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Burnout in Canadian physios

This post may be the most important post that I have done in the past year.  This topic has piqued my interest since a person on a PT FaceBook page wrote about regretting becoming a PT.

My passion for this profession has grown in the 11 years since starting the profession.  I never…ever…thought that I would be able to impact people from all over the world with my content, but it is happening.  I never thought that I would be voted among the most influential therapists, but it is happening.  I laughed the first time that someone told me that they follow my content, but it is happening more and more.

This profession is awesome…if you let it be.  This profession can be very destructive to those in the profession…if you let it be.

Today’s post will cover burnout and will take quotes from the paper “Burnout Among Alberta Physiotherapists”.

“Burnout is defines as ‘…a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with people in some capacity.'”

Is this the healthcare practitioner that you want as a patient?

Is this the healthcare practitioner that you signed up to be when you graduated from PT school?

No?  Well then what are you going to do about it?

If you don’t make a change in your life situation, then life situations won’t change around you.

I have more zeal for my profession now than I did 10 years ago, 5 years ago and even 2 months ago.  I am meeting new people on social media and engaging in meaningful conversations with the “big dawgs” of the profession.  You know what…so can you!  You just have to take that first step from behind the keyboard or phone and just reach out.  Everyone that I have interacted with, from across the world, has been very awesome to talk to and at no point did I ever feel like I was a burden or a vampire on their energy or time.

These relationships help to prevent emotional exhaustion for me.

I love people! Really, I do…most of the time at least.  I don’t understand the depersonalization portion of burnout, because we signed up for working with people.  This is an inherent part of the job.

Reduced personal accomplishment….hmmm…what do I say about this?

This is inherent.  I don’t understand how an external force can allow for reduced personal accomplishment.  Each day we have choices to make.  One choice could be to stay in the situation that you are in, but another could be to just make a different decision.  I have worked with many people that weren’t satisfied with their job or their career, but when asking them why don’t do something different, the answer was always the same…I can’t afford to.

When the money becomes to good to leave, there is a problem.  When the money over rides personal accomplishment and satisfaction, there is a problem.  The problem is that the person may no longer recognize the person looking back at him in the mirror.  I’ve made 6 figures in this profession.  I took a major pay cut and essentially started over.  I have to work multiple jobs in order to try to accomplish a goal of being my own boss and creating an army of PT’s that have similar goals and wants in the profession.  I will try to keep this dream alive as long as possible.  This is what I am trying to accomplish.

“The concept of work engagement is also relevant and is considered the opposite of burnout. Individuals may demonstrate a high degree of burnout if they report high levels of emotional exhaustion and depersonalization and low levels of personal achievement.”

here is so much that I struggle with in these papers.  I come from a blue collar family.  My dad served as a Medic in the 101st Airborne during the Vietnam War.  When he returned home, he went to work as a laborer putting in water and sewer lines.  He nearly died multiple times at his job and he showed up he next day.  He had multiple broken bones from accidents and he showed up the next day.  Work ethic seems to be a lost trait.  For years, I just put my head down and worked.  I made my first boss look good.  I made my second boss look good.  At not time did I ever worry about making myself look good.  I always assumed that if I made the organization look good that I would reap the benefits.

I had to leave my last job because there was too much of a gap between the highest producer and the lowest producer not only in terms of productivity, but also in terms of patient satisfaction and outcomes.  That’s when I realized that I could no longer continue to work for the same company and decided it was time to put my work ethic to use for my family and my community.

This is work engagement.  When I realized that I needed to shift places of employment, I really learned about professional engagement.  In the year of deciding to leave the comfort of a fairly high paying hospital, I since became one of the most influential people of 2017, simply by putting my head down and working.  I am hosting my first CEU course in the next month and I have found a way to piece together enough hours through other opportunities to cover the lost income from leaving the high paying cushy job.  I will continue to put my head down and work.   I feel like I am accomplishing more at this point in my career than I did during the previous decade.

“Research has demonstrated that burnout and work engagement are negatively correlated”

This is not earth shattering information, but serves to demonstrate that loving your job and actively engaging your work can combat depersonalization and emotional exhaustion.  My previous cushy job had me working from 9:30-6 M-F without any forced weekends or need for overtime.  I was paid higher than the median salary, but I realized that the company as a whole was full of donkeys.  This is a Dave Ramsey reference.  Don’t get me wrong, my immediate team had some thoroughbreds, but they were definitely outnumbered by… you guessed it!

I saw myself climbing the ladder at this location and when I got near the top rung, there was no place left to grab onto.  Some of the people that had the position that I was gunning for had no intention of retiring.  At that point, I knew that if I stayed it would only have been for the $$$$$.

“37.3% of survey respondents were estimated to demonstrate a high degree of burnout based on thier EE (emotional exhaustion) subscale sore.”

Overall, the scores for burnout were average to low, but there were some aspects of the survey that demonstrated high burnout levels.  Being emotionally exhausted is a topic that was recently discussed in a FB post.  One PT posted that he was emotionally drained from the treatment of patients.  This is an issue and should throw up a flag for some employers.  When looking at work engagement and burnout being negatively correlated, there is research that states that high burnout rates may lead to compromised care.  Hopefully, this is actually a concern, but in reality I’ve learned that many corporate based therapy clinics care more about the Benjamins than patient outcomes.

“Respondents 61 years of age and older reported statistically significantly lower mean EE (emotional exhaustion) scores than respondents in other age categories…there was a decreasing trend in depersonalization scores with increasing experience”

There is a light at the end of the tunnel…and it’s not an oncoming train! If you can make it in this field for at least 30 years, then you will no longer let it get to you.  (I’m trying to make a funny).  Why should we have to wait until almost retirement age before we experience less emotional exhaustion and depersonalization.  I have personally seen this in practice, but from my experience, it is due to the therapist just not caring as much.  It’s like some of them have started counting down the days to retirement.  I’ve seen therapists that are more focused on the upcoming vacation than they are on the patient in the present.  They anticipate the vacation for weeks and then leave for a week or two and when they return they talk about it for two months until they start to anticipate the next vacation.  Work is just a way to pass the time while waiting for vacation.  Nothing wrong with that if it’s your style, but that’s not the Doctor that I want treating me!

We have to do better, otherwise the newbies in the profession won’t last until they can reach the age in which they can stop caring about the stresses of the profession.

There were some flow sheets from the paper that I will put in at the end.  I highly recommend reading this paper as a whole if you are interested in burnout.

“The most commonly reported symptoms of burnout related to fatigue and exhaustion”

It’s not uncommon to hear that therapists are staying after hours to complete documentation.  If you are a patient and you have read this far…kudos to you.  After your visit with a PT, the note may take anywhere from 5 minutes to 30 minutes to complete.  If the therapist is spending 100% of the time with you, then the note will have to be completed after you leave.  If the therapist is seeing 12 patients per day, then there could be as much as 2-3 hours of paperwork left at the end of the day.  In many places, this time is unpaid since it is part of the salary.  If it is paid, then it may count against the therapist because the time is “unproductive”, which means that the company is not making any money although they are paying a therapist to work for that time period.  This is a no-win for the therapist…unless they are over 61 years-old, of course.

“Respondents identified many perceived work-related causes of burnout including work overload, unrealistic expectations, lack of recognition from management and client demands.”

Ours is a profession that is consistently ranked in the top 10 professions in the country.  Why would there be people feeling burned out?

We get into this profession with dreams of helping people and fixing the world.  Those dreams are quickly crushed when corporate greed takes precedence over patient care.  It’s not uncommon to see a therapist trying to manage the circus of “treating” (I use that term loosely here) multiple patients at once.  I have talked to therapist that take pride in “treating” 30 patients per day.  I don’t know how much “treatment” actually gets accomplished when there are three patients in the clinic at the same time.  They actually wear it like a  badge of honor.  sometimes these therapists don’t understand that specific insurance companies require that a patient be treated one-on-one.  This means that the therapist is legally required to only charge the patient for the time that the therapist is actually working with the patient.  We are not allowed to charge insurance companies for having a technician (usually a high school or college that wants to be a therapist).

Patients: If you are unsure if the person treating you should be treating you, simply ask if the person has a license

Therapists: if you are allowing technicians to treat patients…why? Does it benefit you, corporate PT or the patient? If you can answer the patient, I follow with one more question…Is there ever a time in which you believe that the patient is in better hands with an unlicensed professional than with you?

Unrealistic expectations? Never!

I’ve seen therapist that are expected to do their paperwork at home for 2-3 hours per night.  I used to be one of those therapists.  You essentially are working 60 hour weeks for 40 hour pay.

If a patient is doing well and is ready for discharge, good luck with that.  There is pressure from some supervisors to keep patients longer than they need to be in therapy.  This too is illegal, but I hear about it on a monthly basis from therapists all over the country.

Client demands! The client is the boss.  There are very few demands from the client that we shouldn’t attempt to accommodate. The chief demand is accessibility.  Patients want access to therapists essentially around the clock.  This is to be expected in a social driven by social media and access to news/information and advice.

“…burnout prevention…maintaining a healthy lifestyle, and the importance of social relationships.  Within the work environment, flexible hours, career change, positive workplace relationships and continuing education were perceived to help prevent burnout”

All you new grads………

Re-read that paragraph!

Get out there an move! Be an example that your patients can follow.  It will not only give you more authority with your patients, but it may save you from burning out in the long term.

Flexible hours are a plus, but the positive workplace relationships is what kept me in a position for 10 years.  I was able to work with the thoroughbreds for a majority of my career.  I started at that location taking a pay cut from the previous job because I was impressed with some of the people with whom I would be working side-by-side.

Recommendations for employers:

identify burnout early

improve communitcation

address flexible work hours

provide recognition

provide professional development

These are paraphrased from the article and I find some of them overkill.  Zig Ziglar repeatedly stated that people would quit jobs because they were underappreciated.  I have never felt this way in my over a decade long career.  I have always been the work horse in the company, whichever company I worked for, and have never felt unappreciated.

Work hours are important for family and life balance, but goals have to be determined.  If work-life balance is the chief goal, then the flexible hours are extremely beneficial.  If work and learning your craft is important then so be it and make your choice from there.

This is by far and away the most important post that I have done in the previous 2 years of posting.

I hope that all those that read this learn from this and don’t allow themselves to get eaten up by this profession and fall to the wayside due to burnout.

Excerpts from:

Bainbridge L, Davidson K, Loranger L. Burnout Among Alberta Physiotherapists: A White Paper. Physiotherapy Alberta. 2017:

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2 thoughts on “Burnout in Canadian physios

    1. Thanks for this comment. As much as I get the negative connotation from it, I’m glad that the pride I have in my practice has come through the writing. It took way too long for me to speak up on issues in this profession. I really hope that everyone, including you feels like a legend at something he/she is passionate about.

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