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Musings: Blog of the JAAPA Editorial Board


Blog of the JAAPA editorial board.

Monday, October 8, 2018

Beyond burnout

Brian T. Maurer, PA-C

In a recent research article, Coplan and colleagues looked at burnout, job satisfaction, and stress levels of PAs. Analysis of data gleaned from the 2016 American Academy of PAs salary survey shows that, in general, PAs experience modest levels of burnout at work. Nearly 57% of PA respondents rated spending too many hours at work as an important contributor to stress. Job dissatisfaction correlates with lack of opportunities for promotion, relatively low income given the level of clinical responsibilities, an inability to provide patients with the quality of care they need, too many bureaucratic tasks, increasing computerization of practice, too many difficult patients, and difficult colleagues or staff in the workplace.

Suggested strategies to reduce burnout and improve the work lives of clinicians include interventions to streamline workflows, strengthen teamwork, and promote flexibility and work-life balance.

In a separate opinion piece in STAT, Talbot and Dean take the issue of clinician burnout to another level, that of moral injury, defined as an inability to provide high-quality care and healing in the context of healthcare delivery.

“[B]urnout is itself a symptom of something larger: our broken health care system,” they write. “The increasingly complex web of providers’ highly conflicted allegiances—to patients, to self, and to employers—and its attendant moral injury may be driving the health care ecosystem to a tipping point and causing the collapse of resilience.”

In their opinion “without understanding the critical difference between burnout and moral injury, the wounds will never heal and physicians and patients alike will continue to suffer the consequences.”

Talbot and Dean argue that establishing clinician wellness programs won’t solve the problem. “Nor will pushing the solution onto providers by switching them to team-based care; creating flexible schedules and float pools for provider emergencies; getting physicians to practice mindfulness, meditation, and relaxation techniques, or participate in cognitive-behavior therapy and resilience training.”

Instead, they propose “[a] truly free market of insurers and providers, one without financial obligations being pushed to providers, [to] allow for self-regulation and patient-driven care.”

In a subsequent STAT opinion piece, Morris-Singer, Pollack, and Lewis offer an additional take on addressing the issue of healing moral injury:

“While the sources of professional dissatisfaction vary, the sources of fulfillment are consistent: It’s all about connection—to patients, to colleagues, and to the calling of medicine. Indeed, nearly three-fourths of providers view their relationships with patients as the most meaningful part of their work.

“[U]niting and building community must be the first step” in the process of healing moral injury.

Brian T. Maurer has practiced general pediatrics for more than 30 years. He is the author of Patients Are a Virtue and blogs at The views expressed in this blog post are those of the author and may not reflect AAPA policies.