While many new graduate physiotherapists report feeling engaged and satisfied with their work, there are alarming signs that their first year of practice may be pushing them towards burnout. 

Understanding these dynamics is essential for developing strategies to support young professionals and ensure their long-term success in the profession, says Associate Professor Kerrie Evans (pictured above) FACP, a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2007) and Group Chief Education and Research Officer at allied healthcare organisation Healthia.

Discussing her and her colleagues’ research papers ‘The first year of private practice— new graduate physiotherapists are highly engaged and satisfied but edging toward burnout’ (Evans et al 2022) and ‘Supporting new graduate physiotherapists in their first year of private practice with a structured professional development program; a qualitative study’ (Chipchase et al 2022), Kerrie says new graduate physiotherapists often enter the workforce with high levels of enthusiasm and a desire to make a meaningful impact on their patients’ lives. 

Many report feeling a strong sense of professional fulfilment, especially when they see positive outcomes from their treatments and build rapport with clients. 

This initial engagement is further fuelled by the opportunity to apply newly acquired skills in real-world scenarios where their training can be put into practice, Kerrie says.

Fostering a greater understanding of new graduate physiotherapists’ experiences in the first year in private practice can help identify factors that could address workforce retention and attrition, says Kerrie. 

One of the factors explored in the Evans et al (2022) paper centres on job satisfaction— a key driver for many new graduates— which is underpinned by mentoring and peer support, autonomy, opportunity for career progression, work-life balance and workplace flexibility. 

Kerrie says the new graduates interviewed in the study reported having high levels of job satisfaction.

However, despite that high satisfaction, there was a concerning trend towards burnout, which began to manifest as new graduates navigated the realities of private practice.

Kerrie says the demands associated with managing a full case load, meeting productivity expectations and adjusting to the business administration aspects of physiotherapy can be overwhelming for many new graduates. 

The steep learning curve coupled with limited clinical experience often leaves new graduates feeling overburdened and underprepared, which may lead to stress, fatigue and, eventually, burnout if not addressed.

‘No matter how hard you try to teach about the administrative side of practising at uni, no matter how hard you try to set that up for them at the beginning of the interview or even the first couple of weeks of practice, you don’t get it until you get it,’ Kerrie says. 

‘I think the burden of admin, the diagnostic uncertainty and that pressure of giving of yourself—but not so much that you end up being burned out—that’s hard.’

The paper highlights the fact that the shift from academic learning to working in a fast-paced private practice setting can be a significant source of stress. 

New graduates are expected to perform at a high standard while also continuing to learn and develop their skills, often with minimal supervision. 

The pressure to do well—along with the emotional demands of patient care—can make it difficult for them to maintain a healthy work-life balance. 

As a result, while new graduates may start their careers with high levels of engagement, the risk of burnout remains a critical issue that requires targeted interventions.

High engagement and satisfaction despite burnout risk 

The Evans et al (2022) study found that new graduate physiotherapists were highly engaged and satisfied throughout the year. 

At each evaluation point—three, six and 12 months—participants in the study reported enjoying their work, feeling a sense of fulfilment from positive patient outcomes and gaining confidence in their clinical skills. 

This enjoyment was supported by positive interactions with patients, with some graduates noting the satisfaction they felt when patients referred friends and family or returned for additional treatment.

However, despite high levels of satisfaction, reports suggesting burnout began to emerge by the nine-month mark, the study showed. 

Burnout was characterised as being at a ‘moderate level’ by the end of the year, with participants citing fatigue, administrative burden and challenging patient cases as contributing factors. 

There was a noted decrease in engagement and satisfaction scores at 12 months compared to earlier in the year, suggesting a potential onset of burnout, Kerrie says.

Resilience matters

The Evans et al (2022) study explored whether traits such as resilience, grit and mindset could influence engagement, satisfaction and burnout. 

Of these traits, resilience showed a significant positive relationship with job satisfaction at six- and 12-month intervals. 

Kerrie says this finding indicates that the ability to bounce back from adversity is associated with greater satisfaction, even in the face of increasing work demands.

Interestingly, there was no significant correlation between these traits and burnout or clinical performance, suggesting that while resilience can enhance job satisfaction, it does not necessarily shield against burnout. 

This finding highlights the need for targeted strategies beyond fostering resilience to address burnout risks.

In the study by Chipchase et al (2022), the authors describe grit as a combination of passion and perseverance towards long-term goals that influences job satisfaction and engagement in various professional settings. 

Grit has been found to reduce burnout risk in healthcare professions by fostering a determination to overcome challenges—a crucial trait for new graduate physiotherapists navigating their first year in private practice. 

Kerrie Evans from Healthia.

Those with higher levels of grit are better equipped to persist through the demands of a busy workload and administrative tasks, showing resilience and consistency in maintaining high performance levels throughout the year.

The paper uses Carol Dweck’s framework to categorise mindset, describing it as ‘a belief in the malleability of one’s abilities and
talents’ (Dweck et al 1995). 

A growth mindset, which reflects the perception that abilities can develop through effort, was associated with better adaptation to the complex demands of clinical practice. 

New graduates with a growth mindset were more likely to engage actively in problem-solving and to view setbacks as opportunities for learning rather than reflections of fixed capabilities. 

This approach aligns with higher engagement and job satisfaction, potentially mitigating burnout as individuals adapt to the evolving complexities of their roles, Kerrie says.

Several themes emerged in the Evans et al (2022) study in relation to the difficulties faced by new graduates, including increasing workload and complexity of patient cases, self-doubt and uncertainty and burnout as a ‘perceived norm’.

Kerrie says the administrative demands and complexities of some cases were greater than many participants expected. 

As the year of the study progressed, the graduates were responsible for more patients, which also led to an increase in administrative tasks such as paperwork and communication with third parties.

The study showed that the transition to practice involved ongoing self-reflection in which graduates questioned their clinical decisions, particularly when patients did not respond to treatment as expected. 

This self-doubt persisted despite growing confidence in other areas.

Shoring up the support

Getting new graduate physiotherapists off on the right foot is crucial to their longevity and success in the profession. 

Kerrie, whose role at Healthia bridges academia and clinical practice, says building support and scaffolding around new graduates at the earliest stage of the career journey was one of the key findings of the Evans et al (2022) study. 

At Healthia, there are currently more than 150 new graduates across the allied health disciplines, meaning that work needed to be done to retain these new graduates during their early career and beyond.

‘I am always a bit surprised when senior clinicians and employers aren’t aware of the level of support they need to provide to new and recent grads. 

'It’s not because they don’t want to—for some it’s just been a while since they have either employed a new grad or had a fourth year on placement,’ Kerrie says. 

‘So part of the purpose of the study was to highlight how we can all do a better job of supporting new grads and their transition to becoming proud and effective autonomous professionals.

‘Part of it is looking at the journey and trying to help them understand that the first year of practice is literally that—just the first year of practice. 

'Enjoy it, embrace it, but you’re not going to be the Wallabies physio at the end of that first year. There’s still a lot to learn and it’s a marathon, not a sprint.

‘Whether it’s peer-to-peer mentoring or mentoring by a more senior clinician or a boss, support is critical. 

'We have a recent graduate coordinator, Emily Hodkinson, whose role is dedicated to supporting recent grads. 

'She’s a clinician by background and she’s also somebody that a new grad can go to if they’re not comfortable talking about what’s happening in their own clinic. That role has been really important,’ Kerrie says.

Completing the circle

Both studies highlighted the complex and evolving nature of new graduates’ experiences in private physiotherapy practice. 

While the first year is marked by high engagement and satisfaction, it is also a period where burnout risks emerge. 

Strategies to manage workload, promote resilience and provide structured support can help mitigate burnout and enhance job satisfaction, ultimately supporting new graduates’ transition into the workforce, Kerrie says.

By addressing these factors, employers and educational institutions can create environments that foster professional growth and sustainable career development for new physiotherapists, helping to ensure a resilient and satisfied workforce.

Staying strong in the first year

To mitigate burnout and sustained engagement, participants from the studies (Evans et al 2022, Chipchase et al 2022) recommended several key strategies to help new graduate physiotherapists through their first year in private practice.

Work-life balance

Planning regular breaks, scheduling leave and ensuring sufficient time to adapt to full-time work (eg, longer appointment times initially) were emphasised as ways to reduce stress and avoid burnout. Graduates suggested implementing changes in rosters to allow for more breathing room during busy periods.

Self-care practices

Maintaining good sleep hygiene, exercising regularly and pursuing hobbies were highlighted as essential self-care practices to help manage the physical and emotional demands of the job.

Perseverance and resilience training

The importance of persevering through challenging days and recognising that successes and difficulties are part of the learning process was a recurring theme. Some graduates found value in resilience training to help them cope with the ups and downs of clinical work.

Implications for practice 

The findings of the studies by Evans et al 2022 and Chipchase et al 2022 underscore the shared responsibility between educational institutions and employers to better prepare graduates for the realities of private practice. 

Recommendations include:

Enhanced training programs: Universities could consider incorporating more training that focuses on the business aspects of private practice, such as managing administrative workload and understanding the complexities of fee-for-service models.

Structured mentoring and support: Private practices can benefit from establishing formal mentoring programs that provide new graduates with guidance on clinical and administrative tasks. This mentorship can help bridge the gap between academic learning and real-world practice.

Careful/considered diary management: Allowing new graduates some flexibility in scheduling, such as longer appointment times, can alleviate pressure while they adjust to full-time practice. Practices could also consider dedicating time for administrative duties to reduce the risk of burnout.

Regular monitoring of burnout symptoms: Practices should regularly assess burnout levels among new graduates, with attention to workload, administrative burden and patient case complexity. Early identification of burnout symptoms can lead to timely interventions, which can improve retention and job satisfaction.

Read the full studies here and here. 

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