In the fall of 2014, I led a focus group discussion at the Physician Assistant Education Association Conference called “Avoiding Leadership Burnout: How to Help Students Find the Balance.” This discussion brought back my own feelings and thoughts about PA school, and how it had seemed to be one of the more difficult times in my life.
I started to think to myself: Did I experience burnout? Did I notice the signs? If I did, would I have done some things differently? During my PA school career, I saw several issues going on with other classmates. Some had marriages fall apart; others had substance abuse issues, and we even had a fellow PA student who committed suicide. While these events cannot be directly attributed to attending PA school, we all felt the overwhelming stress and difficulty that medical education can contribute to your life.
It is widely accepted that PA school is challenging, hard and downright one of the most difficult things you’ll ever attempt. I’ve even heard it described as “taking a drink of water from a fire hose.” But as a student, you say to yourself, “I’ll be fine. It won’t really be as hard as they all say, and if it is, it will all be worth the sacrifices in the end.”
But will it be? And, do PAs or PA students really have to sacrifice themselves, their lives and their sanity to do what we all love—taking care of patients?
The old school, simple answer to these questions is “yes.” Yes, you must sacrifice yourself, your family, your friends and your life in order to be the absolute best person you can be, and in this case, the best PA you can be. I must admit, I used to be of that “old school mentality.” I was raised that way, as I’m sure many were. But in all my years as a clinically practicing PA, and now, as a PA educator, I’ve realized that that old school mentality is not the best mentality at all, and it may in fact do more harm than good.
An article published in 2014 in the journal, Academic Medicine, examined signs and symptoms of burnout among medical students and, I must say, the results were shocking! Approximately 40 to 50 percent of the medical students surveyed reported that they experienced signs and symptoms of burnout during their medical training. Another 58 percent screened positive for depression symptoms, and 10 percent showed signs and symptoms of suicidal ideation.(1)
I was floored. Over half of students were burned out or depressed, and almost 10 percent contemplated suicide? This is crazy … and we need to do something about it, before it’s too late!
So, what can we do about it? To figure out the answer to that question, let’s start with a better one: What is burnout? Burnout has been defined as “a state of mental exhaustion caused by ones professional life.” (4) It is often characterized by three components: emotional exhaustion (feeling overworked and overextended); depersonalization (becoming unfeeling in our response to our patients or peers); and a low sense of personal accomplishment and success.(3) Early recognition of the signs and symptoms is important. Prolonged periods of burnout have been thought to lead to depression, attrition, medical errors, substance abuse and an overall decreased quality of life.(3)
So, back to our original question: What can we do about it? For one thing, we can get rid of that “old school” mentality. We can lead by example to show that we can’t do everything, and we don’t have to sacrifice everything in our life in order to be successful. Also, we can learn about it. We can recognize the signs and symptoms of burnout and factors that contribute to it. Some common factors are work-home conflict, long work or school hours, high-performance expectations or feeling that we have little control over what we do. (3) And finally, we can take steps to combat it. Three widely accepted strategies include:
1. Balance personal and professional goals. (Clarify what is most important in your life and recognize conflicts and time management solutions.) (2)
2. Identify stressors and optimize meaning. (Find meaning in what we do as PAs and PA students; identify what energizes you and what drains you.) (2)
3. Determine wellness strategies (diet, exercise, mindfulness, stress reduction).(5,6)
As PAs and as PA students, we do a lot of patient education. We tell them to eat right, exercise and take care of themselves, both mentally and physically. And doing all of those things will lead to a balanced, healthy and happy life. I wonder: If this is ideal for our patients, why isn’t it ideal for us as PAs? That’s part of the reason I became a PA wasn’t it—to achieve work-life balance?
Looking forward to the future, I hope that the issue of student stress and burnout can be addressed and recognized by, not only PA educators, but PA students, preceptors and PAs alike—so that we can all achieve the ideal work-life balance.
1. Dyrbye LN, West CP, Satele D, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443-451.
2. Shanafelt TD, Oreskovich MR, Dyrbye LN, et al. Avoiding burnout: the personal health habits and wellness practices of U.S. surgeons. Ann Surg. 2012;255(4):625-633.
3. Surawicz CM. J. Edward Berk distinguished lecture: avoiding burnout: finding balance between work and everything else. Am J Gastroenterol. 2014;109(4):511-514.
4. Freudenberger H, Richelson G. Burn out: The high cost of high achievement, what it is and how to survive it. Bantam Books, New York, NY, 1980.
5. Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302:1284-93.
6. Beach MC, Roter D, Korthuis PT, et al. A multicenter study of physician mindfulness and health care quality. Ann Fam Med. 2013;11:421-8.
Jennifer M. Orozco MMS, PA-C, is director of clinical education at Rush University Department of Physician Assistant Studies in Chicago and director of PA clinical practice, Rush University Medical Center.