PAs React: What Fortifies or Tears Down Their Job Satisfaction?

How satisfied are physician assistants (PAs) in their chosen career and with their work-life balances? In the Medscape Physician Assistant Career Satisfaction Report 2022, about 9 in 10 said they are glad they became a PA. so one might assume that satisfaction is quite high.

But comments by respondents to the survey and readers of the report show the reality is more nuanced.

Making a difference in patients' lives was the aspect of a PA's job chosen most often as rewarding.

"I like helping patients get better and helping them care for themselves," one respondent wrote. Another likes "using the medical education and people skills which I have honed over the years."

PAs also feel good about the indirect impact they have on patients by training others. One respondent takes pleasure in "ensuring the next generation of providers are competent and compassionate." Another is gratified to be "a source of evidence-based medical information for students, patients, friends, and family."

But Do PAs Feel Respected and Understood?

Several respondents reported enjoying "excellent relationships with colleagues" and feeling respected and appreciated. But those benefits are not universal.

Not all PAs enjoyed that type of respect. In the Medscape survey, lack of respect from physicians, managers, peers, or colleagues was chosen fourth most often as an undesirable aspect of the job. And some respondents reported a lack of gratitude from patients or their families.

A perceived lack of understanding of what a PA does is a sore point for some respondents and readers. So is the discrepancy seen between PAs and nurse practitioners (NPs) when it comes to respect and compensation.

"We have more schooling than NPs but less independence and recognition," one PA wrote. Another described "being seen as below NPs in pay, skills, abilities, respect, opportunities, and support."

Still, a recent study projected that the PA workforce likely will expand by 35% by 2025. And PAs now can directly bill Medicare for their services, a change favored by nearly 79% of respondents in the Medscape report. With these changes, greater respect from colleagues and patients could follow.

COVID-19's Impact on PAs

One possible silver lining of the COVID-19 pandemic is that the scope of PA practice temporarily expanded to help handle the patient onslaught. Almost all respondents in the Medscape report favor making these expansions permanent.

But for the most part, COVID-19 wreaked havoc on PAs' professional lives, and the laments show up in their comments.

One respondent is no longer practicing in his specialty, for example. Others described working harder and longer hours because of pandemic-related understaffing, being unable to provide optimal patient care in overcrowded facilities and managing COVID-19 testing.

Overtaxed and Underpaid

Many respondents celebrated the benefits of being a PA, including receiving adequate or better than adequate compensation and having a flexible schedule. "I have a great job, great salary, and the ability to work part time," one enthusiastically wrote. Another described the most rewarding part of her job as "flexibility, time with my family, and being able to maintain a good work-life balance."

However, many other PAs reported feeling overworked in general (and the pandemic just worsened things). "The volume of work is too much for one person: prepping surgical patients, obtaining prior authorizations, and responding to patient messages," one complained. Another puts in "a 55- to 60-hour workweek with very few breaks." Others are struggling with night shifts or "sacrificing my personal and family life to my job."

And some PAs feel inadequately compensated for all that extra work. "I get no overtime...no bonus," one complained. Another described not being paid for on-call hours.

Paperwork Can Be Burdensome

Many respondents and commenters described the volume of documentation (on paper and in electronic health records) they manage. They described these types of administrative tasks as adding to an already overflowing workload and creating "competing priorities."

They conceded that the paperwork is necessary to maintain board certification and to avoid potential malpractice lawsuits, however. Possible litigation appeared as a bogeyman in comments time and again. "I'm afraid of being sued," one PA wrote.

Although some PAs were happy that they had "ample time" to spend with each patient, 15% of female PAs and 10% of male PAs felt that they didn't have sufficient time to spend with each patient, and one also lamented the "inability to provide adequate follow through for patients."

Batya Swift Yasgur, MA, LSW, is a freelance writer with a counseling practice in Teaneck, NJ. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-oriented health books as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom (the memoir of two brave Afghan sisters who told her their story).

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