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Stouder A, Ayars CL. Burnout, Personal, and Occupational Factors as Predictors of Physician Assistant Faculty Intent to Leave After the COVID-19 Pandemic. J Physician Assist Educ 2024:01367895-990000000-00133. [PMID: 38595214 DOI: 10.1097/jpa.0000000000000579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
INTRODUCTION This study addressed whether burnout, personal, or occupational factors predicted physician assistant (PA) faculty intent to leave and established a new postpandemic national benchmark for PA faculty burnout and intent to leave. METHODS In spring 2023, a nonexperimental, cross-sectional survey was emailed to 2031 PA faculty drawn from program faculty listings and the PA Education Association member database. Descriptive statistics were used to describe the sample, and a multiple regression analysis was conducted to analyze the predictive ability of the independent variables on intent to leave. RESULTS The response rate was 30% (609 of 2031), with 496 responses (24.4%) included in the analysis. The sample reflected the population of PA faculty. The regression model significantly predicted intent leave (P < .001). The adjusted R2 was 0.46, indicating the combination of independent variables predicted 46% of the variance in PA faculty intent to leave. Significant predictors included emotional exhaustion and identifying as multiracial (P < .001), control and values (P < .01), and depersonalization, fairness, rewards, and clinical year faculty role (P < .05). The sample had moderate levels of burnout and experienced burnout at higher rates than in prepandemic studies. Physician assistant faculty in administrative leadership roles had the highest levels of burnout and intent to leave. Despite this, PA faculty intent to leave measures were similar to prepandemic levels. DISCUSSION Several of the predictive variables were related to well-being and social-emotional aspects of the workplace. These findings have implications for institutional policies and practices that support faculty well-being and workplace culture to enhance retention.
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Affiliation(s)
- April Stouder
- April Stouder, EdD, MHS, PA-C, is an associate professor, associate program director of Duke Physician Assistant Program, Durham, North Carolina
- Candace L. Ayars, PhD, is an associate professor, A.T. Still University, College of Graduate Health Studies, Kirksville, Missouri
| | - Candace L Ayars
- April Stouder, EdD, MHS, PA-C, is an associate professor, associate program director of Duke Physician Assistant Program, Durham, North Carolina
- Candace L. Ayars, PhD, is an associate professor, A.T. Still University, College of Graduate Health Studies, Kirksville, Missouri
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Drennen AV, Heard JC, D'Antonio ND, Kepler CK. PA and NP burnout in orthopedic surgery. JAAPA 2024; 37:1-5. [PMID: 38484304 DOI: 10.1097/01.jaa.0001007336.48746.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To quantify the burnout rate among physician associates/assistants (PAs) and NPs in a large orthopedic surgery practice affiliated with an academic institution. METHODS The Maslach Burnout Inventory (MBI) and original research questions were given to all PAs and NPs in orthopedics at the facility. Burnout was defined as a high level of emotional exhaustion or depersonalization on the MBI subscale. RESULTS Of the 129 PAs and NPs in orthopedics at our institution, 91 (70.5%) completed all survey items. Nearly 42% of respondents were burned out, as defined by high depersonalization or emotional exhaustion. PAs and NPs who met the burnout criteria were significantly older than those who did not (41.8 ± 10 versus 36.5 ± 7.71 years, P = .007) and spent longer in practice (12.4 ± 6.66 versus 9.35 ± 6.41 years, P = .01). CONCLUSIONS The prevalence of burnout is high among PAs and NPs in orthopedics who practice in an academic setting.
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Affiliation(s)
- Alexis V Drennen
- Alexis V. Drennen practices at the Rothman Orthopaedic Institute in Philadelphia, Pa. At the time this article was written, Jeremy C. Heard and Nicholas D. D'Antonio were research assistants at the Rothman Orthopaedic Institute. Mr. Heard is now a medical student at Thomas Jefferson University's Sidney Kimmel Medical College in Philadelphia, Pa. Mr. D'Antonio is now an orthopedic surgery resident at Cooper University Orthopaedic Surgery in Camden, N.J. Christopher K. Kepler is a spine surgeon at the Rothman Orthopaedic Institute. Dr. Kepler discloses that he receives royalties from Inion, Inc., and research support from RTI Surgical. The authors have disclosed no other potential conflicts of interest, financial or otherwise
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Huffman MK, McGuirt DR, Patil DM, Mattingly TJ. Exploring Pharmacy Student Experiences with Student Debt and Perspectives on Future Burnout and Loan Relief. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100134. [PMID: 37914462 DOI: 10.1016/j.ajpe.2023.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Pharmacy students with substantial educational debt are at risk for excessive workloads, burnout, and clinical errors. During the COVID-19 pandemic, policies addressing economic hardships for all student debt borrowers included temporary suspension of monthly payments and 0% interest during the pause. This study aimed to understand student-level factors regarding student debt from the lived experiences of current pharmacy students and aimed to understand how current pharmacy students view temporary loan relief. METHODS We used semi-structured interviews of pharmacy students across 4 years of progression in their pharmacy program to better understand student experiences with debt, different factors that may influence the impact of student debt on short-term and long-term outcomes for students, and student perspectives on debt relief policies and potential solutions. Our thematic analysis was grounded in existing evidence and a conceptual framework, while also allowing codes to emerge directly from the data. RESULTS A total of 20 pharmacy students were interviewed with a median student debt of $77,000, with debt amounts ranging from $0 to $209,000. Students described what mediating factors influenced their experiences, the influence of student debt on clinician burnout, and other outcomes impacted by student debt. Six overarching themes emerged relevant to current students: student debt influences education and career decisions, debt is risky given the saturated pharmacy market, debt is an accepted burden, debt will inhibit starting a life, the COVID-19 loan relief is revealing, and early financial education is needed. CONCLUSION Pharmacy students burdened with debt described a variety of different experiences and attitudes toward that debt and provided their perspectives on how student debt influences short-term education and career decisions. While students accept the trade-off of debt for their education as an inevitable burden, reported coping mechanisms and strategies shared suggest some solutions may be available to ameliorate this burden.
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Affiliation(s)
- Mary Katherine Huffman
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Delaney R McGuirt
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Divya M Patil
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - T Joseph Mattingly
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA.
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Kim M, Oh Y, Lee JY, Lee E. Job satisfaction and moral distress of nurses working as physician assistants: focusing on moderating role of moral distress in effects of professional identity and work environment on job satisfaction. BMC Nurs 2023; 22:267. [PMID: 37580762 PMCID: PMC10424341 DOI: 10.1186/s12912-023-01427-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/31/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Physician assistant was created in response to a shortage of physicians. However, this profession is not officially recognized in Korea. Many nurses are working as physician assistants. Their job satisfaction was low due to role conflict. Job satisfaction plays a major role in providing high quality nursing. This study aimed to investigate effects of work environment and professional identity on job satisfaction and identify the mediating role of moral distress in such effects. METHODS Participants were 112 nurses working as physician assistants. They were recruited from three General Hospitals. A questionnaire scale was used to collect data. Data were analyzed using frequency, descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation, and Macro Model 4 with SPSS Statistics. RESULTS Job satisfaction of nurses working as physician assistants had a score of 3.08 out of 5. It showed significant associations with work environment and professional identity. Moral distress had a partial mediating role in relationships of job satisfaction with work environment and professional identity. CONCLUSION Many nurses are working as physician assistants, although physician assistant as a profession is not officially recognized in Korea. Nurses working as physician assistants experience confusion about their professional identity and moral distress. For better nursing outcomes, physician assistant policy should be improved, and various strategies should be provided to improve their job satisfaction.
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Affiliation(s)
- Minsub Kim
- School of Nursing, Research Institute of Nursing Science, Hallym University, 1 Hallymdaehak-gil, Chuncheon, 24252, Gangwon-do, Republic of Korea
| | - Younjae Oh
- School of Nursing, Research Institute of Nursing Science, Hallym University, 1 Hallymdaehak-gil, Chuncheon, 24252, Gangwon-do, Republic of Korea
| | - Joo Yun Lee
- College of Nursing, Gachon University, Incheon, Korea
| | - Eunhee Lee
- School of Nursing, Research Institute of Nursing Science, Hallym University, 1 Hallymdaehak-gil, Chuncheon, 24252, Gangwon-do, Republic of Korea.
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Carey F, Newton PM. Career Development Needs of Physician Associates in the United Kingdom: A Qualitative Study. J Physician Assist Educ 2023; 34:123-129. [PMID: 37195249 DOI: 10.1097/jpa.0000000000000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
INTRODUCTION The physician associate (PA) profession is relatively new to the United Kingdom (UK) with the first UK-trained PAs graduating in 2008. Unlike other UK health professions, there is currently no well-established career framework after graduating as a PA. This pragmatic research aimed primarily to provide useful information for the future development of a PA career framework that will best support the career development needs of the PA profession. METHODS The current study used qualitative 1:1 interviews to understand senior PAs' aspirations, postgraduate education, career progression, development opportunities, and perceptions for a career framework. Where are they now? What are they doing? What are their expectations for the future? What subsequent changes do senior PAs think a career framework might bring to the profession? RESULTS Most PAs support a career framework and the opportunity to highlight and facilitate the PA's unique ability to transfer specialties; both generalist and specialized PA experience should be recognized. All participants supported a postgraduate standardization of PA practice citing patient safety and equal opportunities for the PA workforce. Furthermore, although the PA profession was introduced to the UK with lateral rather than vertical progression, the current study demonstrates the existence of hierarchical roles within the PA workforce. DISCUSSION A postqualification framework is needed in the UK, one that supports the current flexibility of the PA workforce.
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Affiliation(s)
- Frances Carey
- Frances Carey, M.Ost, MSc, Med Ed, is a PA student at Swansea University Medical School, Swansea, Wales, United Kingdom
- Philip M. Newton, is a professor at Swansea University Medical School, Singleton Park Campus, Swansea, Wales, United Kingdom
| | - Philip M Newton
- Frances Carey, M.Ost, MSc, Med Ed, is a PA student at Swansea University Medical School, Swansea, Wales, United Kingdom
- Philip M. Newton, is a professor at Swansea University Medical School, Singleton Park Campus, Swansea, Wales, United Kingdom
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Treusch Y, Möckel L, Kohlstedt K. Working conditions, authorizations, mental health, and job satisfaction of physician assistants in Germany. Front Public Health 2023; 11:1082463. [PMID: 36908456 PMCID: PMC9998044 DOI: 10.3389/fpubh.2023.1082463] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
Objective This study explores associations among the overall and facet-specific job satisfaction, work-related factors, responsibilities, and mental health of physician assistants (PAs) in Germany to identify factors that prolong the lifetime and wellbeing of PAs in practice and to counteract the shortage of healthcare staff. Methods An online survey comprising sociodemographic and work-related items, items from the short questionnaire of general and facet-specific job satisfaction (KAFA), and the Depression, Anxiety, and Stress Scale (DASS-21) were distributed to PAs working in Germany in 2021 (cross-sectional survey design). Descriptive statistics, DASS-21 subscale score analysis, t-test, ANOVA, or Kruskal-Wallis test was used. Results PAs (n = 169) were working mainly in surgery (23.2%), internal medicine (20.3%), or orthopedics and trauma surgery (17.5%), whereas only a few PAs were working in emergency care, geriatrics, neurology, or oncology. They were responsible for a broad spectrum of medical activities depending on the practice setting. PAs working in emergency care claimed to be the most empowered, followed by PAs in orthopedics and surgery. Almost all PAs carried out documentation, anamnesis, and diagnostic services. Although almost all PAs rated their overall job satisfaction as good, satisfactory, or pleasant (91.6%), single facets of job satisfaction were rated differently. Colleagues and supervisors were assessed very positively, whereas payment and professional activities were rated rather average and development opportunities even worse. PAs working in oncology demonstrated the highest overall job satisfaction, followed by PAs working in geriatrics and emergency care. Overall job satisfaction was significantly negatively associated with depression, anxiety, and stress scores (p ≤ 0.001, p ≤ 0.05, and p ≤ 0.05, respectively). Particularly, female gender, having an urban residence, and PAs working in oncology demonstrated significantly increased anxiety scores. Moreover, depression scores of PAs working in oncology or neurology or with a low net income exceeded critical cutoff values. Conclusion Interventions aimed at removing the significant negative correlation among job satisfaction, depression, anxiety, and stress scores are needed. To retain PAs in their jobs, salary, autonomy, and development opportunities should be improved and prevention programs for anxiety and depression should be offered. Remarkably, PAs' overall good job satisfaction was mainly determined by good evaluations of supervisors and colleagues.
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Affiliation(s)
- Yvonne Treusch
- Department of Health and Social Affairs, HSD University of Applied Sciences, Cologne, Germany
| | - Luis Möckel
- Department of Health and Social Affairs, HSD University of Applied Sciences, Cologne, Germany.,IU Internationale Hochschule GmbH, University of Applied Sciences, Düsseldorf, Germany
| | - Karin Kohlstedt
- Department of Health and Social Affairs, HSD University of Applied Sciences, Cologne, Germany
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Optimizing the productivity and placement of nurse practitioners and physician assistants in outpatient primary care sites. J Am Assoc Nurse Pract 2022; 34:1022-1032. [PMID: 36330553 DOI: 10.1097/jxx.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is increasingly imperative that organizational leaders continually assess nurse practitioners' (NPs) and physician assistants' (PAs) productivity, turnover, and vacancies. Optimizing the feasibility, impact, strategic placement, and monitoring increases patient access, improves wait times and affordability, and increases revenue. LOCAL PROBLEM A healthcare system needed a systematic, data-driven approach aimed at optimizing productivity and placement of NPs and PAs in outpatient primary care sites. METHOD Results from this project are reported using the Revised Standards for Quality Improvement Reporting Excellence framework. After formation of a QI team, a gap analysis, and action plans were developed and implemented. INTERVENTION/RESULTS Priority areas requiring action included the development of an integrated position justification algorithm and tracking form addressing NPs' and PAs' placement, establishing consistent patient contact hours, setting workload expectations, and consistently communicating these via an organization-specific situation background, assessment, and recommendation communication tool. CONCLUSION Health care leaders should leverage the talents of NPs and PAs meeting organizational benchmarks and goals as well as the needs of patients. Nurse practitioner and PA leaders should focus on benchmarking performance and analyzing barriers to optimization. These efforts are most beneficial when multidisciplinary in nature.
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Zaletel CL, Madura B, Metzel JM, Lancaster RJ. Optimizing the productivity and placement of NPs and PAs in outpatient primary care sites. JAAPA 2022; 35:41-49. [PMID: 35881717 DOI: 10.1097/01.jaa.0000840496.00307.5b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Organizational leaders must continually assess the productivity, turnover, and vacancies of physician assistants (PAs) and NPs. Optimizing the feasibility, effect, strategic placement, and monitoring increases patient access, improves wait times and affordability, and increases revenue. This quality improvement project sought to develop a systematic, data-driven approach to optimize productivity and placement of NPs and PAs in outpatient primary care sites. METHODS Results from this project are reported using the Revised Standards for Quality Improvement Reporting Excellence (SQUIRE) framework. Postformation of a quality improvement team, a gap analysis, and action plans were developed and implemented. RESULTS Priority areas requiring action included the development of an integrated position justification algorithm and tracking form addressing NP and PA placement, establishing consistent patient contact hours, setting workload expectations, and consistently communicating these via an organization-specific situation, background, assessment, and recommendation communication tool. CONCLUSIONS Healthcare leaders should leverage the talents of NPs and PAs meeting organizational benchmarks and goals as well as the needs of patients. NP and PA leaders should focus on benchmarking performance and analyzing barriers to optimization. These efforts are most beneficial when multidisciplinary in nature.
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Affiliation(s)
- Cynthia L Zaletel
- At Advocate Aurora Medical Group in Downers Grove, Ill., Cynthia L. Zaletel is a family NP and professional development specialist in the Office of Advanced Practice Clinicians, Brenda Madura is director of advanced practice clinicians for Illinois, and Julie Miyamasu Metzel is a family NP and advanced practice clinician consultant in primary care in the Office of Advanced Practice Clinicians. Rachelle J. Lancaster is nursing research manager and a nurse scientist in the Center for Nursing Research and Practice at Advocate Aurora Health. The author has disclosed no potential conflicts of interest, financial or otherwise
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Corby S, Ash JS, Mohan V, Becton J, Solberg N, Bergstrom R, Orwoll B, Hoekstra C, Gold JA. A qualitative study of provider burnout: do medical scribes hinder or help? JAMIA Open 2021; 4:ooab047. [PMID: 34396055 PMCID: PMC8358329 DOI: 10.1093/jamiaopen/ooab047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/07/2021] [Accepted: 06/07/2021] [Indexed: 12/01/2022] Open
Abstract
Objective Provider burnout is a crisis in healthcare and leads to medical errors, a decrease in patient satisfaction, and provider turnover. Many feel that the increased use of electronic health records contributes to the rate of burnout. To avoid provider burnout, many organizations are hiring medical scribes. The goal of this study was to identify relevant elements of the provider–scribe relationship (like decreasing documentation burden, extending providers’ careers, and preventing retirement) and describe how and to what extent they may influence provider burnout. Materials and Methods Qualitative methods were used to gain a broad view of the complex landscape surrounding scribes. Data were collected in 3 phases between late 2017 and early 2019. Data from 5 site visits, interviews with medical students who had experience as scribes, and discussions at an expert conference were analyzed utilizing an inductive approach. Results A total of 184 transcripts were analyzed to identify patterns and themes related to provider burnout. Provider burnout leads to increased provider frustration and exhaustion. Providers reported that medical scribes improve provider job satisfaction and reduce burnout because they reduce the documentation burden. Medical scribes extend providers’ careers and may prevent early retirement. Unfortunately, medical scribes themselves may experience similar forms of burnout. Conclusion Our data from providers and managers suggest that medical scribes help to reduce provider burnout. However, scribes are not the only solution for reducing documentation burden and there may be potentially better options for preventing burnout. Interestingly, medical scribes sometimes suffer from burnout themselves, despite their temporary roles.
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Affiliation(s)
- Sky Corby
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Joan S Ash
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Vishnu Mohan
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - James Becton
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Nicholas Solberg
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Robby Bergstrom
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Benjamin Orwoll
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Christopher Hoekstra
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey A Gold
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Patel PB, Hua H, Moussavi K. Burnout assessment at a college of pharmacy, college of optometry, and school of physician assistant studies. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:914-921. [PMID: 34294254 DOI: 10.1016/j.cptl.2021.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/20/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION There is limited research on burnout among students and faculty of health professions programs. This study was designed to assess burnout among students and faculty at a college of pharmacy (COP), college of optometry (COO), and school of physician assistant studies (SPAS). METHODS The Professional Quality of Life Scale (ProQOL) was distributed to faculty and students at Marshall B Ketchum University (MBKU) COP, COO, and SPAS. Scores for burnout, compassion satisfaction, and secondary traumatic stress were compared between programs, faculty, and students. RESULTS Median secondary traumatic stress scores were statistically higher for respondents (students and faculty) in the SPAS (24 [interquartile range (IQR) 17-27]) vs. respondents in the COP (20 [IQR 18-26]) and COO (19 [IQR 16-22]). Faculty had statistically higher median compassion satisfaction scores (41 [IQR 34-44]) vs. students (36 [IQR 32-40]), while students had statistically higher median burnout scale scores compared to faculty (27 [IQR 23-32] vs. 21 [IQR 17-26]). There was no difference in secondary traumatic stress between students and faculty, and there were no differences in compassion satisfaction or burnout between programs. CONCLUSIONS This study demonstrated that students in the COP, COO, and SPAS had higher burnout scores when compared to faculty at the study institution. These results suggest that efforts to address burnout should first focus on students. SPAS students and faculty may require specific efforts to address secondary trauma.
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Affiliation(s)
- Puja Baldev Patel
- Department of Pharmacy Practice, Marshall B. Ketchum University College of Pharmacy, 2575 Yorba Linda Boulevard, Fullerton, California 92831, United States.
| | - Henry Hua
- Department of Pharmacy Practice, Marshall B. Ketchum University College of Pharmacy, 2575 Yorba Linda Boulevard, Fullerton, California 92831, United States.
| | - Kayvan Moussavi
- Department of Pharmacy Practice, Marshall B. Ketchum University College of Pharmacy, 2575 Yorba Linda Boulevard, Fullerton, California 92831, United States.
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Nguyen OT, Shah S, Gartland AJ, Parekh A, Turner K, Feldman SS, Merlo LJ. Factors associated with nurse well-being in relation to electronic health record use: A systematic review. J Am Med Inform Assoc 2021; 28:1288-1297. [PMID: 33367819 PMCID: PMC8200260 DOI: 10.1093/jamia/ocaa289] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/09/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Although nurses comprise the largest group of health professionals and electronic health record (EHR) user base, it is unclear how EHR use has affected nurse well-being. This systematic review assesses the multivariable (ie, organizational, nurse, and health information technology [IT]) factors associated with EHR-related nurse well-being and identifies potential improvements recommended by frontline nurses. MATERIALS AND METHODS We searched MEDLINE, Embase, CINAHL, PsycINFO, ProQuest, and Web of Science for literature reporting on EHR use, nurses, and well-being. A quality appraisal was conducted using a previously developed tool. RESULTS Of 4583 articles, 12 met inclusion criteria. Two-thirds of the studies were deemed to have a moderate or low risk of bias. Overall, the studies primarily focused on nurse- and IT-level factors, with 1 study examining organizational characteristics. That study found worse nurse well-being was associated with EHRs compared with paper charts. Studies on nurse-level factors suggest that personal digital literacy is one modifiable factor to improving well-being. Additionally, EHRs with integrated displays were associated with improved well-being. Recommendations for improving EHRs suggested IT-, organization-, and policy-level solutions to address the complex nature of EHR-related nurse well-being. CONCLUSIONS The overarching finding from this synthesis reveals a critical need for multifaceted interventions that better organize, manage, and display information for clinicians to facilitate decision making. Our study also suggests that nurses have valuable insight into ways to reduce EHR-related burden. Future research is needed to test multicomponent interventions that address these complex factors and use participatory approaches to engage nurses in intervention development.
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Affiliation(s)
- Oliver T Nguyen
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Shivani Shah
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Arpan Parekh
- Prevention and Population Health Group, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, Maryland, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
| | - Sue S Feldman
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lisa J Merlo
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA
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Abstract
OBJECTIVE To understand the relationships between burnout, job satisfaction, and career plans among physician assistants in the United States. METHODS The authors surveyed PAs in 2016. The survey included the Maslach Burnout Inventory and items on job satisfaction and career plans. RESULTS Overall 82.7% of PAs were satisfied with their job, 32.2% indicated intent to leave their current position, and 19.5% reported intent to reduce work hours. On multivariate analysis, burnout increased the odds of job dissatisfaction, intent to reduce work hours within the next year, and intent to leave the current practice in the next 2 years. CONCLUSIONS About a third of PAs indicated intent to leave their current practice and one in five indicated intent to reduce their clinical hours. Burnout was an independent predictor of job satisfaction and career plans.
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Affiliation(s)
- Michael P Halasy
- Michael P. Halasy is an assistant professor in health care administration at the Mayo Clinic in Rochester, Minn. Colin P. West is a professor of medicine, medical education, and biostatistics and codirector of the Mayo Clinic Program on Physician Well-Being. Tait Shanafelt is a professor of medicine and associate dean of the Stanford (Calif.) University School of Medicine. Danielle J. O'Laughlin is an assistant professor in the Division of Community Internal Medicine, Department of Medicine at the Mayo Clinic. Daniel Satele is a statistician in the Department of Health Sciences Research at the Mayo Clinic. Liselotte N. Dyrbye is a professor of medicine and medical education and codirector of the Mayo Clinic Program on Physician Well-Being. Funding for this study was provided by the Mayo Clinic Program on Physician Well-Being. Funding sources had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The authors have disclosed no other potential conflicts of interest, financial or otherwise
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Lee B, McCall TC, Smith NE, D'Souza MA, Srikumaran D. Physician Assistants in Ophthalmology: A National Survey. Am J Ophthalmol 2020; 217:261-267. [PMID: 32360345 DOI: 10.1016/j.ajo.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the scope of practice and training of current physician assistants (PAs) in ophthalmology and gauge their interest in further training and involvement in ophthalmology. DESIGN Cross-sectional survey study. METHODS An anonymous survey on vision and ocular care in the PA profession was administered to PAs in ophthalmology within the American Academy of Physician Assistants member database. All survey questions were optional. RESULTS A total response rate of 47/94 (50.0%) was obtained. Respondents reported an average of 9.8 years (SD = 9.0) of experience as a PA in ophthalmology. Over half of the respondents (59.5%) did not have previous experience in vision and ocular health before becoming a PA. Most respondents (79.5%) reported that they are able to provide their primary clinical responsibilities for ophthalmic care independently. In addition to providing clinical ophthalmic care, many of the respondents have duties that involve consenting patients for ophthalmic surgery and procedures (62.5%) and assisting in ophthalmic surgery and minor procedures (65.0%). Only a minority of respondents independently perform procedures, such as intravitreal injections (23.1%) and minor lid procedures (38.5%). Most respondents reported interest in additional training in providing vision and ocular care (69.0%), in continuing their career as a PA in ophthalmology (87.5%), and in joining a specialty organization for PAs in ophthalmology (88.1%). CONCLUSIONS The PAs participating in this survey provide a range of clinical and some procedural ophthalmic care. The development of formal PA postgraduate training programs in ophthalmology may expand the pool of PAs qualified to practice ophthalmology.
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