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Abstract

Background:

Burnout disproportionately affects professionals who spend much of their time in direct patient care. The physical and emotional demands of pelvic floor therapists, coupled with identity-based stressors, may place Black women pelvic floor therapists at an increased risk for experiencing burnout.

Objective:

The purpose of this study was to explore the experiences of burnout among Black women pelvic floor therapists in the United States.

Design:

This is a short-form qualitative study with data collected from an online survey.

Methods:

We recruited Black women pelvic floor therapists from November 2023 to February 2024 to complete an online survey comprised of open-ended questions about their experiences of burnout. The coding team analyzed the short-form qualitative data using inductive structural tabular thematic analysis.

Results:

Of the 59 participants in the total sample, 37 reported experiencing professional burnout. Main themes were: (1) contributors to burnout, (2) signs of burnout, and (3) consequences of burnout. Notably, contributors to burnout were predominantly structural and included workplace factors, such as unrealistic productivity standards and experiences of discrimination and microaggressions. Signs of burnout were primarily emotional. Consequences of burnout included leaving the current work setting, a strong desire to transition to a different setting, or taking a break from the profession overall.

Conclusion:

This study revealed that it is not only the intensity of Black women pelvic floor therapists’ workload but also the nature of their tasks and the contexts within which they operate that contribute to burnout.

Plain language summary

Why is this study important?

Pelvic floor therapy (PFT) is an increasingly popular medical treatment for genito-pelvic pain/penetration disorder (GPPPD). Black women pelvic floor therapists’ are at a high risk of experiencing professional burnout due to the limited number of PFTs in general and the desire for Black women patients to have Black doctors. The current study sought to understand Black pelvic floor therapists’ experiences of burnout.

What did the researchers do?

The research team surveyed Black women pelvic floor therapists and anticipated that these women would report burnout from the demands of their jobs, being overworked, and experiencing gendered racism within their workplaces.

What did the researchers find?

Out of a total of 59 Black women PFTs, 37 reported professional burnout. The main sources of burnout for participants were structural issues within the workplace, such as inadequate time for administrative duties, limited support for patients, unrealistic workloads and productivity standards, and workplace discrimination. Burnout manifested for participants through a lack of motivation and passion towards their work, emotional disengagement, and fatigue. As a result, some participants left their jobs or experienced health issues. Healthcare fields should consider ways to promote wellness and work–life balance, especially for Black women with physically and emotionally demanding roles.

Keywords

pelvic floor therapy Black women burnout physical therapy workplace

Introduction

Professional burnout is a psychological syndrome in response to chronic stressors on a job. Potential outcomes of professional burnout include “overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment” (p. 103).¹ Professional burnout can result from poorly organized or managed work environments that cause exhaustion and consume workers’ psychological resources. The multidimensional theory asserts that burnout has three components: emotional exhaustion (individual level), depersonalization (interpersonal level), and reduced personal accomplishment (self-evaluation).² Emotional exhaustion refers to feeling emotionally overextended and depleted of one’s emotional resources due to workload or personal conflict at work. When workers feel emotional exhaustion, they often feel drained, with minimal sources of replenishment and a lack of energy to assist someone in need. Depersonalization refers to the negative, cynical, and detached response to others. Depersonalization is a protective strategy used to cope with emotional exhaustion that, if prolonged, can lead to dehumanization—especially among those in people-orientated professions.³ The third and final component of burnout is reduced personal accomplishment, which refers to a decline in feelings of competence and productivity at work. Reduced personal accomplishment can result in a lowered sense of self-efficacy related to one’s job and contribute to depression and an inability to cope with the demands of the job. Workers may feel like failures without adequate social support and professional development opportunities.

Burnout disproportionately affects professionals who spend considerable time in direct patient care.⁴ Specifically, healthcare professionals are more likely to experience frenetic burnout than people not in helping professions.⁵ Frenetic burnout results from working in environments overloaded with intense duties and workloads.⁵ In these environments, workers tend to show greater dedication to work, high involvement, and participate in active problem-solving by working numerous hours. Frenetic burnout is associated with high levels of exhaustion when active problem-solving is the only coping strategy, which does not always lead to solutions. Problem-solving includes working overtime and involvement in numerous tasks.⁶ As a result, professionals may abandon their personal lives, ignore their health, and fail to maintain work–life balance or boundaries.

A 2002 study found that 58% of physical and occupational therapists experienced high levels of burnout due to the physical and emotional demands of the profession.⁷ Physical therapists often encounter physically demanding challenges throughout their workday. Additionally, they are at risk of experiencing compassion fatigue (reduced capacity for empathy toward patients) because they are likely to have patients who are seeking treatment because of trauma, which requires additional emotional resources from the physical therapist.^8,9

Physical therapists may also experience a “burnout bump.” This phenomenon can occur between the first and second year after physical therapy (PT) school when professionals are excited to support patients, but have inadequate work–life balance or underdeveloped self-care strategies and boundaries.¹⁰ Similarly, younger physical therapists and those with fewer years of experience are more likely to experience burnout due to simultaneous experiences of education-related burnout when first entering the field.^11,12 Importantly, the setting in which physical therapists work influences their likelihood of experiencing burnout. For example, physical therapists in private practice often have greater freedom and autonomy, which may result in less emotional exhaustion and a lower risk of burnout.¹³ Despite high rates of burnout among physical therapists, a recent systematic review found that only 12 quantitative studies in the United States have focused on physical therapists’ burnout.¹² However, none of these studies focused specifically on the experiences of pelvic floor therapists.

Pelvic floor therapy

One in three women living in the United States suffers from a pelvic floor disorder every year.¹⁰ Pelvic floor disorders are often treated with pelvic floor therapy. Occupational and physical therapists can practice pelvic floor therapy; therefore, throughout this section, we will use the term pelvic floor therapy/therapists to encompass people of various professional training backgrounds. Over the last 5 years, online searches for “pelvic floor therapy” increased by 56%.¹⁰ During the COVID-19 pandemic, pelvic floor therapists used social media platforms like Instagram and TikTok to make medically accurate information about pelvic health, pelvic floor dysfunction, and sexual pain disorders accessible.

Additionally, every major online news outlet covering women’s health published at least one article on pelvic floor health in 2023, which increased awareness and desire to seek treatment from pelvic floor therapists.¹⁰ Since there are fewer than 10,000 pelvic floor therapists in the United States, the increased awareness of pelvic floor therapy heightens their risk of burnout by increasing their caseload. Additionally, only 4.2% of all physical therapists in the United States are Black. Although the number of members of color in the American Physical Therapy Association Pelvic Health directory¹⁰ increased to 27%, compared to 22% in 2018, there are no published data on how many members are Black. Black pelvic floor therapists may be in higher demand due to the desire for racial and gender concordance among Black women patients¹⁴ in addition to the overall pelvic floor therapy shortage. Therefore, it is important to investigate and understand the experiences of burnout among Black women pelvic floor therapists to assist them in avoiding burnout and providing quality care to their patients. Accordingly, this study explored experiences of burnout among certified Black women pelvic floor therapists in the United States.

Methods

Participants and data collection

The goal of the IRB-approved (#90138) parent study was to examine the experiences, needs, and perspectives of Black women’s pelvic floor therapists and the perceived barriers to Black women accessing pelvic floor therapy. COREQ guidelines¹⁵ informed the preparation of this study, which is a follow-up to the first author’s Pain and Pleasure Study. The Pain and Pleasure Study explored Black women’s experiences of sexual pain, pleasure, and anxiety. Within this study, only two participants reported receiving a referral to a pelvic floor therapist for their Genito-pelvic pain/penetration disorder (GPPPD; persistent and/or recurrent pain with intercourse and/or penetration) symptomology. This finding informed the primary investigator’s interest in the perspectives of Black women pelvic floor therapists and their perceived barriers to Black women’s referral and treatment. Initially, the study only included participants who (1) identified as cisgender Black women, (2) were certified and currently practicing as a pelvic floor therapist in the United States, and (3) provided treatment for GPPPD. Due to low numbers and multiple inquiries from occupational therapists who practice pelvic floor therapy, the primary investigator expanded the study after two months of data collection to include certified occupational therapists, pelvic floor practitioners, and physical therapists.

The research team recruited participants from November 2023 to February 2024 using purposive and snowball sampling through social media, email, and LinkedIn postings and messages. The study coordinator sent four emails to Black pelvic floor therapists in the Women of Color Pelvic Floor Physical Therapy directory.¹⁶ The survey link was not included on the posts/flyers to prevent data from bots and spammers. Participants contacted the primary investigator (first author) or other research team members for a link to the survey.

Participants completed an online Qualtrics survey using the provided link. Upon meeting the eligibility criteria, participants viewed an informed consent form and checked whether or not they consented to participate in the study. Once they consented to participate, they accessed the full survey. Participants completed a series of open-ended questions about their pelvic floor therapy training, experiences working with Black women patients, perceived barriers to Black women seeking pelvic floor therapy, their perceived sexuality-related training needs, and experiences of burnout. A total of 59 pelvic floor therapists completed the study. Participants had the option to include their email at the end of the survey if they wanted a $20 Amazon gift card.

Participants received three open-ended questions about burnout; however, we only used one for this article. First, participants were asked, “Have you ever experienced burnout?.” Participants who responded “yes” (n = 37) or “I’m not sure” (n = 4) received the following prompt, “Tell a time that you experienced burnout. Tell it like a story.” A total of n = 37 participants answered this open-ended question. Participants were between the ages of 23–53, with an average age of 35. Participants practiced pelvic floor therapy for 1–30 years, with an average of 9 years. For more details on the participant demographics, see Table 1. For a detailed list of the participants’ specialties, see Supplemental Document 1.

Table 1.

Participant descriptives (n = 41).

Descriptives	M ± SD (range) or N (%)
Age	34.9 ± 6.51 (25–53)
Ethnicity
African American	28 (78.3)
Caribbean	7 (17.1)
African	2 (4.9)
Biracial	2 (4.9)
Latina	1 (2.4)
Multiethnic	1 (2.4)
Years of practice	9.33 ± 6.65 (1–30)
Work setting
Private practice	15 (36.5)
Women’s health practice	14 (34.1)
Orthopedic outpatient	10 (24.4)
Home health	6 (14.6)
Telehealth	5 (12.2)
University medical center	4 (9.8)
Acute care	2 (4.9)
Pediatrics	1 (2.4)
Other	3 (7.3)
Location of practice
Alabama	1 (2.4)
California	1 (2.4)
Washington, DC/DMV Area	2 (5.9)
Florida	4 (9.8)
Georgia	2 (5.9)
Illinois	1 (2.4)
Kentucky	1 (2.4)
Maryland	6 (14.6)
Michigan	1 (2.4)
New Jersey	1 (2.4)
North Carolina	1 (2.4)
Pennsylvania	3 (7.3)
Texas	3 (7.3)
Virginia	1 (2.4)
Accepts insurance	25 (61)
Accepts sliding scale payments	3 (7.3)

Participants could choose multiple work settings; therefore, the percentages will not equal 100%. Only n = 16 participants reported working in one setting. This table represents the demographics of the total number of participants who reported that they experienced burnout or were unsure if they experienced burnout. A total of 37 of these participants answered the open-ended question.

Data analysis

The coding team used inductive structural tabular thematic analysis (ST-TA) to analyze these data.¹⁶ Robinson developed ST-TA in 2021 to provide “an adaptable technique for working with brief qualitative data in a relatively structured way” (p. 194).¹⁷ ST-TA requires using spreadsheet software to analyze brief texts. The coding team used Microsoft Excel and followed the steps created by Robinson for inductive ST-TA. First, the first and second authors (coding team) immersed themselves deeply in the data by reading transcripts related to the participants’ burnout experiences. The coding team read the data at least twice during this process and took initial notes for potential codes. Second, the coding team generated initial codes and themes. Next, the coding team attached data segments to themes in a tabulated form to check agreement and calculate frequency. The coding team kept a log of all themes and theme name changes, and discussed discrepancies via comments to finalize and develop a clear set of themes and subthemes. We removed any mention of coping strategies (n = 5) as participants received a separate question specifically about their coping strategies, which informs another article.

Next, the coding team calculated the theme and subtheme frequencies. These frequencies showed how salient certain themes were across the sample and increased the transparency and trustworthiness of the analysis.¹⁸ The frequency of each theme showed the prevalence of the theme. Next, the coding team created a figure representing each theme, subtheme, and the relationships between them (see Figure 1).^17,19 Dissemination through articles and reports was the final step. The “Results” section integrates the frequencies provided by the ST-TA and representative quotes for each theme since many participants included a paragraph-length response.

Figure 1.

Themes of Burnout for Black Women Pelvic Floor Therapists.

Results

ST-TA resulted in three themes capturing participants’ experiences of burnout (see Figure 1): contributors to burnout, signs of burnout, and consequences of burnout. Most participants endorsed more than one component of each theme.

Contributors to burnout

Unsupportive work environment

Being in an unsupportive work environment contributed to participants’ burnout. These environments included having an unsupportive supervisor and working in the corporate or public sector. Working in unsupportive environments and lack of support often led to participants feeling “significant dissatisfaction” for various reasons. Three participants reported wishing their manager cared about them as individuals and showed interest in supporting their professional development activities outside of work. For example, one participant stated, “My management not providing support or caring/asking how I’m doing outside of the clinic. This made me want to open my own private PFPT practice for women.” The lack of managerial interest in this participant’s whole personhood and well-being led her to open a private practice. Two other participants shared that their managers often overlooked and failed to celebrate professional development opportunities because they were unrelated to their day-to-day work and numbers. One participant felt unsupported when “trying to work on other projects outside of work like research articles and volunteering with APTA [American Physical Therapy Association].” Similarly, another participant reported that her full-time job accused her of being burned out due to her volunteer position and denied that it resulted from the toxic and unsupportive work environment.

I experienced burnout at my previous job after starting their pelvic floor therapy program. It took me several years to get approval to create the program, and then was informed that all my education and training would have to occur at my own expense. Despite the lack of support, I was able to create a service line that quickly grew from a few patients to requiring additional clinicians, requests from other hospitals in creating their own programs, interdisciplinary training, and requests from MDs, even as far as being the negotiating factor in wooing a star urogyn [Urogynecologist] fellow to our hospital. All this while still managing my regular ortho [Orthopedic] case load, senior therapist administrative responsibilities, and mentoring others . . . When I finally submitted my resignation, I agreed to stay for 6–8 weeks beyond what was required, found and trained my own replacement, convinced my colleague to come on part time to help train others in my absence and began the groundwork for a formal entry level pelvic therapy program for new graduates or new to pelvic PT practitioners. My departure was riddled with accusations of “burnout” from a volunteer position I occasionally did during my time off . . .

Eight participants reported that working in corporate or public settings increased their stress and led to unrealistic caseload expectations because they lacked control over their schedules. Participants who worked in outpatient facilities, corporate-based companies, and acute care settings were more likely to cite their work setting as a contributor to burnout. However, two participants experienced burnout after starting a private practice due to the risk of financial strain if they did not have a steady stream of patients:

There is overall burnout due to the economy. But I opened a clinic with another therapist but there was a lot up against us in terms of overhead and scheduling. It led to burnout. It was also during covid times. So that didn’t help. Many people didn’t want to come to therapy. So, we closed the clinic.

When I was in private practice for myself, I was exhausted with cancelations and the never ending need to find new patients.

Unrealistic performance standards

Six participants reported facing unrealistic performance standards, including the expectation to maintain large caseloads and manage administrative stress. Two participants experienced the previously mentioned “burnout bump” because it was their first job. These unrealistic performance standards were typically imposed on participants not in private practice settings. For example, participants described being “double and triple booked,” seeing “3-5 patients every hour,” and working “four 10 hour days for two years straight.” One participant reported that she was the only pelvic floor therapist in her office and had to manage their 6-week waitlist on her own. One participant stated, “I would frequently be reprimanded by management for not maintaining their required productivity quota because I did not double or triple book pelvic or orthopedic patients.”

Other participants highlighted how the expectation of managing large caseloads often made them feel undervalued: “I worked at an orthopedic outpatient facility where all that matters are your numbers and feeling as though my worth is only based on those numbers; not feeling like a valued member of the team.” Additionally, one participant mentioned that a lack of respect for the field of pelvic floor therapy contributed to unrealistic productivity standards, which ultimately affected patient care: “Our profession is not respected, and we are forced to adopt certain productivity standards that limit our ability to offer the best work we believe our patients deserve.”

Along with large caseloads, administrative stress was the most frequently reported cause of burnout among participants. Participants often felt they did not have enough time to complete their patient documentation, leading them to skip breaks, work overtime, or feel they had “no mental capacity to do paperwork.” Insurance requirements also contributed to administrative stress: “The expectations were very high for complete of not only daily documentation but also insurance-related paperwork.” However, when administrative staff were underqualified, participants had to bear the additional burden of training them. For example, one participant stated, “I was finally assigned a marketing liaison, but she had no idea what I did and would often leave me to create all publications, schedule meetings, and be in service with physicians.” A participant provided a meaningful summary of this theme in closing stating,

In short, burnout occurs when our profession is not respected, and we are forced to adopt certain productivity standards that limit our ability to offer the best work we believe our patients deserve. We can experience burnout from trying to give the best of our professional expertise but can be faced with so much red tape and barriers to offering the level of care we believe people deserve.

Complex patients and compassion fatigue

Although participants appreciated having consistent, new, and returning patients, the nature of medical diagnoses and presenting medical complaints often increased their risk of burnout through compassion fatigue. For example, a participant said, “I was seeing a 90% show rate for patients, but most of them were complex.” Here, complexity refers to the nature of a patient’s symptoms, diagnosis, or interactions. Multiple participants found that certain presenting concerns contributed to some participants’ burnout. For example, a participant stated that “most patients at this time [i.e. time of burnout] were chronic pain or pelvic pain (vaginismus, dyspareunia).” Participants also shared that having high rapport and trust with patients added to the complexity patient of interactions. For three participants, rapport and trust led patients to confide in them for reasons unrelated to their treatment, often sharing “heavy” topics. The emotional burden made the participants feel like they were “carrying the baggage” of their patients. One participant highlighted how her rapport with a patient made the patient more open to expressing concerns:

It’s very easy to become burnt out in the pelvic floor setting. We have to act as the patient’s physical therapist, counselor, and even primary care providers as the patients moving sale often tell us stuff that they don’t tell their MDs. It can be very overwhelming.

Two participants experienced compassion fatigue through secondary trauma as a result of their patients’ traumatic experiences, including various types of abuse and life challenges that their patients experienced:

I have a patient that was sexually assaulted, emotionally and physically abused, and very depressed. I was not ready to receive all the information she gave me and when I went to ask for help from a lead PFPT in my facility, I was told to move on. I feel like I need to be more vulnerable with patients to show I care but at the same time, leave my feelings and these stories at work to both fuel my drive to continue to be a caring therapist, but also decrease my burnout.

She complained a lot about her pain and how none of her other providers would listen to her; sometimes, it was very mentally taxing, listening to her complain. The patient shared with me that her and her two special needs daughters have been homeless for the past year. I tried to continue the session as normal, however, that information weighed so heavily on me that it brought tears. I had to take a break before my next patient. The entire rest of the day I racked my mind for how I could help this poor woman. I felt so insignificant as her pelvic floor provider while she was going through these large obstacles. She was always positive and so thankful for my help with her pelvic floor dysfunction. I always remind myself that I do my best and I am providing great care to these patients, but I cannot carry every burden on my shoulders.

Discrimination

Four participants reported experiencing microaggressions, racism, and discrimination in their work environments.

I experienced extreme racial discrimination at my previous place of employment. I was attacked by a colleague. She was not fired or punished. I was prevented from clinical and academic promotion. I was “blackballed” from important meetings and discussions as a director. It broke me and my spirit. I am a different person because of it. I do not trust systems or white people, really.

One participant reported how microaggressions impacted her physical health. Another participant explained that when she tried to find a balance in her workday by blocking off time to do her administrative duties, she was labeled as “lazy and demanding.”

Another participant reported experiencing financial discrimination,

Upon inquiry, I also discovered that my pelvic caseload was bringing in significantly more money than the rest of our diagnoses . . . I was the most credentialed senior therapist in their department and was being paid at least $5–8 less an hour than a male white counterpart with less experience.

Life stressors and lack of work–life balance

Five participants reported how life stressors and a lack of work–life balance contributed to their burnout. One participant identified “personal challenges surrounding grief” as a key life stressor that contributed to her burnout. Another participant noticed burnout following motherhood:

I started to feel burnout when I tried to be a mom of two and work full time. I felt I always had to choose between my family and work. I always felt guilty taking vacations and calling in sick because I didn’t have anyone to cover me when I was not in the clinic.

Two participants identified overworking and having a lack of work–life balance as a contributor to their burnout. One participant said, “I feel burnt out with scheduling and giving all my energy to my patients and leaving very little for myself and my husband.” Another participant described how, despite the overwhelming success of her career, she struggled to maintain a healthy work–life balance, especially after her husband became ill:

My business was taking off with more patients than I had ever had, my family was needing so much of my time and energy, and I was doing all the tasks related to my business on my own . . . After my husband was hospitalized with a nasty infection, I completely broke. It felt like I could not get out from under any task. Every call became a mental workout. Every patient was more difficult to engage with. I had to call in backup and ask for help.

Signs of burnout

Participants reported three major signs of burnout: emotional health symptoms (n = 37), physical health symptoms (n = 5), and mental health symptoms (n = 3). Many participants experienced one or more of these symptoms simultaneously. Since these symptoms did not occur in isolation, some quotes contain two or more categories of symptoms.

Emotional health symptoms

More than half of the participants reported emotional signs of burnout, and several reported more than one emotional symptom. For example, one participant said unrealistic work standards “led to significant dissatisfaction and feelings of despair at times due to feeling unsupported and overwhelmed.”

Emotional disengagement and detachment were the most common emotional health symptoms (n = 13); “I felt detached from the workplace. I didn’t care as much”), One participant’s feelings of disengagement from work ultimately led to the depersonalization of her patient: “I was unable to express empathy to my patient regarding their pelvic pain and found myself getting frustrated. I had to walk outside of the treatment room to collect myself.” One participant learned about this sign of burnout from a supervisor: “My supervisor said during a meeting that burnout was related to when people lost the passion for their work. I quit several months later.” For some participants, work becoming unenjoyable accompanied a loss of motivation and/or passion for some participants: “I was totally unmotivated to see patients or better myself.” Additionally, although one participant had been passionate about her work at one point, she acknowledged her disengagement because she was overworked, “I was stuck in paralysis as I tried to show up to events, answer the phones, and treat patients.”

The second most common emotional sign of burnout was overwhelm (n = 4; “It feels very overwhelming at times,” “It can be very overwhelming!”). One participant also mentioned the feeling of dread (n = 1; “I would wake up and dread the day ahead, not wanting to get up from under the covers”).

Physical health symptoms

Exhaustion, which can be an emotional and physical health symptom, was reported by five participants. A participant reflected, “Just being asked to write it [burnout] down is exhausting.” Five participants reported physical health symptoms, including “stress-sweat,” and feeling physical “weight” or “baggage.” Four participants reported feelings of fatigue (“I felt irritable and fatigued at the start of each day,” “I had no energy and I felt very fatigued”).

Mental health symptoms

Three participants reported mental health signs of burnout—most notably anxiety. Participants said, “It felt horrible to go to work every day and experience anxiety” and “I developed an anxiety disorder and found myself in counseling and on medication.”

Consequences of burnout

The Consequences of Burnout theme reflected the outcomes participants associated with experiencing workplace burnout. Six participants mentioned leaving or changing their work environment, while three discussed their desire to change their work environment (e.g. “made me want to open my own private PFPT practice for women”). One participant who initially faced a high caseload, minimal administrative time, and unrealistic productivity standards, stated “Once I specialized and transitioned to a different work setting, my enthusiasm skyrocketed.” Another participant shared, “My job was not willing to meet me where I needed despite all I had provided to the role and the facility. I left and started my own practice.” Witnessing others leave motivated one participant to quit her job: “Several others had decided to leave. I didn’t realize how bad it was until I left to open my own practice.” The remaining consequences included a negative change in professional identity—specifically related to goal pursuits (n = 1; “I no longer had the energy to pursue long term goals and tried to stay away from work”)—a forced need for a break (n = 1; “I needed a hiatus. Getting through the day, but looking for the next vacation”), and health issues. Regarding health issues, a participant shared:

I was working too many hours during the week and felt fatigued to the point of passing out at times. I became ill and ended up in the hospital a few times for stress-induced painful conditions. I was diagnosed as pre-diabetic, and many hormones were out of balance.

Another participant said burnout “resulted in her body’s difficulty getting through the day.” Health issues, a forced break, and changing jobs were consequences for one participant who reported,

I ended up taking a leave due to a high-risk pregnancy and, at the time, was unsure if I wanted to continue. After a one-year break, I realized I missed it and found a more nurturing, balanced, supportive environment to align myself with.

Discussion

Burnout among healthcare professionals is associated with poorer quality care and negative workforce outcomes, such as intent to leave the field.^20,21 Certain fields, like pelvic floor therapy, have high levels of burnout among their practitioners. Burnout is exacerbated for practitioners of marginalized groups such as Black women who face more professional discrimination, anti-Blackness, sexism, and exploitation compared to their White counterparts.²² As such, this qualitative study explored 37 Black pelvic floor therapists’ experiences of burnout. Participants reported on contributors to, signs of, and resulting consequences of burnout.

Contributors to burnout were primarily structural and included different workplace factors, such as inadequate time for administrative duties, insufficient support with patients, unrealistic productivity standards, and discrimination in the workplace. These factors are complex to modify at the provider level and highlight the importance of organizational-level interventions to foster a healthy, inclusive workplace and promote work–life balance. These results align with a recent systematic review, which found that nearly a third of avoidable burnout risk factors among physical therapists were structural or organizational, including high workloads, inadequate resources, and lack of support.¹² However, participants in this study also identified discrimination in the workplace as a contributing factor to burnout. This highlights how hostile or unsupportive work environments, shaped by gendered racism, impacted their experiences. These findings mirror a study among Black women healthcare professionals during the double pandemic of COVID-19 and structural racism.²³ In that study, respondents reported feeling unsafe and undervalued due to unfair treatment, expectations of overwork without additional compensation, and pressure to take on additional duties outside of their scope of expertise.

Participants primarily reported emotional signs of burnout, such as exhaustion and feeling overwhelmed. These symptoms suggest a lack of control over their ability to effectively help patients while facing various workplace constraints. Similar to Black women pelvic floor therapists, Black nurse practitioners also identified emotional exhaustion as a component of burnout, which they attributed to experiences of racism and microaggressions, social isolation, and uncompensated labor aimed at advancing health equity.²⁴ Feeling-as-information theory posits that emotions provide information about one’s well-being and can guide behavior.²⁵ When emotions are persistent or recurring, they may signal the need for change in one’s internal or external environment. Therefore, the emotional signs of burnout reported by participants could indicate the need to adopt coping strategies to manage workplace stressors or adjust their working conditions as they can.

Racial and gender concordance between pelvic floor therapists and their patients may be rewarding and beneficial. However, it also poses challenges. Working with complex patients, such as those who have experienced sexual assault or have unmet basic needs, may lead pelvic floor therapists to experience secondary traumatic stress. This stress can add to feelings of defeat and helplessness and may contribute to burnout, especially when therapists are overworked. A study of Black mental health providers found that race-related stress and hours worked per week significantly predicted burnout and secondary traumatic stress.²⁶ Although Black pelvic floor therapists differ from Black mental health providers in the tools and strategies they use, both groups often work with issues related to pain and trauma, making them more susceptible to secondary traumatic stress–especially if they lack training in trauma-informed care. To build resilience, Black pelvic floor therapists may benefit from additional training and support in managing the complexities of working with patients of the same race and/or gender. This recommendation aligns with suggestions for Black mental health providers who experience similar issues.^26,27 Prior research demonstrates that increased resilience can predict lower levels of secondary traumatic stress and burnout among human service professionals.²⁸ As such, future research should focus on organizational and individual strategies to enhance resilience among Black pelvic floor therapists.

The setting where burnout occurred was also important. Several participants mentioned working in acute care or hospital settings when they experienced burnout. In contrast, fewer participants reported burnout in private practice settings. This finding aligns with previous research finding that burnout is less prevalent among physical therapists at-large in private practice,¹³ perhaps due to greater autonomy and control over their caseload and schedule. Additionally, participants in our study mentioned that burnout led them to leave their current work setting, consider transitioning to a different one, or take a break from the profession altogether. Research by Cantu et al. found that higher levels of burnout were associated with a greater likelihood of leaving the organization and that an overemphasis on productivity contributed to professional burnout.²⁹ These consequences harm the individual’s well-being and impact the field by reducing the number of professionals available to work with patients. Therefore, it is crucial for organizations to change their culture to support workforce retention and promote professional well-being.

Limitations

While this study provides novel insight into burnout among Black pelvic floor therapists, it is not without limitations. There are concerns regarding the applicability of these findings to all Black pelvic floor professionals treating GPPPD. Initially, the study only included cisgender Black women currently practicing pelvic floor therapy. While expanding these criteria to include occupational therapists increased study participation, it is questionable how the results apply to both professions despite similar treatment practices. Additionally, it is unclear whether these experiences of burnout extend to Black pelvic floor therapists who discontinued practice or treat other conditions.

Recruitment resulted in 59 completed surveys. It is possible that more Black pelvic floor therapists did not receive word of this study via snowball sampling, particularly if they were not in close community or regional connection with the participants or outreach groups. The Women of Color Pelvic Floor Physical Therapy directory was only recently established. Indeed, representation and support for Black pelvic floor therapists remain low, and potentially limited exposure to this study.

Finally, there are limitations concerning this study’s data collection strategy. The research team used an online survey with open-ended questions to inquire about burnout, among other interests. Several factors potentially influenced the length and depth of participant’s responses (e.g., survey fatigue). Notably, reflecting on burnout while burnt out may have impacted some responses. The selected data analytic strategy was specifically designed to examine short-form qualitative data comprehensively. Nevertheless, findings likely reflect a lack of depth or thick description in some respects that in-depth interviewing could remedy.

Future implications

The findings from this study underscore the urgent need for interventions at both the individual and organizational levels to mitigate burnout among pelvic floor therapists, particularly those who are Black women. Future research should explore comprehensive wellness programs specifically designed to meet the unique challenges Black women pelvic floor therapists face in their work. These programs could encompass strategies for managing emotional fatigue, building resilience, learning healthy coping strategies, and enhancing job satisfaction through mentorship, peer support, and professional development opportunities.³⁰ Most importantly, fundamental organizational reform is needed. Healthcare institutions must reassess and adapt their policies and practices to provide equitable support and resources, diminish workload pressures, and combat gendered-racial discrimination that puts Black women in healthcare at heightened risk for burnout. The introduction of culturally tailored, trauma-informed care training and the promotion of racial concordance, without imposing undue burdens on Black women pelvic floor therapists, along with clear paths for professional growth and personal well-being, are key components for fostering a supportive work environment.

For employers and researchers, assessing staff ratios, creating manageable caseloads, reducing time spent on direct patient hours, and exploring the advantages of an interdisciplinary system could yield valuable insights into optimizing care delivery while safeguarding the well-being of healthcare professionals. The ultimate objective of future work should be to cultivate an environment where Black women pelvic floor therapists can thrive personally and excel professionally without compromising their well-being, thus guaranteeing the highest quality of care for all patients, especially those from marginalized communities.

Conclusion

This study illuminates the multifaceted nature of burnout among Black women pelvic floor therapists, revealing that it is not just the intensity of their workload but also the nature of their tasks and the contexts within which they operate that contribute to burnout. Contributors to burnout also encompass systemic issues such as lack of support, discrimination, and the pressures that come with racial concordance in the pursuit of health equity. Emphasizing burnout as a public health concern, this study calls for immediate action from healthcare institutions, professional societies, and policymakers to mitigate its impact on care quality and these essential healthcare workers’ mental, physical, and emotional well-being. As such, this study advocates for targeted and multi-layered approaches to address individual, organizational, and systemic factors to support the unique experiences of Black women in the healthcare profession.

Supplemental Material

sj-docx-1-whe-10.1177_17455057241300739 – Supplemental material for “It’s easy to be burned out in this line of work”: Experiences of burnout among Black women pelvic floor therapists in the United States

Supplemental material, sj-docx-1-whe-10.1177_17455057241300739 for “It’s easy to be burned out in this line of work”: Experiences of burnout among Black women pelvic floor therapists in the United States by Shemeka Thorpe, Praise Iyiewuare, Brenice Duroseau, Natalie Malone and Kaylee A Palomino in Women’s Health

Supplemental Material

sj-pdf-2-whe-10.1177_17455057241300739 – Supplemental material for “It’s easy to be burned out in this line of work”: Experiences of burnout among Black women pelvic floor therapists in the United States

Supplemental material, sj-pdf-2-whe-10.1177_17455057241300739 for “It’s easy to be burned out in this line of work”: Experiences of burnout among Black women pelvic floor therapists in the United States by Shemeka Thorpe, Praise Iyiewuare, Brenice Duroseau, Natalie Malone and Kaylee A Palomino in Women’s Health

Footnotes

Acknowledgements

None.

Declarations

ORCID iD

Shemeka Thorpe

Supplemental material

Supplemental material for this article is available online.

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