by Jessica Spissinger, LICSW, PA-C, CAQ-Psychiatry

While the pandemic increased dialogue about mental health, one phrase in particular — burnout — has become embedded into our cultural consciousness.

Burnout is a colloquial term generally defined as a state of emotional, physical or mental exhaustion due to long-term stress. Although symptoms can present as clinical depression, burnout tends to have more of a specific psychological manifestation, typically a prevailing state of emotional dettachment and increased cynicism and a sense of futility. It’s usually tied to a specific situation like work or caregiving.

About half of U.S. workers experience daily stress, but this hits the health care industry especially hard. For PAs, this translates to resignations, changing specialties and even leaving their health care professions altogether.

According to NCCPA’s 2023 Statistical Profile of Board Certified PAs, 34.1% said they have one or more symptoms of burnout. While among PAs who intend to leave their primary clinical role within the next 12 months, 44.9% cited professional burnout as the reason.

To prevent burnout among PAs, we must recognize both systemic and individual stress factors. Institutions must acknowledge systemic issues such as high caseloads, long work hours (including covering longer shifts than expected) and lack of mentorship. The solution involves bolstering resources to prevent them from occurring. Employers must invest in clinicians, support staff and infrastructure to prevent overwork. Ongoing mentorship needs to be provided, recognizing that even seasoned clinicians benefit from peer supervision. It’s essential to protect clinicians’ sense of duty to provide care rather than exploiting it.

PAs can be proactive to protect their mental health by recognizing their vulnerabilities. Burnout can stem from feeling out of control over time, innate perfectionist or altruism, and internalizing challenging patient encounters. In certain clinical settings, ongoing exposure to chronic and acute illness, often coupled with repeated exposure to tragedies can take a toll. Witnessing colleagues and leadership compromising their moral integrity can be the tipping point for a PA already on the edge.

Steps PAs can take to be proactive and avoid settings where they may be vulnerable to burning out

When interviewing, take note of any red flags. Look for frequent department turnover, inability to maintain senior clinicians and productivity-based contracts.

Essentials in all settings include paid time off, medical leave and competitive market compensation.

Even after finding an ideal job, there is still more work to do to prevent burnout. The first line of defense is mastering your time management skills, ideally honed during PA school. Real self-care does not always mean getting a massage and burning a scented candle (though those are delightful!) Sometimes it means turning down extra shifts, even when they offer financial rewards.

PAs may consider eight self-care pillars: physical activity, emotional well-being, healthy nutrition, risk avoidance, good hygiene, health literacy, financial security and spiritual connection. Reflect on these areas, strive for balance and prioritize basic needs like sleep, exercise and your medical and dental needs. Self-care includes advocating for institutional change, which can look different for everyone depending on who they are and their circumstances. 

Balancing these eight pillars varies for each PA. If feeling overwhelmed, consider seeking out counseling via outpatient mental health practices and employee assistant programs (EAPs). While EAPs tend to help get people connected to help quickly, they are generally time limited. Outpatient counseling offers longer support. Alternatives to traditional counseling include life-coaches, personal trainers and complementary medicine such as reiki, acupuncture and massage.

Peer support groups such as Balint groups can also help by processing the difficult clinical content PAs are often exposed to and fostering community. These peer support groups can reduce the sense of individual isolation and boost morale. 

PAs must “walk the walk” and practice self-care in order to remain available to their patients. This includes establishing robust and healthy coping mechanisms to navigate stress. Incorporating movement and leisure activities into daily routines can help.

Remember the optimism that led you to PA school, and keep the long game in mind. You do not have to white-knuckle through burnout alone. Take that stress dial down a fraction or two and perhaps in doing so, you may pave a better path for future PAs.

Jessica Spissinger, LICSW, PA-C, CAQ-Psychiatry, is a Board Certified PA who graduated from Rosalind Franklin University in 2013 and has practiced in psychiatry ever since. She works in PA education as faculty instructor at Mass General Brigham Institute of Health Professions (MGH-IHP) and launched a post-graduate PA Accelerated Certificate in Psychiatry in Spring 2023. In addition, she is the current President of the Association of PAs in Psychiatry.