It’s becoming more challenging to create a sustainable career in medicine. Hospitals and private practices are pushing for their practitioners to serve more patients per hour while providing the same pay as ten years ago. It’s more work, less time, same pay. Navigating this trend has shown to be quite tricky.
Over half of all physical therapists report having chronic pain. It’s not unreasonable to say the average therapist sees between 50-60 patients per week, which is 10-15 patients per day.
While these numbers may seem manageable for a physician or nurse, physical therapy comes with unique challenges. You don’t asses, prescribe, and move on your way. Creating a healing environment takes more than a diagnostic assessment and prescription, making decreases in treatment time a challenge.
As detailed by Campo et al Job, burnout is related to a myriad of psycho-social factors, with decreases in treatment time a contributing factor. Job turnover is associated with high job demands, low job control, and job strain. While, like many complex issues that involve a multitude of subjects, there are no obvious solutions.
With science guiding us, let’s see if we can put the puzzle pieces together.
Find an Environment Where Patient Load is Manageable
The trend of shorter patient interactions is proving to hold steadfast. These standards are entrenched in our current economy. Decreases for patient treatment times due to higher patient load are detrimental and known to lead to burnout and most work stress is caused by excessive workloads; both clinical and administrative.
These unrealistic workloads infringe on your self-esteem and self-efficacy and job stress can sometimes be perceived as a personal failing. We know that feeling like a failure is harmful to self-efficacy, which is one of the three facets essential to personal motivation. This loss of self-efficacy can lead to a host of burnout related quandaries.
A better idea would be to find an employer that is not tied to large patient quotas. While we love to see our patients succeed, we must also take time for ourselves. These employers exist and encourage better outcomes for you, and your patients.
Create Efficient Systems
If you do find yourself in a workplace that won’t allow a decrease in patient loads, you can try to create more efficient systems to decrease job strain.
Job strain + high demands + low control = increases in the likelihood of poor patient outcomes
Creating systems that streamline processes are the time-restricted therapist’s savior. We know building rapport via interpersonal communication skills are vital for increasing your control.
So how can you create a system for that process?
Chris Voss of the Black Swan Group recommends mirroring, labeling, and asking open-ended questions. To quickly build rapport in a time sensitive environment, mirror your patient’s verbal and non-verbal actions. Then, after a statement has been explained, repeat what they said back to them, using the correct emotion they’re feeling. An example would be after a patient talks about her frustrations with low back pain, a good response may be, “Sounds like your back pain is really frustrating for you.” Listen to her response and calculate a good open-ended question that starts with a ‘What’ or ‘How’. Ask them, “what do you think will make it better?” or “how do you think we can work through this?” Both would be good open-ended questions that will facilitate a rapid interpersonal connection.
System two is staying on top of the current evidence. Deviation from evidence-based practice can take up vital mental resources and slow you down. For every potential treatment surprise, create an evidence-based system to follow. Say you have a top notch rotator cuff tear treatment protocol that works well with the majority of your patients. Not deviating from this system, by creating exercises at the moment, will help you reserve your mental energy and allow you to get more done in less time.
Check your Total Hours Worked
Always know your total hours worked. You may be a salaried employee, with a set hourly rate, based on an 8 hour day. Every time you work late or are pushed to work without pay, you are decreasing your personal margin. For example, $45 per hour, with daily take-home paperwork, quickly becomes $35 per hour. More work, particularly unpaid, is not always better. To increase your personal margins and yield, maintain healthy boundaries for your time.
If you are struggling in this field, remember there are steps you can take to relieve your stress. Physical therapy is an amazing field with potential for lots of personal satisfaction. Tasked with promoting patient quality of life, we have an opportunity to substantially benefit someone’s well-being. What other professions can have this much impact? You are valued and provide a life-changing service, don’t let bureaucracy get in the way of your patients.
Remember to find a better employer, create time-saving systems, and always check your margins.
Armed with these strategies, you can go back to doing what you love: helping others.