I remember my first day as a physiotherapy resident like it was yesterday. After six years of university education, it was hard to believe that I was part of the working world.
I was promised mentorship opportunities and I knew that I was going to need it – I only had one private practice placement. That meant that I had only assessed and treated six weeks-worth of patients to prepare me for my career.
It was hard to wrap my mind around how patients were now paying to see me for assessments and treatments as a physiotherapy resident! Exciting – but intimidating.
I remember having a conversation with my boss, who, during my first week, told me to “try to get patients to come in at least eight times”.
A few weeks later, when I excitedly shared with my boss that I had improved a patient’s shoulder issue within four visits, they angrily replied “If all your patients are better in four visits, you’ll be hearing from me!”
I was at a loss for words. The comment was stated in such a harsh way that it made me feel like I would not be valued as a clinician, or even as a person, if I did not see patients for extended numbers of visits.
Some patients could barely afford the $92.00 physiotherapy assessment fee, never mind the follow-up fees. Bringing patients in more often than they needed made me feel like I was not putting the patients’ interests first.
As we all know, patients sometimes self-discharge from physiotherapy for a variety of reasons, including financial ones, or simply because they don’t make the time to come in.
When my patients would self-discharge before the clinic-recommended “eight-visit mark, it left me with a feeling of anxiety and worry over my job security. I think that enthusiastic health care professionals should be focusing on quality patient care, not on the potential backlash regarding a clinic’s cash flow.
The expectation to see patients more than they may need to is an ethical issue. It is putting the needs of the clinic ahead of the needs of the clients.
My eyes were opened to the fact that, at times, the business-side of private practice physiotherapy holds greater importance than patient care, professional development and learning experiences of its physiotherapists.
At the same time that I experienced these reflections, I was also studying for the national exam!
Ultimately, I decided to leave the facility. I simply felt too much pressure to see patients for a standard minimum number of visits.
This formula is not patient-centered. Different patients need different numbers of physiotherapy visits for a variety of different reasons.
I think it is important for physiotherapists to speak up that physiotherapy is not “one size fits all” and to reinforce that we place patient-centred care above money-driven business ideals.
Over to you
- As a clinic owner, what kinds of guidelines do you provide new grads to help balance the patient care interests with your business interests?
- As a new grad, what steps could you have taken to address this situation, without having to leave the clinic? What resources could you have accessed to help in this situation?
- What advice do you have for PTs who may feel vulnerable in a new work setting?
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