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During her training as a physician associate (PA), Stephanie Neary, MPA, MMS, PA-C, assistant professor adjunct and director of didactic education in the PA Online Program at Yale University, New Haven, Connecticut, said she adopted a "survivor mentality" when the going got tough.

"I thought if I can just get through this, things will get better," she said. "I don't need to get help now. If I can just get through this big deadline, this paper, this first year on the job, the next big event, I will be fine."

Neary said she's heard it described as a horse race. "Instead of seeking help for mental health when we struggle, we just put on our blinders and race to the finish line, only to put another finish line in its place."

While that is far from the only reason why PAs who may be dealing with mental health issues don't seek help when they need it — stigma, scheduling issues, imposter syndrome, and potential licensing repercussions also rank high on the list — Neary said, given the high levels of burnout in the PA community, it is essential that the field better understand barriers to care to overcome them.

In Medscape Physician Assistant Burnout Report 2023, 60% of respondents said they were burned out, 29% were depressed, and 24% were both burned out and depressed.

To that end, Neary, with colleagues Sean Kolhoff, PhD; Noël Smith, MA; and Christopher Roman, DMSc, PA-C, have been examining access to mental health resources for the PA community. They most recently completed a survey looking at awareness and access to provider health plans (PHPs), a confidential resource for care providers to receive care for behavioral health and substance use issues provided by each state.

Neary presented the results of the study at a Research in Action session at the American Academy of Physician Associates (AAPA) 2024 Conference & Expo in Houston.

"These plans are meant to protect patients through the identification, treatment, remediation, and/or monitoring of clinicians with health-related issues that could compromise patient safety," Neary told Medscape Medical News. "PHPs are there to help get our providers back to their most healthy state and to provide the best patient care that they can. And we wanted to understand PA willingness to use these programs."

A Resource for PAs, Not Just Physicians

While most in the healthcare realm are aware that these programs are available for physicians, it isn't always clear that, in most states, they also cover PAs.

"Every state except Massachusetts has one [a PHP] that serves PAs and that includes the District of Columbia," said Neary. "And Massachusetts now has a law (Dr. Lorna Breen Health Care Provider Protection Act) in place that says they have to create a plan…although they don't have a timeline to do that, to my knowledge."

She said some PHPs are clearly advertised on PA licensing board websites and constituent organization websites. Others, not so much.

"For some states, it took days for us to try to find information of where to go if you needed help," she said. "Put yourself in the position of someone who is feeling really down. Are you going to search for days on websites and reach out to multiple people in hopes that someone will call you back? If you are facing something like substance abuse or suicidal ideation, you're probably not going to wait to be transferred to someone who can answer your questions or to get connected to the care you need."

An Underutilized and Misunderstood Resource

With little prior data in the literature regarding PA use of PHPs, Neary and colleagues leveraged the annual AAPA Salary Survey in 2023, adding questions, including the professional fulfillment index, to measure burnout, as well as several PHP-related questions to understand both use and perceived use of PHPs.

More than 2800 Salary Survey respondents agreed to complete these additional questions. The researchers found that only three quarters of respondents reported that their state had a PHP. Neary said this shows a significant gap in awareness that these programs even exist.

"Only 2% of our respondents reported utilizing a PHP," she said. "While you have to take the number lightly because this is self-report, I don't think it would go up to 30%. This means it is a significantly underutilized resource."

Additionally, nearly 40% of respondents had concerns about using PHPs if they needed treatment. "These are big gaps — and we need to explore why that is," said Neary.

The research team also conducted a regression analysis, which revealed an interesting trend: PAs were much less likely to be willing to hypothetically seek treatment with a PHP if it was listed on the licensing board website.

"If the program was listed on a constituent board website, no one had a problem with that. If it was on a PA academy website, nobody had a problem with that," Neary said. "But when we asked, 'If you were experiencing impairment, how likely would you be to utilize a PHP if the information were available on the website of your PA licensing board,' people had a problem with that. We would love to look into why as we move forward."

Advocating for Awareness and Access

When asked what she hoped attendees of her presentation would take away from the study, Neary said that she would like PAs to reach out to their state organizations and ask for PHPs and to make more PA-specific information readily available on constituent organizations and PA academy websites.

"We need to do more to make sure that PAs and PA students know that this resource exists," she said. "Because even finding the information for your state can be very challenging. Then, if you can find the information, it doesn't address confidentiality. It doesn't say whether PAs are included in the programs. It's important we ask for the information to be clarified so PAs know that they can access this resource if and when they need it."

She also said that when we see these gaps, we need to address them and do more to advocate for ourselves because the system doesn't know how to help us unless we show it what we need.

Neary added that she also hopes that struggling PAs reach out for help.

Kayt Sukel is a healthcare and science writer based outside Houston.