Burnout and exhaustion.

The high workloads faced by physiotherapists had severe impacts on their well-being, leading to burnout and exhaustion. Participants frequently reported emotional and physical exhaustion due to the relentless pace of their work. They often managed numerous patients daily, with back-to-back appointments and minimal breaks in between. This relentless schedule left little time for recovery, leading to physical exhaustion. "The back-to-back patient appointments with no time to breathe in between have pushed me to my limits," shared one physiotherapist.

This lack of recovery time resulted in feeling constantly overwhelmed and struggling to maintain their professional responsibilities. One participant highlighted the emotional toll of the job, stating, "There have been times when I felt so drained, both physically and emotionally, that I could barely function." This emotional exhaustion often led to decreased motivation impacting their ability to provide quality patient care as the role requires to continuously engage with patients, listen to their concerns and provide emotional support.

The aftermath of COVID-19.

The COVID-19 pandemic exacerbated the challenges faced by physiotherapists, significantly impacting their workloads, mental health, and the support they received from management. Challenges included inadequate staffing, limited resources, and increased administrative demands, all of which significantly contributed to burnout. This period brought an increase in both anxiety and workload, as well as the need for significant organisational changes. Participants reported handling more patients than ever, often under stressful conditions. "The heightened anxiety affected my mental health and work performance, making it challenging to maintain professional responsibilities," noted one interviewee, indicating how the already high demands of their job had been intensified. This increased pressure contributed significantly to burnout, as physiotherapists found themselves stretched thin, both physically and mentally.

The uncertainty and stress related to COVID-19 continued at the end of the pandemic. Staffing challenges also became more pronounced during and after this era. Teams were left short-staffed which further increased the burden on those who remained. One participant shared, "We were already dealing with high workloads, but with colleagues off sick or quitting, it became nearly impossible to manage."

The transition to remote work introduced a new set of challenges. Physiotherapists had to adapt quickly to virtual consultations and new technologies, often without adequate support from management. "The lack of consistent support from management during COVID-19 has made the situation even more stressful and frustrating," noted one physiotherapist.

However, remote work remained after the pandemic and increased administrative burdens. Many physiotherapists found themselves dealing with more paperwork and bureaucratic processes than before which many felt they had not "signed up" to do. As explained by one participant, "I would spend hours on admin tasks, and then come back to the clinic the next day only to find we were behind on patient care tasks. It felt like we were constantly playing catch-up." The need to juggle multiple roles left many feeling they were unable to give their best to their patients, further contributing to feelings of professional dissatisfaction and burnout.

Work environment.

The work environment emerged as a critical factor influencing the burnout and resilience of physiotherapists. Inconsistent support from management was significantly affecting physiotherapists’ ability to manage their workloads and maintain their motivation. Many participants expressed also feelings of isolation and frustration. One physiotherapist said, "The lack of consistent support from management makes it hard to stay motivated."

The absence of consistent management support was not only demoralising but also led to a sense of helplessness exacerbating the already high levels of stress associated with their role. Physiotherapists frequently found themselves navigating complex and demanding situations without the necessary guidance or backing from their managers. This lack of support contributed to a feeling of being undervalued and increased the risk of burnout. Another participant noted, "When management is not there, you start to question why you are putting in all this effort."

Bureaucratic challenges were frequently cited as significant sources of stress for physiotherapists. The changes in protocols, coupled with the increasing administrative workload, added layers of complexity to their daily routines. "The bureaucracy and constant changes in protocols are exhausting," shared one physiotherapist. These hurdles not only increased the time spent on non-clinical tasks but also detracted from the time available for patient care, which many physiotherapists found particularly frustrating. They often felt disconnected from the practical realities of clinical work, leading to inefficiencies and added stress. One physiotherapist explained, "I spend hours on paperwork that seems pointless, and it takes away from the time I should be spending with patients."

Participants called for better support systems as the current structures were often seen as rigid and unsupportive, contributing to the high levels of stress and burnout. Suggestions included streamlined processes for handling administrative tasks, better communication from management, and the introduction of more flexible work arrangements. One participant explained, "The system needs an overhaul. We need structures that support us, not ones that add to our stress."

Finally, the impact of workload and burnout varied significantly across different career stages, highlighting the unique challenges faced by physiotherapists at various points in their professional journeys. Newly graduated physiotherapists often felt immense pressure and lacked sufficient support. One participant shared a distressing experience: "I used to lock myself in the storage room to cry because I felt so much pressure, and my seniors didn’t have the time to help me—they only criticised." Similarly, senior physiotherapists also faced considerable challenges, often feeling overwhelmed by their responsibilities. These included supervising students, managing patients, provide training for others and handling bureaucratic tasks.

Perfectionism.

Perfectionism was another critical factor that influenced the burnout and well-being of physiotherapists. The high standards and expectations that physiotherapists set for themselves often led to increased stress and emotional exhaustion. They explained that felt inadequate and constantly strived to meet unattainable standards. "I always feel like I need to do everything perfectly, and it just wears me out," shared one participant. This pursuit of perfection not only contributed to emotional exhaustion but also affected their professional performance and personal life. One participant noted, "The constant need to be perfect in everything I do is exhausting. It feels like I’m never good enough, no matter how hard I try. I just want to quit from life".

Some participants employed various strategies to cope with perfectionism, including therapy, self-awareness practices, and developing self-compassion. However, other challenges highlighting the difficulties in managing their high standards and expectations. "Sometimes, despite my efforts, I still find it hard to let go of my standards," shared one physiotherapist.

Moral injury.

Physiotherapists often entered the profession with a strong sense of duty and commitment to providing high-quality patient care. However, participants discussed that systemic issues such as inadequate resources, high workloads, and bureaucratic obstacles frequently prevent them from fulfilling their roles causing deep frustration. One participant explained: "It’s incredibly frustrating when I know what the best care for my patient would be, but I skip it ".

In addition, the ongoing struggle to reconcile professional values with the constraints of the healthcare system often resulted in significant moral distress. Participants found themselves in situations where they had to compromise on the quality of care due to factors beyond their control, such as limited time, insufficient staffing, or restrictive protocols. This led to feelings of guilt, shame, and dissatisfaction. For example, one participant said, "I feel like I’m constantly fighting against a system that doesn’t care about the patients or staff,".

The emotional and psychological consequences of moral injury were clear as physiotherapists reported feelings of anger, betrayal, and disillusionment with the healthcare system leading to burnout, and even a desire to leave the profession. One participant explained "I feel like I’m constantly battling the system. It’s draining and makes me question why I chose this profession. And imagine that I was a mature student and this was my dream job".

Team dynamics.

Team dynamics were crucial in shaping the work environment and overall experience of participants. They explained that effective team support and interaction significantly mitigates stress and burnout. Many participants emphasised the importance of having a cohesive team where members understand and support each other. One participant noted, "Having a supportive team makes a huge difference. We look out for each other and help manage the workload."

However, not all participants experienced positive team dynamics. Some reported a lack of understanding and support from their teams and managers, which exacerbated their stress levels. "The lack of consistent support from management makes it hard to stay motivated," explained one interviewee. This inconsistency especially in managerial support left them feeling isolated and overwhelmed, highlighting the need for better leadership.

Effective communication within teams also emerged as a pivotal factor. Participants who reported good communication within their teams felt more equipped to handle their responsibilities and less isolated in their roles. "Good communication within the team helps us stay on the same page and manage the day efficiently," noted one physiotherapist.

Support networks.

Support networks, both within and outside the workplace, were essential for the emotional and professional well-being of physiotherapists. These were categorised as formal, such as management-led initiatives, and informal, such as peer support networks, to emphasise their complementary roles. Participants highlighted the benefits of having mentors or peers they could turn to for guidance. They explained that their colleagues often serve as a primary source of support, providing both emotional and professional assistance. "Support from my colleagues has been invaluable. They understand the pressures of the job and are always there to lend a hand or offer advice," shared one participant.

In addition, emotional support systems extended beyond the workplace, encompassing family and friends who provided a crucial safety net. "Having support at home helps me cope with the stresses of the job. My family and friends are my rock," explained another interviewee. This external support was vital in helping physiotherapists with burnout to manage the emotional toll of their work.

Interpersonal challenges.

Despite the benefits of strong support networks, many physiotherapists faced significant interpersonal challenges. Participants described constructive criticism as feedback aimed at improvement, whereas others faced bullying as comments involved personal attacks undermining their professional competence.”Being criticised and bullied by colleagues or managers was a common experience that negatively impacted their job satisfaction and mental health. "I felt constantly criticised by my seniors, which made me doubt my abilities and increased my stress levels," shared one participant. The impact of these challenges was particularly pronounced for newly graduated physiotherapists who often felt immense pressure and lack sufficient support.

Minimal team interaction and conflicts with colleagues further contributed to these challenges. "There were times when I felt completely isolated because my colleagues were too busy to even talk to each other" noted one physiotherapist. These interpersonal conflicts not only hinder team cohesion but also increase individual stress and frustration. Such negative interactions can create a toxic work environment, leading to further isolation and burnout.

Emotional impact.

Physiotherapists frequently reported that the lack of support and negative interactions led to feelings of isolation and emotional dysregulation. Emotional dysregulation often led participants to withdraw from their colleagues, exacerbating feelings of professional isolation and further contributing to burnout. "The constant criticism and lack of support made me feel isolated and emotionally drained. I was wondering ‘what am I doing here?”," explained one participant. This emotional toll affected their professional performance but also spilled over into their personal lives, impacting their overall well-being. Participants noted that the stress and emotional exhaustion from work often strained their relationships with family and friends. "By the end of the day, I’m so exhausted that I can barely spend time with my family" shared another physiotherapist.

Recognition and appreciation.

Recognition and appreciation from patients and colleagues were crucial for professional fulfilment among participants. The acknowledgment of their efforts provides a sense of validation and boosts morale. One participant expressed, "It’s been appreciated either you know by patients or sometimes by colleagues that you’ve been helpful." This appreciation not only reinforced their professional efforts but also fostered a sense of belonging within the professional community.

Appreciation in work also contributed to job satisfaction. Physiotherapists who felt valued in their roles reported higher levels of motivation and commitment. Being recognised for their contributions was not just a morale booster but a critical aspect of their professional identity. One interviewee shared, "Recognition by patients and colleagues makes a big difference. It feels like all the hard work is acknowledged and appreciated. Then I know I am at the right place".

Sense of accomplishment.

Physiotherapists derived significant satisfaction from their ability to make a difference in their patients’ lives. This sense of accomplishment was closely tied to their confidence in their professional roles. One participant shared, "Feeling useful and productive in your work helps maintain motivation and purpose…That I am in the right place and I can do this and I can do that.." reflecting the intrinsic motivation and self-assurance that came from performing well in the job. Participants often spoke about the joy and fulfilment they experienced when their efforts led to positive patient outcomes. "When a patient tells me that they feel better because of my treatment, it makes all the hard work worth it," said one physiotherapist.

Career development and growth.

Many physiotherapists expressed that while continuous professional development (CPD) is essential for maintaining the requirements of their professional body and enhancing their skills [13] the demands of their workload left them feeling overwhelmed and exhausted. One participant highlighted, "Continuous learning is crucial for my growth and to feel confident in my role, but the expectations and time commitment can be daunting." This sentiment was echoed by others who felt that the time and effort required for CPD, on top of their already demanding workloads, contributed to their burnout.

Moreover, the expectations set by professional bodies for CPD often felt unrealistic and added to the sense of pressure. For example, professional bodies require physiotherapists to complete mandatory CPD hours annually and obtain certifications to maintain their registration. "The professional bodies have set such high standards for CPD, and it feels like there’s no flexibility. It just adds another layer of stress, and they are oblivious to what is happening to us and how demanding is our profession" remarked another participant. The lack of structured and supportive CPD opportunities within their organisations also emerged as a concern. Many physiotherapists reported that they had to pursue CPD on their own time, which often encroached on their personal time and work-life balance. "We’re expected to do all this CPD, but there’s no time allocated for it during work hours. It’s like we’re expected to do it in our own time, which just adds to the burnout," noted a participant.

Working outside of their roles to create opportunities was a strategy employed by some physiotherapists to overcome the lack of formal career progression pathways. They took on additional responsibilities or pursued further education to broaden their career prospects. "I had to take extra courses on my own time to stay ahead," shared one participant". However, the absence of structured career progression opportunities often led to frustration and a feeling of being undervalued. Another participant articulated, "The lack of career progression opportunities makes me feel stagnant. I need new challenges to stay motivated."

Career stagnation and change.

Career stagnation was a significant issue, with many physiotherapists feeling stuck in the same role for extended periods. This lack of movement not only hindered their professional growth but also contributed to job dissatisfaction. Participants discussed the desire for career change as a natural response to this stagnation. Participants explored career options such as private practice, academic roles, or further specialisation to counter stagnation. Some contemplated shifting careers entirely to burnout and others to escape the monotony and seek new challenges. This desire was driven by the need for professional fulfilment and the aspiration to find a role that offered better growth prospects. One participant shared. "I’ve been doing the same thing for years now, and it feels like I’m just spinning my wheels. I’m seriously thinking about switching careers because I need something new and challenging to keep me motivated and balanced."

Some physiotherapists considered shifting to different roles within healthcare or entirely different fields. "I’ve thought about leaving physiotherapy altogether because I don’t see any future growth here," shared one participant. This desire reflected the need for a more supportive workplace that offers opportunities for career advancement and work-life balance. "I’ve been doing the same thing for years, and it feels like there’s no way out," noted one interviewee.

Work-life integration and flexibility.

Participants frequently highlighted the challenges of maintaining a healthy work-life balance. The demanding nature of their job often led to poor work-life balance, with many struggling to separate their professional responsibilities from personal time. Some participants reported working an additional 10–15 hours per week due to increased administrative and clinical demands. "It’s hard to switch off after a long day at work. I often find myself thinking about patients and pending tasks even when I’m home." The struggle with maintaining work-life balance was evident as many physiotherapists found their personal lives impacted by their professional commitments. "I used to have hobbies and interests outside work, but now I hardly find the time or energy for them," shared by another participant.

Flexibility in scheduling and the ability to set boundaries emerged as crucial factors for achieving better work-life integration. "Being able to adjust my schedule and take breaks when needed has been a game-changer for my mental health," noted one physiotherapist. This flexibility (where possible) allowed them to manage their workload more effectively and allocate time for personal activities, thereby reducing stress.

However, this was not always supported by the organisational structures in place. Many participants expressed the need for better support systems and resources to help manage their workloads. "We need more support from the management to ensure that breaks are respected, even if this is for lunch, a walk or a counselling session" emphasised a participant, highlighting a gap in current practices.

Personal well-being and coping mechanisms.

The toll on personal well-being was a recurrent issue, with many physiotherapists reporting mental health struggles, physical health symptoms, and sleep disturbances. "The constant stress and pressure have led to frequent headaches and insomnia," shared one participant, highlighting the physical manifestations of work-related stress. Emotional resilience was identified as a key factor in managing these challenges. Developing self-compassion and seeking professional help, such as therapy, were common coping strategies. "Therapy has been instrumental in helping me deal with the emotional burden of my job," noted one physiotherapist.

Exercise and self-awareness practices were also frequently mentioned as effective coping mechanisms. "Regular exercise has been my go-to stress buster. It helps me clear my mind and stay physically fit," shared a participant. Another added, "Practicing mindfulness and staying aware of my emotional state has been crucial in managing my stress levels." Despite these efforts, many physiotherapists still struggled to find a balance, indicating the need for more systemic support. "No matter how many coping strategies I employ, the workload and pressure sometimes feel overwhelming," confessed one participant, highlighting the limitations of individual efforts in the absence of broader organisational changes.

Management respecting work-life balance.

The role of management in respecting and supporting work-life balance was emphasised by many participants. The need for better mental health support and resilience-building initiatives from management was a recurring theme. "We need management to acknowledge the stress we are under and provide resources and the time to support our mental health" stated one physiotherapist.

Support from family and friends played a critical role in helping physiotherapists cope with their demanding jobs. "My family has been my rock. Their support keeps me going," shared one participant, illustrating the importance of a strong personal support network. However, there was a clear call for more structured support from the workplace to complement these personal networks. Participants also expressed a need for management change and training to foster a more supportive work environment. This included providing more resources, improving communication, and creating a culture that values and respects work-life balance. "Management needs to listen to our concerns, recognise burnout and take concrete steps to reduce our workload and stress," emphasised by one physiotherapist.