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Current business model for healthcare fails both patients AND employees…

I’m ending my first year of this blog by almost going full circle – I’ve covered this topic in previous pieces ( and ( and have gotten large amounts of feedback and comments from readers weighing in with their stories and experiences, it’s something that we really do need to speak about…

Our profession is heavily based on technical training, clinical skills, reasoning, experience and being able to interact and help patients to overcome whatever ailments, injuries or the multitude of other reasons for them enlisting our services – our profession is NOT however, geared towards business – and I mean business referring to making healthcare lucrative to be an employer or employee.

I engage frequently with other health professionals about the ins and outs of starting a practice – is it worthwhile? Is it better than being an employee? Do you earn more money? My answer is generally, how long is a piece of string? Granted, with an industry based on caring for others, it almost seems ‘wrong’ to worry about salaries and money – but at the end of the day, we’ve all gotta eat right?

Here’s what generally happens in the transition from community service to private practice (from a physio point of view) – you leave the state system, get a job in private practice where you earn commission and maybe get a basic salary (this is generally a bit of a pay cut from comm serve – spoiler alert!) but you work your way up (because you’re a hardworking professional) and at the end of two years of private practice your annual increases marginally beat inflation and you feel stuck- openening up your own practice seems like the best idea compared to ploughing on and hoping that your patients/day increases or your commission does and end up either burning yourself out or losing enthusiasm for a career that seems so altruistic, yet barely affords you a “comfortable” life (I’ve seen some of the best practitioners LEAVE the profession due to this occurrence, and it’s tragic).

Older practitioners will tell you, this is how it was for us, so you must pay your dues – but I seriously wonder, is this the way that it HAS to be??

It really is a two-way street, and I like to think I’ve seen a bit of both sides of the coin – I’ve been the frustrated employee with the bleakest financial future you can imagine (especially when you’ve got loans, and financial independence), but I’ve also been the employer, frustrated that my employee is just going through the motions when “they’ve got a better deal than I had”. There’s merits to both sides, but I really do believe the solution is in all of us re-finding our reasons that we got into this profession – to care for people.

My personal mission and the primary driver behind everything my practice does is: To help patients to take control of their health, to improve their quality of life and to optimize their daily living through education and exercise-based physiotherapy.

Whether it’s a feasible business you’ll have to stay tuned to find out – but every interaction with a client, pursuit of a contract, planning of rehab or giving ‘homework’ is done with this mission in mind. I truly do think as an industry – we’re failing our primary mission of caring for people, and I attribute this largely to our lack of a good business model that benefits employers, employees and most importantly the patients.

The stereotypical private practice employment business models – sucks (for employees and patients).

We don’t employ people well and there’s little room to grow vertically in most practices – everything starts out well, but it’s an awkward situation when you realize that you’ve reached the glass ceiling of employment and there’s no room left to grow. So, you’ve added and OMT or SPT or even a MSc., now what? You fight the same battles and the only way to scale your salary is to see more people – time for money. If you leave, the practice will just replace you and start the process again with someone new.

In an ideal world, room to grow, develop and move up within the practice bringing leadership opportunity, more responsibility, more feeling of worth and value, will more likely get employees to stay even if the salary isn’t great – however again our profession is very technically focused, so we don’t necessarily look to grow, value and empower employees or even get to know their goals and aspirations professionally. I feel it’s the rigid business structure (or lack thereof) which forces things to unravel and it’s ultimately led to a massive dilution of private practice. It’s often not great to be an employee for more than 2 years but in the same breathe – I dare you to start a private practice next year, and build a base of clients from scratch – unless you’ve got 5+ years of your life to build it up slowly, I strongly suggest looking into alternative models which are WIN-WINs for everyone, INCLUDING the patients. So where to from here?!

We don’t have mission statements based on caring for employees or patients and our turnover of both is high. There is little trust between either employer, employee and the poor patient is caught in the middle – it’s a sad reality.

So, our business models have limitations – how do we ensure we maintain our client base and patient numbers? We focus on our competition – other physio or allied practices. If we can beat our immediate rivals, surely we will continue to grow? (trick question – that’s a slippery slope). We beg Dr’s for referrals, compete with other practices for patients and territory, we try to lure clients with ‘state of the art’ equipment and while these are good short-term fixes for practice revenue, it is ultimately to the detriment of the patients. Who is going to fit the bill for the latest shockwave machine? Our state of the art treadmill? The 3-D k-tape? All of our shiny toys which “differentiate” us from others?

This situation causes us to pick fights with colleagues, complain that other professions are poaching our clientele when really, we’re the architects of our own downfall – it’s this mindset that is effectively plummeting our stock price as a profession and causing us to fight like crabs in a bucket instead of raising the profile of our profession.

The silver lining:

It’s not all doom and gloom as I’ve painted here – there’s enough of a young community emerging and pitching up on social media, hungry to connect, share knowledge and opportunities. I’ve seen this first hand, and I KNOW for a fact that this situation will be changed if we all collectively start to operate a bit differently. The #makephysiogreatagain movement started within my MSc. class with the likes of Darryn Berry and Handre Hay is picking up momentum and it’s not hard to connect with practitioners of this caliber and pick their brain about how we go about solving these issues. The fact that someone with the stature of Chris Allan takes the time to write for our little physio blog or Craig Govender, Proteas physiology frequently engages with us about our content – definitely shows that the wheel is turning and that young guns and industry heavyweights are setting the new standard, we just need more clinicians to follow this lead.

Here’s what I say:

Look for WIN-WIN models of employment where employees can grow, learn, be rewarded financially and feel like they’re doing valuable work instead of just selling tape and follow up sessions to make a living. Let’s find our WHY (again).

Shift from the mindset of competing with peers to enhancing the reputation of our profession collectively.

Ditch the “sausage factory” practice mentality, 20-minute consults, lots of passive treatments and very little patient care.

Let’s get back to putting our patients first. Let’s not squeeze them for consults and sell them machines and special tape to boost our monthly commissions.

Let’s actually care about making people better and explore “employment” options which may require a more collaboration between independent practitioners, but might change our working landscape for years to come.

Take care and have a great festive season – thanks to everyone who has been supporting this blog through its first full year!

Cheers, Nick

If you have any feedback or want to contribute to this conversation, drop us a comment on social media or feel free to mail – as always, we love engaging in these discussion and look forward to hearing from you!