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Episode 26: Physical Therapist Burnout: Causes and Solution

Episode 26: Physical Therapist Burnout: Causes and Solution
32 minutes, 2 seconds
Remote Media URL
Name
Physical therapist burnout causes and solutions
Authored on
Wed, 11/02/2022 - 10:15

Richard Leaver, PT
Richard Leaver
Chief Executive Officer

In this podcast titled,  “Physical Therapist Burnout: Causes and Solution” we have the great pleasure speaking with Meredith Castin,  a licensed physical therapist, entrepreneur, career strategist, and owner of The Non-Clinical PT.
 
Our discussion with Meredith focuses on:

  • What we mean when we talk about clinician burn out
  • How burnout is manifested
  • Why clinician burnout is such an important issue to discuss
  • Why more people are feeling burned out
  • The main causes of clinician burnout
  • Underlying intrinsic and extrinsic factors
  • Whether the problem is getting worse or better
  • External factors that contribute towards clinician burnout
  • What type of environment clinic leaders need to provide to mitigate the risk factors contributing towards possible clinician burnout
  • How we see the future of outpatient physical therapy
Podcast Transcript

Richard: Welcome back to Agile&Me a physical therapy leadership podcast series. A podcast device to help emerging experience therapy leaders learn more about various topics relevant to outpatient therapy services. Today’s podcast is titled physical therapist burnout causes and solutions and today’s guest is Meredith. This is a topic that I’ve been wanting to speak about for a long time, and it’s certainly a topic that is of significant interest and concern within the professional world over the last few years. Before we dive into that, would you be able to perhaps introduce yourself to the listeners?

Meredith: My name is Meredith Kasten. I run the nonclinical PT and I am a physical therapist. I graduated in 2010 and treated for about five years before leaving for a non-patient care career. After that happened, people started reaching out nonstop. That’s what kind of led me to start the nonclinical PT just as a resource for other therapists and clinicians who wanted to remain PTs at heart, but do something else with their careers.

Richard: Now with regards to burnout, what do we actually mean? It’s a common term, but I don’t necessarily know that people truly understand what we’re talking about. So could you perhaps provide the readers with a nice idea of what you mean?

Meredith: I hear burnout constantly being mentioned in all sorts of careers from the tech industry to startups and marketing to the arts. Most people just burn out in general. So to your question, really when you’re burned out, it generally just means that you’re feeling a sense of detachment and a little bit of loss of control over the feelings of satisfaction and happiness related to your work and instead you’re feeling like all you’re doing is working and all your thoughts are about work.  I’m again using burnout in terms of work for our purposes, but this can relate to anything in your life. If you’re a parent, if you were a caregiver, you can experience burnout in the same sense , you may feel just completely overwhelmed or you feel like it’s consuming all of your time.

Richard: When I think of burnout, the term burnout, I think of a term that I believe is overused, has negative connotations and also associated with failure, but that’s really not helpful.

Meredith: Erika Del Pozo and she’s an OT and she studied burnout a lot. She points out that a lot of the literature says fighting burnout, beating burnout, and it’s not necessarily a fight to be one because burnout is going to be kind of something that we’re dealing with our whole lives. If you think about it, just the idea that if we let something become our entire lives or if we don’t take care of ourselves or if people don’t maybe respect us on the job, these can all be contributing factors. So to simplify it or reduce it down to beating burnout makes it seem like there’s this easy solution. I don’t necessarily think that it’s something that can just be solved by attending a yoga class or eating clean or any of the suggestions that I’ve heard thrown at by others.

Richard:  I wish it was just as simple as going to a yoga class. I think that the term is really deceptive because the issues that contribute toward a multi-factorial and the factors that one needs to consider to reduce or eliminate or you know, deal with burnout are also matched multifactorial.

Meredith: I think some of it’s within our control and some of it is outside of our control. It’s just understanding how the elements that are outside of our control can be addressed so that we’re able to really just better face each day and approach things from a healthy mindset instead of catastrophizing things. So we’re going a little bit deeper into the weeds with that kind of conversation, but because certain things we will never have control over that. I think it’s important to understand what’s in our control and what’s out of our control and it’s important for the people whom we report to understand that certain degrees of things are out of our control. So if they’re in their control, it’s up to them to step up and try to address those factors.

Richard: I think that’s critical. Isn’t it? It’s just acknowledging the multi-factor nature of this, that there are certain components that are beyond our control. Whilst we’d love to be able to control them, we can’t, and it’s just working on those factors that we can isn’t it. I think that’s usually sufficient to reduce or eliminate burnout in most instances, but there are certain times where we have limited input. As I said, burnout is a term I think is used too much. I think it’s used when really we’re just under any type of anxiety or stress rather than true burnout. How does burnout manifest itself? When would you use it?

Meredith:  I think probably differently in everybody, but there are a couple of common factors that tend to stick out. One of them is just feeling really detached from your work. Just basically feeling like you don’t care, you just kind of never phoning it in, or if you’re normally a really empathetic person, and you’re starting to realize that your inner monologue is saying, I don’t care about the stupid knee replacement patient or that type of thing, if you’re just starting to notice major changes in how you approach the job and you’re noticing that you don’t care anymore, if you used to be a really ambitious or growth oriented person. All of a sudden you don’t really care and you’re just kind of checking your phone the whole day or hanging out in the big break room as often as possible. Or if your documentation is going down the drain now, to your point, I think a lot of these things can signify stress, but if they’re just kind of ongoing and you feel like you don’t care anymore, then I would start to think this could look like burnout. If you’re just feeling like you just don’t care or you don’t have any interest in the future.  “I just don’t care. I don’t want to hear it. I don’t want to listen.”  That’s where I start to think, okay, this might be a case of burnout. This might be a situation where your burnout is related to feeling like you don’t have enough maybe locus of control in your work, or it might be that the work itself just isn’t good, a good fit for you, or maybe productivity is getting to you, but if it’s just a kind of long-term ongoing situation where you’re completely checked out and you just feel like your empathy isn’t quite there anymore. I would start to look at it like this could really be burnout. It’s that ongoing sense of perhaps helplessness or detachment, isn’t it. I think a lot of it has to do with detachment and helplessness.  That’s when people ask why are people burning out now? I think the main difference is that at this point we feel as though there isn’t as much opportunity to actually make a difference in patients’ lives because the treatments are getting shorter. The documentation is taking longer. At this point, it’s just that frickin productivity. Just the idea that you need to build that or units, you need to see more patients. We are all trained and educated in our academic systems to listen to patients carefully, take a full history, really be their partner, be present. And it’s so hard to be present when all you can think about is my productivity in the toilet. I can’t bill for this time. I’m going to have to. Cut another patient short because this one’s going longer and that patient would have gotten me more billable units. So when we’re thinking about it, that way, it’s really hard to feel engaged and to feel like we’re making a difference. I think a lot about burnout. If you feel like you’re not succeeding, you will ultimately most likely feel burned out. If you are in a career where the number one priority is to make money and you’re a salesperson or close deals or any of those things and you cannot meet your goals, especially if it’s outside of your control. You’ll probably become burned out. The same thing goes for patient care.

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Richard: I have been very fortunate in my career where I’ve been able to change my roles. Obviously I’ve been managing either direct patient care or indirectly through managerial positions, musculus clinical injuries and involvement with MSK prevention or treatment in some manner. But thankfully I’ve avoided it. I had when I felt that I’d been going down that road, I’ve had the capability and the ability and the opportunity to, to modify my role. And that’s not to say I haven’t gone back to treatment, but I can take a break from what I believe was one of the, some of the core stresses and factors, and then kind of regroup and then feel as if I can then tackle it again. I would imagine that’s probably hasn’t been possible for a lot of people that actually have burnout symptoms probably. Right?

Meredith: You hit the nail on the head again, there with the idea that you’ve had the ability to step away and take a break as you’ve needed to and change things up. And it’s kind of on your terms. Another thing I’ve thought about, I’ve been chewing on this a lot recently, and again, this doesn’t have to do with the literature. This is more just me kind of lying awake in bed at night. Wondering why is everybody so burned out? I do think some of it’s generational. We, my generation, I’m technically gen X, but I get lumped in with millennials a lot. So I think a lot of times with millennials, we were definitely raised with a lot more kind of control over our destiny, or at least being told that we can do whatever we want. We felt a lot more control over our destiny. Whereas my parents are boomers and they’ve always felt very much like you get a job, you stick to it, you deal with the bad days and it’s not to say that millennials don’t have a good work ethic because I think they have a phenomenal work ethic. But I do think there’s a little bit more focus on control and kind of building your destiny and creating that life that you want.  I work with people and say, all right volunteer to do this offer to help your supervisor through this. They come back and they say, I had a conversation with my supervisor and he or she said, they already have someone doing that and they don’t need the help. That’s a big issue is that if you’re working in a system where you’re only viewed as a clinician, not to say that we don’t work really hard to become excellent clinicians, but if you’re only seen as a clinician, you honestly do start to feel like a cog in a machine and you start to feel very replaceable. You’re basically being told that if you’re not out there on the floor, treating patients, you’re not really valuable or worthwhile and investing in. I think it has a lot to do with things. So that’s why you do see a lot of people working on cash practices, or just trying to be in search of that kind of elusive environment where you’re allowed to take on work. That isn’t necessarily a hundred percent clinical all the time. Also  this is a bit of a side note. I worked for a company once where I was on the fence about taking the job. This was transitioning out of patient care and they had a policy where four days out of the week, you could work on whatever, you know, whatever their requirements were or whatever your job description was. But as long as you were meeting your goals, you could take the fifth day, each week and work on your own personal pet projects. I was so excited by this, but then when I went to actually kind of cash in on that, and I had a pet project, it was not. Received. Well, they basically said this isn’t really part of our initiatives. This isn’t really part of our business plan. I think a lot of companies are trying to do this, but at the end of the day, it’s not a hundred percent happening. It’s not. I wasn’t talking about starting a jewelry store or anything. In fact, I was talking about starting a nonclinical wing of their company, because that was what gave me the idea of the nonclinical. It just didn’t really fit their business model. I understand that, but for me, it was one of those things where, you know, I guess it’s the millennial in me. I was exhausted all the time. I was working really long days and I really felt like I could do a lot with this side wing of the company and it just wasn’t happening. So I think there is a bit more tendency in the millennial and younger generations to say, okay, well, I was promised this and I was told this, and if this isn’t happening, I’m going to go do it myself. I think maybe there’s a combination of factors in that that’s more possible for our generation, maybe just what we were taught growing up. But my parents would say that a lot of the time, if you know, we just want you to be happy and if you’re not happy with something, it’s okay to try something else. I’m not sure what boomers were told from their parents, but I’m not sure if they got the same message.

Richard: As a boomer, we were told to suck it up, which probably wasn’t any more healthy than saying. Do what you like. But I think there’s a happy medium. What I want to perhaps expand a little bit on what you’ve said, obviously when everyone talks about burnout.  People usually talk about the job stresses and factors and don’t get me wrong. They are critical and they are probably paramount, but it’s also related to individual factors. Like you’ve just touched upon personality traits, even family type and there’s definitely generational issues. Even down to the idea of generational expectations, that were placed upon me, or as growing up, I’m sure are extremely different than yourselves. Even the generations that now are kind of leaving school and I think sometimes we try to over simplify the issues of burnout and blame it just on the job stresses. We forget about all the individual factors and social and economic and environmental factors.

Meredith: So side note, before I forget to say that, or before I forget about this, but I do some content editing for a website called OT potential and the woman who owns the website, Sarah, she’s an OT. She runs a research journal club and so she’s just constantly consuming research. One thing she did tell me is that anxiety is one of the most contagious emotions, or I guess mind states, whatever you would want to call it. I wouldn’t call it an emotion, but anxiety is considered very contagious. So if you’re around people who are anxious, it’s going to rub off on you. So do you think that there’s in our society and I can’t speak to other places. You’ve got an accent. I’m sure you can speak to other countries and, and what the cultures are like. But we have such a perfectionist kind of individualistic culture here and tear point of just family expectations and societal expectations and social media expectations. All of us, if we listen to social media and what we’re being told every day, you know, by, I hate to say the term social media but just, what we’re seeing in advertisements and everything else, I mean, we should all be perfect. Looking extremely educated, extremely successful, have 2.5 beautiful children who are super successful, but also be extremely environmentally friendly, drive 2 battery operated cars, never have to use any waste and we should be waking up at 5:00 AM every day, exercising for two hours. Pounding a green smoothie, getting to work, being the perfect therapist, staying for two hours after work every night to study and read up on all the latest research and then get home. I mean, it just goes on and on and on. I think that there’s a lot to be said for these external factors, because otherwise it would only be healthcare clinicians who are burning out. I mean, we’re talking about all of this pretending like COVID isn’t happening, but COVID is absolutely putting people to the breaking point. So talk about burnout. I think you have made a point about stress versus burnout. I do see so much more actual burnout going on because it comes down to just not having control and not feeling respected and not feeling like you have autonomy.  So I think when you really pull in the idea. That you don’t have control, it really makes it rough because again, we’re being told by everything around us that we are responsible for our destiny and we are responsible for being perfect. So then if you go into your job and you can’t even feel safe, and then you’re surrounded by other people who don’t feel safe and they’re anxious and it’s contagious and you’re catching onto the anxiety and it’s making it hard to concentrate. I mean, it’s just a recipe for disaster. Really?

Richard: Absolutely, Moving on a little bit. Do you believe that more people are feeling or getting burnt out or do you just think it’s a topic that is socially acceptable to talk about now? It is just the fact that people are reporting it more. I’ve often wondered about this point.

Meredith: That’s a really good question. When you talk about it just being reported more or is it happening more? I will say. I think there’s more of it, but again, kind of what we were discussing earlier. It’s not just medical fields. It’s not just healthcare. I think everybody’s feeling more burned out and everybody’s talking about it more, but I do feel like there’s a lot more pressure on people coming from the inside and from the outside. So again, back to the societal pressures to be perfect, but then you also have newer grads. For example, one thing that I often stress is that newer grads are getting burned out. I think because they’re not seeing the fruits of all their hard work and labor, they’re going into these jobs often fresh out of PT school, they’re seeing like 25 patients a day. How are they expected to get results when they’re not even able to spend a long enough time kind of honing their treatment process and honoring their evaluation processes. So I think that yes, people are burning out more frequently and I also think it’s being reported more, but I also think that it can’t be blamed entirely on any one thing. I think a huge factor is that no one’s getting the joy of true mentorship. Actually that’s not entirely true. There are lots of really good mentorship programs out there, but very few clinicians who are promised mentorship or getting true actual support and mentorship. So they think they’re getting this great mentorship opportunity. It turns out they’re just going to a mill with a PA with a PT who’s maybe a year out of school, kind of telling them what they’ve learned in their year of working at a mill then they’re not able to feel like they’re being successful with patients. They’re getting more and more paperwork crammed down their throats. It’s different because people who burn out when they’re older, like we were saying, it might not even be a feeling of burnout because they had years and years of feeling like they got to hone their skills, get excited, specialize, not go broke or got into crippling amounts of debt in the process. They were able to become really skilled clinicians and then it was only when they felt like, okay, it’s time for a new chapter, my back hurts or any of those other factors. Then they’re able to say, and I’d argue, I don’t even know that they’re burned out. I think in many cases they’re ready for a change. It’s just the younger people. They don’t get to feel like they’re effective in their jobs because I feel like I graduated right before things really got rough. I graduated in 2010. I was able to have a few jobs where I felt like I was still able to be pretty effective with my patients and there’s still some jobs like that out there, but I was working in a big city and it wasn’t yet flooded by young clinicians because I was one of the first graduates of a brand new PT school, the first PT school in the area. Now there are two PT schools in San Diego and they graduate hundreds of clinicians every year.

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Richard: I think control in any aspect of life can be a stressor if you don’t have control or lack of control, but also I’m wondering. We’ve mentioned, touched upon the kind of generational differences. I’m wondering whether it’s to do with expectations as well. Even though I’m not quite a boomer, I think I have a combination of a traditional and boomer temperament.  I’m probably one of these people where they’ll shout boomer, but my expectations out of employment in some ways less, I believe. That as a result of being brought up in an era where the majority of people just stayed in one job. The expectations of life were probably fairly basic as it pertained to having enough food, having a house, having a car, having one vacation a year abroad and just being able to go out occasionally. I think from a work perspective, there was almost this expectation that you would find a job. You probably wouldn’t be totally happy with it, but as I said earlier, suck it up and put up with it. I think obviously my generation wants to impose that we want more opportunities for their children. I think this may have set the stage or the expectations perhaps unrealistically. It’s not to say they aren’t aspirational, but I think there may be a mismatch. What are your thoughts on that?

Meredith: I definitely think expectations versus reality is a huge factor in anybody’s feeling, just disappointed about the decisions they’ve made or what work they’ve pursued. I think in the case of PT, it’s partially generational. I do agree with that. That we, again, we’re surrounded by images of these Instagram influencers who are off traveling the world and making hundreds of thousands of dollars per week by blogging. So we definitely, what is it? I forget. Was it Ben Franklin or somebody who said contentment or what does it compare is the enemy of contentment. I wish I could attribute the quote properly, but someone, one of your listeners will say who it was, but that’s, we’re bombarded now with more. Images of what we’re not having. And so in the past, it would have been, all we really see is the people around us at work who are in the same boat that we are. But now we’re seeing other people on Instagram all day, or we’re seeing people who. Again, a lot of people make a lot of money out of, of promising, oh, you can work remotely or work for yourself, or like open this type of practice or that type of practice. So you always have to look at people that are selling things and what they’re promising. This is a realistic expectation or are they just kind of becoming a GRU, but that’s a little bit of an aside there. I think there is something to say about the generational divide, but I also think that things have become increasingly focused on productivity and money. If you were looking at getting a job as a PT today, with all the loans that people have to take out. Then the fact again, that just the volume of patients you’re expected to see and the amount of paperwork you’re expected to fill out on top of delivering the care that you’re expected to give and read up on every patient carefully. It’s just not realistic for a newer clinician. I think it really boils down to more than anything. There’s the expectation of things being perfect. That’s being given in PT school. That’s a big problem. If PT school was more realistic and they said, Hey, the deal is you’re probably going to be running around a lot. Then I think people would be a little more prepared for it, but we go through these clinicals and these lab practicals. I think we’re given the impression that we’re going to have an hour to treat every patient. So it’s just expectations that don’t always match our reality. Our parents were feeding us this, this narrative that we’re expected to have this wonderful life. If we’re not perfectly happy in our careers, that’s okay. You can try something else. So I’m sure that’s part of it. But the other part is that. It’s like control out of control. It’s the same two-sided Pendle of any of this, but so much of it has to do with the fact that people are coming out of school and just such a different reality than then older clinicians had older clinicians did. They just had way more flexibility and way more time and that makes a lot of difference when you’re a newer clinician and just not having loans hanging over your head. I can’t tell you how many people are working multiple jobs. So when you have multiple jobs and you’re working a full-time PT job documenting off the clock, usually to make sure that you get all of your charting done, and then you are working on the weekends as well, so that you can not even make money, just pay off your wounds. I think that’s where you get a lot of people who just have a feeling of helplessness.

Richard: I always wondered why one employee would sustain an injury? Whereas another employee wouldn’t whilst they did the same job. I knew that the injury was work- related to a large extent, not necessarily completely, but it was certainly a factor and in a similar manner, why would one clinician experience burnout, whereas the person doing the same job next to them doesn’t have any ideas?

Meredith: I think that’s a great question and what it makes me think of as pain science, because what a lot of pain science is showing is that people, like you said, can have the exact same injury and one person has chronic pain from it and another doesn’t. I don’t have the answers, I think that we’ll probably find a lot of similar answers to the burnout conundrum, as we would find in pain science, in terms of brain pathways and relearning of different thoughts, the idea of If your brain kind of reinforces those feelings of pain and danger and alert and pain, danger alert, and people sort of reinforce those pathways of feeling helpless or feeling out of control or feeling helpless. I might’ve said helpless already, but just those feelings, the negative thought patterns that you might have that are kind of contributing to the burnout feelings, then I just have a feeling it’s going to turn out the same way. I have to confess, I wrote this article on burnout and I get people asking me a lot about burnout and that’s, I’m really not an expert in it. I’m not even close to an expert I’ve written about. At the time I consulted the literature, I wrote a couple of really big articles, probably four or five years ago, but I haven’t kept up with the literature. That carefully, because there are people who are way, way more experienced. But for certain people, they might need some manual therapy for certain people. They might need to feel like they can get up and be active and see that they’re not getting hurt because of it. For some people, they might need someone to just listen to them, talk to someone else. They might need to talk it through. So there’s not really an easy answer for any of this. I guess that’s my really long-winded answer as to, I’m curious to see what pain science continues to come out with. I’m curious to see what all of the evidence on burnout comes out with.  I have a feeling it’s going to come down to a lot of kind of agile individual approaches combined with retraining the brain, combined with employers, listening to employees and making them feel valuable and empowered. They do have some locus of control and for clinicians to understand and get a better idea of what they’re okay with, not having control over.

Richard: Now the podcast is for clinic leaders aspiring and experienced leaders. Obviously as a leader of a relatively large PT business recruitment and retention, particularly retention is critical. I want my clinicians, all my employees to be happy, contempt satisfied with that position and role and have opportunity for growth and development. But I can’t afford to lose clinicians from burnout for two reasons, one obviously from a selfish perspective from company performance, but also on a larger scale, the profession can’t afford to lose people. So it’s incumbent upon people like myself to provide an environment that at least tries to address burnout and mitigate the risk factors that contribute towards it. So  what do you feel I should do? Also what my team of leaders and managers are doing to help?

Meredith: So glad you asked that, and even just the approach you took to asking, it shows me that you care so much, and I really appreciate you and leaders like you having this conversation. I think so much of this boils down to communication, just honest and open communication with your leaders and then with the clinicians themselves, between both you and the sort of middle management leaders, just having these conversations during performance reviews. Where you talk to the clinicians and ask them, what does growth look like for them? What does success look like for them and telling them what success looks like for you and saying, what do you feel makes you thrive in this job and asking them those questions, because everybody is going to have different answers and everybody’s going to have a different personality. You might find that you have one person who wants to be a leader within one year. Because they’re not getting there fast enough, they’re going to bail, but they would be the best leader ever. But if you’re not having those conversations, they would feel burned out because they don’t see, like, they don’t feel like they’re viewed as anything, but a clinician and will always be a clinician maybe because of their age or their gender or their accent. I hear accents a lot, holding people up from opportunities. So having these conversations where you’re honest about where people want to be is critical. Then just asking people, how do you feel about your current workload? I rarely even bring up burnout unless they do, but definitely ask them how they’re feeling. How do you feel coming into work every day? Are you excited? Are you feeling like there are any barriers we can eliminate? And then one other recommendation I would make is give people ownership of solutions without putting it all on them. So if someone says the documentation system is driving me crazy. We have to click so many times on XYZ and it’s holding me up. Then getting solution focused is super important, but making sure that they feel supported and also like they can take some ownership of those solutions. If they’re interested. Now, I know that they’re not going to be able to just change the productivity requirements, obviously, but if there’s a way for them to do any sort of process improvement work, or if they’re able to do some clinical informatics sort of tweaking of the system work, just offering them opportunities to flex their muscles so that they don’t only feel important and valued, and that they’re part of the change, but that also helps them build some of their nonclinical skills so that if they do want to move within the company into a nonclinical role, you get to retain them. Instead of hiring someone else from outside the company, you can retain your clinicians and kind of repurpose them in these non clinical or hybrid roles where they then do get to bring their clinical insights and their problem solving PT brains into these other roles that are a little more technical in nature, or maybe a little bit more process or quality improvement in nature. So that to me is one of the missing links that I think a lot of times, and I’ll be honest, sometimes someone might be seen as a bit of a problem employee, or maybe not a high performer clinically, and they would be so good in another role they would be so fired up in another role. It’s the conversations about where they see themselves and where you see them aren’t being had. So just having those conversations and asking them, is there something that interests you within the company that I never would have imagined you doing, but you have an interest in doing that. Side note, that company that I kind of threw under the bus earlier, I didn’t use their name, but they had a program called “over the fence” where they would let only full-time employees. So the problem is if you were a PRN, then you couldn’t take part in this program, but they would let you spend a day observing another department and exploring what they’re doing. Even though I felt like it was more of a, one of those kinds of well-intended programs that wasn’t really maybe being advertised or used the way it should have been. Having a program like that could be really helpful where someone gets to stay, spend a day with someone who’s doing regional therapy operations, or someone gets to spend a day working alongside who, maybe someone isn’t even a clinician, but they’re doing some sales or account management for the company. It would be so good. It would make the clinicians feel so valuable and like there’s so much hope. There might be someone doing wounds and you’re not necessarily even aware that someone else really wants to do wounds or aquatics. I made the mistake at my very first job, which I actually really loved and really would go back there if I still lived in San Diego and if I still wanted to treat clinically, I should say, but they had a pool at the time. I remember saying that I was interested in doing aquatic therapy when I was getting hired, but then it never was brought up again and I didn’t bring it up and they didn’t bring it up. Then they brought in a new hire and she immediately started to go into the pool.  I remember that for me it was really, I was so disappointed and frustrated and kind of angry.  I looked back and I’m like, I just needed to bring it up because they probably heard that in my interview and for black and never thought about it again, it’s not their job  to read my mind. They shouldn’t be expected to read my mind. But if you have those structured conversations where nobody has to read anybody else’s mind at all, then you don’t have to have these situations happening. Ultimately, they ended up closing the pool anyway, so it doesn’t matter. But it’s just one of those things where I think of this all the time and, and I liked it. I had a great collegial relationship with everybody. I liked the job. I liked the patients. I liked my coworkers. I liked my bosses. So it wasn’t any, I think they assumed because I came in with a smile on my face every day that I was super happy and then nothing was wrong. So, again, those structured conversations, those check-in points, those frequent conversations.

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Richard: If I try and kind of collate the various points that you’ve just kind of presented really, to me, it sounds as if culture is probably the fundamental factor. What I mean by that is having it providing an environment where employees feel as if they’re being listened to adequate or significant communication they’re supported. They have a degree of autonomy, obviously within the parameters in which they can be given that. Also they have a sense of control and ownership.

Meredith: Absolutely. I mean, can you think of anyone who’s truly excited about going into work every day? Who’s also burned out. I’m sure there are people out there who would say so, but I’ve never met someone like that. Usually the people who are feeling burned out are the same people who are dreading going into work every day. So if someone is dreading going into work, then there are usually some things that can be done to address it. Without having a conversation, you’ll just never know what those things are. And I agree. I think having a good culture, having a positive culture and you hit the nail on the head. I think hierarchy is not a problem. If it’s structured and a healthy, positive culture, it’s when you have that dictatorial way of leading where it’s my way or the highway. And I won’t hear anything else. This is how we’ve always done it. And you can, I definitely don’t think that everyone should have a flat management structure. In fact, my husband’s an engineer and his company over the years has had very hierarchical management. They’ve had flat management, they’ve kind of explored different types of managerial styles and they can all be pretty effective if they’re done properly. So I don’t think there’s one way of management that’s better than the other inherently, but you also have to kind of manage according to your company’s needs your client or your patient’s needs, your client’s needs, your clinician’s needs and understand which style keeps things moving most  smoothly without making people feel like they don’t have a voice and it might be a blend of, of styles.

Richard: I think the fundamental point as a leader is, you know, as what is obviously wanting to promote the profession and protect clinicians so that they’re able to have a fulfilling career and longevity from a business perspective is blunt. Isn’t it? You know, somebody’s burned time patrol heading down that path. They’re not productive. If they’re not productive, it’s not helping the organizational, the business. It’s as simple as that, isn’t it. There were those days where I felt on top of the world and I can always look back to my patient care days.

Meredith: I remember the days where I felt like I was doing a good job, my patients were making progress. I was able to see enough people because everyone came on time. When I was an outpatient  everybody arrived on time and came back to my room on time. And there was an easy chart review, whatever it was those days where you are in the zone.

Richard: What I like to ask all my guests is that. Thoughts on the future of outpatient physical therapy. You know, there’s certainly a lot of change and I believe that’s kind of ongoing challenges perhaps, but I’d love to get your overall thoughts on, on the future of outpatient PT.

Meredith: Ooh, that’s a big question, especially because I don’t hang out too often in that space anymore. I haven’t treated an elevation in any many moons at this point. I do think that we’ve got a lot of changes coming up because we’ve got a lot of AI moving into that space. A lot of telehealth companies are moving into that space, a lot of consolidation going on. So those bigger corporations kind of take over the smaller clinics for better, for worse. I am not really in the know enough to even say what’s for the best. I will say. I think we’re going to have a lot of changes and change can often be a good thing. As long as people still feel like things are trending in the right direction.

I disagree. I don’t think they’re going to be the death of the profession. I just think we need to adapt accordingly and figure out how to improve our models to work with those models.

Because the fact of the matter is. If they take off and they’re successful, it’s because they’re meeting the need of our clients, our patients, if people want on demand therapy from home, then these companies are meeting that need and people aren’t going to use these companies if they’re not getting results.

Well, thank you, Meredith really appreciates the time today and your insight. It’s been great to talk to you and, and share knowledge and information.

So thank you. Thank you so much for having me. This has been a really enjoyable conversation from my end too. I love these deep, insightful conversations and so glad we connected. Thanks for inviting me on. Thank you.

Podcast Transcript

Podcast Transcript

Richard: Welcome back to Agile&Me a physical therapy leadership podcast series. A podcast device to help emerging experience therapy leaders learn more about various topics relevant to outpatient therapy services. Today’s podcast is titled physical therapist burnout causes and solutions and today’s guest is Meredith. This is a topic that I’ve been wanting to speak about for a long time, and it’s certainly a topic that is of significant interest and concern within the professional world over the last few years. Before we dive into that, would you be able to perhaps introduce yourself to the listeners?

Meredith: My name is Meredith Kasten. I run the nonclinical PT and I am a physical therapist. I graduated in 2010 and treated for about five years before leaving for a non-patient care career. After that happened, people started reaching out nonstop. That’s what kind of led me to start the nonclinical PT just as a resource for other therapists and clinicians who wanted to remain PTs at heart, but do something else with their careers.

Richard: Now with regards to burnout, what do we actually mean? It’s a common term, but I don’t necessarily know that people truly understand what we’re talking about. So could you perhaps provide the readers with a nice idea of what you mean?

Meredith: I hear burnout constantly being mentioned in all sorts of careers from the tech industry to startups and marketing to the arts. Most people just burn out in general. So to your question, really when you’re burned out, it generally just means that you’re feeling a sense of detachment and a little bit of loss of control over the feelings of satisfaction and happiness related to your work and instead you’re feeling like all you’re doing is working and all your thoughts are about work.  I’m again using burnout in terms of work for our purposes, but this can relate to anything in your life. If you’re a parent, if you were a caregiver, you can experience burnout in the same sense , you may feel just completely overwhelmed or you feel like it’s consuming all of your time.

Richard: When I think of burnout, the term burnout, I think of a term that I believe is overused, has negative connotations and also associated with failure, but that’s really not helpful.

Meredith: Erika Del Pozo and she’s an OT and she studied burnout a lot. She points out that a lot of the literature says fighting burnout, beating burnout, and it’s not necessarily a fight to be one because burnout is going to be kind of something that we’re dealing with our whole lives. If you think about it, just the idea that if we let something become our entire lives or if we don’t take care of ourselves or if people don’t maybe respect us on the job, these can all be contributing factors. So to simplify it or reduce it down to beating burnout makes it seem like there’s this easy solution. I don’t necessarily think that it’s something that can just be solved by attending a yoga class or eating clean or any of the suggestions that I’ve heard thrown at by others.

Richard:  I wish it was just as simple as going to a yoga class. I think that the term is really deceptive because the issues that contribute toward a multi-factorial and the factors that one needs to consider to reduce or eliminate or you know, deal with burnout are also matched multifactorial.

Meredith: I think some of it’s within our control and some of it is outside of our control. It’s just understanding how the elements that are outside of our control can be addressed so that we’re able to really just better face each day and approach things from a healthy mindset instead of catastrophizing things. So we’re going a little bit deeper into the weeds with that kind of conversation, but because certain things we will never have control over that. I think it’s important to understand what’s in our control and what’s out of our control and it’s important for the people whom we report to understand that certain degrees of things are out of our control. So if they’re in their control, it’s up to them to step up and try to address those factors.

Richard: I think that’s critical. Isn’t it? It’s just acknowledging the multi-factor nature of this, that there are certain components that are beyond our control. Whilst we’d love to be able to control them, we can’t, and it’s just working on those factors that we can isn’t it. I think that’s usually sufficient to reduce or eliminate burnout in most instances, but there are certain times where we have limited input. As I said, burnout is a term I think is used too much. I think it’s used when really we’re just under any type of anxiety or stress rather than true burnout. How does burnout manifest itself? When would you use it?

Meredith:  I think probably differently in everybody, but there are a couple of common factors that tend to stick out. One of them is just feeling really detached from your work. Just basically feeling like you don’t care, you just kind of never phoning it in, or if you’re normally a really empathetic person, and you’re starting to realize that your inner monologue is saying, I don’t care about the stupid knee replacement patient or that type of thing, if you’re just starting to notice major changes in how you approach the job and you’re noticing that you don’t care anymore, if you used to be a really ambitious or growth oriented person. All of a sudden you don’t really care and you’re just kind of checking your phone the whole day or hanging out in the big break room as often as possible. Or if your documentation is going down the drain now, to your point, I think a lot of these things can signify stress, but if they’re just kind of ongoing and you feel like you don’t care anymore, then I would start to think this could look like burnout. If you’re just feeling like you just don’t care or you don’t have any interest in the future.  “I just don’t care. I don’t want to hear it. I don’t want to listen.”  That’s where I start to think, okay, this might be a case of burnout. This might be a situation where your burnout is related to feeling like you don’t have enough maybe locus of control in your work, or it might be that the work itself just isn’t good, a good fit for you, or maybe productivity is getting to you, but if it’s just a kind of long-term ongoing situation where you’re completely checked out and you just feel like your empathy isn’t quite there anymore. I would start to look at it like this could really be burnout. It’s that ongoing sense of perhaps helplessness or detachment, isn’t it. I think a lot of it has to do with detachment and helplessness.  That’s when people ask why are people burning out now? I think the main difference is that at this point we feel as though there isn’t as much opportunity to actually make a difference in patients’ lives because the treatments are getting shorter. The documentation is taking longer. At this point, it’s just that frickin productivity. Just the idea that you need to build that or units, you need to see more patients. We are all trained and educated in our academic systems to listen to patients carefully, take a full history, really be their partner, be present. And it’s so hard to be present when all you can think about is my productivity in the toilet. I can’t bill for this time. I’m going to have to. Cut another patient short because this one’s going longer and that patient would have gotten me more billable units. So when we’re thinking about it, that way, it’s really hard to feel engaged and to feel like we’re making a difference. I think a lot about burnout. If you feel like you’re not succeeding, you will ultimately most likely feel burned out. If you are in a career where the number one priority is to make money and you’re a salesperson or close deals or any of those things and you cannot meet your goals, especially if it’s outside of your control. You’ll probably become burned out. The same thing goes for patient care.

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Richard: I have been very fortunate in my career where I’ve been able to change my roles. Obviously I’ve been managing either direct patient care or indirectly through managerial positions, musculus clinical injuries and involvement with MSK prevention or treatment in some manner. But thankfully I’ve avoided it. I had when I felt that I’d been going down that road, I’ve had the capability and the ability and the opportunity to, to modify my role. And that’s not to say I haven’t gone back to treatment, but I can take a break from what I believe was one of the, some of the core stresses and factors, and then kind of regroup and then feel as if I can then tackle it again. I would imagine that’s probably hasn’t been possible for a lot of people that actually have burnout symptoms probably. Right?

Meredith: You hit the nail on the head again, there with the idea that you’ve had the ability to step away and take a break as you’ve needed to and change things up. And it’s kind of on your terms. Another thing I’ve thought about, I’ve been chewing on this a lot recently, and again, this doesn’t have to do with the literature. This is more just me kind of lying awake in bed at night. Wondering why is everybody so burned out? I do think some of it’s generational. We, my generation, I’m technically gen X, but I get lumped in with millennials a lot. So I think a lot of times with millennials, we were definitely raised with a lot more kind of control over our destiny, or at least being told that we can do whatever we want. We felt a lot more control over our destiny. Whereas my parents are boomers and they’ve always felt very much like you get a job, you stick to it, you deal with the bad days and it’s not to say that millennials don’t have a good work ethic because I think they have a phenomenal work ethic. But I do think there’s a little bit more focus on control and kind of building your destiny and creating that life that you want.  I work with people and say, all right volunteer to do this offer to help your supervisor through this. They come back and they say, I had a conversation with my supervisor and he or she said, they already have someone doing that and they don’t need the help. That’s a big issue is that if you’re working in a system where you’re only viewed as a clinician, not to say that we don’t work really hard to become excellent clinicians, but if you’re only seen as a clinician, you honestly do start to feel like a cog in a machine and you start to feel very replaceable. You’re basically being told that if you’re not out there on the floor, treating patients, you’re not really valuable or worthwhile and investing in. I think it has a lot to do with things. So that’s why you do see a lot of people working on cash practices, or just trying to be in search of that kind of elusive environment where you’re allowed to take on work. That isn’t necessarily a hundred percent clinical all the time. Also  this is a bit of a side note. I worked for a company once where I was on the fence about taking the job. This was transitioning out of patient care and they had a policy where four days out of the week, you could work on whatever, you know, whatever their requirements were or whatever your job description was. But as long as you were meeting your goals, you could take the fifth day, each week and work on your own personal pet projects. I was so excited by this, but then when I went to actually kind of cash in on that, and I had a pet project, it was not. Received. Well, they basically said this isn’t really part of our initiatives. This isn’t really part of our business plan. I think a lot of companies are trying to do this, but at the end of the day, it’s not a hundred percent happening. It’s not. I wasn’t talking about starting a jewelry store or anything. In fact, I was talking about starting a nonclinical wing of their company, because that was what gave me the idea of the nonclinical. It just didn’t really fit their business model. I understand that, but for me, it was one of those things where, you know, I guess it’s the millennial in me. I was exhausted all the time. I was working really long days and I really felt like I could do a lot with this side wing of the company and it just wasn’t happening. So I think there is a bit more tendency in the millennial and younger generations to say, okay, well, I was promised this and I was told this, and if this isn’t happening, I’m going to go do it myself. I think maybe there’s a combination of factors in that that’s more possible for our generation, maybe just what we were taught growing up. But my parents would say that a lot of the time, if you know, we just want you to be happy and if you’re not happy with something, it’s okay to try something else. I’m not sure what boomers were told from their parents, but I’m not sure if they got the same message.

Richard: As a boomer, we were told to suck it up, which probably wasn’t any more healthy than saying. Do what you like. But I think there’s a happy medium. What I want to perhaps expand a little bit on what you’ve said, obviously when everyone talks about burnout.  People usually talk about the job stresses and factors and don’t get me wrong. They are critical and they are probably paramount, but it’s also related to individual factors. Like you’ve just touched upon personality traits, even family type and there’s definitely generational issues. Even down to the idea of generational expectations, that were placed upon me, or as growing up, I’m sure are extremely different than yourselves. Even the generations that now are kind of leaving school and I think sometimes we try to over simplify the issues of burnout and blame it just on the job stresses. We forget about all the individual factors and social and economic and environmental factors.

Meredith: So side note, before I forget to say that, or before I forget about this, but I do some content editing for a website called OT potential and the woman who owns the website, Sarah, she’s an OT. She runs a research journal club and so she’s just constantly consuming research. One thing she did tell me is that anxiety is one of the most contagious emotions, or I guess mind states, whatever you would want to call it. I wouldn’t call it an emotion, but anxiety is considered very contagious. So if you’re around people who are anxious, it’s going to rub off on you. So do you think that there’s in our society and I can’t speak to other places. You’ve got an accent. I’m sure you can speak to other countries and, and what the cultures are like. But we have such a perfectionist kind of individualistic culture here and tear point of just family expectations and societal expectations and social media expectations. All of us, if we listen to social media and what we’re being told every day, you know, by, I hate to say the term social media but just, what we’re seeing in advertisements and everything else, I mean, we should all be perfect. Looking extremely educated, extremely successful, have 2.5 beautiful children who are super successful, but also be extremely environmentally friendly, drive 2 battery operated cars, never have to use any waste and we should be waking up at 5:00 AM every day, exercising for two hours. Pounding a green smoothie, getting to work, being the perfect therapist, staying for two hours after work every night to study and read up on all the latest research and then get home. I mean, it just goes on and on and on. I think that there’s a lot to be said for these external factors, because otherwise it would only be healthcare clinicians who are burning out. I mean, we’re talking about all of this pretending like COVID isn’t happening, but COVID is absolutely putting people to the breaking point. So talk about burnout. I think you have made a point about stress versus burnout. I do see so much more actual burnout going on because it comes down to just not having control and not feeling respected and not feeling like you have autonomy.  So I think when you really pull in the idea. That you don’t have control, it really makes it rough because again, we’re being told by everything around us that we are responsible for our destiny and we are responsible for being perfect. So then if you go into your job and you can’t even feel safe, and then you’re surrounded by other people who don’t feel safe and they’re anxious and it’s contagious and you’re catching onto the anxiety and it’s making it hard to concentrate. I mean, it’s just a recipe for disaster. Really?

Richard: Absolutely, Moving on a little bit. Do you believe that more people are feeling or getting burnt out or do you just think it’s a topic that is socially acceptable to talk about now? It is just the fact that people are reporting it more. I’ve often wondered about this point.

Meredith: That’s a really good question. When you talk about it just being reported more or is it happening more? I will say. I think there’s more of it, but again, kind of what we were discussing earlier. It’s not just medical fields. It’s not just healthcare. I think everybody’s feeling more burned out and everybody’s talking about it more, but I do feel like there’s a lot more pressure on people coming from the inside and from the outside. So again, back to the societal pressures to be perfect, but then you also have newer grads. For example, one thing that I often stress is that newer grads are getting burned out. I think because they’re not seeing the fruits of all their hard work and labor, they’re going into these jobs often fresh out of PT school, they’re seeing like 25 patients a day. How are they expected to get results when they’re not even able to spend a long enough time kind of honing their treatment process and honoring their evaluation processes. So I think that yes, people are burning out more frequently and I also think it’s being reported more, but I also think that it can’t be blamed entirely on any one thing. I think a huge factor is that no one’s getting the joy of true mentorship. Actually that’s not entirely true. There are lots of really good mentorship programs out there, but very few clinicians who are promised mentorship or getting true actual support and mentorship. So they think they’re getting this great mentorship opportunity. It turns out they’re just going to a mill with a PA with a PT who’s maybe a year out of school, kind of telling them what they’ve learned in their year of working at a mill then they’re not able to feel like they’re being successful with patients. They’re getting more and more paperwork crammed down their throats. It’s different because people who burn out when they’re older, like we were saying, it might not even be a feeling of burnout because they had years and years of feeling like they got to hone their skills, get excited, specialize, not go broke or got into crippling amounts of debt in the process. They were able to become really skilled clinicians and then it was only when they felt like, okay, it’s time for a new chapter, my back hurts or any of those other factors. Then they’re able to say, and I’d argue, I don’t even know that they’re burned out. I think in many cases they’re ready for a change. It’s just the younger people. They don’t get to feel like they’re effective in their jobs because I feel like I graduated right before things really got rough. I graduated in 2010. I was able to have a few jobs where I felt like I was still able to be pretty effective with my patients and there’s still some jobs like that out there, but I was working in a big city and it wasn’t yet flooded by young clinicians because I was one of the first graduates of a brand new PT school, the first PT school in the area. Now there are two PT schools in San Diego and they graduate hundreds of clinicians every year.

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Richard: I think control in any aspect of life can be a stressor if you don’t have control or lack of control, but also I’m wondering. We’ve mentioned, touched upon the kind of generational differences. I’m wondering whether it’s to do with expectations as well. Even though I’m not quite a boomer, I think I have a combination of a traditional and boomer temperament.  I’m probably one of these people where they’ll shout boomer, but my expectations out of employment in some ways less, I believe. That as a result of being brought up in an era where the majority of people just stayed in one job. The expectations of life were probably fairly basic as it pertained to having enough food, having a house, having a car, having one vacation a year abroad and just being able to go out occasionally. I think from a work perspective, there was almost this expectation that you would find a job. You probably wouldn’t be totally happy with it, but as I said earlier, suck it up and put up with it. I think obviously my generation wants to impose that we want more opportunities for their children. I think this may have set the stage or the expectations perhaps unrealistically. It’s not to say they aren’t aspirational, but I think there may be a mismatch. What are your thoughts on that?

Meredith: I definitely think expectations versus reality is a huge factor in anybody’s feeling, just disappointed about the decisions they’ve made or what work they’ve pursued. I think in the case of PT, it’s partially generational. I do agree with that. That we, again, we’re surrounded by images of these Instagram influencers who are off traveling the world and making hundreds of thousands of dollars per week by blogging. So we definitely, what is it? I forget. Was it Ben Franklin or somebody who said contentment or what does it compare is the enemy of contentment. I wish I could attribute the quote properly, but someone, one of your listeners will say who it was, but that’s, we’re bombarded now with more. Images of what we’re not having. And so in the past, it would have been, all we really see is the people around us at work who are in the same boat that we are. But now we’re seeing other people on Instagram all day, or we’re seeing people who. Again, a lot of people make a lot of money out of, of promising, oh, you can work remotely or work for yourself, or like open this type of practice or that type of practice. So you always have to look at people that are selling things and what they’re promising. This is a realistic expectation or are they just kind of becoming a GRU, but that’s a little bit of an aside there. I think there is something to say about the generational divide, but I also think that things have become increasingly focused on productivity and money. If you were looking at getting a job as a PT today, with all the loans that people have to take out. Then the fact again, that just the volume of patients you’re expected to see and the amount of paperwork you’re expected to fill out on top of delivering the care that you’re expected to give and read up on every patient carefully. It’s just not realistic for a newer clinician. I think it really boils down to more than anything. There’s the expectation of things being perfect. That’s being given in PT school. That’s a big problem. If PT school was more realistic and they said, Hey, the deal is you’re probably going to be running around a lot. Then I think people would be a little more prepared for it, but we go through these clinicals and these lab practicals. I think we’re given the impression that we’re going to have an hour to treat every patient. So it’s just expectations that don’t always match our reality. Our parents were feeding us this, this narrative that we’re expected to have this wonderful life. If we’re not perfectly happy in our careers, that’s okay. You can try something else. So I’m sure that’s part of it. But the other part is that. It’s like control out of control. It’s the same two-sided Pendle of any of this, but so much of it has to do with the fact that people are coming out of school and just such a different reality than then older clinicians had older clinicians did. They just had way more flexibility and way more time and that makes a lot of difference when you’re a newer clinician and just not having loans hanging over your head. I can’t tell you how many people are working multiple jobs. So when you have multiple jobs and you’re working a full-time PT job documenting off the clock, usually to make sure that you get all of your charting done, and then you are working on the weekends as well, so that you can not even make money, just pay off your wounds. I think that’s where you get a lot of people who just have a feeling of helplessness.

Richard: I always wondered why one employee would sustain an injury? Whereas another employee wouldn’t whilst they did the same job. I knew that the injury was work- related to a large extent, not necessarily completely, but it was certainly a factor and in a similar manner, why would one clinician experience burnout, whereas the person doing the same job next to them doesn’t have any ideas?

Meredith: I think that’s a great question and what it makes me think of as pain science, because what a lot of pain science is showing is that people, like you said, can have the exact same injury and one person has chronic pain from it and another doesn’t. I don’t have the answers, I think that we’ll probably find a lot of similar answers to the burnout conundrum, as we would find in pain science, in terms of brain pathways and relearning of different thoughts, the idea of If your brain kind of reinforces those feelings of pain and danger and alert and pain, danger alert, and people sort of reinforce those pathways of feeling helpless or feeling out of control or feeling helpless. I might’ve said helpless already, but just those feelings, the negative thought patterns that you might have that are kind of contributing to the burnout feelings, then I just have a feeling it’s going to turn out the same way. I have to confess, I wrote this article on burnout and I get people asking me a lot about burnout and that’s, I’m really not an expert in it. I’m not even close to an expert I’ve written about. At the time I consulted the literature, I wrote a couple of really big articles, probably four or five years ago, but I haven’t kept up with the literature. That carefully, because there are people who are way, way more experienced. But for certain people, they might need some manual therapy for certain people. They might need to feel like they can get up and be active and see that they’re not getting hurt because of it. For some people, they might need someone to just listen to them, talk to someone else. They might need to talk it through. So there’s not really an easy answer for any of this. I guess that’s my really long-winded answer as to, I’m curious to see what pain science continues to come out with. I’m curious to see what all of the evidence on burnout comes out with.  I have a feeling it’s going to come down to a lot of kind of agile individual approaches combined with retraining the brain, combined with employers, listening to employees and making them feel valuable and empowered. They do have some locus of control and for clinicians to understand and get a better idea of what they’re okay with, not having control over.

Richard: Now the podcast is for clinic leaders aspiring and experienced leaders. Obviously as a leader of a relatively large PT business recruitment and retention, particularly retention is critical. I want my clinicians, all my employees to be happy, contempt satisfied with that position and role and have opportunity for growth and development. But I can’t afford to lose clinicians from burnout for two reasons, one obviously from a selfish perspective from company performance, but also on a larger scale, the profession can’t afford to lose people. So it’s incumbent upon people like myself to provide an environment that at least tries to address burnout and mitigate the risk factors that contribute towards it. So  what do you feel I should do? Also what my team of leaders and managers are doing to help?

Meredith: So glad you asked that, and even just the approach you took to asking, it shows me that you care so much, and I really appreciate you and leaders like you having this conversation. I think so much of this boils down to communication, just honest and open communication with your leaders and then with the clinicians themselves, between both you and the sort of middle management leaders, just having these conversations during performance reviews. Where you talk to the clinicians and ask them, what does growth look like for them? What does success look like for them and telling them what success looks like for you and saying, what do you feel makes you thrive in this job and asking them those questions, because everybody is going to have different answers and everybody’s going to have a different personality. You might find that you have one person who wants to be a leader within one year. Because they’re not getting there fast enough, they’re going to bail, but they would be the best leader ever. But if you’re not having those conversations, they would feel burned out because they don’t see, like, they don’t feel like they’re viewed as anything, but a clinician and will always be a clinician maybe because of their age or their gender or their accent. I hear accents a lot, holding people up from opportunities. So having these conversations where you’re honest about where people want to be is critical. Then just asking people, how do you feel about your current workload? I rarely even bring up burnout unless they do, but definitely ask them how they’re feeling. How do you feel coming into work every day? Are you excited? Are you feeling like there are any barriers we can eliminate? And then one other recommendation I would make is give people ownership of solutions without putting it all on them. So if someone says the documentation system is driving me crazy. We have to click so many times on XYZ and it’s holding me up. Then getting solution focused is super important, but making sure that they feel supported and also like they can take some ownership of those solutions. If they’re interested. Now, I know that they’re not going to be able to just change the productivity requirements, obviously, but if there’s a way for them to do any sort of process improvement work, or if they’re able to do some clinical informatics sort of tweaking of the system work, just offering them opportunities to flex their muscles so that they don’t only feel important and valued, and that they’re part of the change, but that also helps them build some of their nonclinical skills so that if they do want to move within the company into a nonclinical role, you get to retain them. Instead of hiring someone else from outside the company, you can retain your clinicians and kind of repurpose them in these non clinical or hybrid roles where they then do get to bring their clinical insights and their problem solving PT brains into these other roles that are a little more technical in nature, or maybe a little bit more process or quality improvement in nature. So that to me is one of the missing links that I think a lot of times, and I’ll be honest, sometimes someone might be seen as a bit of a problem employee, or maybe not a high performer clinically, and they would be so good in another role they would be so fired up in another role. It’s the conversations about where they see themselves and where you see them aren’t being had. So just having those conversations and asking them, is there something that interests you within the company that I never would have imagined you doing, but you have an interest in doing that. Side note, that company that I kind of threw under the bus earlier, I didn’t use their name, but they had a program called “over the fence” where they would let only full-time employees. So the problem is if you were a PRN, then you couldn’t take part in this program, but they would let you spend a day observing another department and exploring what they’re doing. Even though I felt like it was more of a, one of those kinds of well-intended programs that wasn’t really maybe being advertised or used the way it should have been. Having a program like that could be really helpful where someone gets to stay, spend a day with someone who’s doing regional therapy operations, or someone gets to spend a day working alongside who, maybe someone isn’t even a clinician, but they’re doing some sales or account management for the company. It would be so good. It would make the clinicians feel so valuable and like there’s so much hope. There might be someone doing wounds and you’re not necessarily even aware that someone else really wants to do wounds or aquatics. I made the mistake at my very first job, which I actually really loved and really would go back there if I still lived in San Diego and if I still wanted to treat clinically, I should say, but they had a pool at the time. I remember saying that I was interested in doing aquatic therapy when I was getting hired, but then it never was brought up again and I didn’t bring it up and they didn’t bring it up. Then they brought in a new hire and she immediately started to go into the pool.  I remember that for me it was really, I was so disappointed and frustrated and kind of angry.  I looked back and I’m like, I just needed to bring it up because they probably heard that in my interview and for black and never thought about it again, it’s not their job  to read my mind. They shouldn’t be expected to read my mind. But if you have those structured conversations where nobody has to read anybody else’s mind at all, then you don’t have to have these situations happening. Ultimately, they ended up closing the pool anyway, so it doesn’t matter. But it’s just one of those things where I think of this all the time and, and I liked it. I had a great collegial relationship with everybody. I liked the job. I liked the patients. I liked my coworkers. I liked my bosses. So it wasn’t any, I think they assumed because I came in with a smile on my face every day that I was super happy and then nothing was wrong. So, again, those structured conversations, those check-in points, those frequent conversations.

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Richard: If I try and kind of collate the various points that you’ve just kind of presented really, to me, it sounds as if culture is probably the fundamental factor. What I mean by that is having it providing an environment where employees feel as if they’re being listened to adequate or significant communication they’re supported. They have a degree of autonomy, obviously within the parameters in which they can be given that. Also they have a sense of control and ownership.

Meredith: Absolutely. I mean, can you think of anyone who’s truly excited about going into work every day? Who’s also burned out. I’m sure there are people out there who would say so, but I’ve never met someone like that. Usually the people who are feeling burned out are the same people who are dreading going into work every day. So if someone is dreading going into work, then there are usually some things that can be done to address it. Without having a conversation, you’ll just never know what those things are. And I agree. I think having a good culture, having a positive culture and you hit the nail on the head. I think hierarchy is not a problem. If it’s structured and a healthy, positive culture, it’s when you have that dictatorial way of leading where it’s my way or the highway. And I won’t hear anything else. This is how we’ve always done it. And you can, I definitely don’t think that everyone should have a flat management structure. In fact, my husband’s an engineer and his company over the years has had very hierarchical management. They’ve had flat management, they’ve kind of explored different types of managerial styles and they can all be pretty effective if they’re done properly. So I don’t think there’s one way of management that’s better than the other inherently, but you also have to kind of manage according to your company’s needs your client or your patient’s needs, your client’s needs, your clinician’s needs and understand which style keeps things moving most  smoothly without making people feel like they don’t have a voice and it might be a blend of, of styles.

Richard: I think the fundamental point as a leader is, you know, as what is obviously wanting to promote the profession and protect clinicians so that they’re able to have a fulfilling career and longevity from a business perspective is blunt. Isn’t it? You know, somebody’s burned time patrol heading down that path. They’re not productive. If they’re not productive, it’s not helping the organizational, the business. It’s as simple as that, isn’t it. There were those days where I felt on top of the world and I can always look back to my patient care days.

Meredith: I remember the days where I felt like I was doing a good job, my patients were making progress. I was able to see enough people because everyone came on time. When I was an outpatient  everybody arrived on time and came back to my room on time. And there was an easy chart review, whatever it was those days where you are in the zone.

Richard: What I like to ask all my guests is that. Thoughts on the future of outpatient physical therapy. You know, there’s certainly a lot of change and I believe that’s kind of ongoing challenges perhaps, but I’d love to get your overall thoughts on, on the future of outpatient PT.

Meredith: Ooh, that’s a big question, especially because I don’t hang out too often in that space anymore. I haven’t treated an elevation in any many moons at this point. I do think that we’ve got a lot of changes coming up because we’ve got a lot of AI moving into that space. A lot of telehealth companies are moving into that space, a lot of consolidation going on. So those bigger corporations kind of take over the smaller clinics for better, for worse. I am not really in the know enough to even say what’s for the best. I will say. I think we’re going to have a lot of changes and change can often be a good thing. As long as people still feel like things are trending in the right direction.

I disagree. I don’t think they’re going to be the death of the profession. I just think we need to adapt accordingly and figure out how to improve our models to work with those models.

Because the fact of the matter is. If they take off and they’re successful, it’s because they’re meeting the need of our clients, our patients, if people want on demand therapy from home, then these companies are meeting that need and people aren’t going to use these companies if they’re not getting results.

Well, thank you, Meredith really appreciates the time today and your insight. It’s been great to talk to you and, and share knowledge and information.

So thank you. Thank you so much for having me. This has been a really enjoyable conversation from my end too. I love these deep, insightful conversations and so glad we connected. Thanks for inviting me on. Thank you.