What leads to burnout?
One aspect of physical therapy that many therapists – new grads and seasoned veterans alike – struggle with is burnout. I have seen first-hand how many of my friends and colleagues are experiencing burnout within their first year of practicing. Why is this so? We are faced with the challenges of dealing with hurting people, seeing high volumes of patients, dealing with insurance companies, and the stresses of documentation.
In our first year of practice we are considered “Entry Level PTs,” but new grads are rarely prepared for the rigors of a demanding schedule. Sure, our clinical rotations during PT school give us exposure to this, but realistically, PT school is meant to provide us with a foundation of clinical knowledge for taking the boards. School does not prepare us for the stresses involved with treating a high volume caseload, for understanding the full patient experience, and with effective ways to communicate with our clients and referral sources.
When starting out of school we are faced with treating a full schedule of patients ranging from six patients a day to 25 patients a day, depending on the setting in which yu practice. Whether someone is going through injury recovery, a stay in the hospital or nursing home, it is a tough time for them mentally, physically, and emotionally. As PTs we are responsible for creating care plans and modifying them from visit to visit based on how the patient is progressing. Physical therapy involves blending manual skills, therapeutic exercises, modalities when appropriate, education, and, yes, even a dose of psychology in order to progress a patient towards established goals. What physical therapy is NOT is a “quick fix.”
It is our job to motivate, encourage, and provide a support system to our patients through their recovery. Being fresh out of school, our experience is limited to supervised clinicals. We tend to blame patient outcomes on ourselves, which puts immense stress on our shoulders. When someone does not get better we blame it on our treatment — at least I do, as do others. But there are many factors that may contribute to these “failures.” Was the patient active with a prescribed home exercise program? Is the patient doing things at home that can be inhibiting their progress? Are there family situations, emotional stresses or other comorbidities that could be affecting their outcomes? Are they motivated?
You could be the best therapist and come up with the best plan, but if the patient is not following the prescribed plan, they may not reach the desired outcome. Remember, a patient may not always be as motivated to improve as you are to help them. Don’t let this weigh you down!
Another challenge we face as new grad PTs is documentation. It is often said that documentation is the worst part of being a PT. Seeing 16-20 patients/day means writing just as many notes! Our employers may expect our documentation to be completed within a specific time, which can be overwhelming. Designated documentation time is rarely built into a therapist’s day. This, undoubtedly, leads to added stress.
Outside of the clinic (or whatever setting one may be working) we have our own lives, families, children, bills, and many other tasks. Our options are usually to work on notes while patients are in clinic, to do them during lunch break, or to work on notes at home. The stress of taking notes home can carry over into our lives outside of work. Late nights and early mornings documenting can wear you down as a PT and can lead to burnout.
I know all of this sounds negative, but I promise I will get to the positives and the solutions!
Lastly, we typically get many referrals from MDs, from patient to patient referrals, and from patients who are returning. In some states, physical therapists have Direct Access. For most clinics, the majority of the patient referrals come from a Medical Doctor. All of these doctors have expectations of particular protocols, standards of care, etc. We want to impress these MDs so they will keep sending patients to us. Again, this can place a stress on us to perform at high levels.
Remember that we are only with patients up to 3 hours per week, which is 1.8% of their week. Only more reason not to place the blame on yourself if a patient is not getting better when you are doing everything you possibly can.
Ok . . . enough of the negative stuff, and time for the POSITIVE.
How to avoid or reduce burnout as a new grad:
In my time as a PT (1.5 years) I have been very fortunate to work for an amazing company, have amazing mentors, and develop other tools I have learned that can help combat the issue of burnout.
The most important thing you can do as a new grad PT to help avoid or reduce burnout is to work on yourself. Now what exactly does that mean? Let’s dive in.
Who is in your circle?
Surround yourself with the right people – those who lift you up; not bring you down. Also, we need to be around people who have been in our shoes before and have come out successful on the other side. These people can relate to you and know what you are going through. This means mentorship.
It is extremely important to have a mentor, especially an in-clinic mentor and a virtual mentor would be an added bonus. When you have questions or concerns about patients or treatment you can go to this person and have full confidence they will get you through your struggles.
Personal development is engaging in activities that help you to address areas in which you may be deficient. For example, if you are struggling with confidence as a new grad, there are plenty of books and other resources out there to help with this. If you struggle with organization, communication, productivity, etc., there are many resources available to assist with these as well.
Working on your personal development for 15-20 minutes every day will help make you a more well-rounded individual. This will also translate into your work, because you can deal with situations better, become more efficient with your time, communicate better with patients and so forth. When you work on yourself, you grow both personally and professionally.
These are some of my favorite personal development resources.
- The Hunt for Greatness with Greg Todd
- The Physical Therapy Business School Podcast
- PTonICE Podcast
- The Cash-Based Practice Podcast: Success in the Private Pay Healthcare Business Model
- The CashPT Lunch Hour Podcast with Aaron LeBauer
- The Confidence Gap, A Guide to Overcome Fear and Self Doubt
- Awaken the Giant Within
- The Compound Effect
- Time Management from the Inside Out: The Foolproof System for Taking Control of Your Schedule—and Your Life
Self reflection is key in the field of PT. You must know that you will make mistakes. Remember to use these as learning experiences. We must know that we cannot get everyone better. We are in a field of helping hurting people, but not everyone can be helped. Some people need other services: surgery, injections, etc. This was a hard pill for me to swallow as a new grad because I wanted to help EVERYONE.
Master Your Documentation
With documentation, learn to be efficient with your time so that all paperwork can be completed prior to leaving the clinic. Our clinic utilizes templates for documenting certain body parts, which saves a lot of time. I personally document through lunch, while patients are in clinic and at home. But that is what works best for me:everyone’s situation is different. If you have a family at home, it is important to develop a strategy that works for you in order to not miss out on your loved ones.
Taking Care of Yourself
Exercise, eat right, and sleep. It is difficult to care for others at your best if you first do have not taken care of YOU. The last thing you want to do is be tired and fatigued when listening to patients, talking to MDs, or doing your notes.
What to Do Now
Remember why you got into the profession. If you are not passionate about helping other people recover during tough times, then it may be challenging to achieve job satisfaction. Take each day to bring your energy and enthusiasm for serving others. If you treat every patient the way you would treat your family, and serve them in every way possible, you will be successful. Attend to your personal and professional growth, manage your time effectively, and you are very likely to experience a long and rewarding career!