a restful bedtime routine, which might include a warm bath before bed. Turn off your phone at night, or at least put it in another room.
Exercising Habits
Prioritize exercise because it lifts your mood, sharpens your focus, and improves your creativity. At least 30 minutes a day can maximize stress relief. Consider exercises such as walking, running, swimming, dancing, weight training, aerobics, or yoga. Be sure not to over-exercise, which can be used as an unhealthy coping mechanism.
Set Boundaries
Take inventory of your stressful situations and consider ways that you could modify them in order to reduce your stress levels.
Try to delegate as much as possible, even for a short time, as you work to balance your professional and personal life. Set boundaries in your life. It may be the first time, but it’s time to learn how to say “no.” At the end of each day, take a break from technology and set aside time to relax.
Communicate
Whether you feel like it or not, it is important to stay social and reach out to your friends, family, and partner to let them know what’s going on. Sometimes just verbalizing your feelings can help start the process of healing. Limit your time with people who have negative attitudes and bring you down.
As you put these strategies in place, it should help reveal your work environment more clearly, so you can make decisions on how to make changes. If these changes are not enough, it’s important to seek professional help to reduce your risk of significant consequences.
Prevent Burnout and Raise Job Satisfaction
Whether you have experienced it or not, it is never too late to take measures to prevent burnout from happening. Here are several steps to consider that will help you develop a plan to reduce your risk.
Rediscover Your Purpose
It goes a long way toward avoiding burnout if you can rediscover the driving force behind becoming a physician assistant and thus your purpose. By adding meaning to what you do, you have a greater potential of prioritizing your own care.
Think Giving and Not Receiving
The expression, “it is better to give than to receive,” speaks to the psychological benefit of thinking outside yourself. As a physician assistant, most of what you do every single day is giving yourself to others and providing excellent patient care.
However, small acts of kindness outside your professional role are energizing and help identify meaning in what you do. In the same way you give to others, it’s time to think about giving to yourself so you may regain some control over your well-being.
Learn to Identify and Manage Stress
Be ready to identify when you feel stressed, and understand your triggers. If you have a difficult time recognizing your physical symptoms of stress, consider asking family or friends to tell you what they see when you’re stressed. They will likely be happy to share.
Consider keeping a stress diary to record what you feel and when you feel it, as well as what you did to cope. This can help you identify poor coping strategies and learn to include healthy ones.
Consider practicing deep breathing, yoga, meditation, prayer, walking, exercise, or Emotional Freedom Techniques to manage your stress. Another excellent method is a gratitude journal where you write down everything you’re grateful for.
Doing this practice at the end of the day helps refocus your mind on the positive, and it serves as a gentle reminder of the good things that happen each day.
