Burnout remains one of healthcare’s most persistent workforce challenges, but years after the COVID pandemic, experts said the nature of burnout among nurse practitioners (NPs) and physician assistants (PAs) has evolved rather than disappeared.

Like physicians, advanced practice practitioners (APPs) continue to contend with staffing shortages, growing patient complexity, documentation requirements, and increasing administrative demands. But as health systems increasingly rely on APPs to help address physician shortages, many experts said these clinicians also face pressures unique to their roles, including varying scope-of-practice requirements, supervision expectations, role ambiguity, and expanding responsibilities.

Rather than viewing burnout among APPs as simply another version of physician burnout, experts said organizations should recognize the distinct workplace challenges affecting one of healthcare’s fastest-growing clinical workforces.

Burnout Remains Widespread

Recent research suggests burnout remains common among APPs. In a  2025 study published in Health Affairs Scholar, researchers analyzing responses from more than 122,000 certified PAs found that 34.2% reported at least one symptom of burnout. Burnout was most common among PAs working in emergency medicine, and worsening working conditions emerged as the strongest predictor.

Cara Sammartino, PhD, MSPH, chair in the Department of Health Science at Johnson & Wales University in Providence, Rhode Island, said the findings reflect workplace realities.

Poor work environments and inadequate staffing are the most commonly cited factors for burnout among clinicians, she said. Long work hours are a major factor, with the likelihood of burnout doubling when providers work 60 h/wk and tripling when they work 70 h/wk.

“The biggest predictor of burnout is declining working conditions, including income, work-life balance, and total hours worked,” she said.

Burnout Has Changed Since the Pandemic

Although the pandemic intensified burnout through staffing shortages, overwhelming patient volumes, and emotional exhaustion, today’s challenges look somewhat different.

Kristin Olson, DNP, APRN, a NP with telehealth and online services provider Nutrition Coaching, said burnout has evolved rather than improved.

“The best answer to this question is it has simply changed,” she said.

Olson said the widespread adoption of telemedicine improved access to care and gave many clinicians greater flexibility, but it also blurred the boundaries between work and home.

“It can be difficult to turn the switch off because the great majority of us are completely dedicated to being healthcare providers, and knowing we are able to jump on and help someone at any time of day is very gratifying,” she said.

Shared Stressors, Different Pressures

Although documentation burden, staffing shortages, high patient volumes, and increasing administrative responsibilities affect physicians, NPs, and PAs alike, several experts said APPs also face pressures unique to the structure of their roles.

Archana Shrestha, MD, an emergency physician and chief wellness officer at Physician Wellness Solutions, said APPs often face challenges that extend beyond the workplace pressures shared by all clinicians.

“Unique stressors that NPs and PAs face are role ambiguity, inconsistent scope-of-practice expectations, lack of recognition, and also being utilized as a solution to workforce shortages sometimes without adequate support,” she said.

“Burnout is not just a physician problem. It’s a healthcare workforce problem given that NPs and PAs are taking care of more patients than ever before.”

Michael Kane, MD, chief medical officer at Indiana Center for Recovery, said the pressures facing APPs should be understood on their own terms.

“APP burnout is not merely a scaled-down version of physician burnout,” he said.

Kane said many APPs carry significant clinical responsibility while simultaneously navigating scope-of-practice limitations, supervision requirements, and role ambiguity.

“They may be asked to carry a heavy load of complex patients, meet productivity targets, support access needs, yet retain limited autonomy relative to their workflow, staffing, and decision-making,” he said.

Jack Szary, LMHC-D, said that lack of empowerment can gradually wear down clinicians’ confidence and engagement.

“When you’re trained and competent to make a decision but still need someone else’s approval to act on it, eventually it erodes your sense of autonomy and self-efficacy,” he said.

Olson said state-specific supervision requirements, collaborative practice agreements, and continuing education requirements can also add to administrative burdens for APPs.

Why Burnout Matters

As health systems increasingly depend on APPs to meet growing demand for care, Sammartino said persistent burnout among APPs has implications that extend well beyond individual clinicians.

“With APPs playing an increased role in providing primary care, burnout will create additional shortages leading to longer wait times to see providers and reduced access to care,” she said.

“High turnover rates will lead to increased costs for healthcare organizations due to having to train new hires. Organizations with high turnover rates also will have a challenge in recruiting new APPs as high turnover likely indicates poor work environments. Burnout also reduces the institutional knowledge available from long-standing providers and reduces the number of mentors available to train new APPs.”

Szary said APP burnout has received less attention than physician burnout, leaving important gaps in understanding the experiences of other healthcare providers.

“The consequences of this lack of attention lead to lower quality care. Many of these providers are willing, capable, and desire to make a positive impact, but the result of burnout often is disengagement that puts survival and getting through the day at the forefront and quality patient care in the background,” he said.

Kristina Del Mistro, JD, an attorney at Hall Booth Smith and a former PA, said burnout may also increase risk in ways clinicians do not always recognize.

“Providers experiencing burnout may struggle to maintain the level of engagement and communication patients expect, leading to patient dissatisfaction and the likelihood of litigation,” she said. “Burnout can also lead to documentation shortcuts, such as overreliance on templates or copying prior notes, which may introduce inaccuracies to the medical record and increase litigation risk.”

“Because providers often do not recall the encounter at issue, the medical record becomes the primary evidence that the care provided met the standard of care,” she said. “Therefore, incomplete or inaccurate documentation can create vulnerabilities that are difficult to overcome once a complaint is filed.”

Looking Beyond Wellness Programs

Several experts said addressing burnout requires more than asking clinicians to become more resilient.

Shrestha said addressing burnout requires both system-level changes and better preparation for practicing in demanding clinical environments.

“While moral injury and our strained healthcare system must be addressed, there is another piece of the burnout puzzle,” she said. “Physicians, NPs, and PAs receive extensive training in patient care but very little on the skills needed for sustainable success, especially in high-stress environments.”

Organizations also can help reduce burnout by improving workplace conditions and ensuring adequate staffing, said Sammartino.

“Policies put into place to provide supports to APPs through ensuring high-quality work environments are ones to be the most supportive,” she said.

For Olson, adaptability and control have been effective burnout-reduction strategies.

“I appreciate what the independent contractor life has given me in terms of flexibility over my work hours, increasing productivity when needed, and backing away temporarily when needed to optimize my physical and mental well-being,” she said.

No reported disclosures.