Over one third of physician assistants (PAs) working in oncology in the United States report fairly high levels of burnout even though they are generally happy with their career and choice of specialty, the first national survey of its kind suggests.
“Physician assistants are in most cases satisfied with the work they are doing — they find it challenging, yet very rewarding,” lead author, Eric Daniel Tetzlaff, MHS, Fox Chase Cancer Center, Philadelphia, Pennsylvania, said in a statement.
“Our research suggests, however, that there are several gaps we need to address to strengthen team relationships, better define roles and responsibilities and reduce burnout,” he added.
“By understanding the personal and professional characteristics associated with burnout, meaningful changes and modifications in team-based care design can be implemented to lead to more effective care delivery,” Tetzlaff suggested.
The study was published online November 30 in the Journal of Oncology Practice.
For the survey, the researchers used the membership database of the Association of Physician Assistants in Oncology as well as registration data from the 18th annual APO continuing medical education conference to identify participants.
Of 855 members contacted, 250 responded to the survey. To assess the level of burnout, researchers used the standard 22-item Maslach Burnout Inventory (MBI), a well-recognized questionnaire designed to measure professional burnout.
All respondents were currently in some form of oncology practice in the United States. Almost all were female, and most were married. The mean age of respondents was 41.8 years.
“On average, participants had been a PA in oncology for 9.6 years,” the study authors note.
“Overall, 34.8% of oncology PAs had MBI scores that indicated professional burnout (ie, high scores on either the emotional exhaustion and/or depersonalization subscales),” the researchers report.
Specifically, on different subscales, 30.4% of respondents indicated they were experiencing high levels of emotional exhaustion.
Another 17.6% reported feeling high levels of depersonalization, while almost 20% reported feeling a low sense of personal accomplishment.
The degree to which PAs engaged in different professional activities also affected the risk for burnout, with direct patient care being associated with a significantly lower risk compared with indirect patient care, such as phone calls, reviewing laboratory results, and charting.
Table. PA Engagement in Different Professional Activities
| Activity | PAs With Burnout (%) | PAs Without Burnout (%) | P Value |
|---|---|---|---|
| Direct patient care | 60 | 70 | .005 |
| Indirect patient care | 25 | 20 | <.001 |
Whether participants felt they were “fairly compensated” also affected burnout risk. Fewer than 20% of PAs who felt compensation was fair reported burnout, whereas among those who “strongly disagreed” that they were being fairly compensated, the percentage rose to 65% (P < .001).
In contrast, “there were no significant differences in the reporting of burnout for PAs with respect to sex, relationship status, years as a PA in oncology, compensation model, and practice settings,” the researchers observe.
Noteworthy was the finding that over 86% of respondents indicated they were satisfied with their career, and almost 89% indicated that they were satisfied with their choice of specialty.
Furthermore, only 3.6% of survey respondents indicated they planned to switch careers or specialty over the next 2 years and only 2% indicated they planned to retire within the same time interval.
Burnout Risk
The relationship between a PA and their collaborating physician (CP) also affected burnout risk.
For example, “PAs who did not feel valued by their collaborating physician, did not feel encouraged to achieve professional goals, or whose contributions to the practice were not acknowledged by their CP were more likely to be burned out,” the authors observe.
How well a PA felt the CP could provide leadership guidance also significantly affected the risk for burnout as well.
“It is recognized that using PAs results in increased efficiency and productivity for the practice,” study authors observe.
“[But] the rate of burnout is of significant concern because the wellness of providers has been associated with quality of care and patients’ safety,” they add.
[I]f burnout is not addressed, the impact of PAs to help meet the demand for oncology care may be hindered.
“[I]f burnout is not addressed, the impact of PAs to help meet the demand for oncology care may be hindered,” the researchers conclude.
Study authors stress that strategies to improve collaboration between members of the oncology team might help reduce the risk for burnout.
“Supportive relationships lead to less burnout and represent an important modifiable factor than can strengthen the oncology workforce,” Tetzlaff emphasized.
Commenting in a statement on the survey findings, Robin Zon, MD, an expert spokesperson from the American Society of Clinical Oncology, felt that survey findings can provide important guidance for the specialty as the number of PAs working in oncology increases with growing demand.
“While it is reassuring that PAs in oncology report high levels of satisfaction in their profession, they also experience high rates of burnout in a manner similar to oncologists,” Dr Zon said.
“The collaboration of an entire team — from the front desk to the PAs to the institutional leaders — is critical to patient and provider satisfaction,” she added.
A study published in 2014 found that almost 45% of oncologists surveyed in the United States reported feelings of burnout.
Mr Tetzlaff and Dr Zon have disclosed no relevant financial relationships.
J Oncol Pract. Published online November 30, 2017. Abstract
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