COMMENTARY

Encouraging Resilience and Grit May Be Fueling PA Burnout

Talia Sierra

Disclosures

November 04, 2022

For several years, Medscape has published an annual report on physician depression and burnout. In October, they released their first Physician Assistant Burnout Report. Having worked in the field of physician assistant (PA) burnout advocacy and research, it is brutally apparent that research and awareness in this area is scarce, particularly when compared with other clinician roles.

One of the main highlights of the report indicates that 37% of PAs reported being burned out, 6% reported depression, and 26% claim to experience both depression and burnout. The depression rate is lower than it was for a similar study in which I participated. Though some rates may differ between our study and Medscape's, the latter adds valuable information to an area in which data are limited and allows us to delve further into this area.

The Medscape report revealed that part-time employees ranked their burnout as more severe when compared with full-time employees. Though this may seem counter-intuitive at first, we know that as employees become burned out, they are more likely to reduce their employment status from full-time to part-time.

When we feel burned out, we view work as the offending agent or the threat that is causing the distress. We also perceive that we have no control over administrative decisions, our schedule, patient load, etc. Our jobs become a threat that we cannot control or change, and when this happens, our drive for self-preservation kicks in. Because we can't change the work environment, our only option becomes to limit our exposure to the "threat" and, subsequently, reduce our full-time status to part-time.

PAs consistently report high rates of job satisfaction while simultaneously reporting high rates of burnout. This is probably owed to the satisfaction and enjoyment that we gain from patient interactions and building positive relationships with our patients.

However, bureaucratic tasks such as documentation, attendance in committees, and other responsibilities often consume a large portion of our days. We gain less satisfaction from these activities. After all, no one said that they wanted to go into medicine so that they could do billing and charting, and these activities can consume a large percentage of the workday, leading to burnout. Unsurprisingly, bureaucratic tasks were reported to contribute most to PA burnout, according to the Medscape report.

One of the unique characteristics of this report is that it touches on personality type. I am often questioned about personality when it comes to considering burnout, and it's always a thought-provoking issue. Most clinicians have been told at one point or another that we need to increase our resilience or grit. This always makes me cringe because it places the burden of burnout on our shoulders and demonstrates a lack of understanding of the problem at large if it is not combined with systemic changes. While increasing grit and resilience have proven helpful in preventing burnout, without systemic interventions, it fails to address the root of the problem.

Instead of burnout resulting from a lack of resilience, those with high resilience may be at highest risk for burnout. They are most likely to over-dedicate themselves and to persevere despite warning signs telling them to stop, leading to their burnout. Those with less grit or resilience would simply stop before reaching significant burnout.

To this point, studies have shown that clinicians have greater resilience than does the general US population but still suffer from burnout at substantial rates. And although medical students have lower rates of burnout at the beginning of medical school when compared with their peers who are pursing nonmedical careers, once medical school begins, their burnout rates increase and surpass that of their nonmedical career–seeking peers.

In other words, when we take the most resilient people and put them in a system that pushes them to the breaking point, the problem is not the individual. Interventions focusing solely on increasing resilience miss the mark as the biggest impact is going to be seen by implementing systemwide interventions.

We should also keep in mind that, by default, PAs are groomed to take on excessive workloads, overcommit, and overachieve. Because entrance into PA programs is highly competitive, we have to find a way to stand out in a crowd of other high-achieving adults. To get into a PA program we have to demonstrate our altruistic nature through volunteer work, have significant healthcare experience, and shadow other PAs, all while performing at the top of our class. That doesn't include making time for family and friends.

Further, this pattern continues once we get into a PA program. We survive rigorous course loads, are inundated with exams, and must meet extremely high expectations, which means these high-achieving, hard-working behaviors continue to be reinforced in our educational programs, with very little breaks. We don't have the option to say, "I need to slow down," and these personality traits follow us into our careers.

We are in desperate need of sustainable systemwide change. Awareness is the first step in this direction, which the Medscape report draws attention to — a part of the profession that was previously overlooked. The report provides an opportunity for healthcare administrators and clinicians to come together to create meaningful and lasting changes to the healthcare system.

Talia Sierra, PA-C, is an associate professor in the PA program at Idaho State University and Co-founder of the nonprofit The Burn Clinic, which offers education, prevention, and treatment of burnout for healthcare providers and students.

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