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Burnt Out

Discussion in 'Australia' started by hard_corn, Jul 23, 2011.

  1. hard_corn

    hard_corn Member

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    Hello everyone.

    I have been working for 2 years following my graduation.

    I have established a successful private practice and there is strong demand for appointments. I am earning great money and have administration staff whom are really enjoyable to work with. These are really positive aspects to my job.

    However, I am starting to feel really burnt out. I wanted to share my situation with you, because I am curious to see whether anyone else ever feels like this, and if so, what you did to address the circumstances. ?

    Aspects of the job I find challenging:

    - The patients. I work in a regional 'retirement' area whereby a lot of my patients have moved to for their retirement, many from well-to-do suburbs of Sydney. Whilst most of my patients are lovely, I have some extremely demanding patients on my books. For instance, I offer a 30minute consultation time. Some people do not come in for 6months, with calluses and corns all over their feet, and honestly expect me to sit there in the session and work on them until everything is looking 100%, often going overtime into the next session. When I politely say that "you may need to make another appointment because we have run out of time", they just stare at me. In response to my 30minute consultation time, one lady replied "is that all, 30 minutes is not long enough!" - Some patients seem to equate the idea of a Podiatry consultation with a full Pedicure/spa treatment. Some patients sit in the chair and "direct" me how to do my work on their feet. Some inspect their heels, or rub their hands on their feet afterwards to ensure that I have removed calluses to their satisfaction.

    One gentleman came in a few weeks ago, and stated that I had not cut his nails short enough last time. I had seen this man many times before without incident. This time, however, he had actually drawn lines in black permanent marker on his nails, and then instructed me to cut where he had drawn the black "marker" lines.

    - Most of my work in this regional area is general foot care. When patients come in with issues such as plantar fasciitis or other pathology, they balk at the idea of having to pay several hundred dollars for custom made kinetic orthoses devices. Whilst I have a really strong interest in sports Podiatry and biomechanics, I have probably only prescribed and fitted 10 pairs of custom orthotics in the past 12 months. People here just will not pay the money for it.

    - I find it very draining to constantly be cutting nails, removing corns and calluses all day, every day, all under the delightful glow of a fluorescent lamp. I find the work monotonous. I also find it very straining on my back. I try to do a good honest job for each and every patient that I see in the day, and I am going home absolutely exhausted. - Does anyone else here ever honestly feel like this ??

    - It is not all doom and gloom though. I have some great laughs with a few patients, and it is these patients that make everything seem worthwhile again.

    - I am beginning to consider going back to University and retraining into another industry.

    Does anyone else ever share these, or similar, frustrations ? :confused:

    Thank you. And I apologise for the rant.

  2. Perthpod

    Perthpod Active Member

    Hi Kimberley,

    If youre making great mony, maybe you could cut it down to part time and do something else you enjoy to offset the exhaustion? I have been out 7 year and I find it's the things you do outside of work that also make you who you are. Sometimes working for someone else, where you dont take work home can take that extra pressure off. Although, if it is private practice and you are being worked too hard, it will feel the same/worse than working for yourself. I have worked both for myself and in private sports practice, and the below (which I find fantastic)
    I work at a government subsidised allied health practice where although the work is repetitive, I set my own appointment times, holidays, continued professional development days etc and get payed well, without relying on patients paying me.
    The hours are good and I can study/be involved in things that interest me after 3.30 pm. I find exercise and core strength very important to decrease tiredness and back/neck pain. Sometimes living quality is so much more important than seeing lots of interesting biomechanical cases. Maybe take a break into this kind of job and keep studying/working pt in what really interests you.
    Cheers, Pip.
    If you really cant handle it, you should probably put measures in place to preserve your financial status so you dont just throw in the towel without backup.
  3. RobinP

    RobinP Well-Known Member

    My advice would be to up your prices by quite a bit and up your treatment slot times a little to give you a little leeway.
    Better to see 50 % of the patients and charge 50 % more(give people your time and take the stress off your appointments). You will undoubtedely lose some patients btu I bet you will be surprised at how many you keep. See less people, charge more but give more value for money.

    As far as the biomech goes, the bit that should make you the money should be your time. Charge them an appropriate amount(don't be afraid to charge at the top level if you think you are good enough) and don't try to sell them custom orthotics all the time. Use what you think is most appropriate and don't be ashamed of what it will cost them. They don't have to accept and you shouldn't take it personally if they don't.

    When you go to get your car serviced, does the person on reception apologise for charging you hundreds for the pleasure? No - they provide a service and you want a problem solved. This is how much it costs, take it or leave it.

    I use far more prefabs that anything because I try and minimise the cost to the patient but if they are unsuitable for anything other than custom made insoles, I let them know how much it is and leave the decision to them.

    It's a big step to whack up your prices but if the choice is practicing the way you want and charging accordingly or burning out and not having a life or business, then it's a no brainer. I speak from personal experience.

    Good luck

  4. W J Liggins

    W J Liggins Well-Known Member

    Hi Kimberley

    It's not just where you are in Oz. It's the UK and, I suspect everywhere else!

    Robin's advice is good, but if you really don't want to raise your fees, then simply work on the basis of time slots. For example, initial consultation is always going to be more time consuming than routine t/t, so allow another 15 minutes and make it clear in your literature/reception communication that you have to charge for it. This would also apply in the case of the freeloaders - tough; double appointment time costs double. If they don't like it then they can find themselves an alternative.
    As for the 'sorts' who have the nerve to tell you how to do your job, well, I always believe that courtesy counts but I would give them one opportunity only, explain to them all about potential infection etc. If they try it on again bid them a fond farewell explaining that you are a professional who knows their job and they do not, so please find an alternative. You just don't need these because there are enough frustrations in life without them.

    Stick with it and you'll have a fulfilling and sometimes enjoyable professional life; the patients who need your particular skills will gradually find their way to you. Don't put up with the b@stards - there are enough of us here in Pommieland lusting to thrash your cricket team (again), without your having to meet us in working life!

    Pommie Bastard Bill
    Last edited: Jul 23, 2011
  5. twirly

    twirly Well-Known Member

    Hi Kimberley,

    Just my take on demanding patients with extended times.

    I allocate 30 minutes for routine appointments. I also have a notice of charges for appointment times. I indicate that a 'routine' appointment is up to 30 minutes & an extended/intensive appointment (up to an hour) is a 50% greater charge. I also indicate if a patient has not pre-booked an extended apptointment a repeat appointment may be required at full charge for up to 30 minute routine treatment.

    If a patient has multiple problems they are usually aware (if they have been seen previously) that their foot problems will take time to treat accordingly. If they are a new patient then this should be discussed at their initial assessment & planned accordingly for further treatment timing.

    Patients may pay the bills but you set the rules. Don't be bullied. I have one particular patient who is rather trying. I refuse to treat further than I feel is appropriate. I will not be told how to do my job but I always discuss prior to treatment what the patient expects & also post treatment is there anything I may have missed. If the patient demands shorter, less, they don't mind if it bleeds! I then explain the reason I have provided the given treatment & no more.

    Patients are our livlihood but shouldn't make you want to pack up & leave. Never forget you have an option to discharge & refuse to treat a patient who you feel you cannot provide with the service they demand. The choice is both yours & theirs.

    Kindest regards,

  6. LuckyLisfranc

    LuckyLisfranc Well-Known Member


    Your experience is similar to many, many new podiatrists.

    The most valuable lesson I was ever taught was to work smarter not harder. By this, I mean you go to work to satisfy your own objectives, and seeing patients is often a sideline activity to achieving what you really want out of your career. For some it is about income, others it is to extend your scope of practice and specialise, and so on.

    The 'hardest' issue I see for new graduates is age. You are often very young relative to your more senior patients. They like to 'try it on' and pressure you into doing things you don't want to do - particularly if you are a younger female practitioner. This can be directing you to undertake their care in certain ways, or telling you 'how much' you are 'worth'. Having gone through this myself, and now closer to middle age - you don't put up with that b*llsh*t any more - and they are less likely to try it on in the first place. Harden up, put on your best professional face, and lay down the rules firmly and politely. They won't do it again.

    Early on in my career, I diversified my practice into a small amount of hospital based public work, and teaching. This left 3/4 of the week for private practice. This makes a big difference - so I would suggest breaking the monotony of the week by getting out of your clinic and working in some different settings (NOT nursing homes!). As others have suggested, charge more to weed out some of the more testing patients. We have a rule that all patients that we really dislike and get us down about our work and 'referred on' to other providers. Its not worth the mental anguish.

    We have always presented our practice and ourselves as equivalent to a medical specialist. This is reflected in fees, the nature of our care, and look of our practice, and the services we provide. If people perceive you in a way you wish to be treated, then you will be rewarded by more respectful patients who are grateful (mostly) for you care and attention.

    Burn out is a very real and troubling feature of the podiatry profession.

    You need to turn the situation around. You can have a good income, generally pleasant and satifying days, and a professionally rewarding future.

    Go and spend a day or two with some podiatrists you respect and admire. See how they operate. See how it *can* be done. Take the best bits and integrate it into your practice, and discard the things you professionally or ethically disagree with.

    Don't waste the time, money and effort that has gone into your education. You just need to flip the situation into making your business satisfy your needs, rather than letting it dictate you.

  7. hard_corn

    hard_corn Member

    Can I just say, I am so very pleased and grateful to hear this advice from my more senior colleagues.

    I have very carefully re-read, and reflected, on each of your above posts. I am so grateful for the sharing of your insights, it has helped my outlook immensely.

    You have given me many ideas. Thank you so much again, it is very reassuring to hear your views.
  8. Jbwheele

    Jbwheele Active Member

    Sometimes your work is not the problem, consider things like, Depression, where your brains physiology is not allowing you to cope with the problem pts. See your GP if you need help for depression as it can sneak up on you, especially in a job like yours where you need to "PUT ON A HAPPY FACE " for your customers.........Cheers Joe
  9. Kara47

    Kara47 Active Member

    You don't " have" to treat difficult patients, as it's your business. You dictate the terms ( one of the joys of self employment!) Either refuse to book them or politely say "if you aren't happy there is another podiatrist in town". Life is too short to put up with painful people if you don't have to. ( public health is a different story)
    My pet peeve this week is the EPC patients who have just finished telling you about their European holiday, but can't possibly pay for an appointment when their EPCs run out.( at risk of getting an ulcer, mind you)
    Working long hours with no free time for yourself and an interest away from work will produce burnout in most people. Money is not everything. Cut back your hours to something that will allow you a lifestyle, have a holiday, etc.
  10. cornmerchant

    cornmerchant Well-Known Member

    If you are only prepared to give it 2years before feeling this way I suspect the job is not the right one for you.

    I agree with most of the previous points, once the business is established you can choose to treat or not to treat but along with the few interesting cases a week that we all see, there will be a lot of palliative work. If that is the demographics that you're working within then you have to accept this and enjoy it for what it is! If you want to move purely into the biomechanics field then that is what you should do but it may take a very long time to make a success in such a niche market .

    I love my work, it is never a problem to get up in the morning and I enjoy the benefits that a good living brings with it. I can honestly say that maybe 10% of patients are not my cup of tea, but I keep them on as it is a challenge winning them round.

    Joe-depression is a luxury of the employed pod. In pp there is not the time to be depressed!

    Last edited: Jul 25, 2011
  11. Lab Guy

    Lab Guy Well-Known Member

  12. OneFoot

    OneFoot Active Member

    Hehehe soooo true...
  13. Jbwheele

    Jbwheele Active Member

    Geez corn merchant that is the most un PC comment I have seen ! Dont you read the statistics.......Depression one of the biggest Killers in the western world.

    It is simply a physio/psychological reacting to undue stress, a legitimate illness.
    I was simply stating that if you can't cope with Difficult people, Improving your own coping mechanisms. (I.E Dealing with depression as one possible factor) may improve Quality of Life...................:empathy:
  14. cornmerchant

    cornmerchant Well-Known Member

    It may be un pc as far as you are concerned, but as a single parent of 2children and no other income I have had to build up a business through thick and thin. Trust me, depression is not an option even when times are very hard.
    It does help that I love the work as much now as I did when I qualified 17 years ago and I have a very positive outlook. Sadly that is not the impression I get from the original poster who feels burnt out after a mere 2 years. This is not going to be due to depression, more a case of dissatisfaction with the job or having had expectations of the job which have not come to fruition.it may be time for hard-corn to rethink the future.

    As for depression being the biggest killer- I don't know- statistics can be manipulated to tell you what you want to hear. It's about time people started taking responsibility for themselves. as I said before, none of my colleagues take time off sick unless they are literally bedridden, however many colleagues of a friend in education take time off on a regular basis because they get paid when they do!

  15. Jbwheele

    Jbwheele Active Member

    Depression is "not" an option its a condition....
  16. Lab Guy

    Lab Guy Well-Known Member

    I doubt hardcorn has depression after reading her post again, sounds like she is just frustrated and burned out. When your suffering from depression, it takes all your strength just to get out of bed in the morning let alone write a lengthy post on Podiatry Arena.

    A lot of people invest a lot of time and money in obtaining a degree in a profession only to find that its not suited for them. Hopefully, she will find a career that ignites her passion so much that she looks forward to going to work on Monday. Still, in today's economy, one should feel blessed to be your own boss and make a nice living.

  17. DMax

    DMax Member

    LOL..... that's what my wife and I have argued about not long after our son was born last year. she ended up winning the argument as usual of course :p
  18. SarahR

    SarahR Active Member

    I have one clinic location where a few frustrating clients refuse to come more often than evey 4 months (one lady ALWAYS has an ulcerated apex and refuses to wear FREE toe prop). My hand will literally cramp by the end.
    My appointments are 15 min for $42 (I'm lightening fast btw, if I can't get you done in 15 your feet are a terrible mess). Some people are booked for 30 at a higher fee $70. New PTs are $75 and booked for 30 min or 45 depending on the phone triage and estimated work to be done.

    I explain to my patients (both new and established) that the goal is to get their feet feeling better all the time, not just for the few weeks after treatment. This means regular cleanup/debridement plus necessary offloading to slow down onychophosis accumulation, and slow down corns and calluses. We go over the optimal management plan as often as necessary to drill it in (more frequent care to start, longer intervals are only recommended once results are seen). It is made very clear when they refuse to come more often that their feet are almost as bad, or just as bad as their first visit, and indeed the work is worth the higher cost. We will even call the stubborn ones around the 8-10 wk post treatment mark and remind them that if they don't accept and attend a booking they will be charged the higher price for their next visit. Those who get on board reap amazing results, some feet are unrecognizable within a year.

    It can be frustrating when you aren't seeing progress/results due to poor adherence to management plan. It bugs me when I've done an amazing job and I've had to clean up another clinician's mess the next visit, or deal with fixing crummy self care or outright neglect, especially when they leave it so long as to make any touch excrutiatingly painful let alone trying to debride anything, then have the nerve to complain that their 5 month neglected toe still hurts after all the callus was removed. Um hello, guess I forgot my magic wand at home today. Make sure you do your part and spend enough time educating your client about what you are doing and why; the etiology of the corn/callus etc. Remind them the pain is due to damage to underlying soft tissue/skin; corns don't hurt or we couldn't cut them off. Some people will surprise you!

    A badgering tone is not helpful; educating them about how much you are able to help them if they are willing to put on the cream should be a supportive and positive conversation. Their feet are shouting at them loud enough (unless neuropathic) so we don't have to.

    And don't be afraid to go at some of those hds that literally stick out of the foot with nippers or a good carbide bur to get down to the softer bits before busting out the blade. It helps save the wrist a bit on the stubborn clients who are attached to horrible feet. :) can hurt them less too.

    They are getting fewer every year. I have to be firm because after 5 years of practice I still apparently only look "about 20 years old dearie". Waiting impatiently on some grays. ;-)
  19. Perthpod

    Perthpod Active Member

    So true Sarah. Awesome to come on here and not feel alone in the job ;D
  20. Jbwheele

    Jbwheele Active Member

    Hey I like that got get em attitude SarahR, I too used the old nippers to quickly debride the corns/ callus and the old dental number 4 burr is a great enucleation tool, for phosis and subungual/sulci HDs. Quicker and IMO less risky than the Blade. Also If you need to debride slough off an ulcer the foot over the sink and give it a good ol buzz with a burr and flush with saline, quicker and more effective than tweezers and a blade. anyway best get back into it. cheers

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