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


PAs who have work exhaustion and a lack of interpersonal engagement are more likely to disengage from their job, consider reducing their hours, or ultimately quit, according to a poster presented at the American Academy of PAs 2021 Conference (AAPA 2021).

One of the hallmarks of the PA profession is providing patients with team-based health care. In these settings, both the safety and quality of care depend on teamwork and communication. Negative workplace culture, disrespectful behavior, incivility, and interpersonal toxicity can all lead to medical errors and higher care costs, explained Timothy C. McCall, PhD, and Noël E. Smith, MA, of AAPA.

Continue Reading

In these types of environments, the presenters noted, clinicians may take steps to disengage or seek new employment, increasing the employer’s burdens associated with turnover and lost productivity. Researchers sought to determine if the interpersonal workplace environment is associated with PAs who feel more disengaged, who put in fewer work hours, who reduce work commitments, or who quit.

Study Based on AAPA Salary Survey

Participants included 7377 PAs who completed the 2019 AAPA Salary Survey questions pertinent to this research.

In order to predict the odds of PAs becoming more disengaged, reducing hours, or quitting, the researchers included data on gender, race, ethnicity, years of experience, primary specialty area, leadership roles held, employer satisfaction, relationship with collaborating physician, and 3 different subscales — professional fulfillment, work exhaustion, and interpersonal disengagement — as well as the Professional Fulfilment Index (PFI).

Overall, the researchers found higher odds of a PA disengaging, reducing hours, or quitting if a PA was interpersonally disengaged, had work exhaustion, was in either a formal or informal leadership role, or was a woman. Lower odds were noted if a PA had higher employer satisfaction ratings and a more positive relationship with their collaborating physician (Table).

Table. Likelihood to Consider Becoming Disengaged, Reducing Work Hours, or Quitting

FactorOdds Ratio (CI)
Higher Odds 
Formal leadership role2.0 (1.51-2.63)
Informal leadership role1.62 (1.34-1.96)
Exhausted2.82 (2.34-3.41)
Disengaged1.73 (1.39-2.17)
Lower Odds 
Satisfaction with employer0.47 (0.43-0.52)
Relationship with collaborating MD0.60 (0.53-0.67)
Gender (male)0.79 (0.64-0.94)

Lower odds of reducing work hours or quitting were also associated with professional fulfillment (odds ratio, 0.70 and 0.51; 95% CI, 0.49-0.995 and 0.36-0.71, respectively).

Future research on this topic should strive to understand the systemic factors behind these outcomes, explore interactions between personal and professional factors, and investigate the relationship between PA well-being, patient outcomes, and performance of the health care system, the researchers noted.

“Health care organizations must address the behaviors that lead to a negative workplace environment to ensure the best outcomes for (1) their patients; (2) their providers; and (3) their bottom line,” the researchers concluded.

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


McCall TC, Smith NE. Workplace culture and employee turnover: Predictors of PA intentions to disengage, reduce hours, or quit. Presented at: American Academy of PAs 2021 Conference; May 23-26, 2021. Poster #131.