Founder Letter: The Heat is On: 5 Unconventional Strategies to Fight Burnout in Your PT Practice

With summer in full swing, we are sizzling here in Phoenix. And unfortunately, it seems the rehab therapy industry is up in similar flames—at least, in regard to therapist burnout. 

According to our 2021 State of Rehab Therapy Report, roughly half of therapy professionals stated they felt more burned out now than they did pre-pandemic. And yet despite this seemingly dire report, the majority of our survey respondents also indicated that they have no desire to make any career or retirement changes. This tells us two things:

• Rehab therapists find immense value in their profession, despite the industry’s flaws; and
• Clinic leaders must address burnout now, while therapists still have vested interest in the profession.

Fortunately, now is the perfect time for rehab therapy organizations to take stock of their business and people operations—and zero in on what’s causing their therapists to boil over. To support this reset, I’ve put together some cool approaches to help you beat burnout in your clinic—and establish a more sustainable (and scalable) way forward.

1. Offer flexible work schedules.

Try as we might, it’s incredibly difficult to separate our personal lives from our work lives. Each of your therapists have responsibilities, activities, and goals outside of the clinic that energize them, ground them, and ultimately add value to their existence. However, when there is too much friction between these two lives, it can lead to higher stress, lower productivity levels, and disengagement—the perfect recipe for burnout. 

As with every relationship—personal or professional—there has to be some give and take. And fortunately, moving away from the antiquated nine-to-five mentality can be that reinvigorating change of pace your therapists need.

Our labor force craves flexibility.

According to the SHRMS’s 2015 Employee Job Satisfaction and Engagement report, 55% of employees cited that flexibility as a very important aspect of their job satisfaction. This is especially true among millennials (those between 25 and 40 years of age), a generation that makes up the largest segment of the workforce. Our own research corroborates this, as having a solid work-life balance ranked fourth among the most important job factors for rehab therapists (behind income stability, salary and benefits, and company culture).

This desire for more flexibility is compounded by the way burnout disproportionately affects women. Considering women represent nearly 70% of the rehab therapy industry, instituting flexible work schedules has become a great—and increasingly necessary—solution to fighting industry-wide burnout.

There’s more give than you may realize.

Fortunately, flexibility is just as practical of a perk for rehab therapy organizations as it is for smaller businesses and startups. After all, most clinics have hours that accommodate the working public (e.g., 7:00 AM to 7:00 PM.), giving you ample time to experiment with different schedules that benefit your therapists. 

This is also where you can help your staff better understand the business side of your clinic. For example, monitoring when your clinic’s schedule is most full and comparing this to factors like your clinic’s capacity and therapists’ availability can help you maximize patient volumes while maintaining a level of flexibility that works for your team. 

These small changes aren’t difficult to make—it’s simply a matter of getting to know your therapists, what works with their lifestyles, and what they require in order to do their best work.

2. Explore alternative productivity and performance metrics.

Often, burnout is the result of having too much to do without enough time to do it. And unfortunately, this “more is more” mindset has crept into some rehab therapy productivity standards—bumping up the number of patients therapists are required to see in a day in response to the continued decline in payment for services. Increasing patient volume has long been considered the surest solution to netting more revenue for your clinic. And while on paper this seems to make the most sense, this pattern can be highly problematic for your patients, therapists, and practice if left unchecked.

Reassess your therapist’s worth.

Meredith Castin, PT, DPT, Founder of The Non-Clinical PT said it best in this blog post: “Therapists are intelligent and resourceful, but when you put them in a position where they need to achieve a certain number of units per day at all costs, they’ll do what it takes to get there, and their treatments might start to feel rushed and impersonal.”

Rather than hold your therapists to unrealistic—and downright exhausting—standards, think outside the “patients per day” box to identify productivity metrics that can really move the needle for your team and clinic. Some suggestions include:

• Tracking patient outcomes and Net Promoter Scores®;
• Tracking your therapists’ patient satisfaction scores;
• Monitoring your therapists’ involvement in community events; and
• Noting which therapists seek continuing education or professional growth opportunities.

Fortunately, we’ve curated a handy list of additional unconventional productivity metrics and how to measure them.

3. Look into alternative compensation models.

Alternative compensation models have begun to pick up considerable steam over the past few years as clinic leaders have realized that the timeworn fixed-salary-plus-bonus models may no longer be the most viable compensation plan for both therapists and clinic operations—particularly in this (nearly) post-COVID world. Similarly, more and more rehab therapists have come around to nontraditional payment models, as their benefits act as a natural counter to some of the issues that drive burnout, including:

• Poor workplace culture,
• Lack of social support,
• Lack of control, and
• Unclear job expectations. 

Spread the wealth—and the goodwill.

As Jason Wambold, MSPT, Co-Founder and Managing Partner of OnusOne, “Over the years, we’ve seen [these alternative compensation plans] strengthen teams rather than diminish them. Because [these models are] tied to clinics’ growth initiatives, therapists are more likely to work as a team in order to achieve these goals…Additionally, we’ve found that employees aren’t solely motivated by money; rather, their motivators are tied to concepts like flexibility, professional control, and time away from work. And nontraditional compensation plans can offer all of these.”

Two of the most prevalent alternative compensation models we’ve seen take off are the fixed-pay, performance-based hybrid and the revenue-sharing plans. Although both vary slightly from one another in structure, the benefits are the same in that they:

• Enable providers to have more flexibility,
• Increase transparency between practice leaders and providers, and
• Encourage accountability and collaboration among therapists.

This is just the start, however. To learn more about these two payment plans, check out these two resources (this blog post and this blog post).

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4. Minimize financial risk and stress.

Last year prompted a lot of introspection in terms of business operations, business continuity, and future goals. And although our research indicated that only 14% of practice leaders were interested in selling their clinics, that doesn’t mean that financial partnerships are out of the question. One trend we’re seeing more of is larger operators taking over leases and operating expenses (e.g., salaries, equipment costs, internet) for smaller organizations, helping clinics rebuild without having to exit the industry altogether. In many ways, this option can provide you with the financial security needed to support your business and those working within it. In turn, you can avoid unnecessary stress and prevent your therapists from feeling the heat, as well.

Reconsider your long-term goals.

All that said, now is the time to reevaluate your long-term goals. Are they still moving the needle for your organization? Are they still benefiting your team? Is managing a clinic still something you want to do? Do you envision your clinic continuing to grow in the future, and if so, what does that look like?

Depending on how you answer these questions, there are a variety of financial opportunities at your disposal. It’s merely a matter of selecting the right one—and choosing the right organization to partner with. As stated in this blog post, this organization should “[align] with your clinic’s culture, values, mission, and people, and… is committed to seeing your specific goals through.”

Remember: Entering into a financial partnership isn’t a sign that you’ve failed—it merely means that you need some help getting back on your feet. Knowing when to ask for support can make the difference between running your clinic—and therapists—into the ground (and compromising patient care in the process), and setting your team up for long-term growth and success.

5. Speak—and act—out on behalf of the industry.

Apart from the pandemic, one of the biggest issues driving burnout in the rehab therapy industry stems from never-ending pay cuts and increasingly complex regulatory changes. PTs, OTs, and SLPs have found themselves on the short end of the reimbursement stick for far too long—and it has created a feeling of malaise within the industry. However, if we are to reach our full potential—and douse the burnout flames that engulf our clinicians—we must take action. This isn’t just my opinion—it’s a fact.

Don’t take your foot off the gas.

The challenges our industry faces are many and great, and therefore progress will take time. However, after securing a couple of notable legislative wins last year, we know we are capable of advocating for our interests. And now, it’s a matter of building on this momentum to secure the future we want for ourselves, our clinics, and our profession.

Currently, we have some work to do with regard to CMS’s 2022 proposed rule. As with every year, CMS looks to its constituents for opinions on certain suggested regulatory and financial changes—and I highly recommend taking advantage of this. After all, how is CMS to know what works for therapy professionals (and what doesn’t) if we don’t tell them? So, here are a few issues on which they’re soliciting opinions:

• Is telehealth therapy a viable treatment option? Although CMS has confirmed that it does not plan to add rehab therapy services to the list of permanent telehealth services, it has invited PTs, OTs, and SLPs to share any data that would prove otherwise. 
• Should supervising visits be different in the future? CMS is seeking comments as to whether supervising providers still need to be present in-person, or if they can oversee treatments virtually.
• Should CMS create remote therapeutic monitoring codes (RTM)? CMS is struggling to determine how these codes should be classified and is asking for pointers.
• What are providers’ thoughts on MIPS Value Pathways (MVPs)? Although this program won’t go into effect until 2023, CMS is still looking for feedback. Specifically, rehab therapists should review and provide insight on the Improving Care for Lower Extremity Joint Repair MVP.

Keep in mind, rehab therapists are also facing another round of pay cuts this year (3.5% for PTs, 3.9% for OTs, and 3.8% for SLPs). Although these numbers are smaller than last year’s proposed 9% cut, we cannot afford to let our guard down. If we do, we are setting a worrisome precedent that will not bode well for our profession’s future.

While each of these strategies are viable in their own right, what this all comes down to is knowing which methods are best suited for your team. After all, there is no one-size-fits-all solution to burnout, just as there’s no universal contributor to clinician exhaustion. However, if you devote the time and energy to identifying the key drivers of burnout in your clinical practice, you’ll find ways to take the heat off your team—and drive progress forward in a more sustainable fashion.