Can We Use AI Technology to Decrease Physical Therapy Burnout by Jamie Smith

        Physical Therapy is a growing profession. Yet why is physical therapy experiencing such a large percentage of burnout? About half of the physical therapists reported experiencing burnout found multiple studies, especially those who have been in the profession over 10 years.2,4 In my opinion we spend more time with our patients than any other provider. We listen to their burdens, their hardships, and also get to celebrate with them in their success. If we let it, burnout builds a wall between us and our patients affecting our compassion and ability to form these connections that affect patient outcomes. AI technology is one way we can combat burnout within our profession allowing us to be more productive providers. Documentation is a job stress that is required, but when physical therapists are staying late to finish documentation unpaid or feel like they aren’t able to provide the patient care they want because they are too focused on documenting it leads to burnout. Why wouldn’t we want to utilize a technology meant to make our lives easier leading to less burnout, less time documenting, better patient care, and a better work life balance?

There have been numerous studies conducted over burnout and what may be causing this within our profession. One study published in 2021 stated burnout has 3 characteristics: emotional exhaustion, depersonalization of care, and low personal accomplishment.2 These symptoms can arise when a person experiences job stress that isn’t adequately balanced with job resources.4 The researchers of the study applied the self determination theory model in order to see how it affects the results of burnout.4 The theory is comprised of autonomy, competence, and relatedness.4 I mainly want to focus on competence which is the ability to do something successfully.4 When a provider starts to feel less competent or overwhelmed with their job demands it can lead to emotional exhaustion as a coping mechanism.4 The provider may build a cognitive and emotional wall between themselves and their work to try and combat emotional exhaustion.4 This can hurt our patients care since patient outcomes are tied to the ability to form relationships with our patients and appear confident in our abilities.

Another study published in 2021 found that job stress impacts PT and OT emotional and physical well being leading to 58% of the PTs and OTs in the study to report high levels of burnout.4 Job stress is institutional demands that are not balanced with job resources which can lead to feelings of being overwhelemed.4 The job stress can be high productivity rates that companies place on their physical therapists, seeing two to even three patients at the same time. Documentation is a necessary component of this profession, but when given inadequate time to complete the documentation is when physical therapists can start to resent it. On average, a standard initial evaluation can take 20-30 minutes to document and overall documentation can take 20-30% of your day.1 Over a standard 8 hour day that is 1.5-2.5 hours out of your day on top of direct patient care hours. The study found that job demands are positively correlated with burnout and that burnout stems from job demands that are inadequately balanced with job resources.4

How can AI technology help us combat burnout? One way is by cutting down documentation times. AI is all around us now and being used in so many ways. We as a profession don’t want to be left behind. For example, Comprehend PT, is a company that has produced an AI tool to help specifically with physical therapy documentation.6 The product listens during the initial evaluation and creates a subjective, objective, assessment, plan, and goals based off of the conversation it hears while remaining HIPPA compliant.6 The company claims their tool can save physical therapists up to 40 hours in documentation time each month.6 Now this is not the only AI tool on the market and I am also not endorsing this product, but merely pointing out the amount of saved time could be the difference between feeling burnt out or providing exceptional patient care. 

One concern with this documentation style is that it would take out any clinical reasoning skills and make assessments and plans that aren’t individualized to our patients. We would be letting the AI documentation template guide our clinical reasoning instead of utilizing evidence based practice, clinical experience, and patient preference. Of course, you could go in and edit what AI generated for the note, but it could facilitate lazy PT documentation and practice. Another con is that it costs money. If your company doesn’t want to pay for it, this specific program costs 100 dollars a month coming directly out of pocket.6 My next concern would this be considered best practice? Would signing your name to something that was AI generated sit well with you? 

I also looked into other ways AI technology can help a physical therapist feel more competent and save time within their profession. I looked into AI that could help providers with differential diagnosis for MSK pain, and while I couldn’t find many specifically for physical therapists, ChatGPT kept appearing as an option. You can type in the symptoms and it will generate a possible list of diagnosis and it can also develop exercises that target a specific muscle group.3 I would be weary personally to jump to ChatGPT for differential diagnosis before consulting other resources or other physical therapists. Another way to use ChatGPT is to save time in regards to evidence based practice. You can upload research papers and then type questions into the search engine saving time reading articles.3 

You may be wondering is this ethical or is this best practice. The APTA has released a statement regarding digital health technology and therapeutic products including artificial intelligence.5 Their digital health technology also refers to telehealth, mobile heath apps, virtual reality, and sensor technology.5 They encourage physical therapists to keep up with the ever changing technology landscape and to use it in a way that works best for both the patient and provider.5 They have a whole section regarding ethics and safety, current clinical uses, and regulations. The AI healthcare technology falls under the same regulation oversight as other treatments, such as HIPPA, and is to be used to optimize patient care and outcomes.5 They have a statement that the technology should not be used to replace physical therapists but used as tools to support and further the profession.5

I think the physical therapy profession could use AI responsibly within their work in order to combat burnout and provide better patient care and outcomes. This could be a solution if your institution has high productivity demands and you are left documenting outside of your paid hours leading to burnout. I would just caution you to not let a computer guide your clinical practice. Don’t let it turn you into a provider who doesn’t provide individualized care. We want AI technology to make our life easier, but not at the sacrifice to patient care. If you don’t feel inspired or feel like you don’t have enough time to keep up to date with evidence based practice, AI could help synthesize research articles or utilization of any of the other digital health technology listed in the APTA Digital statement paper could inspire your current practice. Don’t let AI technology replace all the critical thinking and skills we work years to develop. 

References

1. Fraticelli T. Physical therapists: Cut your PT documentation time in Half. PTProgress. November 3, 2021. Accessed November 18, 2023. https://www.ptprogress.com/physical-therapists-documentation-primer-method/#:~:text=As%20a%20PT%20myself%2C%20I,of%20your%20workday%20typing%20notes. 

2.Link K, Kupczynski L, Panesar-Aguilar S. Correlational study on physical therapy and Burnout. 2021. Accessed November 18, 2023. https://www.apta.org/contentassets/3f6e82c0f4ab4b8baff58921b682174e/kristilinkresearchpaper.pdf. 

3. Marr B. Revolutionizing Healthcare: The top 14 uses of CHATGPT in medicine and Wellness. Forbes. September 12, 2023. Accessed November 18, 2023. https://www.forbes.com/sites/bernardmarr/2023/03/02/revolutionizing-healthcare-the-top-14-uses-of-chatgpt-in-medicine-and-wellness/?sh=3a2527306e54. 

4. Patel RM, Bartholomew J. Impact of Job Resources and Job Demands on Burnout among Physical                   Therapy Providers. Int J Environ Res Public Health. 2021;18(23):12521. Published 2021 Nov 28. doi:10.3390/ijerph182312521

5. The digitally enabled physical therapist: An apta foundational paper. November 2022. Accessed November 18, 2023. https://www.apta.org/contentassets/e37aa1765cab4b1791d22717d3ac20af/apta-digital-health-foundational-paper-2022.pdf. 

6. We help clinicians prioritize patients not documentation. Comprehend PT. Accessed November 18, 2023. https://www.comprehendpt.ai/index.html.