Burnout can be isolating, but it is not solely an individual issue. Burnout is defined as a syndrome of emotional exhaustion exacerbated by chronic occupational stress, and burnout frequently occurs among PAs and other health care professionals.
“Burnout is an ongoing process — it never just goes away. So, it requires people to be constantly aware of it and constantly reevaluating what the organization is doing and how the employees are responding,” said Daytheon Sturges, PhD, MPAS, PA-C, DFAAPA, CHES®. Along with Quanté Greenlee, PhD, MPH, MHS, PA-C, RRT, CHES®, Dr Sturges discussed the variety of ways in which clinician burnout can be addressed at both the individual and organizational level during the American Academy of Physician Associates (AAPA) national conference held May 20 to 24, 2023, in Nashville, TN.
Inherently Stressful Workplaces
Drs Sturges and Greenlee outlined 6 domains of the work environment that affect burnout: workload, control, reward, community, fairness, and values. Clinicians have heavy workloads, may not have control of their schedule, may experience inequity in the workplace, and may experience disparities between performing assigned tasks vs preferred tasks.
To have an effective burnout mitigation strategy, Dr Sturges recommends that leaders have open communication with their employees to determine the best way to adjust each domain of the workplace to create an optimal working environment.
“Most of the time, burnout contributors will fall into one of these umbrella terms. You don’t have to do all domains at once, but you should work with people to say ‘What are your priorities right now as we continue to try to address burnout?,’ ” he said.
Creating a Tailored Burnout Intervention
While commonalities exist among health care professionals experiencing burnout, each individual has a different experience depending upon their practice setting and personal experiences.
“When you are developing interventions, it should cater to your organization, but you should also look at departments because not every PA does the same job,” Dr Greenlee said. “If you are doing primary care vs if someone is working in oncology vs if someone is working in the intensive care unit, there could be different factors that contribute to burnout.”
When departmental differences in burnout are delineated in the initial evaluation process, tailored strategies for addressing burnout become clearer to leadership.
Drs Greenlee and Sturges acknowledge that in some cases, employees in leadership positions may also be experiencing burnout, and conducting a full evaluation of burnout among junior employees could be unattainable for these leaders. In these instances, the presenters recommend leveraging external consultants to conduct a burnout evaluation and make recommendations to mitigate burnout.
An Organizational Issue Experienced Individually
Solely addressing burnout at the individual level, such as by practicing mindfulness, is a process that takes 2 days to 3 months, whereas organizational interventions take 2 to 6 months. While individual interventions play a role in stress reduction, workplace-wide changes are necessary to facilitate lasting improvement in burnout symptoms.
The desired outcomes in a burnout intervention should be to reduce stress and increase job engagement, which should result in increased self-efficacy for employees. “If communities are not empowered, they can’t really be effective because they don’t really feel like they have the tools or the skillset that need to address the problems that they have identified that need to be addressed within their organization or community,” Dr Greenlee said.
Detrimental Effects on Patients
Drs Sturges and Greenlee acknowledged that an increased prevalence of burnout among clinicians can lead to issues for patients with accessing care as clinicians leave patient-facing roles due to burnout.
Burnout can also affect quality of care, Dr Sturges explained. “Because people are emotionally exhausted, it could mean that even at the most cellular level of mental energy, they don’t have it to give, and that can lead to medical errors and negative medical health outcomes. It’s dangerous — you need to be well in order to make others well.”
Since clinicians do “people work,” they are at an increased risk for burnout because of the emotional exhaustion that comes with constant interaction with patients in stressful situations. “Compassion fatigue,” Dr Greenlee said, is a natural part of a heavy workload as a clinician. But when compassion fatigue is not addressed, the most vulnerable patients can experience detrimental effects.
“We talk about how patients can be depersonalized where they are labeled as frequent flyers if they are a patient who comes in and out of the hospital a lot, and so their concerns or their issues are not taken seriously,” Dr Greenlee said. “Oftentimes that can lead to medical errors because you just assumed that they are here for secondary gain when they actually have a true medical issue. Instead of seeing them as an individual and taking their complaint seriously, now you’ve missed a complaint because you are compassion fatigued. You just want to get it over with, get them out of the room, and see the next patient.”
Inequity and Burnout
Patients of color often experience depersonalization as a result of clinician burnout, Dr Greenlee said. But it is not just patients of color who experience disproportionate effects of clinician burnout — workplace inequity is a factor for clinicians of color.
The presenters stressed the importance of including questions and conversations about equity in the workplace in burnout evaluations to assess how clinicians of color are uniquely affected by heavy workloads and emotional exhaustion.
Drs Sturges and Greenlee mentioned one common pitfall to avoid in addressing workplace equity: when employees of color are asked to sit on diversity and inclusion task forces and take on an active role in addressing equity issues, this is another addition to their workload. The presenters urge leadership to keep an open dialogue with all employees and ensure that burnout mitigation measures do not unintentionally exacerbate burnout.
Conversations about equity and burnout were more common at the height of the COVID-19 pandemic than they are today, and Drs Sturges and Greenlee urged health care organizations to keep burnout in the conversation as it remains an ongoing issue for clinicians.
“There were a lot of conversations about health equity, justice, diversity and inclusion, and burnout.” Dr Sturges said. “Those had become the biggest buzzwords, and I want to believe that they were not only buzzwords and that they had some sustainability. I think it’s incumbent upon people like myself and Dr Greenlee to keep this conversation going and to give people tools to remind them that yes, this still exists.”
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- Sturges D, Greenlee Q. PA burnout, stress, and coping: recommendations for organizational success. Presented at: AAPA national conference; May 20-24, 2023; Nashville, TN.