We talk about burnout like it’s a single thing. It isn’t. And treating it like one is probably why so many of our attempts to address it don’t actually work.
Burnout has been a talking point in healthcare for years — maybe decades. And yet by almost every measure, it’s getting worse, not better. I don’t think that’s a coincidence. I think it’s because most of the conversations we have about burnout treat it like a single, uniform experience with a single solution. Take a vacation. Practice self-care. Set better boundaries.
Those things matter. But they don’t address the root. And in my experience — both in my own career and in the work I’ve done with healthcare organizations — there are really two distinct drivers of burnout, and they require very different responses.
Burnout Driver One: No Visible Next Step
The first is what I’d call the tunnel problem. It’s the feeling that no matter how hard you work, you can’t see where you’re going. You’re in the same role, treating the same patient population, with the same ceiling stretching out ahead of you for the next twenty or thirty years. That’s not laziness or ingratitude. That’s a legitimate psychological response to a lack of forward momentum.
I felt this early in my career at a skilled nursing facility. The job had looked great on paper — good pay, clinical variety on the surface. But within a few months I was managing two facilities, supervising a handful of coders, and doing nothing but evals and tenth-visit documentation. Every day looked exactly like the one before it. I could see that pattern continuing indefinitely, and something in me started to flatline.
What kept me from fully burning out wasn’t a wellness retreat or a mindfulness app. It was knowing that there was something else on the horizon. I’d had a few conversations with the VA about an open position. There was no offer, no start date, no guarantee — just the possibility of something different. That was enough to keep me oriented. Having a direction, even a distant one, changes the texture of the present.
“Burnout comes from feeling like you’re stuck with no idea how to get out. Anything you can do to give yourself a perception of control starts to alleviate it.”
Driver Two: The Illusion of Control (Or Lack Thereof)
The second driver is structural, and it’s one that the healthcare system has basically built in. Most clinical services are paid on a fee-for-service model, which means reimbursement is directly tied to time. And the only two levers payers have to protect their margins are to deny services or to pay you less for the services they do cover. Both of those levers have been getting pulled, steadily, for the better part of thirty years.
The result is a profession where we’re consistently asked to do more and consistently paid less to do it. And even if you’re not a practice owner — even if you’re just a staff therapist who has never given a moment’s thought to billing — you feel it. In the raises that don’t keep pace with inflation. In the caseloads that keep climbing. In the documentation requirements that seem to double every time someone figures out how to manage them.
That feeling isn’t imaginary. It’s a rational response to a system that is, structurally, working against you. And the helplessness that comes from feeling like you can’t change that system is one of the most reliable pathways to burnout I’ve ever seen.
What You Can Actually Do About Burnout
Here’s what I’ve learned, both from my own experience and from years of working with clinicians and practice owners: the fix has to match the problem. Generic self-care interventions applied to a structural problem don’t work. Neither does a career pivot applied to what’s really just a visibility problem.
If your burnout is about not seeing a next step — start building one, even a vague one. You don’t need a five-year plan. You need a direction. A conversation with someone doing the thing you think you might want to do. A course in an area adjacent to your current role. A commitment to show up to one professional event this year where you don’t already know everyone in the room. Forward motion, even slow forward motion, changes everything.
If your burnout is about feeling structurally trapped — that’s harder, and more honest. The fee-for-service model is genuinely grinding. But understanding it, really understanding it, gives you options you didn’t know you had. Alternative payment models are gaining traction. Value-based care, shared-risk arrangements, direct-pay practices — these aren’t fringe ideas anymore. And the clinicians who understand how those models work are the ones who will be positioned to take advantage of them.
Neither of these is a quick fix. But they’re real ones. And they start with being honest about which problem you’re actually dealing with — because the answer to one isn’t the answer to the other.
Want to go Deeper on the Topic of Clinician Burnout?
The full interview is waiting for you. This article draws from a longer conversation I had with a group at BGSU — covering burnout, mentorship, the future of OT, and a lot more. Paid members get the complete Q&A and the full video.
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My Books
- From Clinician to Something More: A Healthcare Professional’s Guide to Business, Leadership, and Life Beyond the Clinic
- From Clinician to Owner: A Healthcare Practice Owner’s Field Guide
- Better Outcomes: A Guide to Humanizing Healthcare
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