Defining and Identifying Burnout in Rehab Therapy

A private practice owner, Jamey Schrier, PT, was at a pivotal point in his clinic’s growth. And he was ready to move from managing day-to-day clinical operations to focusing more on being a business owner. 

His solution to achieve this shift seemed straightforward: appoint a clinical director. He already had an excellent candidate in mind, and conveniently, she was on his clinical team. Despite suspecting she might not be the best fit as a leader, Schrier convinced her to take the role, assuring her he’d offer coaching and support until she found her stride. 

But in just six months, she quit the new position. The transition into leadership and management led this stellar physical therapist to experience burnout. 

Looking back, Schrier can easily diagnose the source of her burnout, and he blames himself. 

“I wasn’t really clear on what she needed to do,” said Schrier, today the CEO of Practice Freedom. “I was more interested on me just moving than her being successful in the position. There wasn’t a clear job description. There wasn’t clear [standard operating procedures], there wasn’t really clear metrics. I didn’t support her the way I wanted to, and this rockstar therapist just completely became disengaged.” 

The Growing Challenge of Burnout in Rehab Therapy 

Stories about provider burnout have become all too common in rehab therapy and throughout healthcare. In fact, rehab therapist burnout, which has been growing for years but was exacerbated by the pandemic, is reaching epidemic proportions throughout all care settings. 

Rehab therapists often balance large caseloads, intense documentation demands, reducing reimbursement levels, and the emotional weight of helping patients manage difficult recoveries. These and other issues led one recent study to conclude that burnout likely impacts between 45% and 71% of physical therapists practicing today. 

This has resulted in an industry-wide struggle with staffing shortages (which is growing), healthcare costs, and the overall quality of patient care. 

Rehab therapists face a daily grind that, if not addressed, can wear them down over time. Whether working in an outpatient clinic, hospital, or a post-acute setting, all practitioners require clear training and expectations, proper support, and an appropriate work-life balance to avoid the consequences of burnout. 

In this e-book, we will define what burnout looks like in rehab therapy and explore its common causes. We’ll also outline proactive strategies that managers, directors, and clinic owners can use to prevent burnout, such as setting clear job expectations, fostering supportive environments, and ensuring manageable caseloads. 

Finally, this chapter will provide tips for diagnosing burnout in your staff before it reaches a critical point. This includes identifying early warning signs that burnout may be taking hold and providing appropriate ways to react to these signs. 

By understanding burnout, rehab therapy clinic owners, managers, and healthcare administrators can create better working conditions that benefit not just their therapy teams, but also their patients. By developing a thoughtful approach to identifying and addressing burnout-related issues, it’s possible to establish a healthier and more sustainable work environment that keeps rehab therapists engaged, motivated, and capable of delivering the high-quality care patients expect. 

Burnout impacts between 45% and 71% of physical therapists practicing today. 

Source 

What is Burnout in Rehab Therapy? 

Burnout is a state of physical, emotional, and mental exhaustion caused by prolonged stress or being (or feeling) overworked, unprepared, or not provided with sufficient resources, training, or tools for success. It’s characterized by low energy, reduced effectiveness, and a sense of detachment or cynicism toward one’s job. 

While burnout can happen in any profession, it’s particularly prevalent in healthcare today. The high-stakes demands, emotional intensity, and the unpredictable nature of the work have led to around half of all healthcare workers experiencing burnout, leaving many (28.7%) with a desire to exit their professions. 

Rehab therapists are not immune from burnout. High caseloads, documentation requirements, and the need to simultaneously manage multiple patients can make it difficult for some therapists to stay motivated, engaged, and balanced. This makes it difficult for them to absorb new or changing expectations. 

“I imagine a therapist who is experiencing burnout presents to work already frustrated with her day being started,” said Jamie McMichael, OTR/L, CPM, Product Manager with Net Health who has 20 years of rehab leadership experience. “As things happen throughout the day and the schedule adjusts … clinicians that are in what I would call a burnout phase would not easily adapt or adjust to changes that happen throughout the day. They also don’t end their day when they leave from the clinic [as] they actually tend to bring those frustrations home.” 

One study focusing on physical therapy broke burnout down into three components: emotional exhaustion, depersonalization of care, and low personal accomplishment. 

• Emotional exhaustion occurs when a rehab therapist feels overextended in their job, experiences extreme fatigue, and feels their emotional resources have been drained. This can be from simply working too many hours, but it could also be due to a lack of training, resources, and support. Emotional exhaustion often leads to the next component, depersonalization of care. 
• Depersonalization of care happens when rehab therapists begin to feel extremely detached from their job, and this starts to have negative consequences on patient care. Depersonalization happens when caregivers lose their sense of purpose, or their “why” for choosing a career in rehab. It can lead to practitioners feeling detached from their work and no longer seeing the benefits they offer to their patients. 
• Low personal accomplishment is a feeling of incompetence when it comes to delivering services and treatments to patients. Perhaps this is due to a lack of motivation or an inability to see the positive work they do. Rehab therapists who have feelings of reduced productivity and effectiveness are more susceptible to burnout. 

According to Faith Francis, PT, MBA, a Clinical Professional Consultant with Net Health and a former rehab therapy director, losing sight of one’s professional purpose is a common denominator of each one of these three components. 

“[The rehab therapists] either needs change in their daily work or they need to have some new value in what they are doing,” she said. “That was the one thing I focused on a lot with my team was just knowing them and what make them tick, then help them find that value in their work on a day-to-day basis — that ‘connect to purpose.’” 

The Impact of Burnout on Therapists, Patients, and Operations 

Burnout doesn’t just impact individual rehab therapists. Its effects ripple throughout entire therapy and healthcare organizations. From staffing challenges to the quality of patient care, the consequences of allowing burnout to fester without intervention can be far-reaching. 

That’s why it’s critical for clinic owners, managers, and healthcare administrators to understand the various ways burnout can impact operations. Let’s explore some key ways burnout impacts therapists, patients, and overall rehab therapy operations. 

Staffing and Retention Challenges 

One of the most immediate effects of burnout is its impact on staffing and retention. This is especially meaningful now as the need for rehab therapists is growing. 

According to the U.S. Bureau of Labor Statistics (BLS), the need for physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) is projected to grow 12% to 19% between now and 2032 — a much faster growth rate than most other professions. Many rehab therapy operations are already feeling the impact of being short-staffed. 

Yet, burned-out rehab therapists are more likely to disengage from their work, leading to higher turnover rates. 

When a therapist leaves due to burnout, it creates gaps in staffing, putting additional pressure on the clinical team members who remain. If not successfully addressed, this cycle can become self-perpetuating as increased workloads and pressure among remaining staff can exacerbate burnout. 

One study found that when overload was present, healthcare workers were two-to-three-times more at risk of experiencing burnout. Recruiting and training new rehab therapists to replace this staff, should they quit, also takes time and resources, adding to operational strain. 

Decline in Patient Care 

Burnout has a direct and concerning impact on the quality of care provided to patients. Studies show (perhaps unsurprisingly) that greater burnout among healthcare providers is associated with poorer-quality care and reduced patient safety. 

This is because therapists who experience burnout often feel emotionally exhausted and disconnected from their work, leading to lower engagement levels and attention during patient interactions. The result is less personalized care, reduced patient satisfaction, and slower recovery times for some patients. 

In a profession where trust and personal connections are essential for successfully treating patients, burnout can severely compromise the therapeutic relationship. 

Higher Costs of Operation 

The operational costs of burnout can be substantial. One estimate puts the cost of burnout in U.S. healthcare at $4.6 billion annually. What contributes to such a high figure? 

Burnout in all areas of healthcare, including rehab therapy, leads to increased turnover, forcing operations and facilities to invest more in recruitment, onboarding, and training. Additionally, rehab therapists who feel detached from their jobs may take more sick days or require extended leave, leading to disruptions in patient care and adding stress to the rest of the clinical team. 

The financial burden of hiring temporary staff, filling gaps in coverage, or delaying patient appointments (or stopping new patients from scheduling) can quickly escalate, reducing overall clinical efficiency and its ability to grow. 

Reduced Therapist Productivity 

While “productivity” can be a dirty word among rehab therapists who take pride in focusing on patient needs and success, it remains an important key performance indicator (KPI) that reflects  an operation’s ability to balance financial viability with the delivery of quality care. 

So, when productivity declines, it can impact revenue and growth. 

Rehab therapists who are emotionally and physically drained, of course, tend to be less efficient at work, resulting in longer time spent on tasks, a decrease in patient throughput, and difficulty meeting KPI targets related to productivity. 

“Obviously, when people are burned out, they don’t show up the same, they’re not as engaged, and they’re not as aware of things,” Schrier said. “There is a direct cost to this, and there’s also a cost to productivity. People who are burned out, confused, not engaged, are just flat out not as productive.” 

Over time, this reduction of productivity can lead to bottlenecks in patient scheduling and an overall decline in clinic performance. It also negatively impacts the rest of the team, who must make up for the decline. 

Damage to Workplace Culture 

As is likely apparent at this point, burnout does not exist in a vacuum. It affects the entire workplace. This includes the culture many operations have taken years to build. 

When therapists are burned out, it creates an atmosphere of stress and negativity. This can spread throughout the entire team — from rehab therapists and assistants working in the clinic or department to nursing staff, schedulers, billers, and others who support therapists’ work. 

“If [a rehab therapist] can no longer see the value in the work that they do, and they are complainers — they complain about the patients and they complain about the team — that’s a level of cynicism that can destroy a team,” Francis said. 

Colleagues may not inherently notice an immediate drop in morale, increasing frustrations, and even interpersonal conflicts that may arise during high-stress situations. Over time, however, these things can create a more stressful work environment. 

Such a culture can also deter new talent from joining the organization, making it hard to build a stronger, more cohesive team. 

Risk of Burnout Among Leadership 

Feelings of burnout can often extend to clinic owners, managers, and leadership. And when leaders are burned out, they may struggle to support their teams effectively. This can lead to poor communication, a lack of clarity around expectations, and insufficient staff resources like training and mentorship. 

A burned-out leader may also find it difficult to foster a positive work environment or implement programs or efforts to improve well-being, perpetuating burnout across an entire organization. 

What Causes Rehab Therapists to Experience Burnout? 

Whether they work in private practice, outpatient, hospital-acute, post-acute facilities, or deliver at-home care, rehab therapists face numerous challenges that can lead them toward emotional exhaustion, reduced job satisfaction, and decreased quality of patient care. 

Understanding the underlying causes of burnout is the first step in identifying and addressing the issue of burnout while creating a healthier work environment for your team. 

Several key factors contribute to burnout in rehab therapy. These range from staffing shortages to administrative burdens and a lack of upward mobility. Below, we explore many of the more common causes and how to proactively prevent them. 

Short Staffing and Increased Caseloads 

Like the two linked strands that wind together to form a double helix, staffing shortages and burnout are forever connected. Whether going up or going down, staffing shortages will always have an impact on burnout — and vice versa. 

That’s to say that one of the biggest contributors to burnout in rehab therapy is short staffing. This is an industry-wide issue as clinics and rehab departments are facing a significant shortage of qualified therapists. With the need growing for more rehab therapists to serve an aging U.S. population, this means practitioners are being forced to manage larger caseloads.  

It comes as no surprise that the need to care for more patients with fewer therapists on hand increases stress levels and decreases the amount of time practitioners can spend with each patient, leading to frustration, burnout, a reduction in quality of care, and an increase in turnover. 

Some directors and managers strive to stay ahead of this by making constant recruitment a part of their standard operating procedure. Those who can’t do this — say, rehab directors at hospitals that do not allow this practice — may turn to temporary staffing to fill gaps that prevent their regular staff from being overworked. 

In addition, Schrier recommends reducing long-term turnover by hiring not for skill, but for culture. 

“When I’m teaching people how to hire, I say you have to hire for traits and train for skill,” he said. “This means you have to focus on hiring people for who they are [and] what they believe in. If they don’t buy into the same things you buy into, that relationship is not going to work out and that’s going to cause burnout on both ends.” 

Pressure for Higher Productivity 

There’s that dirty word again: productivity. While tracking productivity is critical in ensuring a clinic or department provides the right balance between financial success and quality of care, the pressure on practitioners to meet productivity benchmarks has intensified. 

The reason: reduced reimbursement rates from payers. Due to the continual reduction in these rates, rehab therapy clinics and healthcare facilities are under constant financial strain. To remain viable, many organizations demand high productivity from their therapists. 

This focus on productivity, says McMichael, can detract from meaningful patient care as rehab therapists feel they’re being forced to prioritize quantity over quality. This can lead to emotional exhaustion and feelings of low personal accomplishment. 

That’s why she recommends removing the word “productivity” from clinical discussions related to patient care. 

“I don’t like to use the word productivity, and whenever you’re looking at metrics in a rehab department, I try to take that dirty word ‘productivity” out of my vocabulary,” McMichael said. “Why? Because it’s not necessarily the productivity percentage you’re going to impact. But if you look at other metrics — the time you’ve spent with patients, if you provided them with education and resources — versus saying, ‘How many units did you get?’ … well, we can provide talk about the impact and the outcomes and the value of care we’re providing without using the term ‘productivity.’” 

Documentation and Administrative Workload 

The administrative burden placed on rehab therapists is another oft-cited cause of burnout. Therapists are expected to manage extensive, defensible documentation, often spending as much time on so-called “paperwork” as they do with patients. 

“When we’re a clinician and we go into the career, we don’t go in thinking about the number of documents we’re going to have to write each day or understanding which payer source covers which interventions or how to complete all of your documentations while focusing on your patient needs,” McMichael said. “So, these demands that we receive, whether they’re organizational, regulatory, or payer related, they start to snowball. And if we don’t have a good proactive approach in providing clinicians with tools to help manage these stressors, then the potential for burnout grows as a clinician goes throughout their career.” 

Navigating complex electronic health record (EHR) systems and meeting compliance requirements can further command attention that clinicians would rather focus on their patients, leading to inefficiencies and frustrations.  

“The technology in and of itself is not causing burnout,” said Schrier. “I think the complications of technology, especially maybe for older people aren’t as technologically savvy, [is] it can be difficult to adopt … especially if you’re not properly trained to use it.” 

If documentation is causing headaches, take another look at your documentation practices and the technology being used to streamline the process. Specifically, does the EHR allow the team to document at the point of care using the fewest possible number of keystrokes?

Lack of Work-Life Balance 

Like any employee, rehab therapists will have obligations and passions outside of work — vacations, ballgames, personal appointments, volunteering, etc. — and that’s a good thing. These aspects of life help them recover and reenergize following the day’s stresses while making it easier to focus on the things that matter most. 

The inflexibility of some rehab therapy schedules, however, can make maintaining this healthy level of work-life balance difficult. The demands of patient care can make it hard for therapists to take time off or prioritize personal needs, which can cause emotional fatigue, a contributor to burnout. 

Promoting a better balance on your rehab therapy team is simple. Just be flexible. 

In an effort to be more proactive in promoting work-life balance while reducing turnover, Clemente Aquino, Vice President of Rehab for Life Care Centers of America, said more directors today (including himself) are willing to work with new therapists who request flexible hours. 

“I’ve heard even in the several interviews I’ve had recently that many of our therapists want that work-life balance,” Aquino said. “They don’t want to work the 40-hour week. They want a flex schedule … and I think employers are going to have to adjust to that demand because otherwise we’re not going to be able to attract and keep therapists and we’ll continue to see therapists burn out.” 

Insufficient Training and Resources 

The lack of proper training and professional resources for the rehab therapy team is another common cause of burnout. This is especially true for those stepping into new roles like management or leadership. 

When therapists aren’t given the tools or support that they need to succeed, they can feel unprepared and even overwhelmed. This can be particularly demoralizing within fast-paced, high-pressure environments such as a hospital where new tasks and responsibilities may be added without adequate training.  

Miscommunication and Lack of Support 

Miscommunication between management and therapists can cause a good deal of frustration, especially if it’s a regular occurrence that’s not being fully addressed. This includes fully and clearly communicating expectations  for each of your staff members. 

Without clear job descriptions, metrics for success, or regular feedback and kudos, therapists can begin to feel disconnected from their team and leadership. This lack of support can create confusion about job responsibilities and goals, leading to disengagement. 

“It’s the confusion, the not being sure what’s expected, that causes burnout,” Schrier said. “There’s often misunderstanding and confusion about what’s expected or if you’re even doing a good job because clear expectations haven’t been communicated. That’s what’s causing burnout in my opinion.” 

Limited Opportunities for Advancement 

While not everyone can be promoted at any given time, simply assuring rehab therapy team members that they have potential for growth within your organization can go far in keeping them engaged and focused on positive patient outcomes. 

This includes supporting employee mentorship programs, training and educational opportunities, networking conferences, etc. 

Too many rehab therapists find themselves in roles with limited opportunities for career advancement or professional development. Without a clear path for growth, these therapists may begin to feel stagnant, leading to dissatisfaction and disengagement from their roles over time. 

Lack of Mental Health Resources 

Last but not least, offering support systems and resources for improving mental health can help rehab therapists be more proactive in identifying and addressing their own potential for burnout. 

Healthcare practitioners who regularly work with patients who face emotional and physical challenges often lack the tools to manage their own stress and mental health. Without proper outlets or coping mechanisms for addressing this stress, therapists are at a greater risk for emotional exhaustion. 

Effectively Diagnosing and Responding to Rehab Therapist Burnout 

Burnout in rehab therapy doesn’t appear overnight, but there are warning signs that can alert leaders and managers when a practitioner may be experiencing emotional exhaustion, delivering depersonalized care, or feeling a low sense of personal accomplishment. McMichael likens evaluating these signs to diagnosing a rehab patient. 

“I always look at burnout for a therapist similar to a patient who’s in the course of treatment has plateaued,” she said. “You look at your patient and they’re not progressing anymore, they’re not thriving, they’re not meeting their goals of where you want them to be. So, look at [the rehab team] the same way. What are the signs they may be dealing with burnout? What’s the cause, and how can we work past this point?” 

It’s critical, she added, that leaders and managers don’t wait to the point of “crisis mode” before addressing burnout, otherwise it could be too late to help turn things around. 

So, what are the early signs? Below are some key questions to ask yourself or your staff when attempting to diagnose burnout in your department or clinic. Also included are explanations of what to look for and how to respond when burnout is suspected. 

1. Are physical therapist assistants (PTAs) and others involved with the care team complaining about poor documentation?

What to look for: Burnout can manifest in a rehab therapist’s failure to keep up with documentation or sloppy work that leads to complaints from PTAs and other members of the broader care team. This could mean late or incomplete patient notes, poor communication with support staff, or errors in documentation that impact patient care.

How to respond: If this is happening, it’s important to check in with the rehab therapist in question to understand their workload and whether they feel overwhelmed by administrative duties. Providing extra support, training, and streamlined documentation processes, or redistributing caseloads may help alleviate stress until the therapist’s documentation is back up to par. 

2. Are employees disengaged during meetings and rounds? 

What to look for: A disengaged rehab therapist may not participate in meetings, offer input in rounds, or engage in team discussions. They might remain silent, show minimal interest, or physically distance themselves from the group. If this is new behavior, it will likely be easy for an engaged manager to spot. 

How to respond: Confront disengagement by opening opportunities for communication. Schedule one-on-one meetings during which you can ask how they’re feeling, if they’re satisfied with their workload, and what changes might help them feel more engaged. Offering opportunities for them to contribute in ways that they find meaningful can help reestablish a connection. 

3. Are patients complaining about any rehab therapists on your team?

What to look for: Pay attention to any increase in patient complaints regarding a team clinician’s attitude, attention, or quality of care. Within acute and post-acute settings, it’s helpful for managers to do patient rounds that create opportunities for this kind of feedback. If patients point out that a therapist is less patient than usual, seems distracted, or emotionally unavailable, this may be a sign of burnout. 

How to respond: Approach the therapist directly, but do so with compassion, offering them a chance to express their side of the story and what may be causing their frustrations. You may discover you need to reduce patient load, offer some time off, or provide mental health resources if you feel the therapist needs a recharge. 

4. Are rehab therapists asking for fewer hours or more flexibility? 

What to look for: Therapists on your team asking for fewer hours or schedule changes may be trying to manage their growing sense of burnout. This request could indicate that they are struggling to maintain their current workload. 

How to respond: Be open to discussing flexible scheduling options. This could involve reducing their hours temporarily, allowing more control over their schedule, or offering part-time or remote options, where possible. This flexibility could be the key to preventing burnout from escalating. Such flexibility is also a great selling point during recruitment and can lead to less turnover. 

5. Are members of your rehab team declining to take on harder or more difficult patients? 

What to look for: Rehab therapists who avoid taking on complex or demanding patients may be conserving emotional or physical energy, a common sign of burnout. They may not feel capable of handling the increased challenge or pressure.

How to respond: Consider easing their caseload by redistributing particularly difficult cases. You can also offer more support through additional training or mentorship to help them regain their confidence and emotional bandwidth. 

6. Is someone on your team struggling to adapt to changes in schedules or expectations? 

What to look for: If there’s one undeniable truth about healthcare, it’s that change happens all the time — not just from day to day, but minute to minute. Unfortunately, burnout can make practitioners resistant to change. If you notice that a physical therapist on your team is struggling to adapt to new schedules, technologies, or clinic workflows and expectations, they may be overwhelmed and running on empty. 

How to respond: Approach change management slowly and offer additional training and support when implementing new procedures, expectations, technologies, etc. Check with them regularly to ensure they feel comfortable and have the resources needed to adjust. 

7. Is a rehab therapist showing up late or just on time, when they were previously punctual?

What to look for: Chronic lateness or a change from being early (and prepared to see patients) to barely making it on time can signal emotional exhaustion or a lack of motivation. This may suggest the therapist is struggling to keep up with their work-life balance. 

How to respond: Instead of focusing on the tardiness itself, discuss what might be contributing to their behavior. Are they feeling overwhelmed? Would they benefit from slightly different hours or responsibilities? Opening a dialog can help you uncover the root of the issue. 

8. Have there been any sudden changes in a team member’s personality or how they engage?

What to look for: A previously upbeat rehab therapist who becomes withdrawn, irritable, or cynical may be experiencing burnout. Sudden personality shifts are red flags that their mental and/or emotional well-being has been compromised. 

How to respond: Approach them with care and empathy. Ask if they’re feeling stressed and offer to help with coping mechanisms or professional support. It might also be time to adjust their workload or offer a break. 

9. Are you noticing an increase in cynicism within your staff? 

What to look for: A burned-out rehab therapist may exhibit cynical attitudes toward their job, patients, or even colleagues. This can manifest as negative comments, a lack of optimism about patient progress, or general disinterest. 

How to respond: Recognize that cynicism is often a defense mechanism for underlying stress or exhaustion. Engage with the therapist to understand what’s driving this shift from their usual “can do” attitude and offer constructive solutions, such as time off, mental health resources, or reassessing their responsibilities. 

10. Have you noticed a drop in KPIs related to productivity? 

What to look for: There’s that word again. But unfortunately, productivity matters, and when a rehab therapist’s productivity metrics (i.e., patient volume, treatment outcomes) take a sudden downturn, it could be a sign of burnout. Low productivity often stems from fatigue, disengagement, or emotional overload. 

How to respond: Rather than focusing on the numbers, focus on the individual. Have a conversation about what challenges they may be facing and how you and other members of the team might help. Consider providing additional support or adjusting expectations to allow them time to recover. 

11. Have you noticed a team member has stopped participating in continued education or professional development opportunities? 

What to look for: Rehab therapists who have previously taken an active interest in continuing education or professional growth but have since stopped pursuing these opportunities may be dealing with burnout. A lack of motivation to enhance skills or seek professional development can signal disengagement and emotional fatigue. 

How to respond: Encourage an open conversation about their professional goals and challenges. Offering support for educational opportunities, mentorship, or even suggesting time off for reflection can help reignite their passion for growth and reduce feelings of burnout. Something as small as offering suggestions for good rehab therapy podcasts can help them reengage with what they love. 

12. Has a member of your team told you they feel burned out?

What to look for: They may not say so directly, but if a rehab therapist on your team directly expresses feeling exhausted, tired, or in need of a change, take this seriously. Comments like “I feel like I need a break” or “I’m tired all the time” are clear indications they are on the verge of burnout or are already experiencing it. 

How to respond: Acknowledge their feelings without judgment. Provide options for flexibility, a temporary reduction in hours, or time off to reset. In addition, offer wellness support or counseling if he or she is receptive to it, and feel this could help them manage their stress. It’s important to address it early before it becomes unmanageable.