Trend Toward Addressing Mental Health Earlier May Help
November 30, 2021
By Karen Finklea, PA-C, MHS, and Adam O’Neill, PA-C
Suppose we are, in our mind’s eye, to construct the image of a typical PA provider experiencing burnout. In that case, we might imagine a seasoned provider, under a mountain of administrative paperwork and charting, working late into the evening at a clinic that has left them feeling unappreciated and overworked for years. This may often be the case, and this requires our attention (see Blueprint for Addressing PA Well-being and Burnout), but it isn’t just the seasoned provider who experiences burnout.
Alarmingly, burnout occurs early, in some cases even before students graduate. Several literature reviews establish that not only providers, but medical students experience burnout.1-3 The same can be said for PA students, who experience a full medical education in as little as two years. Burnout is bound to occur equally, if not more significantly, for medical students.4-5 A 2018 study done on students throughout PA schools in Virginia showed that most students had higher levels of depression, anxiety, and overall emotional exhaustion than the general population.5 While this study was awaiting publication, faculty wrote a call to action to improve student well-being.6
Research teams are now working on the issue and we have seen an increase in attention to burnout and student well-being at conferences such as AAPA 2021 and webinars such as This Wasn’t in the PA School Brochure: How Students Are Staying Strong in the Time of Uncertainty.
Most definitions of burnout include some variation of the following: emotional exhaustion, reduced sense of competence, and depersonalization.4 The factors present in medical education which lead to these symptoms are apparent. They include the increased educational qualifications to become a PA (master’s level education), weekly high-stakes testing, large portions of the day spent in lecture, repeated exposure to new and increasingly challenging environments, uncertainties about the future, including what area of medicine to practice and where to practice, lack of diversity and inclusion within programs, and imposter syndrome (IP).
Most PA programs are at primarily white institutions where cultural competence is not adequately addressed. With 282 PA programs, the number of Black PA school applicants and accepted students has dropped.7-8 For those students who are accepted, having to compete with peers to stay at an equal or higher playing field takes a high mental toll. Medical education is a veritable growth medium for burnout among PA students.5 These factors play a role in burnout, leading to physical and mental ailments that are preventable. If these issues are not addressed, we are concerned that feelings of burnout will carry over into students’ first years as a PA.
There is hope for student and early career PAs. A national trend toward addressing the mental health of our medical providers has included, in small ways, an assessment of educational pedagogy and new hire onboarding processes. The National Academy of Medicine has a wealth of resources and information that are carefully curated. The Joint Task Force on Burnout at the AAPA has also curated materials for PAs and PA students. As we look to the future of medicine and the great need for medical care that PAs are so poised to fill, let us remember burnout occurs earlier than we would expect in our students and early career PAs.
If you are concerned that you may have feelings of burnout and/or mental health issues, we encourage you to reach out to a professional and/or avail yourself of the external tools provided by AAPA to learn more about nurturing yourself.
Karen Finklea, PA-C, MHS, and Adam O’Neill, PA-C, are members of the Early Career PA Commission.
- Cecil J, McHale C, Hart J, Laidlaw A. Behaviour and burnout in medical students. Medical Education Online. 2014; 19(1): 1- 9. doi: 3402/meo.v19.25209
- Ishak W, Nikravesh R, Lederer S, Perry R, Ogunyemi D, Bernstein C. Burnout in medical students: a systematic review. Clin Teach. 2013;10(4):242-245. doi: 10.1111/tct.12014. PMID: 23834570.
- Santen SA, Holt DB, Kemp JD, Hemphill RR. Burnout in medical students: examining the prevalence and associated factors. Southern Medical Journal. 2010;103(8):758-763. doi: 10.1097/smj.0b013e3181e6d6d4
- Blueprint for addressing physician assistant well-being and burnout. American Academy of Physician Assistants. Accessed March 15, 2021. https://www.aapa.org/download/65276/
- Johnson AK, Blackstone SR, Skelly A, Simmons W. The relationship between depression, anxiety, and burnout among physician assistant students: a multi-institutional study. Health Professions Education, 6(3), 420-427. doi.org/10.1016/j.hpe.2020.04.003
- Neary S, Bradley M, Roman C. A call to action: Physician Assistant student well-being. J Physician Assist Educ. 2019;30(3):133-134. doi:10.1097/JPA.0000000000000268
- LeLacheur S, Barnett J, Straker H. Race, ethnicity, and the physician assistant profession. JAAPA. 2015;28(10):41–45.
- Physician Assistant Education Association. By the Numbers: Program Report 35: data from the 2019 Program Survey, Washington, DC; 2020. https://paeaonline.org/wp-content/uploads/imported-files/program-report35-20201014.pdf. Accessed November 4, 2021.