Beware of burnout

Musculoskeletal rehabilitation is an active process, both for patient and physiotherapist. Patients frequently lean on their therapists for emotional as well as physical support, but standing alongside a patient for every step of their recovery is tough. 

Is it even possible when faced with a new patient every 20 minutes and limited availability for follow up? My view is that systemic pressure on physios leads to burnout, compromises clinical care and devalues the physiotherapy profession. 

It was only after I started to retrain as a doctor that I realised how much I loved being a physiotherapist. I continued to work 15 hours a week as a physio and committed to a full hour to each assessment. I knew that I was providing better care and I enjoyed it. The big surprise was that, even working alongside full-time study, my energy levels, creativity and job satisfaction were higher than ever. 

The way burnout manifests itself is different for everyone: resenting the patient who neglects his or her home exercises; despair after failing a band 7 interview; losing interest in journal articles; dreading going back to work on Monday. Therapist burnout affects patient care. So how can it be fixed?

First, identify your own risk factors. These could be personal, systemic or a combination of both. For me, it was lack of variety, coupled with an unmanageable caseload. I tried to become the best clinician I could – seeing lots of patients – to the exclusion of other professional interests. The solution in my case was to nurture those other interests: research, medical journalism, sports physio, teaching anatomy to allied health and medical students in the dissection room, and clinical skills tutoring. The NHS career structure encourages management, but I found balance in an academic role. Job sharing in a part-time advanced practice, extended scope physio, or a private practice, could allow you to explore other ‘portfolio career’ opportunities. Systemic causes of burnout are all around us and can feel insurmountable. Reduced funding for NHS services feels beyond our control, but with physios taking on senior management roles, we must take charge of the profession. Patient contacts are essential to generate income, but it is only by supporting clinician development, and promoting quality care, that we will drive forward the perceived value of physiotherapy and support our own income. But with higher salaries and better quality NHS resources, perhaps we wouldn’t need to work those extra hours in private practice. 

• Paul Welford is an academic F2 doctor