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Occupational Therapy Staffing Issues in 2020

by Brittany Ferri


Healthcare is one of the most hands-on professions in the modern world, with no shortage of job settings and job security. However, the growing needs of certain populations is placing an excess burden on younger generations of healthcare providers, especially therapists. The growth of the baby boomers is projected to continue at a rapid pace. By 2029, it is predicted that more than 20% of the United States population will be over 65 years old. This growth will mean an elderly population is expected to outnumber children in just a few short decades.

This places a large burden on the health insurance industry, including organizations such as the Center for Medicare and Medicaid Services who insures a large majority of this population. An additional burden is placed on the small percentage of therapists who are entering the field of geriatric rehabilitation, in settings such as skilled nursing facilities, assisted living facilities, and active adult communities.

Aside from growing numbers, ever-changing regulatory demands are placing increased stress on healthcare practitioners from a variety of disciplines. This has a large impact on the way service is provided, the quantity of care provided, and overall levels of job satisfaction therapists experience. There are many aspects of healthcare that are impacted by these staffing changes the industry is seeing.

An unhealthy work environment

You have likely heard of the term ‘toxic work culture’, which many healthcare facilities are experiencing. This often results from healthcare practitioners who are burned out, dissatisfied with their jobs, and having difficulty keeping up with oppressive workplace demands. This often fosters a culture of negativity, stagnation, and inability to meet job demands. The concept of burnout has a strong relationship with the staffing issues the healthcare industry is facing. This has a negative impact on employee satisfaction, leading to negative behaviors and poor employee relations.

Declines in patient care

Employee relations is not nearly the only area where burnout and growing staffing demands have a negative impact. When healthcare practitioners are burned out, the effects largely influence the work they do. Most practitioners may believe their feelings about their role do not impact the care they provide. However, the earliest signs of a burned out practitioner are often not visible to the person experiencing burnout, despite chronic feelings of exhaustion, emotional fatigue, and lack of compassion.

This often leads healthcare practitioners to avoid the early signs of burnout and difficulties with job performance until problems grow to be even more concerning.

“Many studies confirm a link between symptoms of burnout, clinician error, patient safety, and poor patient/therapist communication and relationship. This ultimately leads to poor patient satisfaction, an increase in on-the-job injuries, and a decrease in profits for some healthcare facilities.”

Job dissatisfaction

Whether practitioners realize it or not, these issues all impact levels of job satisfaction and the ability to feel fulfilled in the workplace. If someone is not feeling connected to the work they do and these feelings are being met with difficulty engaging in basic relations, this has an impact on the individual. Persistent feelings of low self-efficacy and lack of fulfillment at work ultimately have an impact on the individual’s emotions apart from work.

For example, if someone is constantly feeling as if they aren’t able to keep up at work, they are never able to get ahead, and they are no longer making a difference, this will impact most other aspects of their life. This will be met with low self-esteem which creates a vicious cycle, causing a lack of confidence to complete most job duties. Furthermore, this may cause a healthcare provider to lack the confidence to seek jobs that are more suitable, making it more difficult to enter a role with job fulfillment.

Productivity struggles

Productivity is a concept that most working therapists are familiar with, as they are standards set forth by facilities such as hospitals and nursing homes. Productivity is a way that facilities calculate how much treatment their therapists are providing. This can be calculated by dividing billable hours (documented treatment sessions, evaluations, discharges, etc.) by the total time that a therapist works. This gives facilities an idea of how much of a therapist’s workday is being done performing billable services that are reimbursed by insurance companies.

One of the biggest struggles many healthcare providers cite with the workplace is ever-increasing productivity demands. Most traditional clinical settings implement these standards to ensure each patient is receiving the treatment they need in order to fully rehabilitate. However, these standards have been continually increased through indirect pressure from insurance companies wanting as many measurable gains as possible.

This has translated to intense stress for healthcare providers who are expected to complete a certain number of minutes, sessions, or otherwise specified quantities of care for each patient in their facility. Most therapists know more therapy is not necessarily better for patients, especially a fragile and medically complex geriatric population.

The field of occupational therapy, in particular, places great emphasis on the quality of therapy as an integral factor toward providing individualized and client-centered care. External forces placing emphasis on quantity of care is what has led to this additional work-related issue.

These productivity standards are often causing healthcare providers to leave such clinical settings entirely, due to the inability to provide care in the manner in which they feel most comfortable.


A multifactorial approach is one of the most effective ways to manage stress, burnout, and subsequent staffing issues the healthcare industry is currently seeing. By addressing the concept of burnout using a root cause analysis, healthcare facilities and executive leadership will be more likely to see a resolution in both patient and provider satisfaction levels, along with higher staff retention and increased job fulfillment. An integrative way to do this is by implementing approaches on both the system and individual levels.

Facility-level solutions include optimizing electronic medical records (EMRs), lessening practitioner workload by assigning certain clerical tasks to non-clinical staff, lowering office-based inefficiencies, implementing fair and realistic productivity standards, and assigning job roles to the practitioner best suited to complete the work. Facilities may also find success in providing providers with opportunities for personal and professional growth, including leadership opportunities, advancement, and the chance for shared decision making.

Individual solutions include placing an emphasis on self-care and a work-life balance by keeping work tasks within the workplace, allowing practitioners to seek meaningful duties and tasks within their work roles, and engaging in practitioner support groups (either formal or informal) to share mentorship and strategies for success.

Additionally, training regarding awareness, prevention, and strategies to minimize burnout would prove largely helpful in keeping healthcare providers at your facility happy, healthy, and fulfilled. These strategies should include organization, task prioritization, and an assessment (or re-assessment) of both personal and professional goals and values.

With consistent efforts established, your facility will be poised to improve patient care, decrease clinical errors, increase revenue, and provide above-average patient safety.


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