The greatest challenge for private practice

Hands hold up green and purple rectangles against a darker purple background.

The greatest challenge for private practice

Hands hold up green and purple rectangles against a darker purple background.

Physiotherapist and private sector consultant Antony Hirst APAM calls on physiotherapists to stand up for the value of what they do.

What do you do when you’ve got five minutes at a national conference to put forward the five greatest challenges you believe exist within the private sector of physiotherapy?

This is what I was faced with when asked to put together a brief presentation for the FOCUS 2022 conference held in Melbourne.

It’s an honour to represent the private practice sector so making sure I hit the mark was important.

Now, it’s fair to say that one of the five challenges was the key to the other four.

Judging by the questions following the presentation, I have a feeling it stirred debate in the right direction.

I shared with the audience of some 250 to 300 people a football metaphor—‘We need to take a long, hard look at ourselves’—because I believe the greatest problem we have, not necessarily just within the private sector but to some extent within the entire profession, is that we don’t sufficiently value what we do.

Unfortunately, as a general rule, our fees reflect this.

The fact that my AFL team, the Sydney Swans, had been comprehensively thrashed in the grand final by Geelong had no bearing on my choice of metaphor.

If we don’t value what we do, how can we expect those who use our services and rely on our knowledge, expertise and advice to value the contribution we make?

When our value is recognised, it makes our profession more sustainable—not just in terms of career pathways, but by creating an environment that enhances our ability to provide best practice.

It’s almost as if we’re afraid or a bit too timid to actually put our hands up and say that we are really good at what we do.

I know from my years in the industry that this topic is often discussed in hushed tones but I thought it was time to get it out in the open.

I’m not suggesting we should stand on every rooftop with loudhailers and tell the world how great we are but I do think we should try to change our own thinking.

We do not need to change our training or the specialist pathway or the research-backed nature of our profession.

We need to change our internal sense of the worth of what we offer.

Our value is experienced time and time again by individuals who use our services, health professionals who refer to us, universities who continue to see the benefit in training, employer groups who appreciate what we do and, more recently, large corporate groups who are willing to invest significant sums in our industry.

We shouldn’t be hesitant about placing an appropriate value on our services.

One of the questions asked after my FOCUS presentation was ‘Why are we like this?’

That’s a good question.

Does it come from our education in the public system?

Does it come from an inherent personality trait in people who are, generally speaking, high achievers who want to help society?

Is it something else?

Is it because if you raised this issue among your colleagues, historically you may have been frowned upon?

Who knows?

Another question after the presentation was ‘Do you think that we are valuing what we do more now than we did several years ago?’

The answer is yes, I believe we are.

I have witnessed a move away from preferred provider systems set up by large health insurance companies.

Headshot of Antony Hirst.
Antony Hirst.

Our lobbying to the large insurance companies for transport accidents and WorkCover has resulted in remuneration for physiotherapists that is moving closer to what should be expected in terms of a market rate.

However, as I get towards the end of my time in the physiotherapy profession, it’s not yet where it should be.

I still see titled and specialist physiotherapists valuing themselves the same as someone with just a few years’ experience.

This isn’t right.

If you are titled or specialised, your knowledge is far superior in most cases to that of a physiotherapist in the early stages of their career.

While belief in our value is heading in the right direction, it’s happening so slowly that it may lead to the attrition of physiotherapists at a point in their careers when they really have something significant to offer.

Many professions have tiers of value to reflect experience and qualification—the legal and accounting professions, to name two.

We need to join them.

In my work helping physiotherapy practices, I often hear that a clinic has set their fees based on benchmarking with another clinic down the road.

In other words, the fees they set are slightly lower than those of the other physiotherapy clinic.

This is a race to the bottom, a race to unsustainability and burnout, and the end point is customers devaluing what we do because we have devalued it ourselves.

I often hear from practice owners that the reason they have not increased their fees in line with inflation is that their staff didn’t feel comfortable with it.

To quote John McEnroe, ‘You cannot be serious.’

We are the problem.

The good news is that we are also the solution.

We need to remember that to become a physiotherapist requires an extremely high school score, followed by a minimum of four years (and sometimes more) of tertiary education.

Then we have ongoing professional development and strong ethical, legal and professional responsibilities and let’s not forget that we are dealing with our patients’ greatest asset—their health.

Look around yourself at other professionals you deal with—your accountant, your lawyer, your electrician, your locksmith—they value what they do and charge accordingly.

I read recently that intelligence is knowing that a tomato is a fruit and wisdom is knowing not to put it in the fruit salad.

I believe it’s time to start using our intelligence and listening to some wisdom.

Make sure you leave the profession in a better place than when you found it.

For those of you wondering what the other four points of the presentation were, here they are:

  • service delivery models need to evolve constantly and faster
  • salaries don’t meet expectations
  • we continue to accept unacceptable rates of remuneration for compensable bodies
  • we often misunderstand what our patients want and are prepared to pay for—they want outcomes and positive customer experiences.

You might be surprised that a lack of physiotherapists didn’t make the list.

This is for good reason.

If we are able to change how we value what we do, I suspect that will take care of itself.

>> Antony Hirst APAM has been a physiotherapist since 1992 and has always taken a keen interest in private practice sustainability. He is the current chair of the Victorian branch of the APA Business group and spends his time helping physiotherapy clinics through Antony Hirst Consulting.


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