Burnout among physiotherapists impacts the health and wellbeing of individual physiotherapists, gives rise to concerns about the quality and safety of patient care, and has the potential to negatively impact the profession. Individual physiotherapists, employers, health system leaders, and physiotherapy regulators must act to address the problem and reduce the risk of burnout to ensure a healthy physiotherapy workforce now and in the long term.

Did you know?

  • Burnout among health professionals is being recognized more often as a key factor in patient safety and as a workplace psychological hazard.
  • Stress at work is associated with heart disease, depression, musculoskeletal disorders.1
  • Mental and physical health problems can result from high job demands, low job control, and effort-reward imbalance.

The effect of burnout on absenteeism and attrition2 is of concern to Physiotherapy Alberta and to employers. It affects health human resources planning, and can affect patient safety and quality of patient care.3

Physiotherapists, in their roles as service providers, work closely with a range of populations, often vulnerable populations, in a variety of settings. To ensure clinical reasoning and decision-making skills are optimal, and to be safe and effective in their work, PTs need to be physically, emotionally, and cognitively healthy. Burnout, or early signs of burnout, can affect clinician health, and consequently affect patient safety.

It’s time to learn more and take action.

A syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with people in some capacity. A key aspect of the burnout syndrome is increased feelings of emotional exhaustion -- as emotional resources are depleted, workers feel they are no longer able to give of themselves at a psychological level. Another aspect of the burnout syndrome is the development of depersonalization, that is, negative, cynical attitudes and feelings about one's clients. This callous or even dehumanized perception of others can lead staff members to view their clients as somehow deserving of their troubles. ... A third aspect of the burnout syndrome, reduced personal accomplishment, refers to the tendency to evaluate oneself negatively, particularly with regard to one's work with clients. Workers may feel unhappy about themselves and dissatisfied with their accomplishments on the job.4

Research suggests that burnout and work engagement are somewhat negatively correlated – that is that clinicians with high scores in exhaustion and depersonalization are less engaged in their work.5,6,7 This suggests they have lower energy and a weaker connection with the work that they do. However, the correlation is not perfect as “when an employee is not burned out, this doesn’t necessarily mean that he or she is engaged in his or her work. Reversibly, when an employee is low on engagement, this does not mean that he or she is burned out.”8

Note that while burnout and depression can appear similar and they may share common etiology, they are different constructs.9

Review this short YouTube video describing burnout and some contributing factors.

 

Physiotherapy Alberta conducted a research project with the overarching goal to assist in maintaining a healthy workforce, and to support members to provide safe and effective physiotherapy care to patients in Alberta. The literature suggested that burnout (and associated absenteeism and attrition) is a growing concern in the workforce and that it affects health human resources planning and can affect patient care, but there was limited evidence about the prevalence and impact of burnout among physiotherapists in this province.

What did we do?

We surveyed physiotherapists to find out how many were demonstrating a high degree of burnout, and to ask what they’ve seen in themselves and in others related to the experience of burnout. We used two standardized outcome measures (the Maslach Burnout Inventory – Human Services Scale [MBI-HSS]10 and the nine-item Utrecht Work Engagement Scale [UWES-9]11 (these data were analyzed using a two-step ANOVA). Respondents were also asked a series of open-ended questions; the answers were analyzed using thematic analysis methodology.

What did we find?12

The survey response rate was 10.2% (201 respondents). While the mean scores on the two outcome measures fell in the range of average degree of burnout overall, it was interesting to see that some respondents demonstrated a high degree of emotional exhaustion and low scores in personal achievement (two of the three constructs measured in the MBI-HSS). This is important to be aware of as the literature provides evidence that high emotional exhaustion can progress to overall burnout over time. Correlating demographics with outcome measure scores provided additional insight into potential contributing factors to burnout.

The qualitative analysis revealed two global themes: the “Workplace” (suggesting that burnout is affected by work context, the patient population, and individual characteristics of the physiotherapist) (see Fig 1) and the “Continuum” (connecting the prevention of and the contributing factors to burnout – see Fig 2).

Fig. 1

Work Context: Includes Management style and abilities, workload, resources, access to continuing education

The Indidual PT: Includes work-life balance, career choices, healthy lifestyle, seeking help, setting personal limits, and expressing personal limitations

Patient or patient population: Includes unrealistic expectation of patients, patient and family demands, emotional toll, greif and loss

Fig. 2

Contributing factors: include poor management, lack of recognition, work overload, high demands, lack of resources, personal issues, poor lifestyle choices, and home demands.

Mitigating factors: Include healthy lifestyle (exercise, sleep), work-life balance, social supports, recognition from mangement, and opportunities for continuing education.

So What?

With this better understanding of the risk of burnout in its membership, Physiotherapy Alberta has provided recommendations related to positive change to minimize that risk. These recommendations can be used by employers and by physiotherapists. A repository of resources has also been created related to the identification and prevention of burnout.

Click here to learn more about the research project.

Addressing physiotherapists’ risk of burnout requires a wide perspective including tools to identify burnout, and strategies to prevent known risk factors. Addressing burnout is a shared responsibility between individual physiotherapists, employers, organizations, and legislators. Effective interventions to reduce risk of burnout can occur at all levels: environmental, personal, care team, managerial and policy maker/funding agency.   

For You (personal level)

Recommendations:

  • Seek resources and training to ensure early recognition of symptoms of burnout in yourself and others
  • Work towards attaining a healthy lifestyle and achieving a realistic work-life balance
  • Make career and lifestyle choices appropriate to you, your values, and your preferences
  • Access help to minimize stressors at work and at home
  • Seek referral to a mental health specialist if necessary
  • Establish and re-establish personal boundaries with patients and families
  • Identify expectations with patients and families

Resources

For Employers (organizational level)

Why should employers care? Why improve workplace psychological health and safety and find ways to mitigate burnout?

The Standards Council of Canada identifies four main areas of consideration that make the business case for improving workplace psychological health and safety:13

  • Risk mitigation
  • Cost effectiveness
  • Recruitment and retention
  • Organizational excellence and sustainability

Recommendations:

  • Seek training to ensure there is early recognition of symptoms of burnout in employees
  • Improve communication and employee engagement
  • Address flexibility in work hours
  • Provide authentic, frequent, and appropriate recognition
  • Provide access to professional development
  • Conduct open discussions about burnout in the workplace
  • Empower employees to identify signs of burnout and act on them
  • Engage in collaborative problem solving with employees to find solutions that may reduce or prevent burnout
  • Provide resources to employees who work with patient populations requiring a high emotional presence
  • Assess organizational culture to ensure employees perceive it to be supportive
  • Provide team training to improve collaboration and support between colleagues

Resources

  1.   Leka & Jain, 2010. WHO: Health Impact of Psychosocial Hazards at Work: An Overview http://apps.who.int/iris/bitstream/10665/44428/1/9789241500272_eng.pdf
  2.   Suñer-Soler et al., 2014. The consequences of burnout syndrome among healthcare professionals in Spain and Spanish speaking Latin American countries (http://www.sciencedirect.com/science/article/pii/S2213058614000254)
  3.   Lyndon, A., 2016. Burnout Among Health Professionals and its Effect on Patient Safety https://psnet.ahrq.gov/perspectives/perspective/190/burnout-among-health-professionals-and-its-effect-on-patient-safety
  4. Maslach & Jackson, 1996. Maslach Burnout Inventory-Human Services Survey (MBI-HSS). http://www.mindgarden.com/117-maslach-burnout-inventory 

  5. Schaufeli & Bakker, 2010. Work Engagement:  A Handbook of Essential Theory and Research. https://books.google.com/books/about/Work_Engagement.html?id=IZJ5AgAAQBAJ

  6. Schaufeli & Bakker, 2003. Utrecht Work Engagement Scale, Preliminary Manual (Vol 1). http://www.beanmanaged.com/doc/pdf/arnoldbakker/articles/articles_arnold_bakker_87.pdf

  7. Schaufeli, Salanova, Gonzalez-Roma, & Bakker, 2002. The measurement of engagement and burnout: a two-sample confirmatory factor analytic approach. http://www.wilmarschaufeli.nl/publications/Schaufeli/178.pdf

  8.   Schaufeli & Bakker, 2003. Utrecht Work Engagement Scale, Preliminary Manual (Vol 1). http://www.beanmanaged.com/doc/pdf/arnoldbakker/articles/articles_arnold_bakker_87.pdf

  9. Leka & Jain, 2010. WHO: Health Impact of Psychosocial Hazards at Work: An Overview http://apps.who.int/iris/bitstream/10665/44428/1/9789241500272_eng.pdf

  10. Maslach & Jackson, 1996. Maslach Burnout Inventory-Human Services Survey (MBI-HSS). http://www.mindgarden.com/117-maslach-burnout-inventory

  11. Schaufeli & Bakker, 2003. Utrecht Work Engagement Scale, Preliminary Manual (Vol 1). http://www.beanmanaged.com/doc/pdf/arnoldbakker/articles/articles_arnold_bakker_87.pdf

  12. Bainbridge, Davidson & Loranger, 2017

  13. Standards Council of Canada. Psychological health and safety in the workplace — Prevention, promotion, and guidance to staged implementation http://media.wix.com/ugd/04eb69_1bd3775b89f84a918b1f77fc44744771.pdf

Background

The experience of burnout can be defined by its underlying elements: emotional exhaustion, depersonalization, and personal achievement (Maslach & Jackson, 1996). The concept of work engagement is also relevant and is considered the opposite of burnout (Schaufeli & Bakker, 2006). Individuals may demonstrate a high degree of burnout if they report high levels of emotional exhaustion and depersonalization and low levels of personal achievement (Maslach, Leitner & Jackson, 1996).

Although much is known about the phenomenon of burnout among nurses and physicians, there has been no research published on the prevalence or lived experience of burnout among physiotherapists in Canada. While there is some research related to burnout among physiotherapists in other countries, practice in other countries can be significantly different from that in Canada, and this limits the generalizability of non-Canadian research to physiotherapists in Alberta. By quantifying and qualifying the experience of burnout among Alberta physiotherapists, Physiotherapy Alberta seeks to understand the magnitude of the problem, to raise awareness of the issue, and to ultimately provide members with resources to help identify and manage burnout and reduce burnout risk.

Click here to view Burnout Among Alberta Physiotherapists: A White Paper