Burnout in Physical Therapy

Background: 

Prior to entering the field of physical therapy, I was working as a municipal bond analyst, but I was always interested in physical therapy. I grew up playing sports. During my high school and college years I had plenty of opportunities to be in and out of physical therapy clinics. I was immensely impressed by the knowledge and quality of care I received at those clinics. Those experiences had such a large impact on me that I considered changing my major from economics to pre physical therapy half way through my undergraduate career. Before making this large change, I decided to shadow as many physical therapists in the area as I could. I spent my fourth semester of undergrad shadowing physical therapists, working as an aide and continuing with my economics degree. To my surprise, my perception of physical therapy changed dramatically when I was able to see the field from the clinician’s side of care.

During my semester of shadowing and working as an aide, I shadowed mostly at SNFs and a chain of large privately owned physical therapy clinics. I was anticipating this experience to be the catalyst that would change my path in life. Unfortunately, It did not. My shadow and aide experience showed me that interacting with patients and helping them achieve there goals was something I really wanted to do, but I could not overlook the stress I was seeing with the physical therapy staff. Many of the physical therapists felt like they were stuck and were unable to be creative in their work environment. Some of them told me that a combination of the productivity requirements, high debt/income ratio and documentation led them to not enjoy work anymore. To my shock, many of these physical therapists advised me to look into other more lucrative health careers, like physician’s assistant.

Fast forward three years, my mindset about physical therapy changed dramatically after interacting with a few clinicians that owned their own practice and loved what they were doing. I experienced how their high energy level and ability to be creative with their time had such a positive impact on my recovery and other people who attended their practice. Being around these clinicians once again revived my interest in physical therapy, so I left the field of economics and the rest his history. One of my personal goals with going into physical therapy, was to understand why some physical therapists experience career dissatisfaction and stress while others are thriving. Learning about burnout during my first couple of years of PT school convinced me that this topic could help provide information regarding the contributing factors of occupational stress for some physical therapists.

Statement of Need:

Recent research in the field of physical therapy has shown that burnout is pervasive in the field. Anecdotally, I continued to see the impact of burnout on physical therapists during my clinical rotations. With the increased focus and interest on burnout in physical therapy and health care over the last 5-10 years, more information regarding the causative factors has come to light, although there are still much area for research. One area that appears to be lacking is practical information and guidance that physical therapists and organizations can use to reduce/prevent burnout. It’s important to provide this information, because research has shown that health care professionals that are experiencing burn out are more likely to have reduced patient satisfaction and treatment outcomes. In an effort to improve clinical care in physical therapy, there needs to be an investment into the most important capital the field has, it’s practicing physical therapists.

A portion of my capstone consisted of interviewing practicing physical therapists on the impact of burnout on their career. I was amazed by the responsiveness and interest in the topic by these clinicians. Some of the clinicians interviewed held positions of physical therapy management and ownership during their career. I was encouraged by these clinicians to develop a presentation and content to help illuminate the issue with organizations. This excited me, as a lot of the current research has shown that organizations have a large impact on causing burnout in clinicians. Furthermore, research has shown that organizations also play a crucial role in mitigating/preventing burnout.

Purpose:

The focus of this capstone is to illuminate the issue of burnout in physical therapy, identify causative factors contributing burnout in physical therapists and suggest frameworks for preventing/mitigating burnout. Although burnout has become a bigger focus in the field of physical therapy, I have noticed that many physical therapists do not have a good understanding of it. With this capstone I hope to simplify the condition and present it’s manifestations. Due to a paucity of qualitative data surrounding burnout in physical therapy, I conducted interviews with physical therapists to gain an insight on the impact of burnout on the field. The interviews conducted in this capstone can help provide information for organizations and practicing clinicians on what contributes to burnout and what can help mitigate feelings of burnout. Furthermore, outcome measures and structural frameworks included in this presentation can provide a baseline for how organizations can assess the impact of burnout on their clinicians. An educated organization and workforce can help collaboratively address the modifiable issues that are causing burnout and develop programs and assessment that can mitigate further clinician burnout.

Presentation Assessment:

During the process of developing this presentation and pamphlet, I received guidance from my advisor and committee members on ways to present this information to organizations. Originally this presentation was going to be presented to practicing physical therapists, but instead after the review of the research and communications with interviewees, the focus was switched toward organizations. Since the presentation is intended for organizations, I tried to highlight the consequences of staff burnout on the financial bottom line and patient care.

This voicethread presentation was developed in a way to educate organizations on the important issues associated with burnout and provide information on how they can make changes to address burnout. In addition, I synthesized the responses from six interviews to provide opinions and perspectives from physical therapists in the field. With the advice of my advisor and committee I created slide visuals that allowed for more digestible information from interview responses. The responses and suggestions provided by interviewees should be invaluable for management trying to understand areas of improvement. Lastly, actionable outcome measures and core organizational areas of focus were presented to provide something for organizations to consider when developing a mitigation plan.

Products:

For organizational management, I developed a voicethread presentaion. The voicethread provides the viewer with the most up to date research on the definition of burnout, risk factors associated, consequences and prevention strategies for both individual and organizations. At the end of the presentation, I included results from interviews I conducted with practicing physical therapists. The responses from the interview highlight different causative factors for developing burnout and how the clinicians attempted to mitigate those causative factors.

https://unc.voicethread.com/share/19991052/

 

An educational pamphlet was created as a tool that organizations can use in helping educate practicing physical therapists. The purpose of this pamphlet is to highlight the presentation, prevalence and prevention tips for burnout. This tool is way to initiate a conversation between management and practicing physical therapists. The hope is that collaborative conversations between physical therapy staff and management can begin from this product. Additionally, the pamphlet is supposed to be helpful in desensitizing any stigma associated with burnout.

Educational Pamphlet

 

Evaluation Component:

This feedback form was created as an assessment tool for feedback for those who watch the presentation and read the pamphlet. The most important thing I would like to learn from this feedback form, is if the information was useful and practical. This results from these evaluations could help frame future areas of research for burnout in physical therapy.

Presentation Evaluation Form

In general, I have used the guidance and assistance from my advisor, committee members and interviewees along the way to evaluate the visual and written content of the information provided in my Power Point and educational pamphlet.

Self-Assessment:

I am humbled by the amount of support and interest in the topic I experienced during this semester. I was surprised to learn that many physical therapists are interested in addressing burnout in physical therapy. I entered the research portion of this capstone experience thinking that I knew what the research would say because I thought I had “seen” burnout in the field. Not surprisingly, the research showed me things that I would not have considered previously. Going forward in my career, I want to continue looking for what the research has to say and not solely consider my anecdotal experience. Furthermore, during this journey I was moved by the willingness of physical therapists and educational staff to offer their time and energy to this product. I am more excited for my career as physical therapist following this capstone experience, because I can see that this field has people who truly care about the well being of practicing physical therapists. I also feel more prepared to make suggestions and present my understanding of information to both practicing physical therapists and organizations.

Another thing I learned from the research and the people I interviewed is that you need to be aware of yourself, to be a great clinician. I think sometimes it is easy to think that practicing as a physical therapist is only about caring for the patient, and of course that is why we do this, but if a PT is neglecting their own needs then the patient-PT relationship can be negatively impacted. Self care and developing a protective social support system is so important to succeeding as a physical therapists. It should be treated as priority because without it patient care can drop. I am excited to take what I have learned from this capstone and integrate it into future work endeavors.

 

Acknowledgements:

I want to thank my primary advisor, Michael McMorris for not only taking an interest in my capstone proposal but an interest in me. I don’t think this project would have gotten to this point without your guidance. What started off as nugget of an idea in a zoom call in January has blossomed into something I am proud of. You shared with me a lot of time during a very busy semester for you, your feedback was invaluable.

To Erwin Seguia, you are one of these reasons I chose to go back to school for physical therapy. Your passion for the field is unmatched and your interest in developing healthy working environments is unmatched. Thank you for your guidance over the years and with this capstone project.

To Darlene Sekerak, thank you for showing interest in this important research and providing your thoughtful feedback. Your classes have shown me it is important to be brave and embrace the challenges coming ahead in physical therapy, for that I am grateful.

To the six physical therapists I interviewed, I was shocked by the amount of interest and time you were willing to provide to this capstone. You shared many personal struggles and important clinical pearls that I hope can influence others on their journey.