Burnout - Addressing the Elephant in the Room
‘Work keeps getting more demanding. I’m tired, and I’m tired of being tired. I have nothing left to give.’
‘There’s no point in trying to fix things. The people making the decisions have no experience in physiotherapy. Just stay low and keep moving’.
‘Nothing I do makes a difference.’
‘Why is it so difficult to get people to take responsibility for themselves?’
‘If they won’t do their part, I can’t help them.’
Maybe you’ve felt like this, or have had these thoughts about your patients. Maybe you’ve made these comments to your colleagues, or maybe you’ve heard them from someone you work with. After all, everyone has a bad day now and then, right?
What about the person you no longer work with, someone who quit their job rather than ‘keep on keepin’ on’…?
The statements above could reflect a bad day, but I believe they reflect something more; something the physiotherapy community needs to have a serious conversation about: burnout, and its impact on both the profession and on the patients we serve.
What is burnout?
Burnout is “… a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with people in some capacity.”1 Due to the nature of physiotherapy in which we provide care to patients within an increasingly demanding health care system, physiotherapists are at risk of burnout.
The comments above demonstrate the three components of burnout described by Maslach & Jackson.1
Emotional exhaustion is the feeling that one has nothing left to give of themselves.
Depersonalization is characterized by a lack of empathy, and the perspective that others are deserving of their troubles (‘if they won’t do their part, I can’t help them’).
Personal achievement, the sense that you make a difference, can be a buffer against burnout. The lack of a sense of personal achievement (‘nothing I do makes a difference’) contributes to burnout.
The Maslach Burnout Inventory (MBI) is a standardized measure that helps to quantify the experience of burnout.1 A recent study conducted by Physiotherapy Alberta measured the prevalence of burnout among physiotherapists in the province. What we found when all responses were considered were scores in the ‘average’ range of burnout on each of the subscales. But when we looked at the wide range of responses, we saw that about 37% of physiotherapists demonstrated a high degree of emotional exhaustion, and as many as 7% demonstrated a high degree of burnout on all three subscales.2
You could be excused for being underwhelmed by those findings; however, there are a few reasons why I think our profession shouldn’t be too quick to disregard these results:
1. High degrees of emotional exhaustion are a precursor for the development of high degrees of burnout in other domains of the MBI.3
Think of emotional exhaustion as the ‘canary in the coal mine’, a warning sign to be taken seriously. If over a third of physiotherapists are reporting emotional exhaustion now, we should be concerned. This is a harbinger of burnout to come in the years ahead.
2. Burnout contributes to absenteeism and attrition.
The research was inspired by a conversation. When asked about occupational health and safety issues, one health leader commented that the biggest issue she faced was that she barely got one staff member back from stress leave when the next one left for the same reason.
I had worked for that leader’s organization for years and had noticed an ongoing problem with staff retention. Each fall, we would hire several new grads as staff physiotherapists. But by the time September rolled around again, we had numerous vacancies and were barely holding on, waiting to hire new staff from the next graduating class. In talking to physiotherapists working for other employers, I learned that this wasn’t a unique experience.
I don’t know precisely why we suffered this level of turnover, or where people moved to professionally when they left, but the simple fact is that organizations cannot afford to lose staff on an ongoing basis. What’s more, with employers challenged to hire staff, and low vacancy rates for physiotherapists, the profession can’t afford to lose even one.
3. People who are burned out aren’t just ‘unhappy’, they’re risky.
Burnout can contribute to communication problems, a lack of work engagement, low-quality patient care, and disruptive behaviour at work.4 Physiotherapists who are burned out put themselves and their employer at risk of patient complaints and patient safety incidents.
Do the math:
Imagine you work in a physiotherapy practice that employs a total of 15 physiotherapists. If 7% of the people you work with have a high degree of burnout in all 3 domains, at least one colleague is burned out, and more than 4 others are well on their way.
When I worked clinically, I was in a department consisting of roughly 22 physiotherapists and 10 physiotherapist assistants. Looking back, I find it easy to identify the people who were showing signs of burnout. Things they said, the amount of sick time, and their approach to work in general all clearly demonstrated burnout. I can also look back at different phases in my career and recognize when I had moved beyond having a bad day to showing signs of burnout.
I only wish I had realized it at the time.
What do we do about it?
It’s time to get serious about the issue.
Reflect on your experiences, and those of people around you. Are you emotionally exhausted, seeing your patients as things rather than people, feeling that what you do doesn’t matter? Do you know how to recognize if someone you work with is showing signs of burnout?
Discuss the issue with your colleagues, managers and leaders.
Simple changes – how the work day is designed, how feedback is provided, how coworkers support each other when faced with challenging patient scenarios – make a difference. If you’re a leader, ask yourself how you can make work better for you and your team. Realize that even if you are not a leader you have an important role to play in opening the discussion in your workplace, giving and receiving support, and seeking solutions to challenges.
If you are burned out, you need to speak up.
Get support to address the problem. Many employers offer employee assistance programs (EAPs) to support staff in challenging times.
It’s also important to identify when work demands are unreasonable, and act to address the situation. Physiotherapists are high achievers. We like to rise to a challenge and exceed expectations. In this way, we can be our own worst enemies.
Although ‘work-life balance’ is a well-worn cliché, the importance of having work boundaries can’t be overstated and we have to understand that there’s more to life than work.
We’ve all had the occasional bad day at work, that day when everything goes wrong. On those days, I refer to myself as having the ‘merde touch’ (opposite of the Midas touch - apologies to my francophone friends). But if those days are frequent, and joy at work is rare, it may be time to ask yourself whether burnout is the real issue, and find out what you can do to address it.
To find out more about burnout among physiotherapists and ways to address the issue, go to https://www.physiotherapyalberta.ca/physiotherapists/career_work_health_resources/burnout_among_physiotherapists
LEANNE LORANGER, PT is a graduate of McMaster University’s Master of Health Management program (2016) and the University of Alberta’s Department of Physical Therapy (1995). She is the Manager - Policy + Practice at Physiotherapy Alberta and is involved in practice and quality improvement related activities, including resource development and continuing education planning. Prior to taking on her current role, Leanne worked for 19 years in clinical practice.
Leanne Loranger, PT, MHM
Maslach, C., & Jackson, S. E. (1996). Maslach Burnout Inventory-Human Services Survey (MBI-HSS). In C. Maslach, S. E. Jackson, & M. P. Leiter (Eds.), Maslach Burnout Inventory Manual (3-17). Palo Alto, CA: Consulting Psychologists Press.
Bainbridge, L., Davidson, K., & Loranger, L. Burnout among Alberta physiotherapists: A white paper. Retrieved from https://www.physiotherapyalberta.ca/files/burnout_white_paper.pdf Accessed November 14, 2017.
Maslach, C., Schaufeli, W. B., & Leitner, M. P. (2001). Job Burnout. Annual Review of Psychology, 52, 397-422
Health Quality Council of Alberta. (2013). Managing disruptive behaviour in the healthcare workplace: Provincial framework. Retrieved from https://d10k7k7mywg42z.cloudfront.net/assets/531e04a0d6af6803fd000864/HQCA_Disruptive_Behaviour_Framework_041113.pdf Accessed November 14, 2017.