Costs of autism spectrum disorders and access to services in Spain.

Burnout in health care professionals is described as emotional exhaustion, compassion fatigue [–], decreased productivity, decrease in quality of life and team morale and increased turnover and medical errors []. Despite this, Advanced Practice Providers (Nurse Practitioners, Physician Assistants, Certified Registered Nurse Anesthetists, Certified Nurse Midwives, and Clinical Nurse Specialists) (APP or APPs) are rapidly increasing in numbers to address health care demands [–]. There are far less studies on APP burnout compared to physician and bedside nurses. APP burnout has unique contributors specific to APP’s demands such as time constraints, physician demands, limited support by superiors, lack of financial reward and role ambiguity [, ] and signs of burnout may start as early as training []. Additionally, low job satisfaction reported in an empiric review across APPs has been suspected to contribute to turnover [] which may cost organizations up to 100% of the yearly pay []. However, there is limited understanding of the effect of specific APPs work characteristics on burnout. Most studies evaluating APPs burnout focus on a specific subspeciality, single profession or are single center studies. Additionally, there is heterogeneity in defining burnout when using the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS (MP)). Burnout may be defined dimensionally by identifying individuals meeting thresholds on individual MBI-HSS (MP) domains [], or using person-centered approaches that identity co-occurring patterns across domains that reflect a more nuanced multidimensional experience [, ]. Given healthcare shortages, understanding various drivers to burnout among the APPs workforce may allow for meaningful ways to augment job satisfaction and decrease burnout in a strategic cost-effective approach []. Studies have shown that primary care APPs have high rates of burnout [, ], female APPs have higher burnout when compared to male colleagues [, ], and younger career APPs have greater depersonalization []. Supportive coworkers and leadership, opportunities for professional advancement, and work life balance have been shown to be protective against burnout in APPs [].