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Dealing with outpatient PT burnout image

Dealing With Outpatient PT Burnout

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Today’s article is a guest post that discusses how to manage outpatient PT burnout. Super excited to share this one, and eager to know what you all think! Be sure to comment below with your own thoughts!


Growing up, my first love was baseball. I enjoyed every aspect of the game: hitting, fielding, and pitching. I was fortunate enough to play the game at the college and professional ranks before becoming a doctor of physical therapy.

Baseball is a game that offers valuable life lessons. There will be days when you do not perform your best, but you’ve got to put your best foot forward on the diamond. There are also many variables in baseball you can’t control. It is said that baseball is a game where only 20% of the sport is in your hands. 

Why outpatient physical therapy burnout needs to be addressed

I honestly believe a lot of our burnout has to do with being expected to control what is out of our control. Hear me out.

It’s natural to control as much as you can in a new environment. When you move from student to autonomous physical therapist, you’re stretched so thin mentally and physically from trying to control parameters way outside your means. Sound familiar? That was me for the first several years of my career.

Fast forward four years and three jobs later, as a private outpatient PT, and I’ve found that the physical therapy profession sets its clinicians up to burn out.

Most physical therapists got into the profession to make a difference in people’s lives. Physical therapists are smart, selfless, compassionate, driven individuals that have come to a moral crossroads which makes us take a long look in the mirror and ask, “What the hell am I doing?”

This article will be a problem/solution guide that I created to help combat outpatient PT burnout. (I hate when I read a rant with nothing to help improve said rant.) I hope that I can help some of you as you navigate a profession that desperately needs to evolve to fit changing times.

Problem #1: using productivity as the be-all-end-all

A huge focus with my first two jobs was measuring productivity.

Productivity is generally measured by taking the number of patients seen in a given week, divided by how many hours you work in a week. Let’s say I saw 50 patients in a 40 hour work week, giving me a productivity rate of 125%, which is considered exceptional (95-100% is the usual norms for OP PT settings).

I’ve been practicing as a PT in Kansas since June 2015. The famous saying in Kansas is, “If you don’t like the weather this morning, just wait until lunch and it’ll be completely different.” I remember going to work when it was sunny in the morning, and a blizzard by lunchtime—this left the clinic looking like a ghost town in the afternoon. In turn, my productivity tanked, and boss would discuss my lack of productivity. This weather pattern was the norm, so I was consistently reprimanded for something out of my control.

How in the world can we, as professionals, be held accountable for patients missing appointments due to weather, illness, etc.? And, worse, we are often punished by employers when this happens! (I had a job where yearly raises were based on productivity!!!)

Productivity can be measured for informational purposes, but clinicians do not have ultimate control of who does/doesn’t come through our door—unless we pressure people into coming to the clinic sick or risking their lives driving in inclement weather.

A recent article by the APTA revealed that a high focus on productivity can lead to unethical behavior, such as inappropriately discharging patients or falsifying documentation. Speaking of documentation, if your employer expects you to make 95-100% productivity per hour, that literally leaves no time to document, unless you love doing notes at home (more power to you if that’s you, but that ain’t me) or clocking out of hourly jobs and documenting off the clock (which is not OK).

Possible solutions:

Employee:

If you’re currently in a situation like this, you have to realize that you can only control what’s in front of you. Put your attention and care into the patients that DO come into the door, and try not to focus on a productivity number that you can’t control.

If there’s a huge burden of productivity hanging over your head, bring these issues to your employer. There are so many opportunities to help fill these gaps, such as telehealth PT, to help your current work fill those gaps.

Ultimately, you have to ask yourself: is this within the 20% that I can control? If that answer is no, remember this quote from Toronto Blue Jay shortstop Bo Bichette: “No point in chasing an outcome when you can’t control that outcome.”

Employer:

How in the world can you place an unattainable measurement over your clinician’s head when, in the end, it’s out of their control?!? While we do work in the service industry in some ways, it’s also important that our bills are paid, our families’ mouths are fed, and our other basic necessities are met.

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If productivity is a measurement that you heavily utilize, consider a compromise that’s a win-win.

For instance, reduce the burdensome productivity parameters and, in turn, give the therapist the opportunity to perform non-clinical tasks. Case in point: each therapist could create an educational/marketing piece which would
1.) Empower the therapy community
2.) Market your business and your awesome therapists
3.) Let your therapists pursue what they got into this career field to do: HELP OTHERS! 

PT student/new grad:

When seeking a new job, check to see if there are very strict productivity measurements. Almost all companies will track this because it is a very easy objective measure. Tracking is fine. However, if a potential employer utilizes a measure that’s completely out of your control, then uses that measure in large part to determine whether you get a raise or ultimately keep your job, that’s a red flag.


Check out these MedBridge courses on burnout!

Problem #2: performance bonuses

You’re probably a bit taken aback.
“Bonuses are bad?”
“I am/will be swimming in debt from PT school! How can I turn down extra money at this point in my career?!?”

Before I get drug over the coals, allow me to make myself clear. I need to start by saying that, according to a survey done by the APTA in 2019, the average total debt of physical therapists is $96,000. You’d be crazy to think that your employer doesn’t know that.

My first two jobs had different bonus systems.

  • The first job based your monthly bonus on units charged per hour. The largest bonus awarded was capped at $500 bucks cash.
  • My second job was based on your worth (salary + cost of benefits). In order to receive a bonus you had to bill two times more than your worth, and you’d receive 6% bonus of what you billed if you met that billing goal.

There was room for growth, but it was almost impossible to obtain (not to mention mentally and physically draining).

I’d be lying to you if I said I cried foul from the beginning. Just like any eager and freshly minted PT, I wanted to please my employer and get ahead financially.

However, at the end of the day, week, month, year, or career, you’ll have to check your core values that led you to this career in the first place.

I found that the bonus system sets you up for billing sometimes totally unnecessary interventions (think: spinal decompression for an acute ankle sprain…crazy example, but you get my point) that can lead to some ethical/moral issues.

The bonus model may lead to fraudulent billing (it has happened), as well as asking yourself, “Is the bonus really worth compromising the reasons why I got into this profession?”

Possible solutions: 

Employee:

Do you have a niche that you can pair with your passion for physical therapy? If so, that’s a great place to start!

I used my baseball career with my passion as a physical therapist to provide movement screens and hitting instructions for baseball/softball players. Granted, it’s extra work, but there’s nothing more rewarding than taking two loves, blending them together, and HELPING OTHERS.

I have had several athletes whom I have provided baseball or softball lessons, and they have later come into the clinic when injuries struck.

Get out of your PT clinic, and use your knowledge and experience to better the lives of others.

Also, there’s a huge amount of resources such as concierge PT, telehealth PT, and cash-based physical therapy that you can utilize as a “side hustle” so that you can help with loans without irresponsibly billing for the sake of making an extra buck.

Employer:

Let’s call a spade a spade: the more your therapists bill, the more money you make.

It’s no mystery, but keep in mind your clinicians shouldn’t be going against what’s best for your patients (which is why you got into physical therapy in the first place, too).

Consider placing an emphasis on a bonus system on discharging patients who’ve had a successful rehab experience.

This sets up a model of doing what’s best for your patients, rewarding measurable performance, and setting up a word-of-mouth marketing plan (free of charge by the way) that puts the patient first.

A colleague of mine told me of his job’s bonus system, which consists of a bonus for getting a certain number of CEUs and community marketing. This shows you’re investing in your therapists and you want what’s best for your patients. 

PT student:

Getting into physical therapy school is not an easy task. Beating out hundreds of applicants to land one of roughly 40-80 spots in a program is no easy feat. You got there because:

  1. Your grades and test scores are pretty solid
  2. More importantly, you have an awesome background that’s eye opening

Don’t stop using your background coupled with your education as a physical therapist. One person I’m following on Twitter right is Will Lucas, a new grad DPT. All through school, he used his background as a baseball player to set him up as an expert the moment he hit the ground as a PT.

Problem #3: clinic expenses

There are generally two different types of PT clinic workers: revenue generating (providers) and non-revenue generating (administrative, marketing, aides/techs, etc). Don’t get me wrong; we desperately need both types of workers to make the PT clinic running smoothly, but when there’s so much pressure on providers to see a large volume of patients to offset a large non-revenue workforce, it becomes a problem.

Machines are another issue. Despite numerous advances in our profession, we’re still known as the heat/ice/stim/ultrasound people. We, as a profession, have moved toward active treatments, due to recent evidence-based medicine stating electrical modalities have “little to no effect on musculoskeletal conditions”. So, now we have this four-figure electrical modality device that costs on average $500/year to calibrate. Thus, revenue must be generated to offset the cost for equipment that isn’t even supported by the latest evidence based medicine.

Possible solutions: 

Employee/employer:

Just like any business with a budget, communication needs to be done on what services serve more like an investment (dry needling, blood flow restriction, manual therapy and therapeutic exercise techniques, etc.) that bring in revenue, and what expenses can be assessed to see if they’re a necessary item/service in the clinic. 

PT student:

It’s super beneficial to go see a potential employer’s facility. Observe which interventions are used. Look to see if the staff is busy or reading the newspaper, and how the facility itself is being utilized. Ultimately, your schedule will reflect your environment, regardless of what types of patients you’d like to see. 


Outpatient PT burnout has a lot to do with control

I’m so thankful to be a part of such an amazing profession, and I’m grateful for the private outpatient PT clinics that have allowed me to do something I’m very passionate about.

We have so many amazing people in the PT world killing it in all corners of our profession. It’s an unreal time to be a PT!

However; if we’re still dealing with outpatient PT burnout at such rampant rates, then obviously there are some changes that need to be made. We are all well aware of recent Medicare reimbursement cuts, which have taken their toll on our profession—but, in the end, our hands are tied to a certain extent, as this is largely out of our immediate control.

Our goal is to hold ourselves accountable for what’s in our control, just like baseball, and not to assume victimhood for the uncontrollable factors.

The champions of the profession wanted to provide value first, and their value was compensated accordingly. We need to set our sights on the value of our product, not the price of our product. An awesome quote from Richard Branson will set ourselves apart from the pack, “Do good, have fun, and money will come.”


Many thanks to Chris Kersten, PT, DPT, for sharing his thoughts on the burnout problem endemic in outpatient PT clinics. What have you all done to combat burnout? Which factors do you think play into your own feelings of burnout? Please share your thoughts in the comments below!

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