All Things Burnout #physicaltherapy

Part I: Background and issues with defining

After several posts on recruitment and what employers and employees want, it is time to address the elephant in the room known as provider burnout. While I have written extensively in blog posts and Called to Care on this topic, it needs a re-look. A few weeks ago, an APTA-backed Senate resolution focusing on 'Epidemic of Burnout' in Health Care was introduced by Sens. Tim Kaine, D-Va., and Roger Marshall, R-Kan. which articulates support for reduced administrative burden and better access to mental health care for providers. Per APTA, If adopted, the resolution would attempt to reverse a burnout trend that began decades ago and was made worse during the coronavirus pandemic and its aftermath.

A few weeks ago,  I spoke on a panel  and mentioned the increased rate of "burnout" of newly graduated PT's even before they sit for the boards. I made jest that at least employers aren't the only ones implicated in causing burnout. I had a few folks after tell me they were surprised that new PT's can be "burned" out so early. My contention based on the research of physicians is that burnout of new PT's is not new, just now being recognized and employers definitely have to deal with it-along with a host of other issues that have to be dealt with proactively.

In recent years, there has been growing recognition of burnout among physical therapists, highlighting the need for further research and interventions to address this issue. A study published in the Journal of Occupational Health Psychology (2020) found that physical therapists experience high levels of emotional exhaustion and depersonalization, key components of burnout. Another study in the Journal of Orthopaedic & Sports Physical Therapy (2021) revealed that work-related stressors, such as high workload and time pressure, contribute significantly to burnout in this profession. These findings underscore the importance of implementing strategies to prevent and manage burnout among physical therapists, such as promoting a positive work environment, providing adequate support, and offering stress management programs but further posts will deal with prevention strategies.

In order to understand this concept in physical therapy, let's look at our counterparts. Burnout among physicians, including medical students, has been a significant concern that can have serious implications for both the individual and the healthcare system. Research has shown that burnout often begins in medical school and continues throughout a physician's career. A systematic review published in JAMA in 2018 found that the overall prevalence of burnout among medical students was 27.2%, with rates varying by year of study and specialty choice. Another study published in Academic Medicine in 2019 highlighted the impact of burnout on medical students' well-being, academic performance, and future career choices.  My speculation is that since there has been scant research on PT students, it has been assumed that it doesn't exist. This is unfair for all parties.

With burnout rates at least 50% and half of those being newly minted licensed physical therapists or physicians, this is a real issue.

Here are some breakdowns by medical specialty:

Why do we care?

Burnout has been shown to negatively affect patient care. Physician suicide rates are higher than in the general population,and a study of medical students also suggested an association between burnout and suicidal ideation.

The spike in reported burnout is directly attributable to loss of control over work, increased performance measurement (quality, cost, patient experience), the increasing complexity of medical care, the necessary but disruptive use of electronic health records (EHRs), and profound inefficiencies in the practice environment, all of which have altered work flows and patient interactions. The result is that many previously well-adjusted and engaged PT's and  physicians have been stressed to the point of burnout, prompting them to retire early, reduce the time they devote to clinical work,  choose virtual or other aspects of practice that are believed to be less stressful, or leave the profession altogether.

^{Typical reasons for the "cause" of burnout:}

Part of the difficulty in studying burnout is that it is a confusing term with multiple meanings. When I was in high school, the term burnout meant a particular class or gang of kids that were more interested in weed and tobacco more than school and they had a particular look and and uniform that reflected their interests. The term nowadays is a bigger problem as it can take the meaning from stress to depression.  The term is overused and thus makes it difficult. Survey data is easy to respond-hell yes, I am burned out.  Amongst millennials it has become fashionable to be burned out. Let's also throw in  hangovers from a global pandemic where behavioral health issues have gone up to as high as 40% (doubled from well documented 20%) and we must simply move beyond burnout and really address this as a significant mental health concern.

Definition and What Burnout is Not:

In order to study burnout we must level set its definition. The most common explanation is that it is an experience of emotional exhaustion, continual depersonalization, and feelings of low achievement and decreased personal effectivness or accomplishment.  It is common to describe burnout as loss of enthusiasm for work and strong feelings of cynicism. National studies indicate that burnout is more common in physicians than U.S. workers in other fields and that the gap between physician burnout and other workers’ experience is increasing. In definition summary: Burnout is a longer-term state whereby you lose drive and enthusiasm for work, become cynical, have a low sense of accomplishment, and are somewhat perpetually disengaged- this is not normal.  This definition, though, has to be carefully differentiated from short-term depersonalization which is what I refer to as calcification, which occurs naturally in many cases daily from too much short-term fatigue or a disproportionate exposure to bad (overbearing patients, insurance companies, paperwork) and is corrected by replenishment, taking a break, or many other short term hacks that reset a provider for the next patient.

This last point on differentiation is critical and will take us to the next post which will help us get to prevention strategies-most notably what is the opposite of burnout?

Stay tuned!

Thoughts?

@physicaltherapy

All Things #Physicaltherapy