Naming the Problem: Bad Day vs. Burnout
Kicking back for a post-clinic "happy hour" conversation, PA Buchi Neita and PA Shanna Miranti tackle a reality every APP knows: some clinic days end with you flat on the carpet for 15 minutes just trying to reset. Neita is candid that this was one of those days for her. The hosts quickly distinguish the occasional rough day from true burnout, which Neita defines as an ongoing state of feeling overwhelmed, fatigued, and emotionally drained from chronic stress. It's not a bad day, she stresses—it's a chronic condition that can be serious for clinicians, especially in a high-volume specialty like dermatology where seeing 30 to 60-plus patients a day is common.
The numbers back up the concern. Neita cites a 2024 report showing 36% of PAs reported feeling burnout, and 7 out of 10 nurse practitioners reported feeling burnt out or depressed in the past year. The takeaway for listeners: if you're feeling frustrated, you are far from alone—anywhere from 30 to 70% of colleagues feel the same way.
The hosts also flag warning signs worth self-monitoring: exhaustion that lasts all week rather than a day, chronic aches and headaches, getting sick more often, cynicism toward patients, detachment, irritability, and a slump in productivity or job performance. Neita shares her own experience of driving to work feeling chest tightness after a disagreement with her supervising physician the day before—physical manifestations she urges listeners not to ignore.
Know Your Risk Factors
Neita points to two big drivers of burnout among clinicians. The first is the elusive work-life balance—which she isn't even sure exists —noting that when she’s succeeding in one area, she often feels like she's failing in another. Even the basics of life like exercising and drinking enough water get squeezed out; she admits she hadn't finished half of her 64-ounce water bottle by the end of the day.
The second is personality. The hosts observe that most healthcare providers are Type A, high-achieving, and carry heavy expectations—from themselves, their patients, their colleagues, and their medical assistants. When that pressure builds without release, as Neita puts it, the pot boils over. Miranti adds that even seasoned providers can get "snarky" or cynical, and she encourages APPs to literally check their expression in the mirror before walking into a room—the equivalent of putting your own oxygen mask on first.
Setting Boundaries In and Out of the Clinic
Neita credits boundary-setting as one of the most helpful strategies over her career. That has meant cutting back clinic days—she went from five days a week to four, then to three when her second child needed additional therapies. She acknowledges not every clinic allows that flexibility, but encourages APPs to find a situation that fits. She also stopped scheduling her last patients at 4:00 p.m. instead of pushing to later slots, preserving a buffer to finish charting and phone calls before heading home.
Patient-facing boundaries matter too. Both hosts are willing to work in emergencies and accommodate reschedules, but Neita advises capping worked-in patients to a single complaint so a same-day squeeze-in doesn't balloon into a full-body exam plus hair loss plus acne. Patients can return in a few weeks for the rest.
After-hours boundaries are where Miranti shines. Bombarded by photos and "quick question" texts from friends and friends-of-friends at 8:30 or 9:00 p.m., she keeps a saved note on her phone that kindly redirects them to upload photos to the patient portal so her staff can address it properly and medico-legally the next morning. Neita's approach is simpler—she ignores off-hours messages and answers when she's ready. Both agree it's worth looping in practice management or your medico-legal team when off-hours contact becomes a pattern.
Streamlining Workflow and Building In Breaks
Miranti champions front-end investment to reduce back-end frustration: set clear protocols and expectations with your MAs and team—for example, having them check tasks, phone calls, the path log, and Cover My Meds first thing in the morning and again at the end of the day. Learn the nuances of your EMR, build templates so the visit can stay conversational, and create patient handouts for common diagnoses to cut down on callbacks. As she notes, you can counsel until you're blue in the face, but written material patients can take home (or screenshot) reinforces the plan when they're too nervous to absorb it in the room.
Breaks are non-negotiable. The hosts suggest blank slots in the schedule for charting or portal messages, protecting your lunch instead of giving it all to staff meetings or pharma reps, and stepping outside for fresh air—one of Neita's colleagues walks every day. Neita once kept a small yoga space in her office with dim lighting where staff knew not to disturb her. And above all: take your vacations, take a random Friday off, and actually use the time you've earned. Miranti now brings a child or two to conferences so she can pursue professional development without the guilt of leaving family behind.
Self-Care, Connection, and Knowing When to Go
Personal wellness builds resilience. For Neita, that's weights, Pilates, sleep, eating well, and spiritual and relationship time; for Miranti, a self-described ex-athlete, it's professional development and speaking. Both encourage listeners to find what fills their cup. Miranti invokes Ted Lasso's "Be a Goldfish"—learn to let a bad patient encounter go, because the next patient needs you at your best.
Connection is a recurring theme. The hosts advocate for community: reach out to nearby providers, attend local dinner programs, or start a journal club. Neita, a self-proclaimed conference junkie, says networking has opened doors she never imagined. And when the environment itself is the problem—the wrong job, supervising physician, or support system—she gives permission to leave: don't stay where you're not respected or happy.
Finally, both hosts urge listeners not to suffer alone. Neita calls her therapist "my bestie in my head" and endorses professional help, therapy, or medication as needed, along with the many virtual mental health options now available. Miranti reminds APPs that humans are communal, that reaching out sometimes takes courage, and that a simple "I see you" text to a struggling colleague can matter. As Neita closes, we all just need to be there for each other.