what studying pt burnout revealed about the profession

What Studying PT Burnout Revealed About The Profession

The year: 2014. The place: Washington State. The problem: I was burned out on being a PT. I was burned out from trying to get an Ultra-RUG on patients who were not appropriate. I was burned out from hearing that I was not meeting 90 percent productivity. I was burned out on the constant chaos of missing wheelchairs, oxygen tanks, under-appreciated and overworked nurses, missed appointments and unrealistic expectations of nearly every patient.

The solution? I took a trip down the West Coast with my girlfriend for a month. I did not worry about my next job or where I was going to be in five years. I just needed a break from the underwhelming and craptastic healthcare system I was stuck in. I visited friends, camped, skied, and rode mountain bikes. Luckily, I’m a good saver and had money to support the both of us for a while. After my month off I did miss work. Not because I missed the productivity or any of the other administrative things: I missed waking up and going to work as a productive member of society.

You’ve been there. You get sick of working the system. You get sick of your patients. You even get sick of your coworkers. But when you are truly burned out you feel like there is no joy in being a therapist and you just want to dissociate from all your patients and responsibilities.

When you start to feel depressed, exhausted and just do not seem to give a damn about your patients you may be showing symptoms of burnout. My colleague Andy Koenig and I examined literature in order to do a grassroots study of burnout ourselves (we are in the process of analyzing our data). We found some interesting things. First, two of the most interesting articles I write about below are from the 80’s. This demonstrates that burnout is nothing new and that people have been interested in it for years. Secondly, it means you are not alone if you are feeling burned out, as there have been and will be people who feel just like you.

The roots of PT burnout

Way back in 1981, George Wolfe published a report in the journal Physical Therapy specifically on burnout in physical therapy. What did Wolf find? He found that physical therapists, with their prolonged contact with clients, are repeatedly placed in giving rather than receiving roles, which can be emotionally draining and exceedingly stressful. We all know this to be true. But what Wolf concluded was that one of the main causes of burnout was the inability of the physical therapist to realize perceived patient success. It seems that most of us take it personally when a patient does not get better, even though we may have done everything under the sun for these people.

Another main source of frustration he pointed out is patients can have unrealistic expectations in regards to prognosis and healthcare providers. My initial thought when reading this was “not only the patients but families and our supervisors and/or administrators.” Of course, we all know that our patients are dealing with more and more chronic conditions that are often times only manageable as opposed to curable, and as our workloads increase (thank you excessive documentation) that these things further exacerbate the feelings of burnout.

Wolfe reported, “when confronted by frustration or work overload, their initial reaction is to increase their efforts to meet the challenge. This response is adequate in many cases but sometimes can become counterproductive. One early sign of burnout is increased work effort coupled with no increase in productivity. In some cases work output may actually fall.” What an interesting concept (insert sarcasm here)! Sometimes the harder you work at something, or in our case with someone, the outcomes don’t always improve. This is common sense, but it needs to be readdressed because we often forget this important concept. Think about the runner who never takes a day off and gets stress fractures or other overuse injuries. Think about the therapist who gives a patient treatment after treatment, encouraging words after encouraging words and sees no benefit. We have all been there. Again, it is important to note that this has been going on for a long time and you are not alone if you feel defeated because some of your patients are not improving.

Another study we reviewed was a survey of 300 PTs in Missouri called “Impact of Role Stress on Physical Therapists’ Emotional and Physical Well-being,” also published in the journal Physical Therapy by Deckard and Present. The study attempted to find a relationship between stress, burnout, and a number of demographic criteria using a high validated survey called the Maslach Burnout Inventory (the same one Andy and I used for our research).

The authors found significant predictors of high burnout using the MBI included; a perception of improperly allocated time, inadequate staffing and resources, and conflicts between groups with incompatible requests.

No kidding! And this was way back in 1989! They did not find any significant relationship between burnout and age, sex, marital status, years as a PT, educational level, type of employment, salary, or level within an organization.

I find that I get extremely frustrated when conflicts arise between ethical standards, insurance regulations, productivity requirements and patient values. We’ve all been in the role where a patient in a skilled nursing facility is simply unable to handle a RUG level of Ultra, yet our administrators want us to get the level “no matter what.” What a horrible situation to be in. We are trained as patient advocates yet we need our jobs to pay back our crazy student loans! This is simply a recipe for burnout.

Just the other day I was reading Modern Healthcare, a great magazine that everyone who has interest in our health system should read (at least once in a while). One article reported nearly 50 percent of physicians and almost 35 percent of hospital nurses show symptoms of burnout! Holy cow!

Our PT burnout study

In our little study of 77 therapists in Florida and Michigan, when we asked if the current healthcare climate increases your stress level (I’m paraphrasing), overwhelmingly 74% agreed, 17% were neutral and 9% disagreed. My question is, who are the people who disagreed? We haven’t yet looked at demographics related to this question but we probably will. I need to hang out with these people who were neutral and who disagreed. Either they are insulated from the system, super zen or have an overall different outlook on life, and I’d like to feed off their positive energy vibes.

So, ask yourself;

  1. Do you feel emotionally exhausted at work?
  2. Do you dissociate from your patients?
  3. Do you feel little to no personal accomplishment in working as a PT?

If you said yes to the above three questions you may be burned out. Hopefully recognizing and admitting your burnout will be a leap forward into getting your mojo back.

Thankfully we can do things that help us get out of that “burnt to a crisp” burnout feeling. I’ve found that everyone has their own way to recharge the batteries.

I have friends who really love animals, and just spending a day with their dog or horse can help them go from low battery to at least 50 percent charge or more.

Most humans get comfort in being with their kids, significant others, or other family members. Spending time with your closest humans seems to recharge your batteries because they give most of us a purpose and put things into perspective. Had a terrible patient you yelled at you while you were just trying to help them back in bed? Nothing neutralizes the angry or frustrated feeling you felt like having a nice dinner out with your significant other, having a nice porter or stout and relaxing to some good music. Did you have an administrator come down on you for not meeting a 90 percent productivity requirement? My recommendation, hang out with a 1-year-old. They will put your small problem of productivity at work into perspective as they learn to crawl around and speak gibberish which makes us all laugh and laughter is probably the best medicine.

So, to sum up. You are not alone in feeling burned out from your job as a therapist. You have real situations that validate being overwhelmed including ethical conflicts, excessive documentation, unrealistic expectations and sometimes just being a caring person. Simply admitting you are burnt means you can hopefully cope with it in your own way. Feel free to take a month off and travel the US, I highly recommend it, otherwise, there are lots of ways to get over being burned out. If you need any tips, shoot me an email. If you’d like to share how you get over being burned out I’d love to hear from you!

Resources

  1. Wolfe GA. Burnout of Therapists. Physical Therapy. 1981;6(7):1046-1050.
  2. Deckard GJ, Present RM. Impact of Role Stress on Physical Therapists’ Emotional and Physical Well-being. Physical Therapy. 1989;69(9):713-718. doi:10.1093/ptj/69.9.713.

About Justin Johnson

Justin Johnson

2 comments

  1. Drcoachkelli

    Hey Justin,
    Great article and great perspective on what’s going on in the PT world. Thanks for writing

  2. Jordo

    Thanks for this, I’m in my last year as a student (Honors Bsc is 3 years here) and I’ve felt burnt out for about a year straight. I’ve found is extremely depressing that non of my patients seemed to benefit from my effort during each of my clinical placements despite my supervisor and I having plenty of time with each one. One of my patients was almost completely recovered from external shoulder impingement after 2 ultrasound treatments which regarding the literature is impossible, yet another only made progress once she went back to yoga meanwhile I had been mobilizing her ankle for 2 months prior. As a student the thing that kills me the most is that there doesn’t seem to be consistency with what is required by and taught in school, actually reported in the literature, and what happens in real life. Anyone else have this experience or am I simply looking at this wrong? I’ve been searching for our value as a profession and it seems to lie entirely the Biopsychosocial sphere……

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