A clinician agrees to cover an open shift. The manager gets through the day without leaving a gap on the schedule. Next week, the manager asks again.

For a facility leader, each request may feel reasonable. For the clinician who keeps saying yes, those requests can add up to missed recovery time and less control over life outside work. Leaders need to examine that pattern before they treat the next open shift as an isolated problem.

Leaders have reason to look closer at Medscape’s latest survey of physician associates. In the Medscape PA Burnout & Depression Report 2026, 44% of PAs reporting burnout said it had lasted more than two years. That share was 37% in Medscape’s 2024 report and 20% in its 2022 report.

Respondents in the Medscape report pointed to their jobs as the main source of strain. Job stress was the leading driver of burnout and depression, cited by 83% of men and 75% of women. PAs named bureaucratic tasks, insufficient compensation, and a lack of respect from administrators, employers, colleagues, or staff as top contributors to burnout. Roughly 3 in 4 said their employer did not recognize their burnout.

Leaders in any care setting should be asking whether their coverage plan gives people room to recover or depends on them giving up that time.

Examine how you fill the gaps

A filled shift confirms that someone will be there, it does not record how the manager secured that coverage.

A clinician may have volunteered because the hours fit their schedule. Or a manager may have asked the same dependable person for the third time this month, and that person said yes to keep the team afloat.

Leaders need those distinctions to understand the burden behind their coverage numbers. A facility can meet its staffing target while concentrating extra work among a small group of clinicians. Most PAs in the Medscape survey said their employer did not recognize their burnout. Leaders in other settings may be missing similar strain.

Start by reviewing how often you ask staff to work beyond their planned hours and whose names recur. Ask clinicians whether they can decline extra work without guilt or consequences. Include charge nurses and scheduling managers in that conversation. They handle the requests and can help identify where the coverage plan falls short.

Build coverage before the next callout

Leaders decide how much of the uncertainty from absences and shifting patient demand their permanent team must absorb.

They can plan coverage around time off as well as working hours. That means setting expectations for overtime and arranging additional support before managers run out of internal options.

Arrielle Esclamada, clinical director at Briarcliff Surgery Center, faced that pressure when 10 staff members went on maternity leave over about a year and a half. In the same period, monthly patient volume rose from about 250 to 370. She chose not to hire full-time staff for a gap she expected to be temporary, which left a small team covering the difference. “There are a lot of times when it was just me being the only full-time pre-op and PACU nurse,” she told Medely. “We have a lot of last-minute add-ons, and so that sometimes puts us in a bind.”

Flexible staffing can be part of that plan. For roles and settings where it fits, managers can bring in per diem professionals instead of returning to the same employees. Facility leaders still need to confirm qualifications, prepare clinicians for the setting, and match coverage to patient needs.

At Medely, we see flexible staffing as a way to support the permanent team. Facility leaders can use it to add coverage while preserving more of the schedule their employees agreed to work.

Give recovery time a place in the staffing plan

Burnout has causes that staffing alone cannot resolve. PAs in the Medscape survey most often said increased compensation (57%) and lighter patient loads (47%) would help reduce burnout. Leaders also need to address administrative demands and the conditions in which clinicians deliver care. Leaders should not expect flexible coverage alone to lower burnout.

Leaders can still make concrete decisions about scheduling. They can reduce repeated requests for extra shifts, respect time off, and give managers coverage options before a shortage becomes urgent.

The next time a manager fills an open shift, ask how they filled it. Then look at whether the facility can keep using that approach without asking the same people to give up more of their time.