Preventing Burnout by Growing a Caseload of Desirable Patients

By Michelle Collie, PT, DPT, MS, OCS

An internal marketing plan that optimizes long-term relationships with patients is an important and cost-effective way to grow a private physical therapy practice. Additionally, internal marketing strategies provide an excellent opportunity for physical therapists to take ownership of their caseloads, taking responsibility to grow a caseload of the kinds of patients a clinician wants to treat. A caseload of desirable patients is an important approach to preventing burnout in the workplace.1

In the 1970s American psychologist Herbert Freudenberger first used the term burnout to describe the symptoms of exhaustion, lethargy, and inability to cope in people working in “helping” professions. Since then, the term has evolved to be used not just for health care providers but for anyone affected by severe stress and high ideals in the workplace,1 which over time can lead to a number of mental and physical health problems. The ever-increasing challenges in private practice physical therapy certainly have the potential to lead to burnout. High productivity goals, documentation and compliance expectations, noncompliant patients, and the demands of challenging patients are a few of the factors that can precipitate burnout. Motivated and happy physical therapists are more productive, give better care, and can cope with the work-place stresses. Although many of the precipitating factors leading to burnout are out of the control of the physical therapist, there are opportunities to optimize professional satisfaction. For example, a physical therapist with a schedule of “less-than-desirable patients” is much more likely to become dissatisfied, stressed, and burned out. This is a situation that can be prevented.

What is a “less-than-desirable patient”? This depends on the individual physical therapist. The clinician who prefers to see geriatric patients will certainly not be professionally fulfilled if he has a caseload of teenagers with sports injuries and concussions. The eager new physical therapist who wants to see orthopedic and sports injuries will become stressed with a schedule of opiod-seeking patients with chronic pain that she doesn’t have the knowledge to help. Finally, most physical therapists prefer patients who are compliant and are active participants in their care, and a caseload of noncompliant, passive patients can be exhausting and stressful. Providing the expectations and systems for physical therapists to build and maintain their own caseload, a caseload of the “kinds of patients they want to treat,” will result in productive clinicians getting excellent clinical outcomes from satisfied patients. This results in physical therapists who are professionally satisfied and able to cope with the demands of private practice.


Establish an expectation and system in your practice for physical therapists to maintain relationships with the patients who fit their criteria for desirable patients. Consider these examples:

  • On a unique holiday such as St. Patrick’s Day or Halloween, all physical therapists send a hand written card to 20 past patients. Provide the cards and the support staff to address and mail the cards.
  • On a specific day and time every week, physical therapists call 3 past patients to check in and see how they are. Discuss these calls each week, to provide feedback and strengthen the system.
  • On the first of the month physical therapists send an e-newsletter or link to a blog to past patients, specific to the kind of patients they want to see. For example; a physical therapist who wants to see more running injuries sends relevant information to the past runners they have treated. Or a physical therapist building their caseload in the area of occupational health could send a monthly, “Staying Healthy at Work” tip or reminder.
  • Additional material available to members of the American Physical Therapy Association (APTA) and Private Practice Section include “The Fit Factor” (, the Private Practice Public Relations and Marketing monthly toolkit, and content from the APTA’s Move Forward website (

Develop a system in your practice for physical therapists to receive friend and family referrals from the patients they enjoy treating. People typically spend time and are friends with people similar to themselves.

  • Provide a gift certificate to a local coffee shop, or a discount to products sold in your clinic that physical therapists can give patients who refer friends or family.
  • Establish an expectation and a system for physical therapists to spotlight one patient per month on social media. Develop and provide a step-by-step process, starting with how to identify a patient to spotlight and how to ask a patient, to details on photo or video, and how the story will be posted and promoted on which social media platform.

Developing the tools and systems for physical therapists to build their own caseload, tools, and systems that fit the vision and culture of your practice is not only an important component to your marketing plan but one that will help to prevent burnout.


1. Depression: What is burnout? US National Library of Medicine.


Michelle Collie, PT, DPT, MS, OCS, is the chair of the PPS PR and Marketing Committee and chief executive officer of Performance Physical Therapy in Rhode Island. She can be reached at

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