Burnout among physician assistants and physician associates: A systematic review and meta-analysis

Background: Physician assistants and associates (PAs) are health care providers whose role is intended to bridge gaps in the clinician workforce and increase access to care globally. As an aging population and provider shortages burden the health care system, PAs face significant pressures to balance heavy patient loads, navigate complex medical decisions and interdisciplinary collaboration, and deliver quality care within fast-paced clinical environments.Methods and Findings: This review was pre-registered with PROSPERO (CRD42025644630). A comprehensive search strategy was conducted, including the CINAHL, PubMed, Embase, Science Direct, Cochrane Library, and Google Scholar databases, spanning from January 2018 to January 2025. Eligible studies included practicing PAs and reported a burnout prevalence statistic from primary research. Non-English language studies, literature on PA students, and unpublished records and grey literature were excluded. A total of 24,180 physician assistants were included across the 14 included observational studies, and all but one were cross-sectional studies. Meta-analysis was conducted in R using the metafor package. Burnout proportions were logit-transformed and pooled using inverse variance weighted random-effects models (REML) with Knapp-Hartung adjustment. Heterogeneity was assessed by I2 and Cochran’s Q. Publication bias was evaluated via funnel plots, Egger’s regression, Begg’s test, and trim-and-fill analysis. The pooled burnout prevalence among physician assistants was 33.2% (95% CI: 29.1%–37.5%; prediction interval: 19.7%–50.1%; I2 = 96.2%). Publication bias was detected (Egger’s test p = 0.018), though trim-and-fill analysis identified zero missing studies. Subgroup analysis revealed significantly higher burnout rates with MBI instruments (39.9%) versus non-MBI instruments (28.2%, p < 0.001).Conclusions: Approximately one-third of PAs experience burnout which is a prevalence slightly lower than physicians and nurses, though these estimates vary. Contextual factors appear to drive burnout risk rather than demographics such as gender, underscoring the need for tailored, system-level interventions. While limitations exist, including reliance on cross-sectional U.S. based studies, these findings highlight burnout as a critical challenge for the PA workforce. Coordinated efforts by healthcare leaders, educators, and policymakers are essential to promote PA well-being and workforce sustainability.