Clinicians adjust priorities to ward off burnout

Career obstacles ranging from lagging salaries to soaring paperwork demands in treatment centers generally won’t drive the clinicians participating in Addiction Professional’s Quality of Life Survey from the profession. Interviews with several of the respondents to the second annual survey do indicate, however, a degree of restlessness that in some cases has led to diversifying one’s work experience or taking greater control by moving into private practice.

Erika Lohmiller, a certified addiction counselor in Chicago, now splits her time between work in a community behavioral health center and private counseling, keeping her skills sharp by being able to address a broader range of patient needs. Once in a full-time role in community behavioral health, “I was getting burned out from the crisis aspect,” Lohmiller says. “I felt my skills really weren’t getting put to use as much.”

This year’s online survey, conducted in September, generated more than 900 responses from Addiction Professional’s audience. 

Although the overall composition of respondents differed in years one and two, the responses generally offered a similar profile: Clinicians face significant time demands at work and often are left to their own devices to keep self-care as a priority, but they remain committed to a profession that many see as a calling.

“I don’t think there’s any other work that could be more rewarding than to sit in the same room with another person while they reveal their troubles and worries, and you get to witness them come to terms and eventually gain dominance over them,” says Maggie Pike-Thomson, a licensed clinical social worker at High Point Treatment Center in Taunton, Mass. “It’s a blessing.”

Growing caseloads

Being asked to do more with less continues to be a prominent theme among the survey respondents interviewed for this feature.

Overall, 22.3% of survey respondents characterized their current caseload as too heavy, and 51.3% said their caseload had increased in the past two years. Both figures are slightly higher than the numbers from the 2015 survey.

In addition, around four in 10 surveyed individuals reported working at least four extra unexpected hours in a typical workweek, with only one in five respondents saying they don’t tend to work any extra hours.

Pike-Thomsen says the expanded hours surface in part because of a growing complexity of problems that patients bring to treatment. “There are more bodies of knowledge that we’re required to stay up on,” she says.

Rachel English has worked in private practice in Denver for the past two years, having moved from a residential treatment center in part to gain more control over her schedule and workload. As a supervisor in a residential facility, she oversaw multiple programs and more than 35 staff members, and carried her cellphone everywhere she went.

“I was on call 24/7, even when I was on vacation.” says English.

The atmosphere was dysfunctional in other ways, she says, as the pressures on some clinicians who were in recovery would lead to their relapse, or to the emergence of problematic alcohol use that had not been a concern before.

Lohmiller senses that the pressures on clinicians were less intense in the early 2000s, when funding levels for treatment were somewhat healthier and there was less of an emphasis on employing brief therapy strategies (her home state of Illinois has been hit particularly hard by cuts in public funding support for behavioral health services).

Today, “You have to pack a lot into your treatment sessions” because of diminishing lengths of stay, Lohmiller says, and that has contributed to increased stress among counselors.

Her work in both community behavioral health and private practice has helped to ease some of that pressure, she says. “My job, I view it as Park Avenue and park bench,” Lohmiller says. The variety keeps her refreshed. “You don’t ever learn everything there is to learn in this field,” she says.

Lack of focus on patient

Michele Olem has worked in facility settings ranging from a hospital-based program to a methadone clinic, but moved into private practice on Cape Cod around half a dozen years ago. She had served as clinical director in an opioid treatment program, but recalls that the main responsibility of that job involved “just making sure that everybody did their paperwork.”

Olem sees that many facilities have become paperwork-centered rather than patient-centered in their operations. The hospital settings with which she is familiar were ideal places for delivering care until an intensive period of mergers and acquisitions set in across the industry, she believes.

Acclimating to electronic medical records also has proven to contribute to burnout, Pike-Thomsen says. “It has been very stressful for people to make the change,” she says.

Keeping self-care a priority

Only around three in 10 respondents to this year’s survey said they had found self-care to be a high-priority topic in their workplace. A similar number said their workplace paid little or no attention to staff members’ self-care.

Lohmiller, 45, says she engages in multiple activities with friends and family to make sure she stays refreshed. She even has participated in bilateral stimulation therapy (a component of Eye Movement Desensitization and Reprocessing therapy) as part of her own wellness strategy, seeing how it has worked for some of her patients. Plus, “I watch a lot of comedy,” she says.

With 20 years in recovery, Lohmiller sees her work as a life’s mission. “Even if I wanted to get out if it, there’s no way I could,” she says. She also teaches counseling students part-time, and tries to share with them the enthusiasm for working with persons with addictions—something that she often sees lacking in a student population that often would prefer to work in mental health counseling.

“Some of them see [addiction] as difficult, and there are still a lot of people that have the moral model in their head, and see the issue as simply a matter of willpower,” Lohmiller says.

Lohmiller expects to work in the field for the rest of her career, which she believes will extend well past standard retirement age. Overall in the survey, 68.1% of respondents said they expect to remain in the field until they retire, compared with 71.3% in last year’s survey. Only 4.6% said they were looking to get out of the field now, which is about double the number from 2015 but still indicates that most clinicians consider themselves to be in the field for the long haul.