The following article is a part of conference coverage from the American Academy of PAs 2021 Conference (AAPA 2021), held virtually from May 23 to May 26, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading PAs. Check back for more from AAPA 2021.


Burnout rates are high among PA leaders, who face similar challenges as their physician and nurse practitioner (NP) leader counterparts, according to survey findings presented at the American Academy of PAs 2021 Conference (AAPA 2021).1

To date, little data is available on the characteristics of PA leaders, despite the explosive growth of the profession in recent years and the 30% growth rate predicted within the next decade.

Continue Reading

Zachary Hartsell, DHA, PA-C, from the Wake Forest School of Medicine in Winston-Salem, NC, and colleagues surveyed PA clinical leaders to understand the relationship between leadership competency, leadership effectiveness, and professional burnout in this population.

A 23-question online survey was sent to all clinical PA leaders who were members of the AAPA’s special interest group PAs in Administration, Management, and Supervision. Eligible leaders were required to be in clinical practice in the US, with 25% or more of their time spent in a formal leadership role.

Investigators collected and analyzed data centered on demographics, professional burnout, and leadership effectiveness via validated survey instruments, as well as a 2-item competency assessment and 3 open-ended questions focused on professional barriers.

The total cohort included 100 survey respondents. Demographically, the majority of clinical PA leaders were women (59%), less than 30% held a business or management degree, and the most commonly reported workplace titles included “director” and “lead” (35% and 23%, respectively). Approximately 84% of respondents reported participating in some form of formal leadership development training. On average, the PA leaders worked 50.9 hours per week.

Leadership, Effectiveness, and Burnout Domains

Results of the investigators’ descriptive analysis found an average effectiveness score of 8.25 out of 10; mean burnout and competency scores were 2.69 and 3.65 out of 5, respectively. The analyses demonstrated a positive correlation between a PA leader’s perceived competency in leadership and that leader’s effectiveness but no correlation between burnout and either leadership competency or leadership effectiveness.

Completion of a formal leadership development program did not positively impact any of these 3 domains.

Five Practices of Exemplary Leadership Domains

Using the Leadership Practices Inventory (LPI), the investigators compared the current findings with data previously published in 2008 and 2018 on NP leaders and general leaders. The LPI is an empirical instrument to measure the Five Practices of Exemplary Leadership domains (ie, model the way, inspire a shared vision, challenge the process, enable others to act, and encourage the heart).2 Validation and reliability of the LPI are robust, and applicable across settings and study populations.

Across the 5 domains, PA leaders were generally on par with their NP and general leadership counterparts, with the largest difference between PA leaders and general leaders in the domain enable others to act (0.77 vs 0.83).

Common Themes

Commonalities across all responses indicated that PA leaders reported the need for “emotional intelligence, business skills, and strong interpersonal skills” to succeed in their roles. The PA leaders also reported common challenges including organizational culture, role recognition, and lack of organizational support.

“[T]he problems faced by PA clinical leaders are similar to those faced by physician leaders,” the authors wrote. “The PA leader’s self-perceived effectiveness was correlated with their overall competency. Neither competency nor self-perceived effectiveness impacted overall burnout, but burnout rates were found to be high.”

These data, they added, should guide organizations to consider reevaluating their processes to identify and manage PA leader burnout. Common solutions to this challenge — such as defined leadership structures and structured mentorship — may be of value, they said.

Future research should evaluate drivers for PA leader burnout and the role that leadership development program type plays on PA leader effectiveness, competency, and burnout, the study authors concluded.

Visit Clinical Advisor’s meetings section for complete coverage of AAPA 2021.


  1. Hartsell Z, Fick J, Lohenry K, Crandall S. The association between leadership effectiveness, burnout, and leadership competency in PA leaders. Poster presented at: American Academy of PAs 2021 Conference; May 23-26, 2021. Poster 202.
  2. Posner BZ. Investigating the reliability and validity of the Leadership Practices Inventory®. Adm Sci. 2016;6(4):17. doi:10.3390/admsci6040017