Problem 7 Time Based Billing: Therapist burn-out and attrition
Following on from my last post about the sixth problem that the traditional time based physiotherapy model of care produces (pressure on the therapist) the 7th problem ties in closely.
To read more about how time based billing can produce excessive pressure on therapists (Problem 6) click HERE>>
Industry Observations Attrition in Physiotherapy
Over my 12 years as a private practitioner I have observed that therapist attrition in physiotherapy seems high.
Amongst my graduating university cohort I estimate that approximately one quarter to half of my colleagues are still actively engaged in the physiotherapy industry. The other therapists have attritioned out of the industry.
There were 28,855 physiotherapists registered across Australia as as 30 June 2016 (1). If the observations of the percentage of my cohort that had exited the industry were to be extrapolated to the industry, the number would be quite large. It could be that my graduating class is a biased sample, or indeed that the attrition from my cohort is indeed fairly typical of the state of the industry.
So where do these physiotherapists leaving the industry go?
I have observed that they exit to go into orthopaedic sales rep work, study medicine, start families, or do complete career changes to other careers altogether such as law.
What are the drivers of attrition ?
What are the drivers of the attrition from physiotherapy?
My observations are entirely biased towards private practice where I have spent my career to date. In no particular order I believe the key drivers that result in physiotherapist attrition are:
- Lack of career progression. The physiotherapy industry remains ‘cottage based’ (small scale). The majority of private practices exist as micro businesses with teams of less than 12 people. These cottage based practices often lack organisational ‘vision’. The existence of a vision for the practice is vital in giving the physiotherapists a pathway (real or perceived) in which they can professionally progress. An ancient scripture states that without vision people perish. It is a timeless truth that holds true for physiotherapists. I succumbed to the effects of a lack of vision in taking on my first physiotherapy job as a graduate on the Gold Coast. Within several months of my professional life my enthusiasm was fast fading. I wondered ‘what’s next?’. My options were to leave the industry and sit the GAMSAT or start my own practice. I chose the latter.
- Unappealing modelling by senior physiotherapists/ practice owners. I believe many therapists look to their seniors and their employers for professional inspiration. Instead of finding that, they see the opposite modelled. The business owners are often modelling: fatigue, burnout, stress, and a seeming ‘martyrdom’ for their role with their needs being neglected for the benefit of their clients. In the majority of cases in private practice, beyond running a case-load ownership of a practice (in part or whole) is the sole next step in progressing a physiotherapy career. When those ‘watching on’ observe the stress and apparent dissatisfaction, the merits of progressing to follow suit seem few.
- Under remunerated. For a typically intensive university degree and generally intelligent and capable graduates, the pay rate of physiotherapists lags behind other professions such as accountancy, and law. While it is well documented that remuneration is not the key determinant of workplace satisfaction (2) a satisfying remuneration remains important. I believe that it is even more important in industries such as physiotherapy where the worker outputs so much. I recall as a graduate in my first aforementioned workplace reflecting that I was earning more at my uni part time job (at KMART) than I was on my 33% commission as a health professional. It was quite a sad realisation.
- Flooded marketplace. Competition in all services and trades has never been greater. The advent of at the digital age has meant that you can have a business with an Instagram account. The barriers and entry points have been lowered. Many physiotherapists that I have observed are having difficulty navigating the digital age, failing to position themselves well across the many social media platforms that now exist. The result can be a reduction in confidence and a sense of overwhelm and not ‘keeping up’. Both of which can fuel the mindset of quitting verse sticking around.
- Therapist burnout. All of the above can feed into a physiotherapist experiencing burn out. When burn-out occurs the likelihood of attrition from the industry is heightened. According to Maslach (3) professional burnout is a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment.
The ‘burnout’ research
A 2014 study (4) looked at factors that contribute to the development of burnout among 200 physiotherapists with different length of service in physiotherapy. Interestingly they found physiotherapists with more than 15 years of service reported greater satisfaction than those with less than 5 years and between 5 and 15 years of service.
The results suggest that burnout in those with 5-15 years of service is higher in physiotherapists working in health care centers and increases with age and greater financial satisfaction, while it decreases with greater satisfaction with friend and family relations and greater satisfaction with one’s work and profession. In those with more than 15 years of service, burnout increases in the case of working in a setting other than a health care or educational center and decreases with greater satisfaction with one’s work and profession.
So it seems that getting physiotherapists to survive 15 years of industry life is somewhat a ‘safeguard’ against burn-out and possible industry attrition, while those physiotherapists with less than 5 years of industry experience are more susceptible to therapist burnout.
The greatest contributor to therapist burnout (my opinion): session to session pressures
In my opinion the greatest likely driver of therapist burnout is the ever present ‘pressure’ to meet the client’s expectations for their treatment session. This pressure is omnipresent. With professional maturity and skill development therapists can learn to consistently meet client’s expectations. However I have observed that for many physiotherapists the pressure of client expectations across a treatment day, month, and year can be exhausting.
The pressure of meeting clients expectations is further heightened with session to session care whereby the therapist often tries to ‘cram’ all of the key treatment ingredients into a consultation of 30minutes, knowing that the next opportunity to assist the client may come in one week’s time. Such pressure is further heightened when consultation lengths are shorter than 30 minutes, such as 20 minute standard consultations.
While working inside a large corporate I experienced the ill effects on my health (increase stress levels) with such short consult lengths, bouncing client to client every 20 minutes. I felt that the rushed consults did not allow me to ‘connect’ meaningfully with my clients, and did not facilitate a sense of satisfaction of a job ‘well done’ due to key elements of the treatment being neglected to try and stay on time. With it being mandated to treat clients for 20 minutes I was in a constant state of anxiety. I witnessed many therapist burnout under this ‘regime’, quitting their jobs, and sometimes the industry. I count these years as some of my professionally most challenging.
A solution to assist reduce therapist burnout and industry attrition
While client expectations and pressures will always exist I have enjoyed a deeper satisfaction and reduced stressors with clients receiving care on our Finish Line™ Programs. The deeper satisfaction comes from the delivery of gold standard best practice treatments devoid of restrictions to access that exist with traditional session to session time based billing models of care.
The reduced stress is the byproduct of not being pressured to fit everything into a single treatment, but rather enjoying the sequencing of key treatment elements at the best time as afforded by the greater access to services under the fixed fee unlimited access Finish Line™ program model.
I believe that this shift away from the pressures of session to session care is a positive for the physiotherapy team I lead, and also for the physiotherapy industry at large.
Learn more about our Finish Line™ Programs
If you’re a physiotherapist feeling the pressures of practice life, yet still caring about your profession I encourage you to learn more about Finish Line™ Programs.
For more information around the journey we underwent to launch our Finish Line™ Programs click HERE>> (Challenging the Way the Physiotherapy Industry Charges) to listen to a podcast interview.
For an example of how POGO’s Finish Line™ programs achieve great client outcomes click HERE>> (Finish Line™ Case Study-Tom Bowie) to read Tom’s story of overcoming debilitating lower back and sciatic pain.
In the meantime if you are physiotherapy practice owner looking to get more respected results through heightened trust levels with your clients be sure to subscribe for our POGO Partners™ updates HERE>> POGO Partners™ Program.
If you are a physiotherapy consumer looking to benefit from the best in treatment outcomes schedule your initial appointment (Discover Recover Session) HERE>>.
- AHPRA Annual Report 2015/16 http://www.ahpra.gov.au/annualreport/2016/html/national-boards-report.html
- Retaining Employees: How much does money matter? http://www.gallup.com/businessjournal/188399/retaining-employees-money-matter.aspx
- Maslach, K (2002) Job Burnout. Annual review Physcology. 52: 397-422. http://www.wilmarschaufeli.nl/publications/Schaufeli/154.pdf
- Śliwiński, Zbigniew, et al. “Burnout among physiotherapists and length of service.” International journal of occupational medicine and environmental health 27.2 (2014): 224-235.
On my 10th physiotherapy anniversary I sat down to reflect on 10 years of my career and noted the top 10 learnings to that date. Here they are My Top 10 Lessons Learnt Through my First 10 years as a Physio
Physio With a Finish Line™,
Brad Beer (APAM)
Author ‘You CAN Run Pain Free!’
Founder POGO Physio
Host The Physical Performance Show
Featured in the Top 50 Physical Therapy Blog