Burnout among PAs contributes to medical errors, mental health problems
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Burnout, work exhaustion and disengagement are prevalent among physician assistants and may lead to anxiety, depression and medical errors, according to findings published in the Journal of the American Academy of Physician Assistants.
Still, 53% of PAs reported moderate to high levels of professional fulfillment, Noël E. Smith, MA, senior director of PA and Industry Research and Analysis at the American Academy of Physician Assistants, and colleagues wrote.
“Burnout symptoms are key contributors to professional development and medical errors along with depression,” Smith told Healio Primary care. “This supports the growing body of evidence that burnout among all clinicians needs to be addressed by health care systems to optimize patient care and to support their staff.”
Smith and colleagues surveyed 880 PAs using an online questionnaire to assess several measures, including the Professional Fulfillment Index, Patient Health Questionnaire-2, and Generalized Anxiety Disorder Scale as well as depression measures and self-reported medical errors. Among the study cohort, the mean age was 38.9 years; the average duration of clinical practice was 10.6 years; and 70.6% of participants were women. Also, 24.9% of participants worked in a surgical specialty, 21.1% in primary care and 13.6% in internal medicine. Smith and colleagues employed two serial mediation models to ascertain the association between depression, burnout and professional outcomes.
The exhaustion and burnout scores ranged from 0 to 16, with a mean score of 5.6. Also, the interpersonal disengagement scores ranged from 0 to 24, with a mean score of 5.6. Higher scores correlated with greater burnout and disengagement, according to the researchers. They determined that 34.3% of participants experienced overall burnout, 45.9% experienced work exhaustion and 30.2% experienced interpersonal disengagement.
Professional fulfillment scores ranged from 0 to 24, with a mean score of 14.51. Medical errors ranged from 0 to 20, with a mean of 3.53; 80% of participants reported at least one error. Also, depression and anxiety scores ranged from 0 to six and 0 to 12, with mean scores of 0.79 and 4.5, respectively. Overall, 6% of participants exceeded the cutoff for depression and 12.6% for moderate to severe anxiety.
The researchers noted that depression influences feelings of professional fulfillment and medical errors, but these are also mediated by symptoms of burnout, specifically work exhaustion and interpersonal disengagement.
“When experiencing work exhaustion or interpersonal disengagement, one is more likely to make errors. For clinicians, the ramifications are greater than for other professionals,” Smith said. “One of the key things to remember is that PAs are self-reporting these errors and they may be holding themselves to a high quality of care. When they fail to meet that level, they consider that an ‘error’ in terms of how care may have been provided differently.”
This and other studies show that “burnout is a growing problem for PAs,” the researchers wrote. Burnout has also impacted other health care professionals, including physicians and medical students. Overall, clinician burnout contributes to “reduced clinician productivity and increased turnover, which leads to reduced patient access and increased system costs,” the researchers wrote.