Managing Stress Under the Prospect of Burnout

Let’s not panic until it’s absolutely necessary.

By Rachel Jermann, PT, DPT

I remember learning about different kinds of stress in school. “Eustress” and “distress,” or “good stress” and “bad stress.”

I was in seventh grade, and my major source of stress was probably angst over not having flattering khakis. At the time, I would have marked that solidly in the “distress” category. Fast forward to now. A May 2017 graduation from physical therapy school, a move across the country, one new job, one new business started, and one residency program started. All in less than a year. At some point, a state of stress just became constant background noise, the tinnitus of life.

Stress is not a bad thing. However, looming over our heads, just within reach, is that scary seven- letter epitaph: burnout. The American Medical Association (AMA) has declared this a major source of concern. In 2017, the AMA Wire reported that over the four-year period from 2013 to 2017, all specialties saw an increase in reported burnout—over 50 percent of physicians experience burnout at some level. Physicians rated “too many bureaucratic tasks, spending too many hours at work, feeling like just a cog in a wheel, and increased computerization of practice” as the top four concerns driving burnout. Sound familiar? The changing health care environment, with sinking reimbursement rates and a volatile political landscape, does not engender a sense of security.

As a new graduate, I find the mere existence of “burnout” stressful. It’s as though someone has put a shelf life on my career in patient care, though that was the reason I was drawn to rehab. I find myself utterly amazed at clinicians who have been in patient care for 30 years, because I feel I’ve been warned to find an “out” just in case. The stress of completing a residency, running a business, and normal everyday life is complicated by the nagging voice at the back of my mind: “Well, what if you put in all this time learning to treat patients, and you drop out in five years? At what point does your baseline stress translate to burnout?”

Personally, I manage by making my stressors varied in nature; there’s residency stress, personal stress, the stress of running my media company—my theory is that I can pick my stressors as though I’m grabbing lunch from a buffet. The theory makes sense; the perfect execution remains elusive. Managing stress seems to be a constant tradeoff. Immediately, “I will do X now and Y later because X is less stressful.” The long game is less clear. Will the stress of the residency keep me from burning out in five years? Is the stress of simultaneous multiple endeavors better than devoting all my energy to one task? Is splitting my attention now going to adversely affect me later on?

Though managing stress is an individualized endeavor, the system—the association, the practice in which you work—plays a vital role in stress management. New graduates often hear that they should choose mentorship over all else, avoid the “PT mill” kind of practice, and find a place that will help them grow as a practitioner. We’re willing to take the pay cut or go the extra mile to better patient care and feel more secure in our futures—as long as the right environment exists. The American Physical Therapy Association is currently contemplating a policy on the physical and mental well-being of physical therapists; the AMA has their STEPS Forward program, which helps practices set wellness metrics, measure, and prevent provider burnout.

I have a relative who I can hear clearly in the back of my mind when the stressors start to build and burnout seems closer: “Let’s not panic until it’s absolutely necessary.” And so, I put my headphones on, write my list of “Things I Can Get Done in 1 Hour,” and plow on.

Rachel Jermann, PT, DPT, is an outpatient orthopedic physical therapist at Kaiser Permanente in Oakland, California, and the founder of Talus Media: The PT News Project.