Allison Jones
Good morning, good afternoon, and good evening. Welcome to the Therapy Matters podcast. I’m your host, Allison Jones.
On this episode, we continue our discussion with Katie O’Bright. Let’s talk about another big topic that’s out there, another big challenge that providers face today – that’s burnout and provider satisfaction.
How can this approach help with provider satisfaction and help reduce burnout, which is a big issue.
Katie O’Bright
It’s a huge issue. Before we talk about how it can, let’s talk about the problem first.
Burnout and provider satisfaction is, in my opinion, based on my experience in everyone that I’ve talked to and just peers that I know who have left their jobs, it is the business model, generally speaking, that does not allow for autonomous practice. That is driving a lot of that.
I even had a friend one time, she was getting negative performance reviews because she was getting her patients better too fast. So, her average visit per episode of care was about six visits per episode of care, whereas some of the other therapists were closer to like 12 to 15.
She was getting negative performance reviews for that. How is that something that is going to maintain someone’s investment in a particular business? You’re getting your patients better too fast. Slap on the wrist. I’m sorry. That’s just not something that I nor anyone should ever have to deal with.
On that note, if you’re able to get your patients better, quicker, so you’re ultimately saving them money, which I understand on the flip side then, makes it look like the business is receiving less money. That is a dichotomous conundrum that touches up on ethics.
When there’s always an ethics question, anybody who is working in health care should 100% be erring on the side of what is ethical, and what is ethical is to do everything in the best interest of the patient.
Allison Jones
Absolutely.
Katie O’Bright
100% of the time. So when providers are running into these problems with providers satisfaction and burnout, a lot of it comes back to that. It comes back to seeing too many patients in a given week. It’s exhausting taking notes home, doing stuff on our breaks. When I talk to my husband about these kinds of things, and he’s an international business, he’s like, this is all insane.
I can’t even believe that this is kind of like standard in health care that like, it’s kind of expected and it’s okay that you do stuff and a lot of stuff in your off time. So when we shift the model and we kind of adjust it to primary care.
We now actually have evidence. I’m a part of the scoping review. It’s not published yet. We’re still wrapping it up. But I’m a part of a scoping review on the value model of primary care PT. And a lot of the data that we’re drawing, of course, is from international models because it’s not as widespread or at least we don’t have the evidence, the data from the United States up to this point.
But one of the things that we’re seeing as we are seeing improved provider satisfaction, because when providers have the opportunity to do what is medically necessary and to do what they know is evidence based and to upholds their ethical standards of care, they’re going to be more satisfied with their job and with their role than if they feel like they have ethics on one side and evidence and doing what’s right by the patient. But then you have the business on the other side, and the two are conflicting with one another. Those two things in health care have to run in parallel to meet a summit of goodness. That’s the best term that I’m coming up with right now, a summit of goodness.
So that’s when PTs get dissatisfied with their roles is when they feel like, they can’t keep up. They’re not respected. They can’t be autonomous. They have to do things based on business before they can do things based on altruism and ethics and then they’re done, and this is the thing if you listen to.
I have my own podcast as well and I was just interviewing, Dr. Kendall Stone, who’s a physician. She just opened her own primary care practice. One of the things she mentioned was, she’s seeing these patients with complex needs and given ten minutes with them. She didn’t go to medical school to do that. Nobody signs up for this.
We want to care for our patients, and we want to do what’s right by them. But the business sometimes is conflicting with that and it makes it very challenging. So I think that ignoring that is a problem. so how can primary care make a difference there. Well, as a PT, if you have more opportunities to see more patients and then make the correct recommendations for them, even if that is a 1, 2 or 3 time visit, as opposed to like an extended episode of care where somebody really needs traditional rehab, then you’re going to end up just feeling more satisfied at the end of the day.
Another thing related to burnout and satisfaction is when you have the opportunity to work with other professionals that are unlike you. So I’m a PT, surrounded by a physician and a behavioral health specialist and a clinical pharmacist and nurses and social workers, and you’re all able to work together as a team.
There is tremendous benefit from a provider satisfaction standpoint, from a learning standpoint, from a patient satisfaction standpoint, which is if your patients are satisfied, that’s also very satisfying to us as providers. When you look at that as a big picture and we look at team based care, team based medicine, it all just comes full circle. I just think that there’s so much opportunity in this space to save the PTs that we’re losing because of these other issues that I just mentioned before. I just think there’s such big opportunity there.
Allison Jones
Yeah. You mentioned when you were talking to your guests and she said, I didn’t go to school to do this. One of the other issues is that we have sort of a problem coming out of the graduates coming out of PT school, some of them are not even going into practice. Why is that happening and how do we solve that challenge?
Katie O’Bright
I know of this because I’m adjunct faculty for the Tufts DPT program in Boston. Some of the students that I’ve come into contact with have said I don’t know about this anymore. I don’t know if they go out on their clinicals and it is exhausting and they don’t have the time that they need.
First of all, they don’t have time that they need with their clinical mentors. Because if you think about clinical mentorship and going out on clinical rotations, it’s supposed to be this rich, wonderful learning experience and it often doesn’t turn out to be that way. Again, because of just kind of productivity standards and business and so on.
We have to have productivity standards. I understand that I’m not discounting the fact that we need to have business metrics in place to justify the FTE of every employee we have. I am not discounting that. What I’m discounting and what I’m challenging to improve is the fact that, like, we have these students that are brought under our wing and first of all, these programs are having a lot of difficulty even finding clinical sites. So they kind of just take what they can get.
I hate to say it like that. Hopefully that’ll just get better. But they take what they can get. Sometimes it’s a CI who doesn’t want a student. I once had a student tell me that they went out on a clinical rotation and basically said, my CI was the most jaded, like cynical person related to PT. Didn’t even want to be a PT anymore.
And that was her first experience in outpatient care.
Allison Jones
That’s horrible.
Katie O’Bright
And so it’s like if you have that impression and we also know that a lot of new grads are coming out with tremendous debt and not very good salary offers. So, what do we expect? I can’t even say that strong enough.
It’s almost as if as a profession, we’re digging ourselves into a deeper hole by maintaining this crazy outpatient model and when I refer to this, I’m saying the outpatient model that wants more and more and more visits and that’s the biggest metric is like the number of visits per episode of care or per patient that comes through the door when we’re sticking just to that insurance companies look at that and they’re like, man, PT is really expensive. We cannot even afford. And there’s so many other things with reimbursement. We can’t even afford to put more of our money into PT because it is just so expensive.
Whereas if we actually looked at it from a primary care perspective, PT would be would actually save a whole lot of money. We’re seeing. There’s research to show this. But if we keep digging ourselves into this deeper hole of focusing on that business model, reimbursement is not going to get better. It’s just not going to get any better and we can’t just keep going down this rabbit hole and expect that it’s something’s going to change because it’s not. It hasn’t, it’s not going to. I have a very dismal output outlook on what is going to happen unless we really do change as a profession and we are pushing away our next generation, 100%, there’s no question.
Almost a lot of my peers, I graduated in 2014. A lot of my peers are not practicing as PTs anymore. So what are we going to do, add more programs? Yeah, sure. That’s a great idea. Add more debt into the world. I don’t understand.
Allison Jones
Yeah. You mentioned that there aren’t a lot of clinical sites to even place graduates in. Why is that? Why aren’t they open to bringing students in to?
Katie O’Bright
Well, this is another thing that probably a lot of business owners that are listening to this will relate to. So we have this problem where there’s been estimations that by adding… there’s been more PT programs that have developed. No question over the past 5 to 10 years, there’s been more DPT programs that have developed and even more are coming.
But the ones that are actually coming out and working as PTs hasn’t really panned out because and at business owners will relate to this. Nobody wants to work. Job postings for outpatient PT jobs just remain vacant. They just are remain vacant. They don’t have anybody that’s even applying and that’s been something that’s kind of happened across the country.
It’s been really interesting and I think it will continue to be interesting because I think as PTs are finally winding DPT students, when they’re winding down in their programs and they’re seeing that just the ever increasing debt, the ever decreasing job satisfaction, they’re going to maybe go do their own things in the cash market. Maybe they’ll get into health care consulting, maybe they’ll go get an MBA and probably they’re finding other ways to be successful, where they don’t see that happening in a traditional outpatient PT clinic.
So I think that comes back to, well, if clinical sites can’t find good hires, they’re not going to have a place to put a student because they can barely keep up with their own caseload.
Allison Jones
Gotcha. So what can employers do to attract good talent, retain the talent and make it better for their patients?
Katie O’Bright
Yeah. I think that this really comes down to being a good person and thinking about, I’m not suggesting that anybody of a business owner is a bad person. I’m just saying think about it’s the golden rule. Treat others how you would want to be treated. If you hire somebody, don’t undercut them. Don’t tell them that they can’t have any PTO, any holidays and they have to work every evening and every Saturday because that’s what patients need.
I’ve seen employers do this where they actually sort of guilt trip, new grads and new employees into making a terrible life for themselves, basically, promoting work over life. And there was a recent, Jimmy McKay of the PT Pintcast he posted. There was something on LinkedIn about how somebody was like. If you’re a new employee, you should be the first one there and the last one to leave to set a precedent and blah, blah, blah, blah.
And I was like, as an employer, I actually completely disagree because I would like my employees to have a good work life balance. I want my employees to go home at the end of the day and feel like they can enjoy their families and enjoy their time off and refresh and recoup and so that their time at work is more productive.
Because I understand and I’ve been through it myself, that when you stress people to the max, maybe that was a mantra or maybe that was the culture 50 years ago or when my parents were coming up in the world. But times have changed. People have changed. Culture has changed.
I’m a millennial, by the way, and I look at me and my peers. I look at the generation coming up, below me or younger than me. And I see these changes and I see that when you respect people and when you respect their time off and you show that you legitimately care about them, they will turn around and they will work for you, and they will do a good job and they will be loyal to you.
Whereas if you don’t do any of those things, forget it. You are churn. The amount of employees that you’re going to cycle through is going to be very high. It’s going to cost you a lot of money. Churn is the most expensive part of any business, hands down probably, the process of hiring, recruiting and finding people. And then they realize they hate their job and then you lose them.
So if you want to reduce that churn, think outside the box. Ask your employees, ask your staff what do you think is the problem? How do you think we could improve this and then don’t just ask listen to them and maybe do something about it.
Allison Jones
Yes.
Katie O’Bright
There’s a lot of employers or a lot of bosses out there who think that, they give their employees a voice. You might be giving them a voice, but then please act, make a difference. And by your actions, you’re going to show your employees that you care and this is just basic psychology.
People will be loyal to that. They’re more likely to stick around with an employer that they know cares about them and their well-being than an employer who could care less and just wants to boost productivity and boost revenue and drive numbers. People feel very, very not good when they just feel like that is all that is cared about.
Allison Jones
Yeah. Absolutely. All right. So as we wrap it up today, any final thoughts for our audience out there?
Katie O’Bright
Yeah, I’m desperate for pioneers. I am desperate to work with people that want to get into this space and that want to make moves in our industry. I’m having a lot of trouble finding individuals who want to make a difference in this primary care space.
So if you are one of those people, please reach out to me. I would love to try to work with you. I would love to try to educate your staff on what it looks like to be a primary care provider, especially if you are seeing any direct access or if you want to get into integrated medical practice. Get involved in our special interest group. We again, would love to have you.
We really need thinkers. We need innovators. We need people who are ready to drive change and kind of join our movement. Because the more momentum we have behind this, the more we can get the public on board. It will be substantial if we can get more momentum.
Allison Jones
Excellent. And the Special Interest Group is through the APTA, correct?
Katie O’Bright
Yes. So, the Special Interest Group is through the APTA federal. So, if you are an APTA member, you just have to add APTA federal under your APTA profile members and sections. I think it’s like $25. It’s one of the cheapest sections to be a part of.
And then you add our SIG for free. But regardless, if you’re a member or not, we can still share some resources. And we would love to have you, attend our summit, which again, is going to be at Regis University, in Denver, September 20th and 21st, 2024. And the registration for that should be coming out in May of 2024.
It’s going to be awesome. A think tank style conference. Lots of engagement. Not just boring lectures all day long. So, lots of ideas sharing and connections and networking and it’ll be great.
Allison Jones
That’s fantastic. How do our audience get in touch with you?
Katie O’Bright
Yeah. So I can be found on all social media at Redefine Health Ed, except for X. at X, I am @RedefineConEd because Redefine Health Ed was one character too long and then everybody can go ahead and check out my podcast, which is the Primary Care PT podcast. It’s available on Apple Podcasts. And then we have clips of all of the content throughout social media.
Go to my website. Like I said before, redefinehealthed.com and my email address is info@redefinehealthed.com. I’m happy to really connect with anybody. I’d love to hear about where this is happening. And we as a SIG, Special Interest Group, would really like to help people develop in this area. So please do reach out to me. I want to hear from you.
Allison Jones
Excellent. Well, Katie, thank you so much for chatting with me today. Such a great conversation. We are out of time, but, just again, thank you so much for chatting with me this afternoon.
Thank you to our audience for tuning in to the Therapy Matters podcast, your one stop resource for expert insights and advice on everything therapy and rehab.
We look forward to seeing you on the next episode.
