Why healthcare keeps losing good clinicians (or, why I walked away for a second time)


Guest post written by a wonderful PT who has walked away from the profession.

Why healthcare keeps losing good clinicians (or, why I walked away for a second time)

Firstly, I don’t know if the above statement is true. I just know a lot of good people who’ve left healthcare, across many different professions. And I highly recommend reading “This is going to Hurt” by Adam Kay, or if you don’t have the attention span, it’s now a TV series in 25 minute bites.

Last week I resigned from my position as a Physiotherapist and Keyworker, working for a supplier on the ACC pain contract and other physical injury contracts such as concussion. I’ve been working in that role for 3 years since moving to New Zealand, and for the most part, I’ve loved it. I get to make a real difference in people’s lives and see them get some quality of life back, for instance, being able to spend more time with family, or return to valued activities. I had a flexible work schedule, an okay salary, and a company car and fuel card.

Yet, I’m seriously looking at leaving healthcare for good, and searching for pathways to a new career. I don’t know if I can do healthcare again.

So why did I resign? Here goes…

It’s a lonely profession. Technically, I work as part of an “inter-disciplinary team” (IDT) of clinicians of different professions (PT, OT, Psychologists, Social Workers, Speech Therapists, and a Doctor or two), supported by an office. In reality, I hardly, if ever, see any of them. Very occasionally we might be able to tee up a joint session with a client (maybe one a month). Sometimes phone calls, though there’s a lot of missed calls and messages. The majority of our IDT “meetings” happen over email, where replies tend to drift in over the course of several weeks (often long after they are needed) as colleagues work their way through their inboxes. And don’t even get me started about trying to get anything out of our overworked office staff. So, I work as part of a diverse team, and yet, I basically work by myself for 98% of it.

As well as lonely, it’s emotionally draining. Like, having your soul sucked out through your nostrils kind of draining. Yep, there’s the occasional lovely little old lady who makes your day, but for the most part these are long term (that’s what chronic means), broken and tormented souls who take a lot more from you than you give back. As a result, despite being a Physiotherapist, I’m actually an underpaid, undertrained counsellor who is having to play listener, motivator, advocate and a number of other roles to these people. While working out what the actual hell is going on with them and what I’m going to do next. It’s tiring.  

I do (did) a LOT of driving. I was told the other the day that I cover an area of rural New Zealand the size of Belgium. I’m not sure if that’s true, but regardless, I would often spend up to 5 or 6 or 7 hours a day in the car, often to only see 2 or 3 or maybe 4 clients. In my effort to try and be as efficient as possible, this would involve me stringing several nearby(ish) towns together, resulting in 11-12 hour days. The roads I drive are often narrow, rough, hilly, windy, icy, and sometimes covered in cow sh#t (which is sometimes frozen). Once I had to change a flat tyre at dusk parked in a ditch on the side of a major highway barely inches from traffic because the nearest decent shoulder was around 10km away (I know those roads well), and then drive the next 75km home at 80km/h on the space-saving spare. Fatigue, anyone?

Promotion or pay rise, anyone? Not in healthcare. I’m a Physiotherapist, and once I’ve (or my employer has) paid for the right to work (registration, insurance, practicing certificate, continuing education expenses), I get billed out at a rate that is set by ACC. It doesn’t matter if you have four postgraduate degrees, 40 year’s experience, have personally mobilised the Queen’s patella, or are a new graduate with no real idea what the f&#% you’re meant to be doing, that rate is the same. Because, well, it’s “Physiotherapy” right? So that’s why, after 15 years in the game, a Master’s degree and having started more postgraduate study, I’m making less money per year than I was in 2011 (take inflation into account and the picture is even worse). And if I stay working in a clinical role (ie seeing patients) that’s unlikely to change. Many people think that Physios are well paid but compared to the university entrance score and study required and hoops we have to continually jump through just to put some silly coloured tape on you, our pay is lower than most other white collar (and many blue collar) professions that need far less training or navigation of red tape.

There is basically no oversight, or supervision of anyone’s work, so to an extent you can just do what you want. This sounds great, but actually, you spend your entire day questioning whether you are doing a good job or not? It’s up to you entirely to seek feedback from colleagues, mentors or external supervisors, but in reality you can just do whatever you want (or what you believe is right). I’m extremely lucky to have a group of dynamic and clever people as a network to draw upon and tell me I’m being an idiot when I am (and they will).

Which is how I ended up being “bullied” by a colleague. I’m not sure that “bullied” is the right word and I still feel a little silly saying it, though that’s how it felt to me. For a long period (over a year), working with this person has given me significant anxiety, which on reflection, has probably made the situation worse in how I’ve responded to them. But in my defence, and I’m going to say this outright (because if I’ve resigned, then hey, I can), the problem with having little real supervision in our world is that clinicians start to develop and hold on biases, for example “this is how we’ve/I’ve always done things” and then start to believe that that’s how it should be done by everyone, all, the time. And then, let’s say, a colleague does something that said clinician doesn’t think is the right way to do things (according to their bias). End result: they call you up and give you a telling off, pushing you to the point of a panic attack on the side of the highway at the start of another 12 hour day, and then get annoyed and demand an apology because you didn’t agree with them then and there.

Margins are tight in health care. Like you hear about in the news, healthcare budgets are always stretched, whether it’s ACC or the DHBs. Which means that either you’re being pushed towards crazy KPI’s (which thankfully I wasn’t), or like I alluded to earlier, the office ends up understaffed and management (what there is of it) is seriously stretched. And those in management positions are often undertrained when it comes to actually managing stuff. So this is how, after reporting the above bullying issue, it got filed away in the “too hard” drawer for four months before being “dealt with” in a rushed manner on the end of other work meetings in a public café. Suffice to say, that didn’t go so well, I had a major episode of anxiety and ended up at my GP’s office, and haven’t worked since.

So here I am, a healthcare professional in his early 40s, with 15 years’ experience and specific expertise and interest in working in chronic pain, and I’m ready to walk away and find a new career. I’m sick of being lonely, underpaid, and under supported at work. It’s time we start to value healthcare, and the people working in it, and provide safe, supportive and fairly paid working environments for them.

8 comments

  1. This sounds like burnout to me. It seems the author’s despair with this particular job is transferred to the whole profession. There are so many clinical settings other than being a ‘road Physio’ I would think a clinic with lots of different patients and providers would solve some of the malaise. Good luck! I haven’t had a cost of living raise in over 14 years btw.

    1. Hi Steve, sadly I’ve heard this story time and time again in NZ. For a rural-based PT who wants to work in pain management & rehabilitation, this is reality (applies equally to occupational therapists, psychologists). It’s a reflection on poor funding, poor training in teamwork, poor management, and that physiotherapists don’t have professional supervision but instead have “peer review” which seems more about “are you doing it right” than “how are you doing?”

      1. Sorry to hear this. The poor management situation is perplexing. I mean, who would do that!?! I am seeing a much different type of burnout here in Washington State, USA. Huge groups of providers my age (64) are quitting as a result of poor compensation, massive understaffing issues from both Covid and vaccine mandates, and ever growing government regulations/paperwork. And I am referring to Chiropractors, medical docs and a few PTs. Almost all of the Docs I have referred to for 31 years have quit in the last 18 months. Our system is crashing in spite of spending much more per patient than yours and there is no hope in sight.

  2. It’s small business in NZ, and our unique funding situation. We’re dependent on one accident insurer and they’ve driven rates down to where they’re just not sustainable. So large PT-owned corporates employ inexpensive and inexperienced clinicians and run them into burnout. It’s not good for anyone…

  3. Oh I hear you Bronnie!! I’m an OT and resigned from my hand therapy position 9 months ago for a variety of reasons. Despite being ‘in a team’ I also felt professinally lonely and almost never caught up with my colleagues. We worked crazy long days considering you have a new patient in front of you every 30-45 minutes (sometimes without a break for 10 hours). We were expected to do Doctor letters in our own time. I paid for my own mentor so that i felt like I was progressing professionally. A few years back I also had a similar scenario with a bullying colleague who in hindsight was highly insecure but I also became a stressed out mess and resigned that job as it was dealt with so poorly by my seniors. I do still feel a strong pull to work in health care however and although I feel a bit isolated and alone again in my own business, I dream of a big healthy functioning team environment. I think it has to be private and it has to include health professionals like Osteopaths so we can truly start treating the whole person. I have an idea for you. Online mentoring of health professionals working in pain? I would pay for that 🙂

    1. I’m so sorry to hear that it’s happened to you as well!
      I do offer online supervision for people working in pain, it’s something I love to do – always so rewarding because every therapist is different, all are passionate and keen to apply what we discuss.

  4. I share your thoughts and feelings and undoubtedly agree with your comments and critics.

    A similar situation prevails “across the ditch” i.e. rural Australia. I cannot agree more and the
    the current medical system here doesn’t help.

    Thank you for sharing and all the best.

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