Morale and Burnout Among PAs: Examining Perceptions Over Time

Morale and Burnout Among PAs Examining Perceptions Over Time AAPA Research 11/25/202 5 Morale and burnout among PAs: Examining perceptions over time 2 | 1 8 © Copyright 202 5 American Academy of Physician Associates. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise without the express written permission of AAPA. Table of Contents Abstract ................................ ................................ ................................ ................ 3 Methodology ................................ ................................ ................................ ............................... 3 About PAs ................................ ................................ ................................ ................................ 3 About AAPA ................................ ................................ ................................ ............................. 3 How to Cite ................................ ................................ ................................ ................................ .. 3 Executive Summary ................................ ................................ ............................. 4 Overall sentiment: Thoughts on the state of the PA profession and healthcare .................... 4 Outlook on healthcare and the PA profession by gender ................................ ..................... 5 Satisfaction and Burnout in the PA profession ................................ ................................ ......... 6 PA burnout by gender and specialty .............................................................................................. 8 Conclusion ................................ ................................ ................................ ................................ .. 9 Data Tables ................................ ................................ ................................ ........ 10 Table 1. PA feelings on the current state of the PA profession, by year ................................ 10 Table 2. PA feelings on the future of the PA profession, by year ................................ ........... 10 Table 3. PA feelings on the future of healthcare, by year ................................ ........................ 11 Table 4. PA feelings on the profession and healthcare system, by gender and year ............ 11 Table 5. PAs employer satisfaction, by year ................................ ................................ ............ 12 Table 6. Employer satisfaction by year and employer type ................................ .................... 13 Table 7. PAs perceived level of burnout, by year ................................ ................................ ..... 14 Table 8. Stanford PFI measures by year and gender ................................ .............................. 15 Table 9. Stanford PFI measures by year and specialty area ................................ ................... 16 References ................................ ................................ ................................ .......... 18 Morale and burnout among PAs : Examining perceptions over time 3 | 18 © 202 5 American Academy of Physician Associates. All rights reserved. Not for distribution or reproduction. Abstract PAs experience burnout, and this stressor can lead to impacts on wellbeing, productivity, and patient care . However, levels of morale, burnout, and employer satisfaction among PAs can fluctuate over time . In this report, we provide a brief overview of factors related to PA perceptions o f morale and burnout from survey data collected between 2019 and 2025 . Methodology Data were collected from PAs in the United States (U.S.) who had not opted out of AAPA research surveys for which AAPA had a valid email address. A series of questions related to PAs experiences of burnout and morale have been included in AAPA’s Salary and PA Practice Survey in some form from 20 19 to 2025 . The overall margin of error varies by section , breakout , and data collection . “N” refers to the number of respondents and is generally the first column in the data tables. Totals may not equal 100% due t o rounding. Th e survey items reported in this publication were deemed exempt by Sterling IRB (project ID: 11613) as a Category 2 exemption in accordance with US Department of Health and Human Service's Policy for Protection of Human Research Subjects listed at 45 C.F.R. §46.104(d). The author has no conflicts to report. About PAs PAs (physician associates) are licensed clinicians who practice medicine in every specialty and setting. Trusted, rigorously educated and trained healthcare professionals, PAs are dedicated to expanding access to care and transforming health and wellness t hrough patient - centered, team -based medical practice. A PA’s specific duties depend on the settings in which they work, their level of experience, and state law. There are approximately 190,000 PAs in the United States, who engage in more than 514 million patient interactions each year. To learn more about PAs, visit aapa.org . About AAPA Founded in 1968, AAPA is the national professional society for physician associates/assistants (PAs). It represents a profession of approximately 190,000 PAs across all medical and surgical specialties in all 50 states, the District of Columbia, U.S. territories, and the uniformed services. PAs are licensed clinicians who practice medicine in every specialty and setting. Trusted, rigorously educated and trained healthcare professionals, PAs are dedicated to expanding access to care and transforming health and wellness through patient -centered , team -based medical practice. In 2025, U.S. News & World Report named PA the #3 Best Job across all occupations, the #2 Best Health Care Job, and the #3 Best STEM Job. Learn more about the profession at aapa.org and engage through Facebook , LinkedIn , Instagram , and X (formerly known as Twitter). How to Cite Morale and burnout among PAs : Examining perceptions over time . 202 5. American Academy of Physician Associates. Alexandria, VA. https://doi. org/ 10.5281/zenodo.17715680 . Morale and burnout among PAs : Examining perceptions over time 4 | 18 © 202 5 American Academy of Physician Associates. All rights reserved. Not for distribution or reproduction. Executive Summary Like all healthcare providers, physician associates (PAs) experience burnout. Prior research has documented how burnout can influence wellbeing, productivity, and patient care across all providers and PAs specifically. Although PAs often report high levels of professional morale and employer satisfaction approxi mately 12% indicated leaving a job in 2018. 1 Few workplace concerns impact a PA as much as burnout. Experiencing burnout makes it more likely that a PA will reduce their clinical hours and express an interest in leaving their position. 1-3 Data from 2025 indicates that approximately 34% of PAs are experiencing burnout .4 While feeling satisfied at work and maintaining a sense of work -life balance has previously been found to help mitigate the likelihood of experiencing burnout, a decline in workplace conditions – such as what providers encountered during the COVID -19 pande mic – could offset these positive influences. In this report, we pick up the trends of morale and burnout as collected within AAPA surveys from 2019 through to 2025 to evaluate emerging t rends and flag potential areas of concern. Overall sentiment: Thoughts on the state of the PA profession and healthcare PAs generally feel positive and optimistic about the PA profession . In 2019 – the initial year data was collected – over nine in 10 PAs (93%) indicated they were either optimistic or somewhat positive/optimistic about the current state of the profession . However, there has been a slight decline in this proportion between 2019 and 2025 . In our most recent data, the proportion reporting feeling positive was approximately 83% . These numbers were at their lowest during the COVID -19 pandemic when just over 81% h ad an optimistic outlook (Table 1, Figure 1) . Figure 1. Overall morale and feelings related to the PA profession (2019 -2025) 92.9 87.0 82.0 81.2 81.1 81.9 82.6 0 25 50 75 100 2019 2020 2021 2022 2023 2024 2025 Proportion Indicating Optimistic (%) Survey Year Morale and burnout among PAs : Examining perceptions over time 5 | 18 © 202 5 American Academy of Physician Associates. All rights reserved. Not for distribution or reproduction. A similar trend was also observed over the data period for PA’s thoughts on the future of the PA profession. Again, a vast majority of PAs are optimistic about the future – ranging from 92% in 2019 to 81.1% in 2025. At its lowest in 2022, almost four in five PAs (78.8%) still had a positive outlook on the roles PAs would play in the future of healthcare. However, it is important to note that optimism for the future of the profession did not have the same post - COVID rebound in the 2025 data that was present in respondents’ feelings about the current state of the profession. While these differences were not statistically significant, they do reflect a trend that should be monitored as PAs continue to experience regulatory and organizational challenges during t heir clinical practice (Table 2, Figure 2). Figure 2. Percent of P As optimistic about the future of the PA profession (2019 -2025) 2019 2020 2021 2022 2023 2024 2025 92% 85 % 81% 79% 81% 82% 81% Unlike their views on the PA profession, survey respondents from 2019 -2025 had an increasingly pessimistic view of the future of healthcare. A statistically significant logistic regression indicated PAs were 26 times more likely to indicate being pessimist ic for each one-year increase in the data collection period. In 2019 less than half (44.1%) of PAs were pessimistic about the future of healthcare, but this has only increased each year. Almost seven in 10 PAs (68.7%) had negative views on the future of he althcare in 2025, and this figure is projected to reach almost 80% by 2027 (Table 3, Figure 3). Figure 3. Percent of PAs pessimistic about the future of healthcare over time Outlook on healthcare and the PA profession by gender Generally, male and female PAs had similar levels of optimism in their feelings about the current state of the PA profession, the future of PAs, and the future of healthcare. However, there were some interesting trends across the data years. For example. T here were multiple instances where female PAs reported substantially lower levels of optimism related to the future of healthcare. In 2022 that gap was about 6% (37% for female PAs, 43% for male PAs) – increasing to 8% in 2025 (29% for female PAs, 37% for male PAs). While the proportions 44.1 43.6 52.9 61.3 63.5 67.2 68.7 0 10 20 30 40 50 60 70 80 90 100 2019 2020 2021 2022 2023 2024 2025 2026 2027 Percent Pessimistic (%) Projected: Percent pessimistic about the future of healthcare Morale and burnout among PAs : Examining perceptions over time 6 | 18 © 202 5 American Academy of Physician Associates. All rights reserved. Not for distribution or reproduction. were closer in the intervening years, this patten reflects a reversal from early data collections where female PAs were often more optimistic. This is best reflected in 2019 where almost six in ten (58%) of female PAs had a positive outlook on healthcare. Comparatively, onl y 51% of male PAs shared in that optimism (Table 4, Figure 4). Figure 4. Differences in optimism on the profession and healthcare in 2019 and 2025 Survey Year Gender Percent optimistic about … (%) Current PA profession Future of the PA Profession Future of Healthcare 2019 Male 91 87 51 Female 94 94 58 2025 Male 85 83 37 Female 82 80 29 Satisfaction and burnout in the PA profession PAs were typically satisfied with their employers between 2019 and 2025. While there was a dip between 2021 and 2024, employer satisfaction in 2025 was nearing 2021 levels. On a five - point scale ranging from “Extremely dissatisfied” to “Extremely satisfied ” the most often selected response was “Satisfied” across all the survey years. On average, 48% of PAs selected this response between 2019 and 2025. PAs were most dissatisfied with their employer in 2023. In that year, almost one in five PAs (16%) were dis satisfied at their job – with an additional 4.4% indicating being “Extremely dissatisfied” (Table 5). Moreover, overall employer satisfaction across all data years did not significantly vary between employer types. The average employer satisfaction score was 70% - regardless of employer type. When employer type is added as a comparative factor, the average level of employer satisfaction at clinical practices (group or solo; multispecialty or single specialty) was 71%; marginally higher than the reported average from PAs in hospitals (including acad emic medical centers, 70%) and those at all other employers (70%). However, there were some interesting trends related to the movement in the proportion of PAs indicating they were satisfied with their employer between the employer types across the data years. While PAs working in hospitals were the most likely to report being satisfied with their employer in 2020 (78%), these PAs had the lowest levels of satisfaction post COVID -19 pandemic – 61% in 2023. PAs at group or solo clinical practices and all other employers had similar trend lines in their employer satisf action, but those in “all other employers” (e.g., self -employed, convenient care, hospice, college or university) had the lowest levels of satisfaction between 2019 and 2021 (Table 6, Figure 5). On average, 70 % of PAs were “satisfied ” or “extremely satisfied” with their employer between 2019 -2025 . Morale and burnout among PAs : Examining perceptions over time 7 | 18 © 202 5 American Academy of Physician Associates. All rights reserved. Not for distribution or reproduction. Figure 5. Employer satisfaction by employer type Note: This scale does not start at zero in order to illustrate the differences in employer satisfaction between employers . These differences are not statistically significant. AAPA surveys used the 16-item Stanford Professional Fulfillment Index (PFI ) to measure burnout based on items related to professional fulfillment, work exhaustion, and interpersonal disengagement. 5 Typically, single item measures are also included to measure employer satisfaction and burnout. Specifically, the one -question burnout measure is designed to give PAs an opportunity to provide researchers with a “gut -check” on their current feelings of bu rnout. Using this question, we can see a trend similar to P A morale in perceptions of burnout. Based on responses to the one -item burnout measure, PAs were more burned out as the US was emerging from the COVID -19 pandemic in 2023 (45%) than they were in 2022 (40%) or 2021 (39%). While burnout has declined from its high in 2023 to 38% in 2025, levels are still higher than they were in 2020 (35%). Across all data collection years, the most selected response was “ Occasionally I am under stress, and I don't always have as much energy as I once did, but I don't feel burned out ” – ranging from 50% in 2020 to 43.3% in 2023. Generally, PAs who felt burned out were more likely to select “ I am definitely burning out and have one or more symptoms of burnout, such as physical and emotional exhaustion ” than the more serious “ The symptoms of burnout that I'm experiencing won't go away. I think about frustration at work a lot ” or “I feel completely burned out and often wonder if I can go on. I am at the point where I may need some changes or may need to seek some sort of help ” (Table 7, Figure 6). 76.8 74.1 69.9 70.5 63.2 68.2 73.6 76.6 78.0 70.9 65.9 61.3 66.6 70.6 74.8 69.2 68.3 70.1 63.1 69.2 73.0 40 50 60 70 80 2019 2020 2021 2022 2023 2024 2025 Percent Satisfied (%) Survey Year Clinical practice (group or solo) Hospital (including acad. medical center) All other employers Morale and burnout among PAs : Examining perceptions over time 8 | 18 © 202 5 American Academy of Physician Associates. All rights reserved. Not for distribution or reproduction. Figure 6. PA perceptions of burnout (2020 - 2025) While the Stanford PFI is more precise than one -question burnout measure previously referenced within this brief, the proportion of PAs identified by each measure as experiencing burnout was similar across each data year (Figure 7). With the exception of 2024, PFI scores related to burnout were slightly higher than the proportion who reported feeling burned out on the single -item measure . Although there were fluctuations in the average level of burnout reported by PAs within each data year there was no stat istically significant interaction between time and burnout levels. Figure 7. Proportion of PAs experiencing burnout by measure and data year Measure 2020 2021 2022 2023 2024 Avg. 1-Question Burnout 35% 39% 40% 45% 42% 40% Stanford PFI: Overall Burnout Cutpoint 38% 41% 43% 47% 39% 42% PA burnout by gender and specialty Taking a closer look at other factors driving reported levels of burnout, female PAs consistently had higher proportion s of providers experiencing burnout than male PAs. The largest gap was in 2022 when 37% of male PAs reported being burned out while almost half (46%) of female PAs were considered burned out. Burnout peaked in 2023 for male (43%) and female (47%) PAs. While two in five female PAs (41%) were reporting burnout in 2024, the proportion of male PAs experiencing burnout dropped to match their lowest recorded levels (34%). Mu ch of the burnout experienced during this time appears to be driven more by experiencing work exhaustion than interpersonal disengagement. Levels of interpersonal disengagement were similar each year for male and female PAs, but gaps in work exhaustion mirror differences in overall burnout. This sense of work exhaustion may also impact feelings 65.4 60.8 59.4 55.3 61.3 61.9 34.7 39.2 40.3 44.7 41.5 38.0 0 10 20 30 40 50 60 70 2020 2021 2022 2023 2024 2025 Percent (%) Survey Year Not Indicating Burnout Indicating Burnout Morale and burnout among PAs : Examining perceptions over time 9 | 18 © 202 5 American Academy of Physician Associates. All rights reserved. Not for distribution or reproduction. of professional fulfillment – where female PAs also consistently reported lower scores than their male colleagues (Table 8). Specialty also played a role in PA burnout. Specifically, PAs practicing in emergency medicine had higher proportions of respondents experiencing burnout within all data years . In 2023 almost three in five emergency medicine PAs (58%) were considered burned out based on their PFI scores. This was markedly higher than the average proportion experiencing burnout across all PAs who responded in that data year (47%, Table 9). Similar to other reported trends, burnout within specialty groups tended to increase between 2020 and 2023 before falling slightly between 2023 and 2024. However, the rate of increase was not equal amongst all groups. PAs who reported working in surgical subspecialties, pediatric subspecialties, no medical specialty (e.g., administrative o r academic roles), and “all other specialties” (e.g., allergy & immunology, psychiatry, obstetrics & gynecology) often had lower rates of burnout than their peers in primary care (Table 9, Figure 8). Figure 8. Proportion of PAs experiencing burnout by specialty area (2020 and 2024) Data year Primary care Internal medicine Pediatric specialties Surgical specialties Emergency medicine Other specialties Avg. 2020 41% 36% 16% 36% 44% 41% 38% 2024 42% 36% 31% 37% 57% 36% 39% Conclusion PAs are optimistic about the future of their profession but increasingly pessimistic about the future of healthcare writ large. While employer satisfaction has started to rebound from its pandemic lows, PA burnout is still higher than pre -pandemic levels. The effects of burnout are also uneven across gender and specialty. Despite being a majority of the PA workforce, female PAs consistently report higher levels of burnout than their male colleagues and lower levels of optimism about the future of healthcare and the PA profession. Moreover, PAs working in critical specialty areas like emergency medicine and primary care are often experiencing burnout at higher levels than the average survey respondent. While progress has been made to help curtail the impact o f burnout within health professions, more work is needed to develop interventions specific to the PA profession. Current and future PAs need systems in place to incentivize wellbeing , and more research is needed to better understand the role personal and p rofessional demographics play in experiencing and overcoming burnout . The National Academy of Medicine (NAM) released a National Plan for Health Workforce Well -Being which stresses the importance of investing in tools to measure burnout , transforming health systems by developing training and education aimed at fostering well -being, and addressing regulatory and policy barriers adding unnecessary burdens to health workers. While AAPA continues to work on behalf of PAs to improve conditions for the healthcare workforce , PAs also have a unique opportunity to improve well - being in their workplaces. For more information on education, tools, and ways to get involved visit aapa.org/career -central . Morale and burnout among PAs: Examining perceptions over time 16 | 18 © 202 5 American Academy of Physician Associates. All rights reserved. Not for distribution or reproduction. Table 9. Stanford PFI measures by year and specialty area Survey year Specialty area N Burnout Overall: Proportion Burned out Overall Burnout Work Exhaustion Interpersonal Disengagement Professional Fulfillment Average Scale Scores (0 -4) 2020 5,198 38.4 1.19 1.58 0.93 2.54 Primary care 439 40.8 1.22 1.62 2.57 0.95 Internal medicine subspecialties 227 35.6 1.18 1.57 2.60 0.93 Pediatric subspecialties 40 16.1 0.89 1.30 2.71 0.61 Surgical subspecialties 548 35.9 1.13 1.48 2.57 0.89 Emergency medicine 221 43.5 1.29 1.69 2.34 1.03 Other specialties 578 40.6 1.23 1.63 2.52 0.96 No medical specialty 85 29.8 1.00 1.52 2.50 0.70 2021 2,976 41.2 1.26 1.68 0.98 2.44 Primary care 546 43.3 1.32 1.78 2.50 1.02 Internal medicine subspecialties 334 39.5 1.28 1.65 2.50 1.04 Pediatric subspecialties 31 40.0 1.31 1.88 2.39 0.93 Surgical subspecialties 654 39.0 1.21 1.61 2.48 0.95 Emergency medicine 206 50.4 1.43 1.85 2.29 1.14 Other specialties 648 40.4 1.22 1.65 2.36 0.94 No medical specialty 77 36.5 0.99 1.47 2.43 0.69 2022 12,852 43.1 1.29 1.60 1.02 2.34 Primary care 2,529 43.9 1.30 1.63 2.38 1.05 Internal medicine subspecialties 1,561 47.3 1.36 1.72 2.33 1.07 Pediatric subspecialties 201 42.9 1.29 1.66 2.37 1.11 Surgical subspecialties 3,181 38.9 1.21 1.50 2.40 0.99 Emergency medicine 958 54.6 1.50 1.74 2.19 1.22 Other specialties 3,166 41.6 1.27 1.59 2.29 0.96 No medical specialty 484 39.0 1.14 1.48 2.35 0.73 Morale and burnout among PAs : Examining perceptions over time 17 | 18 © 202 5 American Academy of Physician Associates. All rights reserved. Not for distribution or reproduction. Table 9. Stanford PFI measures by year and specialty (cont.) Survey year Specialty area N Burnout Overall: Proportion Burned out Overall Burnout Work Exhaustion Interpersonal Disengagement Professional Fulfillment 2023 12,455 46.5 1.33 1.69 1.09 2.23 Primary care 2,445 47.9 1.34 1.76 2.25 1.07 Internal medicine subspecialties 1,669 45.9 1.32 1.68 2.29 1.08 Pediatric subspecialties 202 43.2 1.28 1.77 1.97 0.96 Surgical subspecialties 3,317 46.2 1.32 1.65 2.27 1.10 Emergency medicine 911 58.2 1.53 1.85 2.06 1.31 Other specialties 3,307 43.2 1.29 1.64 2.21 1.05 No medical specialty 572 44.5 1.28 1.64 2.25 1.04 2024 11,778 38.8 1.19 1.52 0.97 2.36 Primary care 2,314 41.8 1.24 1.60 2.39 0.99 Internal medicine subspecialties 1,526 35.6 1.13 1.47 2.46 0.91 Pediatric subspecialties 197 31.0 1.02 1.40 2.47 0.77 Surgical subspecialties 3,203 37.2 1.18 1.50 2.40 0.97 Emergency medicine 856 56.9 1.46 1.71 2.10 1.30 Other specialties 3,045 35.8 1.15 1.45 2.34 0.95 No medical specialty 385 35.6 1.07 1.51 2.22 0.77 Source: 2020 - 2023 PA Practice Survey; 2022 - 2024 AAPA Salary Survey Question s: Stanford Professional Fulfillment Index Note: Scale scores were calculated by averaging the item scores of all the items within the corresponding scale . These scale scores were averaged across all valid respondents to produce data year averages. The overall proportion experiencing burnout categories are determined from the average item score (range 0 to 4) of all 10 burnout items (work exhaustion and interpersonal disengagement), using a cut -point of 1.33 – with scores above the threshold indicated burnout . Morale and burnout among PAs: Examining perceptions over time 18 | 18 © 202 5 American Academy of Physician Associates. All rights reserved. Not for distribution or reproduction. References 1. Reed H, Bernard K, Smith N. Reasons PAs leave their jobs. JAAPA Off J Am Acad Physician Assist. 2021;34(8):43 -47. doi:10.1097/01.JAA.0000758224.29328.f4 2. Halasy MP, West CP, Shanafelt T, O’Laughlin DJ, Satele D, Dyrbye LN. PA job satisfaction and career plans. JAAPA Off J Am Acad Physician Assist. 2021;34(6):1 -12. doi:10.1097/01.JAA.0000750968.07814.d0 3. Coplan B, McCall TC, Smith N, Gellert V, Essary AC. 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