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Burning and churning: Why PTs are leaving patient care

July 29, 2019 • Advocacy • Heidi Jannenga

For the past several years, my company, WebPT, has conducted an annual survey to get a pulse on the rehab therapy industry, identify trends that are impacting our profession, and assess pain points to guide our advocacy efforts. After all, what’s the point of collecting data if you’re not going to do anything with the results? While the topic of this article shouldn’t have come as a surprise, we’ve known for a while now that burnout is a major issue in health care, we still found ourselves stunned that about half of this year’s respondents (that’s nearly 3,179 rehab therapy professionals and a pretty even split of men and women) are thinking about making a professional change within the next five years. And most of them are hoping to either work fewer hours or move out of patient care altogether. The top motivator for making this type of career change? You guessed it: to achieve better work-life balance, followed closely by the desire for more satisfaction and fulfillment.*

In other words, thousands of therapists are planning to either reduce their involvement in the profession, or leave it altogether, in search of what they believe will be a better life (and that’s not even including retirees). In fact, after just four years of service, rehab therapy professionals increasingly consider reducing their work hours. And interestingly, more men than women indicated that they plan to move into a non-clinical role.

That’s a huge problem, and something we need to work together to address now, before we lose more good people. With that in mind, here are four things I believe are contributing to burnout in our profession and what we can start doing right now to turn things around.

1. Abysmal Salary-to-Debt Ratio

According to the most recent WebPT State of Rehab Therapy report, more than half of rehab therapy students expect to graduate with more than $70,000 in debt; however, nearly three in five rehab therapists make $80,000 or less each year. So, students are coming into the field with as much (or more) debt than they’re likely to make in a year, which means they’re setting themselves up for years of financial struggles. And most of us know how all-consuming those struggles can be. Add that to the other challenges facing physical therapists, difficult patients, impossible-to-meet productivity metrics, and never-ending reporting requirements, to name a few, and burnout seems virtually inevitable. And it’s not taking years to set in, either, which means the new generation, the future of our profession, is stalling out before having the opportunity to really contribute to the field (if they even choose this field at all).


I wish I could solve the student debt crisis in a blog post, but unfortunately, that’s just not going to happen. That said, there are things we can do as leaders in this industry (and in physical therapy academia) to advocate for change and make the path a little easier for the next generation, and that starts with understanding the current landscape and its impact on new hires and young professionals. During the survey, we asked therapy students what they’re looking for in a job, and most of them said they’re seeking income stability first, and a good salary and benefits second. That’s good news for clinics that may be better able to provide income stability and a competitive benefits package more readily than a high entry-level salary. If you can make it work, I also highly recommend offering student loan payoff assistance as part of your benefits package. It can be a strong differentiator to appeal to indebted new grads, not to mention a great retention tool. And don’t forget to prioritize your company’s culture (more on that in a bit). Creating a healthy, supportive place to work can be incredibly helpful for your employees’ mental and emotional well-being, especially as they dig themselves out of financial debt.

2. Unrealistic Productivity Standards

As Meredith Castin, PT, DPT, wrote here, even the word “productivity” comes with some baggage for PTs, and in our productivity-obsessed culture, I can see why. While productivity metrics can certainly inform PT leaders about their team members’ billable hours and workload, we must exercise caution when using them to set goals and enforce in-clinic practices. Otherwise, you risk creating an untenable work environment for your staff, one where your employees feel undervalued and unable to devote the proper time and attention to their patients without fear of running afoul of the metrics. According to Castin, “the vast majority of staff therapists are judged, to some extent, by their productivity numbers, and many are held to unrealistic standards that allow no margin of error to account for bathroom breaks, patient refusals, or even conferring with other medical team members regarding a patient’s care plan.” And your employees aren’t the only ones who will feel the stress of unreachable standards; your patients will likely sense that something’s awry, too. After all, as Castin says, your practice will “feel like a patient mill.”


If you choose to use productivity metrics, use them to gain insight into how your staff therapists spend their days, but don’t make productivity the primary focus, and definitely don’t stuff your staff’s schedule to satisfy some predetermined productivity quota. Instead, broaden your perspective to ensure that every goal you set for your practice, and metric you use to measure your progress toward that goal, actually aligns with the outcome you desire (and is good for your people). For example, you could hold your staff accountable for patient outcomes and Net Promoter Score‚ìá (NPS‚ìá) improvements, both of which allow your team to exhibit more autonomy and mastery in how they go about meeting the goals you set, to ensure that your practice is providing exceptional patient care and engendering loyalty and word-of-mouth referrals from patients. According to Castin, you could also measure soft skills such as leadership and attitude as well as track therapists’ involvement “in interdisciplinary outreach and other collaborative efforts.” She contributed an entire post on unconventional, yet very effective, metrics practice leaders can use in order to avoid the productivity trap. Check it out here.

3. Cumbersome Technology

As the founder of WebPT, I know how much effort we’ve put into creating a practice management solution that actually works for PTs, not against them. Unfortunately, there are plenty of technology vendors on the market that haven’t made that their focus, and it shows. Based on our survey results, non-WebPT users are overwhelmingly unhappy with their EMR systems, with their average NPS score coming in at a whopping negative 24.7. Ouch. That means a large majority of those therapists would not recommend their current technology to a colleague (they also probably wouldn’t wish it on a competitor, but we didn’t take the survey question that far). On the other hand, WebPT Members are much more satisfied with their EMR experience. In fact, the average score for WebPT EMR users was positive 34.9, nearly 60 points higher than the score for non-WebPT users. I am extremely proud of everything we’ve done as a company to ensure we always do right by our Members, and we have big plans to continue helping our Members achieve greatness in practice for decades to come.


If your current practice management platform is making your life, and your staff’s lives, miserable, it’s time to switch. Yes, it may take some effort and training to get up and running on a new system, but the demands on therapists are high enough already, with a litany of new regulations and reporting requirements, without also forcing them to create time-consuming workarounds and constantly clean up errors on a system that simply isn’t functioning the way it should. Technology should make your life easier; if doesn’t, it’s not the right technology for your practice. Plus, the best software platforms are intuitive, easy-to-use, and offer comprehensive training and support for data migration, which means the entire process of switching should be less cumbersome than sticking it out with your current sub-par system any longer.

4. Poor Company Cultures

Leaders who grow a practice without consciously creating, and upholding, their company culture run the risk of having their culture take on a life of its own (and without you at the helm, that’s probably not going to end well for your team or your patients). Creating a positive, nurturing, supportive environment for your staff is just as important as creating that type of environment for your patients. After all, your employees are the ones who are face-to-face with your patients every day, and if their own cups aren’t filled, how do you expect them to fill your patients’? One of the keys to instilling this type of culture is modeling it yourself. If you’re burned out, working extreme hours, and not taking care of yourself, you can only imagine the standard you’re setting for your team. That’s a surefire way to overwork yourself and your staff, and leave all of you more prone to mistakes in patient care.


The best thing we can do as leaders is take regular stock of the work environment we’re creating. Are we happy? Is our team happy? Are our patients happy? Are we fostering personal and professional growth for the people we hire? Are we taking the time to listen to our staff’s needs, and remove obstacles that are preventing them from performing at their best? After all, a company’s greatest asset is its people. Prioritize your people, and profit will follow. Conversely: Prioritize profit above all else, and people will leave. We’re so passionate about company culture at WebPT that we’ve written a slew of content about it. While it’s certainly easier to establish a positive culture from the get-go, it’s never too late to fix the one you have if it’s not supporting your or your therapists’ well-being. To that end, check out this resource, this one, and this one.


Fixing the burnout issue in health care is not going to happen overnight, although we can certainly dream. Instead, it’s going to require each one of us in a leadership role to step up and change the nature of the way we practice. Just because it worked for us when we were straight out of school (or we put up with it), doesn’t mean it’s what is best for our employees, our practices, our patients, and the future of our profession. It’s high-time we took the long view, because if we don’t, we run the very real risk of burning PTs out of health care altogether. And that would be devastating, for us and the millions of people who need our help.


*A few other interesting tidbits from the data: Motivations for making the change shake out as I would expect, with more women interested in work/life balance and more men interested in increasing professional fulfillment and satisfaction as well as improving their personal financial situation (which came in third in the list of motivating factors). At the bottom of the list of motivators was a big life change, and more women than men indicated that this was their reason for making a change.

Heidi Jannenga

Heidi Jannenga, PT, DPT, ATC, is the co-founder and Chief Clinical Officer of WebPT, the leading practice management solution for physical, occupational, and speech therapists. Heidi advises on WebPT’s product vision, company culture, branding efforts and internal operations, while advocating for the rehab therapy profession on a national and international scale. She’s an APTA member,...

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Chip Hurst PT

Commented • February 28, 2023

The simple fact is that therapists' lack of integrity over the last decades has done this to themselves. I've been in 22 years and saw it even back to my volunteer hours in 1995. Therapists lying down to lack of ethics. How many of you stood up to dovetailing which is standard operating procedure now in skilled nursing? The answer is not many. How many of you stood up to OP treating more than one patient at a time? The answer is not many. The fact is most OP therapists have little skill as they have spent their entire careers treating multiple patients. They are glorified athletic trainers mostly. That is an absolute truth. I've not only been fighting this since I started but actually since I WAS an intern. If all of you had shown a little courage and stood up for what was right we wouldn't be here today. You didn't and now here we are. I still treat pts one on one. Always have and always will. The rest of you who hate PT as you see 18-20 patients a day--I have no sympathy for you at all. As far as your debt ratio the idea of the DPT was an absurdity to begin with. You're not doctors in any realm. As far as "graduate school?" It isn't graduate school--not really. You don't teach lower level courses, you don't get a PT degree then an advanced degree, you don't spend six months working on your proposal paper for a real thesis that is defended like graduate school (yes we had research paper due as well at end of term and no neither mine nor yours is the same level of a graduate thesis), you don't have orals prior to the thesis where the grad student is responsible for 5000-7000 pages of literature that can be tested upon--in short you do nothing a real graduate school doctoral student does, except walk around calling yourself Doctor when you're not at all. In short all this misery now in the PT field was self induced. The smartest thing the new grad could have done was not enter PT school to begin with. And that's what I tell volunteer students collecting hours. And don't get mad at my comment which was formulated on watching your two decades of complete lack of ethics which has turned a once honorable profession into a dishonorable one.


Commented • May 26, 2020

This is a great article. Thank for the the problem -- solution approach and advocacy for the profession!

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