Research in Focus: Burnout Among Alberta Physiotherapists
May 6, 2020
Leanne Loranger, PT
The Research in Focus article series is usually a forum to share summaries of recently published evidence relevant to Alberta physiotherapists. However, with the unprecedented COVID-19 pandemic and the burden the pandemic has placed on all health-care professionals, it seems timely to highlight the findings of Physiotherapy Alberta’s own 2016 research into burnout among our registrants.1
Burnout is defined as “… a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with people in some capacity.”2 The experience of burnout can be defined by its underlying elements: emotional exhaustion, depersonalization, and personal achievement.2 The concept of work engagement is also relevant and is considered the opposite of burnout.3
Individuals demonstrate a high degree of burnout if they report high levels of emotional exhaustion and depersonalization and low levels of personal achievement as measured by the Maslach Burnout Inventory.4 Low work engagement is correlated with burnout5 and is demonstrated by low levels of vigor, dedication, and absorption as measured by the Utrecht Work Engagement Scale.3
Due to the nature of their work providing care to patients within an increasingly demanding health-care system, physiotherapists are at risk of burnout.
Physiotherapy Alberta Registrant Survey
In 2016, Physiotherapy Alberta conducted a survey of our registrants to understand their experience of burnout. We conducted the survey as there was no published information about the experience of burnout among physiotherapists despite there being a considerable body of literature related to nursing and medical professionals. Anecdotal evidence suggested that burnout was an issue, so we sought to quantify the problem. A white paper detailing the findings of the survey is available on Physiotherapy Alberta’s website.1
Cross-sectional survey open to all Physiotherapy Alberta registrants in fall 2016.
Qualitative questions related to Alberta physiotherapists’ lived experiences of burnout were included as past research has indicated that burnout in health-care settings is multifactorial with several contributing and mediating factors.
Sample size – 201 responses (10.2% response rate) were received
37.3% of respondents demonstrated a high degree burnout on the emotional exhaustion subscale.
9.4% demonstrated a high degree burnout on the depersonalization subscale.
17.4% demonstrated a high degree burnout on the personal achievement subscale.
13.4% demonstrated a high degree burnout on two MBI subscales.
7.4% demonstrated a high degree burnout on three MBI subscales.
14% of respondents demonstrated a low to very low degree of work engagement.
The survey responses provided a wealth of qualitative data, which were analyzed and classified into two global themes:
Workplace: Burnout is affected by the workplace and the interplay between work context, the patient or client, and the individual physiotherapist.
The Burnout Continuum: The manifestations of burnout are affected by the interplay between the contributing factors to and those that prevent burnout.
The convenience sample and low response rate mean that the findings should be interpreted with caution and may not be representative of all Alberta physiotherapists.
Although the quantitative findings should be interpreted with caution due to the response rate, the qualitative findings can be viewed with greater confidence due to the relatively large sample of qualitative data providing insight into the experience of burnout and related issues described by the respondents.
Relevance to Alberta Physiotherapists - Why are highlighting this survey now?
The COVID-19 pandemic has been and continues to be an unprecedented challenge to health-care workers in all settings, and physiotherapists are no exception. Physiotherapists may have encountered increased stress when providing care to patients due to staff shortages and concerns about the risks that their work may pose to themselves and their family members.
Other physiotherapists may have struggled with moral distress related to restricting in-person services to patients who require physiotherapy assistance.
Physiotherapists in all settings, but particularly those in continuing care environments may have also experienced grief at the loss of patients with whom they have developed therapeutic relationships, in some cases long-standing ones.
In addition, all physiotherapists, as members of society at large, are navigating this pandemic and the stress and challenges it poses for their personal and family lives as well, such as increased caregiver burden, home schooling demands, and decreased social interactions. Many have experienced financial stress and have been laid-off from work.
These factors all are represented in the Workplace global theme identified through the qualitative portion of the survey. The data highlighted that perceived causes of burnout included work overload, unrealistic expectations and client demands, workplace leadership and management concerns, financial or marital issues, and caregiving for family members. Many of these concerns have been well documented in the media in recent weeks. In addition, these challenges are occurring in the context of limited ability to employ preventative strategies commonly used to manage burnout.
When asked about burnout prevention in the qualitative study, the strategies respondents identified were largely focused on activities and actions external to work, such as maintaining a healthy lifestyle, and the importance of social relationships. As identified in the second global theme – the Burnout Continuum, the experience of burnout is affected by the interplay of factors that contribute to and those that prevent or ameliorate burnout. With strategies such as exercise and social connections largely impacted by the current restrictions in place, the ability to positively affect the burnout continuum is challenged.
Finally, these stressors and contributors to burnout are all occurring within a population that previously demonstrating some signs of burnout. Without conducting a repeat study, it is difficult to know but is not unreasonable to suggest burnout among physiotherapists is an issue of some concern. Not only is burnout a problem for the well-being of the physiotherapist, it is also a concern from a patient safety perspective.
It may not seem productive to have the past prevalence and contributors to burnout among physiotherapists pointed out at this time, but the intent of doing so is first to validate that this is a real issue. Secondly, it is hoped that through greater awareness of burnout in general, and the factors that may be increasing the risk of burnout at this time in particular, physiotherapists can start to have frank conversations with their peers about how they are coping, and small changes made help to improve the situation. One thing that is certain is that a culture of silence around this issue is not helpful.
When Physiotherapy Alberta first published the white paper reporting the survey’s findings, we provided recommended actions to address burnout at both an individual and employer level.
For individuals we suggested:
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.
For employers we suggested:
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.
Although some of these strategies may not be feasible at this time, it is worth considering which strategies can be implemented and others modified to be actionable in the context of COVID-19. At a minimum, employers and health system leaders should acknowledge the issue and ensure staff are aware of the availability of external supports such as employee assistance or similar programs.
Maslach C & Jackson SE. Maslach Burnout Inventory-Human Services Survey (MBIHSS) 1996. In C. Maslach, S. E. Jackson, & M. P. Leiter (Eds.), Maslach Burnout Inventory Manual (3-17). Palo Alto, CA: Consulting Psychologists Press.
Schaufeli WB & Bakker A. The measurement of work engagement with a short questionnaire Educational and Psychological Measurement 2006; 66(4): 701-715.