By Tyler Amores | DMSc, PA-C
Godfrey-Harris and Shaw (2023) define Attention Deficit/Hyperactivity Disorder (ADHD) as “a form of neurodivergence, characterized by lifelong differences in attention, impulsivity, and hyperactivity.” While there are considerations for each ADHD subtype, this article will only focus on general presentations as many co-morbidities may occur between the subtypes.
The exact prevalence of ADHD among healthcare professionals varies considerably between studies, with data reported anywhere from 1-24% (Im and Tamarelli, 2023). A study conducted by Corbin et al. (2024) suggested the prevalence of ADHD within their 2024 PA school cohort to be approximately 30%.
In some contexts, ADHD can improve a PA’s clinical practice, empowering them with traits such as increased empathy, performance under pressure, and creativity in treatment planning. However, difficulties that occur with ADHD can often decrease PA satisfaction with clinical practice and leave PAs feeling overwhelmed.
Common challenges in practice with ADHD may include:
- Distractibility
- Hyperfocus
- Emotional lability
Management recommendations include:
- Practice-modifying strategies
- General lifestyle strategies
- Clinical care strategies
I. Practice Challenges
New providers may encounter challenges during practice that differ from those in school or clinical rotations, and those new challenges can be compounded by the added pressure of managing “real patients,” building new relationships with colleagues, and working in less forgiving environments.
Distractibility and Hyperfocus
Distractibility and hyperfocus may be considered different aspects of a spectrum.
In active environments such as an emergency room or urgent care, it may become difficult to focus on a particular patient or presentation, and a clinician may ultimately become overwhelmed. It can also be easy to focus on a single chief complaint or symptom and miss the larger picture that can help narrow down a diagnosis or treatment plan.
Emotional Dysregulation
Per Kirsten Weir (2024), an often-unrecognized component of ADHD is emotional dysregulation, or the concept that people with ADHD may feel emotions more intensely than others. While not all people with ADHD will experience increased emotional sensitivity, this has become an increasingly recognized phenomenon. Some common presentations may include:
- Relationship impairment
- Poor friendship quality
- Elevated risk for depression, anxiety, and irritability
- Greater functional impairments
In clinical care, providers may find they are more sensitive to a particular group of patients or peers or that some practice areas, such as surgery or procedures, may cause elevated emotional stress compared to their peers.
II. Management
Management recommendations for clinicians with ADHD fall into two parts: specific practice-modifying options and general lifestyle recommendations that may influence practice.
Practice-modifying options
Practical strategies as noted by Stavraki (2024) include mitigating the need for prolonged attention when possible.
Establishing routine algorithms and templates, such as a brief list of physical exam tests for knee pain and common formulary treatments, can provide a quick reference that alleviates the need for overthinking. Charting tools like text expanders and auto-text programs can significantly reduce the time required for charting.
Additionally, clinicians with a large charting load at the end of the day may feel pressure to complete it all at once to be done with it. However, some people may have limited periods of productivity, and may benefit more from working in 30-minute increments with small breaks in between.
When addressing emotional dysregulation, taking the time to identify behavioral triggers can provide benefits in establishing routines and workflow that avoid those challenges. Some people may need more morning time to avoid feeling overwhelmed or prefer to conduct procedures before lunch.
By understanding their own habits and patterns, clinicians can reduce the number of frustrations throughout the day and provide more consistent work experiences. Peer support can also be helpful for venting stressors throughout the day and developing partner-assisted strategies so each provider can lean on the other if one needs a break.
Lifestyle Management
In addition to practice-specific considerations, new grads often find themselves overworked, underpaid and stressed, which can exacerbate ADHD symptoms. This can be due to many factors, including student debt, questioning their specialty, or whether they want to conduct patient care as a whole.
While many of these aspects improve with time, there are some options to help address these stressors in the short term.
- A good work-life balance is essential for avoiding burnout and maintaining a functional long-term work environment. Clinicians should include at least brief periods to do things they enjoy each day.
- Sleep hygiene is critical for long-term success. It is no secret that good sleep is restorative, and deprivation is not sustainable for long periods. A substantial risk factor for presentations such as manic episodes is a lack of sleep.
- While work schedules such as night shift, call, and other options may come up, adapting proper sleep hygiene into the mix will likely make these situations more manageable.
- Diet and exercise often go hand-in-hand and provide a solid framework for emotional resilience and a more positive overall outlook. They also improve sleep and cognition, helping to mitigate the practice challenges mentioned above.
- Self-esteem is an often-overlooked aspect of self-care, and this can be particularly true with ADHD, where neurodivergence can already make it more challenging to fit in. When possible, build relationships and establish routines that emphasize strengths and build a positive reservoir of emotion so that when adversity hits, there is something to fall back on.
Clinical Care
Outside of practice-specific considerations and lifestyle management suggestions mentioned above, clinical self-care, including medications and cognitive behavioral therapy or ADHD coaching, can go a long way. In particular, when ADHD is treated effectively, it can also help reduce co-morbid anxiety, depression, and ruminations that occur.
An important note is that when considering stimulant medications, studies have suggested methylphenidate can reduce mood lability while amphetamines may worsen it. If mood is a concern, methylphenidate may be a more robust option when considering stimulant medications.
III. Closing thoughts
Clinical practice with ADHD can be difficult and, at times, feel overwhelming. Managing the workload is a learning curve, and sometimes, the first environment you enter isn’t a great fit.
If making the adjustments outlined above does not improve the overall day-to-day environment, consider whether that environment will be conducive to your long-term health. Remember, there are other options, include different specialties, telemedicine, and non-clinical roles.
Some anecdotal recommendations among colleagues with ADHD have included pathology, radiology (including interventional radiology), and anesthesia, where the pace may be more manageable and allow for greater attention to detail.
References:
Corbin L, Harvey S, Wood A, et al. Prevalence of attention deficit hyperactivity disorder among PA students. Poster presented at: AAPA 2024; May 18-22, 2024; Houston, TX. aapa.org/download/132651/?tmstv=1718217963
Godfrey-Harris, M., & Shaw, S. C. K. (2023). The experiences of medical students with ADHD: A phenomenological study. PloS one, 18(8), e0290513. https://doi.org/10.1371/journal.pone.0290513
Muinos, L. (2022). Common ADHD struggles and tips to overcome them. PsychCentral. https://psychcentral.com/adhd/adhd-struggles-coping-tips
Im, D. S., & Tamarelli, C. M. (2023). Attention Deficit Hyperactivity Disorder in Medical Learners and Physicians and a Potentially Helpful Educational Tool. Advances in Medical Education and Practice, 14, 435–442. https://doi.org/10.2147/AMEP.S398196
Institute, U. D. M. (n.d.). Evidence based treatment of ADHD: UC Davis Mind Institute. Evidence Based Treatment of ADHD | UC Davis MIND Institute. https://health.ucdavis.edu/mind-institute/resources/understanding-adhd/adhd-treatment
Stavraki, I. (2024, January 26). How to manage ADHD: 7 coping strategies without medication. Simply Psychology. https://www.simplypsychology.org/adhd-coping-mechanisms.html
Weir, K. (2024). Emotional dysregulation is part of ADHD. See how psychologists are helping. Monitor on Psychology, 55(3), 30. https://www.apa.org/monitor/2024/04/adhd-managing-emotion-dysregulation
Tyler has been working Psychiatry since 2006 including inpatient, outpatient, social work, drug & alcohol, and research. He completed his Master’s in Physician Assistant Studies through IPAP and his Doctorate in Medical Science through Rocky Mountain University. Tyler has provided clinical care in various settings throughout the US, Alaska, Europe, and Asia, including during active conflicts in Iraq and Afghanistan, and makes every effort to ensure that people feel heard.