Managing and Preventing Burnout In the Modern Physical Therapist

With expanding workloads, insurance reimbursement falling, student loan debt, and increasingly sick patients, many physical therapists, and healthcare providers are reporting burnout record levels. According to a study done at the University of Wisconsin, almost 40% of nurses and 50% of physicians report high levels of emotional exhaustion. These are similar levels exhaustion and burnout that are reported among physical therapist. There are a myriad of reasons for burnout in today’s physical therapists. Some of these reasons include: burdensome paperwork, overwork and increased time at work, high occupational stress, complex and emotionally troubled patients, and compassion fatigue. Burnout is a common symptom of workers who operate in the human service sector. It is important to catch the signs and the symptoms early, as well as working on the effective methods and means to mitigate the effects or onset of burnout.

Some of the signs and the symptoms of burnout include:

  • Anger
  • Cynicism
  • Feeling of emotional exhaustion
  • Depersonalization of patients
  • Negativity
  • Disengagement
  • Lethargy

These symptoms can be common in a clinic for a few hours to a few days. While a concern, the chronic burnout is the condition that needs to be addressed. Chronic burnout is described as having these feelings for three months or more. It is more concerning because it can lead to more advanced stages of depression and suicidal ideation. It is important for managers to look out for these symptoms and address them quickly. Some strategies to manage burnout have been shown to be effective.

An awareness of the problem is the first step. It is important to create a culture of openness and for managers/owners to be in constant communication with their employees about the state of their emotional health. After identifying the problem, some strategies that have been shown to be effective include:

  • Mindfulness
  • Emotional training
  • Relaxation exercises
  • Coping strategies
  • Management of workload
  • Improving efficiency of clerical work

Mindfulness is a mediative practice that focuses on the current state of your body and has been shown to be effective in reducing stress when applied consistently. There are applications such as Headspace and Calm which lead you through guided mediation.

Emotional training involves effective strategies for showing empathy to patients, without becoming emotionally exhausted and internalizing the patients’ problems.

Relaxation exercises involve deep breathing techniques that have been shown to reduce cortisol levels in the body and to lower blood pressure and heart rate. It would be an effective modality if applied before or after an adverse event. Typically a person will concentrate on their breath and even hold between breaths.

While we can not get rid of some of the stressors of modern physical therapy practice, coping strategies are important in order to improve the health and well-being of therapists. These coping strategies can include: journaling, psychotherapy, or mindfulness training as described above.

Physiotherapy has become a challenging landscape with recent changes in reimbursement and with increasingly sick patients, many therapists report seeing a high workload of patients. It is important that managers and employees have a constant conversation about the appropriate level of patients and using support staff as necessary. For the patients, therapists and managers, an appropriate workload can improve care, improve retention of workers, and reduce burnout.

Oftentimes, burdensome paperwork and clerical work, are the most common complaints from providers. With the advent of EMR, clerical work times have actually increased as reported by therapists and other healthcare clinicians. It is important that managers and therapists have open conversations about the minimal necessary paperwork for ethical, effective and clinical efficiency.

It is important that you watch for signs and symptoms of burnout in your self and fellow co-workers. Managing these symptoms will improve the health and mental well-being of therapists.

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