The APA 2023 Workforce Census found that the top drivers of job satisfaction include making a positive impact (98 per cent), receiving recognition (92 per cent) and financial security (96 per cent). 

The census report also found that the average salary for a physiotherapist in Australia is $95,405, with salaries ranging from $68,660 to $122,150. 

Only two in five physiotherapists believe they are fairly paid and just seven per cent strongly agree. 

Insufficient pay leads some physiotherapists to consider leaving the field within the next five years. 

Job satisfaction is high among those who feel fairly compensated (89 per cent) compared to those who do not (58 per cent). 

As one respondent wrote, ‘At some point in my career, I realise there is a ceiling to how much a physio can earn. 

It is essentially a face-to-face service where you have to see a client to earn money.’ 

It is clear that the profession has a problem with retaining clinicians. 

From my experience owning practices and mentoring teams around Australia, one of the causes of a drop in job satisfaction is not feeling appreciated or as if you have made an impact. 

Building a case load of loyal clients who refer to you and return for care themselves creates the environment that clinicians crave.

You can directly see and hear about the positive impact of your work on your patients and those they refer. 

The ongoing flow of clients who recognise the value of what you do then allows you to address the remuneration that is linked with job satisfaction. 

A flourishing case load means you can consider: 

• negotiating a higher fee for your consults because the market has deemed you worth it
• reducing your workload while increasing your fee and still earning the same as a result, leading to more leisure time if that is your goal (work–life balance was seen as very important in the APA survey)
• altering which segments of the market you wish to focus on. 

However, this all starts with client engagement. 

Several years ago, at the Back In Motion Health Group, we participated in a large-scale study using the Net Promoter Score. 

The focus was on what loyal clients love about what we do that encourages them to return for care and refer their friends and family. Results from treatment was rated in the top three qualitative findings. 

It was equally important in the acute, intensive, early stage and in later stages, when clients could be offered options for adapting their lifestyle to help stop the problem from recurring. 

This is consistent with research by McRae & Hancock (2017) showing that clients rated both treatment for pain and prevention highly. 

All too often in my mentoring I see less experienced clinicians underservice, especially in the early, acute stage. 

As a result, they don’t get the results the client wanted. 

The client is not thrilled, is certainly unlikely to refer their friends and family and in fact may be dissatisfied and may seek the care they expect elsewhere. 

When a client self-discharges, the opportunity to assist them in finding ways to reduce recurrence is lost. 

All this creates the opposite of recognition and feeling appreciated, leading to imposter syndrome. 

A paper I presented at the APA national conference in 2023 highlighted the reasons why clinicians undertreated, from an employer’s perspective (see figure below). 

The primary reasons for undertreating were identified as: 

• financial concerns for the patient
• not being taught what is appropriate treatment frequency
• concerns that they would be seen as an ‘overtreater’
• imposter syndrome. In their mentoring sessions, clinicians often ask me why they have lost their client. 

They may think it is because of poor assessment, poor diagnosis and/or poor treatment. 

Yet I find that these are not the most common reasons. 

The primary reason is poor connection—a reduced therapeutic alliance. 

Fortunately, we have wonderful tools to build this quickly: 

• active listening
• goal setting via shared decision-making
• a clear plan outlining how you can help them achieve their goals
• rapid pain relief when that is their initial goal, with intense, early treatment through many modalities including manual therapy, movement, exercise prescription and sound advice. 

However, the intense component is often missing. As Chad Cook has recommended, if you are to use manual therapy for rapid pain relief, use it early—twice a week for two or three weeks. 

Because its effectiveness as a pain modulator weakens after two to three days, physiotherapists should capitalise on this window of opportunity. 

Reducing pain and fear is a wonderful way to gain a therapeutic alliance, which then gives you the scope to address the lifestyle factors that clients want and need addressed. 

As my colleague Tom Hindhaugh says, ‘Give the client what they want so you can give them what they need.’ 

Once you start treating at a frequency that gets the results clients are looking for, they will refer and return for care. 

The clinician will hear more and more about the positive impact they are having on these clients’ lives and on the lives of those they refer. This recognition reduces imposter syndrome and increases the clinician’s confidence. 

Their list builds up with like-minded clients who value the clinician’s expertise, creating a snowball of momentum and allowing for options such as increasing fees and/or altering working hours. 

The APA’s workforce census demonstrated what we need to do to retain our emerging clinicians. 

There are simple ways to change the trajectory and one is as straightforward as seeing your clients as often as they need—focusing on their health outcomes rather than anticipating the constraints of their wallet. 

Click here for references. 

>>James Schomburgk MACP is a co-owner of The Second Visit, the CEO of Physio Practice Connect and an affiliate lecturer at the University of Adelaide. James is an APA Titled Musculoskeletal Physiotherapist.