Ep #109: Designing a Sustainable Caseload: What Thriving Clinicians Do Differently

Episode 109, Designing a Sustainable Caseload: What Thriving Clinicians Do Differently.

Welcome to Clinicians Creating Impact, a show for physical therapists, occupational therapists, and speech-language pathologists looking to take the next step in their careers and make a real difference in the lives of their clients. If you’re looking to improve the lives of neurodiverse children and families with neurological-based challenges, grow your own business, or simply show up to help clients, this is the show for you. 

I’m Heather Branscombe, Therapist, Certified Coach, Clinical Director, and Owner of Abilities Neurological Rehabilitation. I have over 25 years of experience in both the public and private sectors, and I’m here to help you become the therapist you want to be, supporting people to work towards their dreams and live their best lives. You ready to dive in? Let’s go.

Hi there. Welcome back to Clinicians Creating Impact. If you’re listening as this episode comes out, I don’t know about you, but we are in that busy season. It is September, sliding quickly into October. So what that means is kids are back in school, routines are in full swing, and with that comes both the awesomeness and the overwhelm of a packed or at least a busier schedule.

So let me ask you this. How do you keep doing the work you love? And what I mean by that is seeing clients, helping families, making a difference without burning out. It’s a question that I ask because I hear about it from clinicians all the time. A full caseload, documentation piling up, and then there’s that quiet worry. Is this actually sustainable? Well, thriving as a clinician doesn’t actually mean that you’re pushing harder. What I do know to be true is this: thriving means intentionally designing your caseload so that it works for both you and your clients.

And so today I want to share the three things that I consistently see thriving clinicians do differently and how you can apply them today, whether you’re brand new or a seasoned clinician.

So, at Abilities, we’ve intentionally built our clinics around one core idea: that sustainable clinicians create the biggest impact. Because when you’re supported, your clients thrive. Now, this isn’t about bubble baths or other kind of self-care hacks. It’s about building a career and a clinic model that lasts. So let’s talk about these three things that I see that are different. What I notice first about clinicians that are thriving is one, they have strategic scheduling. Thriving clinicians don’t let their calendar run them. They batch sessions, they leave buffers, and they match their most important work to their best energy.

So, for example, one of our clinicians started with us in a traditional 9-to-5, Monday to Friday routine. And over time, because of family needs, he needed to shift, spreading his clients across five days to concentrating on four longer days. The result for him is that he had more energy, his client saw better outcomes, and he found a rhythm that worked for both his life outside Abilities and the work that he was doing inside Abilities.

Second thing I see that thriving clinicians do is that they leverage support. You don’t have to do it all. Using something like a rehab assistant, leaning on team systems, or even AI tools isn’t actually a weakness. It’s really how you stay in your clinical zone of genius. There is no prize for martyrdom in this profession. And I’ll use a story as an example.

One of our speech language pathologists loves working with a very specific and really complex client population, but she found that seeing those clients all day, every day, actually drained her energy. So with Abilities’ support, she built her confidence in working with rehab assistants and learned to expand her impact through that partnership. Now she still gets to do the part that she loves most, which is the assessment and the program planning, while her very capable rehab assistants help to carry out the sessions. Not only is she protecting her own energy in this example, but she’s also growing other clinicians in the process.

So here’s the third thing I notice about clinicians that are thriving: Clinicians that are thriving use boundaries as a strategy. Now, boundaries aren’t just about saying no. They’re about creating space to say yes. Yes to work that fuels both client results and your own sustainability. The clinicians I see making the biggest impact are also the ones with the clearest boundaries. Isn’t that interesting?

For example, one of our clinicians who was working with a family who frequently cancelled. Can you identify with that? Now, with many of our clients, last-minute cancellations are an understandable, and it really is part of the reality of working in this space. But in this case, the cancellations were more about family dynamics than health.

So the clinician decided to set a boundary. He told the family that he’d be happy to see their child when they were ready, but instead of holding a recurring spot that ultimately was rarely used, they could call when they had availability, and he would book them in if he had space. And then the result was actually a win-win. The family still had access to services when it worked for them, and the clinician no longer carried the stress of holding a spot that was almost always canceled. 

So knowing that there are these three things that you can do, here’s a simple exercise that I’d like you to try for this week. Look at your caseload from the last week and ask yourself this question. What’s one small tweak that I could do to make this caseload more sustainable? Just one. I’m here to tell you overall and over time, those small tweaks add up. Now, I know that every situation and every organization is going to be different, but I guarantee you, no matter what the organization and no matter what the situation is, you can make those small tweaks.

Because here’s the bottom line: thriving clinicians design their caseload with intention. They schedule strategically, they leverage support, and they use boundaries as a tool for sustainability. Because when you thrive as a clinician, your clients thrive. And when our clinicians are thriving, I know that’s when Abilities grows with purpose. Because we’re not just building clinics, we’re actually building spaces where clinicians can do their best work in a way that lasts. And that is what I actually believe is the Abilities difference.

If you’re part of our team already, and I know so many of our clinicians listen to this, I hope this encourages you to keep shaping your caseload to work for you. And if you’re listening from the outside and thinking this is the kind of organization I want to be a part of, of course, I’d always love to connect with you. No matter what, thank you so much for turning in. Until next time, keep creating impact in a way that supports both your clients and yourself.

Thanks for joining me this week on the Clinicians Creating Impact podcast. Want to learn more about the work I’m doing with Abilities Rehabilitation? Head on over to abilitiesrehabilitation.com. See you next week.