Robin Zon, MD, FACP, FASCO, ASCO Expert
“While it is reassuring that Physician Assistants (PAs) in oncology report high levels of satisfaction in their profession, they also experience high-rates of burnout in a manner similar to oncologists. This study can provide important guidance for the field as the number of PAs in oncology increases with the growing prominence of team-based care. The collaboration of an entire team—from the front desk to the PAs to the institutional leaders—is critical to patient and provider satisfaction.”
A new Physician Assistant (PA)-based study finds that despite personal satisfaction in the oncology specialty, high rates of burnout –over one third of PAs (34.8%)—are common. These findings reveal important factors that could help to decrease burnout and improve the oncology workforce dynamics, including the relationship between PAs, collaborating physicians, and the care team. The study was published today in the Journal of Oncology Practice (JOP).
Team-based care in oncology is growing in prominence to both overcome current health care and workforce challenges and to improve the delivery of care for patients with cancer. PAs have become an integral part of these teams.
PAs are nationally certified and state-licensed medical professionals that practice medicine on healthcare teams with physicians and other providers. PAs in oncology dedicate a significant amount of time to patient care duties, including exams, tests, treatment plans, prescribing, and diagnosing medical problems. PAs provide medical services and care that a physician would typically provide. They also involve the physician when needed, providing flexibility to respond to patients’ varying needs. In some cases, PAs may also fill administrative, research, or educational roles.
“Physician Assistants are in most cases satisfied with the work they are doing—they find it challenging, yet very rewarding,” said study author Eric Tetzlaff, MHS, PA-C, DFAAPA of Fox Chase Cancer Center. “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.”
About the Study
In a 2014 study of burnout in oncologists published in the Journal of Clinical Oncology, 44.7% experienced symptoms of burnout.[i] The new study published in JOP is the first national study to explore rates of burnout and career satisfaction specifically among PAs in oncology.
The findings are based on survey of 855 PAs (response-rate 29.2%) representative of the PA workforce in oncology. Surveyed PAs were affiliated with the Association of Physician Assistants in Oncology (APAO) through an APAO continuing education conference or an APAO email survey using the Maslach Burnout Inventory (MBI), a leading standard for measuring burnout. The MBI assesses key aspects of burnout: emotional exhaustion, depersonalization, and personal accomplishment.
Though career satisfaction was 86.4% and specialty satisfaction was 88.8%, burnout was reported in 34.8% of PAs. Time spent on indirect patient care tasks, oncology subspecialty, (medical, surgical, radiation, and pediatric) and the relationship between a PA and the collaborating physician emerged as factors associated with burnout.
The individual subscales of the MBI found:
- 30.4% reported high emotional exhaustion
- 17.6 reported high depersonalization
- 19.6% reported a low sense of personal accomplishment
PAs who spent more time on indirect patient care in areas such as phone calls, reviewing labs, charting were also at a greater risk of burnout. Compared to those who did not report burn out, PAs who did reported spending a lower percentage of time on direct patient care (60.0 % vs. 70.0%; p=0.005) and a greater percentage of time on indirect patient care (25.0% vs. 20.0%; p < 0.001).
Additionally, burnout was more likely to be reported by those 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.
However, over the next two years, only 3.6% of PAs plan to pursue a different career or specialty and only 2.0% plan to retire.
With workforce shortages looming in oncology, PAs have been identified as an important part of the solution to meeting the demand for cancer care. The study authors hope to build upon their exploration of PA roles and further study burnout in the context of a team. Future areas of research may include exploring relationships in a more multidirectional manner, including physicians’ perspectives on the PA / MD collaborative relationship to learn more about team dynamics, as well as looking at other drivers of burnout.
“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,” said Mr. Tetzlaff. “Supportive relationships lead to less burnout and represent an important modifiable factor that can strengthen the oncology workforce.”
[i] Shanafelt TD, Gradishar WJ, Kosty M, et al: Burnout and career satisfaction among US oncologists. J Clin Oncol 32:678-86, 2014