1. Professional Longevity for the
Rehabilitation Therapist
By
Shonda Rowell-Hazel, P.T.
First off, I am not a psychologist, psychiatrist or any other type of mental health professional.
I am a clinical physical therapist for 20 years that has been involved in numerous treatment sessions
with the ultimate goal to get the best clinical results possible for my patients. Through the years there
have been those moments of elation that come with a patient surpassing everything that they and all
those witnessing expected. Every time a patient returns to the community from a medical set back, a
sense of joy fills my soul and reaffirms that what I am doing is worthwhile and beneficial for the
greater good.
The reality is that many rehabilitation therapists, especially in the SNF/LTC level of care leave on
average of 1 PT per year and then it can take 10 years on average to fill the vacancy per the APTA’s
report on Physical Therapy Vacancy and Turnover rates in SNF’s. This was an alarming number to
accept, especially considering how many baby boomers are entering into the at risk age range for
possibly requiring this level of care and how difficult it is to get into an occupational, physical or
speech therapy academic program, along with the stress and strain of completing the difficult course
work over an ever increasing number of years of education and tuition burden.
The extreme numbers of vacancy and turnovers in the SNF setting was shocking to see in black and
white but not so alarming when I began to examine my very own career path and noticed common
trends within each workplace and the expectation levels that come with working in a revenue
generating department (RGD). When considering the pressure of being in a RGD while still having the
expectations of the patient, family, other clinicians and the physician to balance on a daily or as
Medicare wants us to track on a per minute categorized basis, the vacancy and turnover rate is not that
surprising after all.
What are the contributing factors that cause us to leave/change our professional healthcare career , one
that pays well and is projected to be one of the best career choices in the future, per Money magazine’s,
Liz Wolgemeth. Understanding that every clinical setting has its own unique dynamics, my main
exposure has been within the long term care and skilled nursing facilities but I have had experience in
all levels of care and have been approached on numerous occasions to start freestanding outpatient
clinics and to partner with a group of physicians.
The core factors that lead to stress at work per Helpguide.org today are:
 Fear of Layoffs
 Increased demands for overtime due to staff cutbacks
 Pressure to perform to meet rising expectations but with no increase in job satisfaction
 Pressure to work at optimum levels – all the time!
Some of these probably do contribute to the shortening of therapist career length but more specifically
the factors that are plaguing clinical therapists from my experience are:

2.  Therapist shortage which leads to increased patient to clinician ratios, longer and more work
days
 Therapist idealistic clinical expectations vs. realistic clinical outcomes
 Lack of boundaries for workday completion, the sense that the work is never done
 Unrealistic/Realistic expectations of patient, family and sometimes other healthcare providers.
 Administrative pressures related to revenue and productivity with less autonomy
 Meeting payor source/legal requirements for accurate: documentation, treatment ratios,
treatment tracking time
 Continual ethical and evidence based practice rationale
I am sure that this is only a general outline of what many of you would consider to be factors, not to
mention the impact all of that has on your personal life. All of the above factors are usually present to
some degree and the majority, need to be present to accomplish quality outcomes while meeting the
budget of those that pay our salary. As rehabilitation therapist we are a very driven, focused, and
intelligent bunch that want our patients and face it our goals achieved. When mentally you are
struggling within the workplace it is hard to take off the “let's make it happen hat” and stop and realize
that you are not a machine, you are really human after all. (Our patient’s knees may be made of
titanium but as clinicians we are not).
If at this point in the article, you as a clinician are completely lost and don't relate to any of the above
information, then continue to enjoy yourself and your career and continue being a positive force for
your patients and coworkers. If on the other hand this sounds all too familiar and you are yelling at the
page “No kidding Sherlock, tell me something else I don't know!!”, then follow me down the road of
“Hey I still want to be a therapist but want myself back”. Great, you are still reading I hope that means
you still want to be in the rehabilitation field. Even if you are not sure and are thinking daily I should
give up and start sacking groceries please continue and see if any of these interventions may help at
least to make you more comfortable on a daily basis, even if it does involve pushing grocery carts.
Emotional energy (E.E.) is a curious thing, it ebbs and flows and is connected to all we do. When we
get too low due to job and or personal stress, lovely symptoms appear like anxiety, irritability, sleep
deprivation, fatigue, lack of concentration, headaches/body aches, stomach/bowel problems, social
withdrawal and sometimes addictions. If I did not know better, that would describe the majority of my
clinical patients within the first 2 weeks of their rehabilitation process. This is not a good thing. If we
are feeling these things how in the world are we going to continue to be able to help our patients move
out of that low emotional energy mode to normal, for themselves. As therapist somehow we are able to
push through and continue to help progress our patients to greater heights. This process sometimes
comes at a big price for the clinician when we don't acknowledge our own emotional energy deficiency
and set reasonable goals for ourselves like we would do for our patients. At the end of the article I have
included an Emotional Energy self-assessment scale (Addendum 1) an emotional energy data
worksheet (Addendum 2) and an Emotional Energy Risk Table (Addendum 3). Be honest with
yourself on a 1-5 scale at approximately the same time everyday subtotaling at the end of each week for
a 4 week period then obtain your grand total to find your Emotional Energy Risk Level. *
SEE ADDENDUM 3:
SCORE RANGES: 100 MAXIMUM E.E. SCORE, 0 MINIMUM E.E. SCORE
75 TO 100 = NO CURRENT RISK FOR PROFESSIONAL BURNOUT
50 TO 74 = SLIGHT RISK FOR PROFESSIONAL BURNOUT
25 TO 49 = MODERATE RISK FOR PROFESSIONAL BURNOUT

3. 0 TO 24 = HIGH OR CURRENTLY EXPERIENCING BURNOUT
Since we are goal driven individuals, I have set a few goals for the clinician suffering from low
emotional energy or thoughts of leaving the profession, the time frames are up to you. Don't worry no
chart audits will be forthcoming.
EMOTIONAL ENERGY GOALS
1. Prioritize your caseload/tasks
2. Schedule your day with breaks and a STOP and LEAVE time.
3. Set reasonable expectations for management (Shhhhh….No not the other way around)
4. Spice up the treatment routine with some of you and your patients personal interests/hobbies.
5. Learn about your coworkers non work related interests and hobbies
6. Increase frequency of participating in your own personal hobbies and interests
7. Modify work schedules or clinical rotations
8. Plan and POST within the office regular vacation plans, no exceptions.
I know this may seem like a lot, and if you have none of these implemented in your professional work
life, then you definitely need to take one goal at a time and set yourself a timeframe. Or you may have
some of these goals already set in place and just need to have another professional say “hey that is great
and keep up the good work and stop feeling guilty about looking out for yourself because ultimately if
you are well your patients will benefit”
ADDENDUM 1:
EMOTIONAL ENERGY SCALE
Instructions: Take a moment and enter a self-assessed energy scale score at approximately the same
time each work day. At the end of each 5 day work week total your score for 4 consecutive weeks using
the Emotional Energy Data sheet (Addendum 2), then take the Grand total of all 4 weeks using the
Emotional Energy Risk Level, (Addendum 3) to find your emotional energy at risk level.
1 2 3 4 5
LE ME HE
LE = LOW ENERGY
ME = MEDIUM ENERGY
HE = HIGH ENERGY

4. ADDENDUM 2:
EMOTIONAL ENERGY DATA
DAY 1/
WEEK 1
DAY 2 DAY 3 DAY 4 DAY 5 TOTAL
EMOTIONAL ENERGY DATA
DAY 1
WEEK 2
DAY 2 DAY 3 DAY 4 DAY 5 TOTAL
EMOTIONAL ENERGY DATA
DAY 1
WEEK 3
DAY 2 DAY 3 DAY 4 DAY 5 TOTAL
EMOTIONAL ENERGY DATA
DAY 1
WEEK 4
DAY 2 DAY 3 DAY 4 DAY 5 TOTAL

5. ADDENDUM 3:
References:
1. Physical Therapy Workforce Project: APTA’s report on Physical Therapy Vacancy and Turnover
rates in SNF’s, 2010
2. 5 Jobs That May Be Your Best Shot at Finding Work,
At a time when there's no easy job, there are some jobs that are definitely easier than others
Money magazine by Liz Wolgemuth, April 23, 2009
3. Helpguide.org, Preventing Burnout
Signs, Symptoms, Causes, and Coping Strategies
4. American Physical Therapy Association
2009 Physical Therapist Productivity Summary Report
*Disclaimer: This Emotional Energy Assessment is not a clinically tested tool and is not meant
in any way to substitute for a true psychoanalytical assessment. If you or someone you know
have signs or symptoms of clinical anxiety/depression or any other emotional concerns please
seek the advice of a licensed medical or counseling professional.
EMOTIONAL ENERGY0
20
40
60
80
100
EMOTIONAL ENERGY RISK LEVEL
EMOTIONAL ENERGY