What’s Behind Staff Burnout?

Explore three common situations involving therapists dealing with burnout and ways to cope

By Jenna Gourlay, PT, DPT, and Phil Plisky, PT, DSc

You’re worried. One of your best employees isn’t performing or engaged like usual.

He’s normally the one lifting others up around him, always learning something new, and one of the most positive contributors to the culture. Yet, he’s not himself. He comes in later than usual, interacts less with coworkers, and the small day-to-day inconveniences seem to affect his entire demeanor. He says he is burnt out.

Or maybe it is you. It is taking every ounce of your energy to do your job. You’re supposed to encourage and inspire your team, but you can’t even motivate yourself. You just took time off, but nothing feels different. You feel burnt out.

We hear it so often that it no longer surprises us.¹ It often marks the beginning of a long road trying to figure out a way to stop it. People will change jobs, change roles, or sometimes even change professions only to get burnt out again. And while burnout seems so common in physical therapy and it seems like all of us know many people that have experienced it, there is not much discussion about what it means.

If we start with the commonly held definition for medical providers it is, “emotional exhaustion, depersonalization, and a lack of sense of personal/professional accomplishment.”²

That is a broad umbrella definition much like patellofemoral pain syndrome or low back pain. It tells you where the problem is, but it doesn’t do anything to define what caused it in the first place or how to improve it. Stephanie Weyrauch also explores this definition and all that goes into it in her article in this issue, “Burnout Response for Leaders,” on page 40.

The secret to eliminating burnout is figuring out what caused it in the first place.³ Before we do that, we need to talk about what it isn’t. Most equate burnout with being overworked or the amount of work that we have to do. Yet, we can all remember a time we were extremely busy but loved what we were doing. Passion projects that keep us up late hours or have us waking up early wanting to do work don’t cause burnout even if they create a heavy workload. But we need to have clarity in our overall and specific purpose. The following are three common situations involving therapists dealing with burnout. We seek to understand why the burnout is occurring and offer solutions to help.

SCENARIO 1: CLARITY

Situation:

Michael has been working as a physical therapist for almost two years. When he got out of school, he was excited and driven. He wanted to be an expert in sports. He took continuing education, learned new skills, and listened to podcasts every day. Slowly, though, he started feeling like he was just going through the motions. He was a much better physical therapist than he was two years ago, but the excitement was gone. He didn’t want to go to work anymore and felt like he was living for the weekend. His caseload only had a few athletes and while he liked his patients as people, they weren’t his ideal clients.

Solution:

Michael’s clinic director noticed his decrease in enthusiasm and encouraged him to apply for a leadership role within the company. Michael thought about it, but it didn’t appeal to him at all. He still wanted to be an expert in sports but didn’t know what his next step should be. When Michael turned down a leadership position, his director asked him to define what it would mean to be an expert in sports physical therapy and also asked him to identify what he could change that would bring back his excitement for work.

He worked on creating his ideal day and realized he not only wanted to help rehab athletes, but also wanted to work on performance development. Over the next year, Michael would work with his clinic to create a sport performance option and would split time between the two. He needed clarity on what he truly wanted from work and who he wanted to be in the profession. He felt burnt out because he didn’t have direction working toward anything. His leader could have helped him more quickly and directly if he would have worked with Michael to help him gain focus and perspective.

THE ROLE OF CLARITY

There are two types of clarity you need to have. The first is clarity on your overall life mission. The second relates to knowing what a great day or week specifically looks like. Here are some questions you can ask to determine if you have both types of clarity:

Overall Life Mission Clarity

• Are you clear on your overall life purpose?
• Do you have acute awareness of mission, vision, and values both personally and professionally?

Specific Week or Day Clarity

• Have you clearly defined success for what a specific day looks like?
  Sometimes we might have a great overall purpose but haven’t translated that into specifics. Without a specific picture in mind of what we want our day and week to look like, we are left with an uncomfortable, uneasy feeling that we are not doing well. In reality, we haven’t even defined what doing well looks like.
• Have you written out your ideal week?
  When are you working? Who are you working with? What does your time off work look like and how do you like to spend it? These are all question that can help you zero in on your ideal week.
• What is your career success metric (i.e. how do you know you are doing it right)?
  Often the problems we see are not because we are not successful but because we are using metrics that don’t accurately define what success really looks like to us. Don’t settle for someone else’s definition/measurement of success. Build your own definition for it, using your own values.
• What is on your “not to do” list?
  This list can help you define the things you won’t do and help you leave more time and energy for the things you actually want to do. Every “yes” you give requires a “no” somewhere else, and this list can be a good place to start determining what your “no’s” should be.

But sometimes, clarity is not enough. We so frequently mistake burnout for being overworked (which can sometimes be true, but more frequently there is a deeper issue). When you are not growing intentionally and passionately, it tends to feel like you are dying on the inside. We all are learning, and many would say they are challenged, but we all need the type of learning that stretches us. The kind that is both exciting and scary. But how do we apply the concept of challenge in the clinical setting?

SCENARIO TWO: CHALLENGE

Situation:

Mark had everything he wanted. He finished his orthopedic specialty, had a great caseload of motivated patients, and great coworkers. Yet some days, he felt like he’d rather be doing anything else besides treating patients. He felt bored and uninspired. How was he going to do this for the rest of his life?

Solution:

Hearing his concerns, his clinic director decided to give him a student. Initially Mark was reluctant. He questioned whether he should be responsible for a student when he wasn’t enjoying work to begin with. The student came with the energy Mark once had and was eager to learn. Mark found himself preparing for how best to teach the student. He was reading new articles and finding ways to help the student. While Mark felt burnt out, the driving force was that he wasn’t challenged.

TESTING YOUR PROFESSIONAL CHALLENGE

To test your level of professional challenge, ask these questions:

• What are you intensely, intentionally learning?
  This goes beyond the typical “I learn something new every day.” This is immersion into a topic to gain mastery.
• Is it a bit of a struggle to learn?
  If there is not some struggle in the learning process, it is likely not challenging enough. Frequently, clinicians will take a continuing education course to jumpstart their excitement. This excitement usually only lasts a week or two after the course. Teaching the newly gained skills to others over long period (not just one lunchtime in-service) can help the challenge in a continuing education course.
• Do you need the help of others to learn it?
  If others are involved, it can indicate that the level of challenge is sufficient. Additionally, the camaraderie and connection that is built goes a long way to feeling satisfied with your career. While having a group of people you are leaning with is important, there needs to be multiple levels of community to combat burnout. A lack of a high-quality community is one of the most common reasons people feel burnt out.⁴ If we are not around people who are chasing the same goals, pushing each other and supporting each other, we can get exhausted pretty quickly. Finding this group is not always easy, but it is always worth it. Searching for challenge and finding community in the process leads in the third scenario:

SCENARIO THREE: COMMUNITY

Situation:

Maria has been a clinic owner for the last 18 months. She initially loved it and welcomed the new challenges. She was accepted by those who report to her and her leadership style helped keep the morale high and culture positive. To anyone in the clinic it seemed like Maria was thriving, but Maria was constantly stressed and often missed her days as a staff physical therapist. She was starting to feel trapped.

Solution:

Maria decided to take a month-long online training course focused on management and clinic growth. She wasn’t particularly excited about it, but she was looking for anything that would reignite her passion for leadership. She figured if she learned something new that may help. What she got was much more meaningful.

During the course, Maria interacted with other owners and realized many of them felt the same stresses that she did. She loved her team of employees, but they couldn’t be the support system she needed because they couldn’t understand the stressors she had. As time passed, she started to feel more alone. Having a group of people chasing the same goals and experiencing similar struggles as she was ultimately led to her engagement and fulfillment. This conclusion falls in line with guidance that “if occupational loneliness is a hidden cost of management, then owner-managers could attempt to strengthen their interpersonal resources, including establishing social connectedness with peers.”⁵

The solution for Maria was community.

FINDING THE RIGHT COMMUNITY

Here are some questions and action steps you can take to help find the right community for you:

• Where do the people chasing the same goals as you hang out?
• Where do people who have the same challenges as you connect?
• At work, do your teammates care about each other both personally and professionally?
• Does your team seek the advice of each other in patient care?
• Combining challenge and community, does your team learn together?

THE SOURCE OF BURNOUT

While burnout is prevalent in physical therapy, it is important to understand that it is rarely just working too many hours. It is a complex interaction of factors, but they can be analyzed by examining your clarity, challenge, and community. By helping your team examine, and more importantly, find and implement solutions to the deficits identified, you can prevent burnout in yourself and your clinic.

References:

¹Anderson EZ, et al. Identifying stress and burnout in physical therapists. Physiotherapy 101. 2015;e1712-e1713.

²De Hert S. Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies. Local Reg Anesth. 2020;13:171-183. Published 2020 Oct 28. doi:10.2147/LRA.S240564

³Chen H, Peng W, Wei W. New perspective on job burnout: Exploring the root cause beyond general antecedents analysis. Psychological Reports. 2012;110(3):801-819.

⁴Seppala E, King M. Burnout at work isn’t just about exhaustion. It’s also about loneliness. Harvard Business Review. 2017;29:2-4.

⁵Fernet C, et al. The psychological costs of owning and managing an SME: Linking job stressors, occupational loneliness, entrepreneurial orientation, and burnout. Burnout Research. 2016;3(2):45-53.

Jenna Gourlay, PT, DPT, and Phil Plisky, PT, DSc, are co-founders of the Professional Rebellion, a company dedicated to guiding and mentoring professionals on the path to their ideal careers. They may be reached at jennagourlay@gmail.com and philplisky@gmail.com.