CT Altruism vs capitalism

[PatrickL]

http://www.somasimple.com/forums/sho...75&postcount=2

Hi all,
The talk by Simon Sinek embedded in the link above was played at a conference I attended last week by these guys www.privatepracticeretreat.com. The conference was for private practice owners and was focused on marketing, increasing referrals, workflow systems, plugging financial leaks etc. I don't own/run a clinic but look forward to it one day.

Most of the speakers treated PT as a fungible commodity (thanks for that term Barrett). One speaker asked the group "raise your hand if your long term goal is to one day step outside of your practice as a clinician, and run your clinic from a purely business perspective". Out of the 100 attendees, i guessed a minority would put their hand up... I estimate that 90% actually did. These people pointed to the need to build value into their business that is not attached to them as the owner/operator. Huh? Some owners there owned 15 clinics, and hadn't practiced as a clinician for years.

I get that these guys work hard over a career, and have a right to build a business in a way that makes it salable but it got me wondering about why these people got into and stayed in the PT business. There seems to be a tension between capitalism and altruism. Any thoughts on how to keep the inner capitalist in each of us from clashing with the inner altruist?

The speaker who played the Simon Sinek video, argued that it is the core values of a clinic that ensure the quality of service (keeps the altruist happy), which in turn should allow the dollars to take care of themselves. I liked this perspective. He suggested that each clinic needs a set of core values, a vision, and mission statement. This is nothing new but I thought it would be fun to develop these in light of the info I've been learning on SS.

I post it here in the hope of some critical feedback

Core values (in no order)
Transparency
Integrity
Safety
Trust
Respect
Humour
Autonomy
Willfulness
Education

Vision
Our vision is to provide our injured and pained friends with the highest quality, scientifically plausible, and evidence based Physiotherapy services. We are reshaping and reinventing the Physiotherapy profession by keeping abreast of exciting advancements in neuroscience and pain research and allowing them to form our treatment philosophy.

Mission
Our role as Therapists is to provide an environment that facilitates the emergence of your body's self-corrective potential for a return to normal sporting, recreational and work activities. Science is telling us that healing and pain resolution are expedited by a Physiotherapist who provides such a context, who is truly present with you, who interacts with you, who guides and educates you, who uses excellent interpersonal and manual therapy skills, while nurturing a sense of trust, openness, fun, safety, integrity, autonomy and respect. Our mission is to be this kind of Physiotherapist for each and every one of our injured and pained friends.

[Jason Silvernail]

I've never understood why altruism and capitalism are seen as mutually exclusive. Seems the most altruistic system in the world to me. Competition for the purpose of providing people what they want for the least amount of money. What's more altruistic than that?


[From my iPhone, please excuse typing]

[John W]

Patrick,

I don't think you can have true capitalism where you have zero-sum competition. Capitalism is based on the principle that the pie will grow as long as people are motivated and rewarded to innovate and improve the products and services that people want.

We don't have anything remotely close to this in health care and certainly not PT. In fact, I think that is the main reason why PT has become a fungible commodity, not the other way around.

And, Jason's right, of course, about altruism and capitalism being simpatico as far as human endeavors are concerned.

[Diane]

Then it turns into consolidated piracy at the expense of the common good.

[PatrickL]

When I moved to the states last year, I interviewed at a couple of big chain-like PT offices. My instinct told me to keep looking for a better fit. I dont really know why. My thought is that with every new office an owner opens up, the more distant the owner is positioned from clinical operations, and the harder it becomes to ensure that the core values that define the operation are adhered to... There is more room for the culture to turn sour. Are there any multiple clinic owners out there who could add some insight? The intent in opening a 3rd, 4th, 5th.... 15th office could well be to help a greater number of people, while also making a buck, but my gut tells me that these guys are more likely interested in the money.

Having said that, I can see how a one man operation, without a set of guiding principles/values could be just as money focused (at the expense of service quality). The core values and workplace culture perhaps are the key factors, regardless of company size. What are your thoughts on the values, vision and mission I outlined above?

[nari]

I checked online for altruism +/- capitalism, dozens of hits with no satisfactory outcomes. Both seem to vary enormously depending on which country one lives in.

Capitalism has always been ripe for greed and corruption, but then so is the other end of the scale. I guess this is why Ayn Rand came up with the moral obligations thing; but that smacks of utopian dreaming to me.

Nari

[PatrickL]

Hi Nari,
In your experience in oz, do you recall many physio businesses with >3-4 locations?

[nari]

Hi Patrick,

I'm not up to date, really, but the most I have heard of is 2. Bjarne, Tim Maher, at one time Sally Catchpole (Manuka and Parliament House) and a few others.

But Canberra is a small city; I suspect Sydney or Melbourne may have more clinics owned by one person. I also think that the owner would remain a clinician, even if part-time. Even the heads of departments give themselves clinical time.

The idea of private PT practices being owned by someone other than a PT to me is bizarre. Do you know if that situation exists in Oz?

Nari

[Randy Dixon]

I'm not sure that the question in your example about the PT business owners is necessarily reflective of the thoughts of most PT's or even the thoughts of those in attendance. It was a false dichotomy and I think there is much more nuances to it than that.

I'm not a PT, but I have owned PT practices and I have been the administrator for another, (as well as being a technician, marketer, work conditioning specialist and sheet changer) and what I see is that PT's really don't like being in the PT BUSINESS. My wife, who is a PT, often says that she wants to have enough money so that she can practice without worrying about the money, no having to schmooze with doctors, no having to treat patients that don't want to be there, no having to try to explain to insurance companies why she is treating a knee when it is a shoulder diagnosis. She loves treating patients, but she wants out of the PT business. It is what she does though, and the only way out is to make enough money to get out. It is a tough situation for even the most dedicated PT who may love treating patients, they also like to have a house, go on vacation, be able to take care of their families and sometimes these two are in conflict.

I think there are some PT's who find that they are really businesspeople, not clinicians, and there are plenty of just plain bad PT's out there, but for the most part I think that most PT's who have been practicing for some time find it hard to differentiate PT from the business of PT and when asked about it, they don't.

I also take exception to the term "capitalism" as being opposed to "altruism". I don't think something is altruistic unless it is given freely and capitalism is the best, although not without faults, system for allowing people to act freely.

[amacs]

I also take exception to the term "capitalism" as being opposed to "altruism". I don't think something is altruistic unless it is given freely and capitalism is the best, although not without faults, system for allowing people to act freely.

Strugg;ling to quite understand the bold

Given that capitalism is almost synonymous with consumerism I remain unconvinced as to how easily those bedfellows sleep together. I wonder if it is the connection between capitalism and healthcare that leads to the likes of the Oz phenomena.

Is capitalism quite so benign as represented?

regards

ANdy

[PatrickL]

Perhaps I should have framed this as revenue raising vs altruistic practice (doing good our patients).
Randy said

I'm not sure that the question in your example about the PT business owners is necessarily reflective of the thoughts of most PT's or even the thoughts of those in attendance. It was a false dichotomy and I think there is much more nuances to it than that.

I'm not sure how else to interpret 90% of the audience stating that their goal as PT is to stop working as a PT and become a business operator. From your description, your wife is at the other end of the spectrum, and you think she represents the majority view of PTs. Perhaps the 100 attendees at the conference were not a representative of the whole PT population.

Nonetheless, these 90 or so PT owners, I gather have lost interest in, or never had interest in the practice of treating patients. Which makes me wonder why they would stay in the game. It makes me wonder if they see PT as a fungible commodity. One that requires no attention/development/review.

Of course, a PT owner could very well do both- revenue raising and clinical standards are not mutually exclusive. But the latter can certainly suffer from an unprincipled focus on the former. This is where the core values become important. And this is what I took away from the weekend. What do you think of the value/mission/vision I outlined?

I'd like to read about other Therapist's values/vision/mission.

[Diane]

I'm happy to make enough $ to stay alive, put some away so my future old lady self can stay alive. I've only ever been
a) a therapist exploited for my labour by a larger business owner
b) a sole practitioner (by far my preference).

[advantage1]

I don't think a PT can own multiple clinics and ensure quality care. In order to operate multiple clinics one would have to rely on non-PTs to ensure quality is being ensured. This doesn't work since how could you expect a non-PT to understand quality PT Rx? Often times the person put in charge of managing a PT practice simply looks at number of visits. The more visits the better. They don't get why a PT had to book an hour to work with a chronic pain patient with multiple areas to Rx and requiring lots of education. Only a PT could understand this.

I think a PT that owns a clinic has to find a healthy balance between runniing the business and treating patients. I think from the beginning the PT must set a reasonable goal as to how much they think they are worth and accept this. The minute you focus on making more and more money you have failed.

[Sheffphysio]

Capitalism, in my opinion needs checking. Just like the opposite. You could argue Capitalism breeds the videos's like Dr Oz chiro chap. All sell, sell, sell. All about marketing, charisma, keeping the client hooked. But thats an argument I really can't be bothered having late on a Sunday night!

[John W]

I agree with Randy. For instance, even though it sounds good to redistribute wealth for the purposes of "helping the poor", if this is gained by punishing the success of the wealthy, then it can't be considered altruistic on the part of the wealthy. It's "coerced" altruism, which is an oxymoron, I think.

Capitalism per se is neither benign or malevolent. It's merely a method of distributing goods and services in society by having producers compete based on price and quality. It provides the consumer with both choice and responsibility. I think this economic system married to democratic principles and the rule of law allows for the greatest appreciation for and expression of individual liberty.

If the system gets skewed in either direction rich people or poor people end up getting screwed. I don't think it's right to screw people just because they've succeeded and gotten wealthy any more than it's right to deny a poor person quality health care.

But the politicians always seem to make out ok. They hardly ever lose their jobs and never their health care benefits and pensions when the economy sours.

Funny how that's worked out.

[PatrickL]

I agree John, can I go back and retitle the thread?

Perhaps I should have framed this as revenue raising vs altruistic practice (doing good our patients).

Is that fairer?

[Diane]

I'd be interested in learning how rich people ever get screwed, John.

[amacs]

In principle I understand and do not disagree with capitalism being an effective method of wealth distribution but I am not sure it does this,

It provides the consumer with both choice and responsibility

It takes a matter of seconds to think of examples where those of wealth distort or skew the market to their advantage, in fact I would suggest it is not in their interest to have a market place with choice.

If the system gets skewed in either direction rich people or poor people end up getting screwed. I don't think it's right to screw people just because they've succeeded and gotten wealthy any more than it's right to deny a poor person quality health care.

There lies the problem I think - how do you keep the balance particularly in relation to areas like healthcare and possibly education?

But the politicians always seem to make out ok. They hardly ever lose their jobs and never their health care benefits and pensions when the economy sours.

Don't forget about bankers John, arch capitalists if ever there were any, they seem to survive pretty well no matter what (yeah I know broken record)

It is interesting to see the cultural differences expressed here interesting stuff albeit rather sensitive perhaps.

I think lots of PT's "act as if" they are running a business in a free market, capitalist system, but they're not

I don't know that it would much different if they were really in such a system, inevitably there will be those who are in this for the money - whether they start that way or become that way.

regards

ANdy

[John W]

Patrick,
I was just responding to ANdy.

I think lots of PT's "act as if" they are running a business in a free market, capitalist system, but they're not. It's not a free market- not even close. And the only thing they're capitalizing on is the ability to game the insurance companies while convincing patients that they have some disease that needs fixing when all the patient really needs is to understand better what's going on in their body.

In other words, a little human primate social grooming. There, I said it.

[PatrickL]

inevitably there will be those who are in this for the money - whether they start that way or become that way.

If i were in it for the money, the first thing I'd do is pick another profession

[amacs]

I hear that,

and perhaps that is what you were witnessing at the course

regards

ANdy

[advantage1]

John,

I would agree that there are some PTs that own practices that are in it for the money. However, there are also many PTs that own practices that are 100% interested in the best interest of the patient and profession.


I think if you were to interview PTs that have locally owened PT practices you would find people that once worked for large clinics and corporations that had to go out on their own. They are typically forced to open their own practices so that they are not influenced by greedy owners.


As for convincing patients that they have some sort of disease that needs to be fixed, that's a problem with some PTs regardless if they own a practice. A great marketing tool in PT is to provide hope and honest advice to patients.

[Jason Silvernail]

I think we are back to Johns contention that we don't have a free market in healthcare. We have a highly regulated market, with the regulations, as usual, recommended by rich organized interests to preserve their advantage (cf state medical boards limiting access to patients, financial organizations influencing legislators, and energy companies and others getting subsidies and tax breaks). That is NOT capitalism, it's corporatism, and that's what happens you give central planners the ability to punish some groups and benefit others. The fact that so many people advocate more central planning (ie pass more laws and have more regulation) to improve this situation would be hilarious if it weren't so common and so influential a worldview in modern industrialized countries.

I think we can have a discussion of quality vs profit without addressing the issue of capitalism vs corporatism per se.


[From my iPhone, please excuse typing]

[PatrickL]

Thanks Jason, my bad for framing the discussion poorly

[Jason Silvernail]

No problem Patrick, it's common in the media to conflate capitalism with anything negative about the profit motive.


[From my iPhone, please excuse typing]

[BrentC]

Patrick-

I like your mission and values very much. I agree that there are many PT's who are more interested in the business aspect of PT as opposed to the healthcare aspect. Where I live there are numerous private practice owners who own 5+ practices and are continuously expanding. I have friends who work for these companies and see 25+ per day and have to delegate a lot of their patients to aides and technicians. Double booking and triple booking are norms and not exceptions. Quality care is NOT top priority for these PT owners although they will claim and market that it is.

This sort of practice is what lead my wife and I to start our own practice 5 years ago. Unfortunately, I feel the reason my wife and I started our practice is the minority. Our business model seems common sense to me. Each patient that comes to our clinic get to see the same physical therapist ever session. We have no support staff involved in patient care. You'd be surprised how rare of a model this is. Most patients that come to us are surprised that they get to see me each visit without being double/triple booked. We like to think if we provide a good service, the monetary aspect will take care of itself. Wishful thinking maybe but so far so good.

Since you were curious of other mission statements. Our clinics is as follows:
'OPTI strives to provide the most sound, ethical care with comprehensive, individualized, and evidenced based physical therapy in order to restore function, improve quality of life, and empower individuals of all ages to maintain a lifelong commitment to health and wellness.'

Simple, but gets the point across. And we try our best to live by it. Also, on our website, we have this paragraph that describes what makes our clinic different than our competitors:
'OPTI was established by two physical therapists as a result of a desire to provide the most effective physical therapy treatment in a sound, ethical environment. At OPTI, patients are awarded one on one care with the SAME physical therapist EVERY VISIT. The physical therapists at OPTI maintain up to date knowledge of current clinical and scientific research on treatment techniques and interventions in order to optimize every visit for the patient. The ultimate goal is to empower the patient to transition towards an independent, self-directed continuation of home exercises that will maintain health and reduce the risk of re-injury. '

In regards to your thread title, we started our clinic with the intension of provided that best possible care for our patients. We wanted to make the rules and ensure that we didn't get put into positions where we felt we were providing poor care. We hope that if we can be successful we will be rewarded not just with the pleasant feeling of doing good, but monetarily as well. So I believe both to be possible.

Brent

[Randy Dixon]

Patrick, my point, which I apparently didn't make, is that I believe many PT's don't or can't separate treating patients with the paperwork, politics and hoop jumping associated with patient care. I know many that find the latter so distasteful that they are willing to give up the former. Of course, I also know some that plain don't like patient care, but I think that those aren't that common. I think, but don't know, that many of those 90% if they considered patient care without notes, phone calls to the doctor, complying with insurance, and other documentation or working with patients that they really don't like working with that the number might be different. It might not also. I guess you were surprised by the answer as well.

[Randy Dixon]

I was tempted to go into the political/economic discussion especially after recognizing a couple of libertarian leaning replies, but once I start it can be hard to stop, so I'm going to pass.

[Bas Asselbergs]

We must look at the effect of larger "franchise" systems in a corporate and also capitalistic context.
Marketing is a big aspect of growth - and when PTs want to be a business success, their undertakings have to grow. Growth is in our society partially an effect of better and bigger marketing - which means bigger budgets. Which means the bigger players are more likely to get bigger.

The idea that in a real free market, quality care is enough to be competitive is a pipe-dream. In our gullible society, trash is being sold at higher rates that quality.

I do NOT want to grow my business. It does not suit my personal and work style, and takes away from the other things in life I like to appreciate. I would not attend a conference on private practice marketing and managing and growth.

I guess that most of those who attended already leaned towards a more business-growth oriented path in their PT-career.

[Sheffphysio]

Originally Posted by Bas Asselbergs

The idea that in a real free market, quality care is enough to be competitive is a pipe-dream. In our gullible society, trash is being sold at higher rates that quality.

How true.

[BrentC]

Originally Posted by Sheffphysio

How true.

I will have to disagree with these statements somewhat. While it may be uncommon, my company invests VERY little money into marketing and pretty much depends on word of mouth. We have grown from 1 PT to 4 PT's over the 5 years we have been open. The marketing we do invest in is spreading the word about how we are different than other clinics in terms of quality care.

Maybe I am a little optimistic, but as more and more financial responsibility falls on the patients with higher deductables and HSA's, I have seen an increase in the number of patients who actively seek out the quality clinics in our area.

Hopefully my optimism doesn't come back and bite me in the butt...

Brent

[keithp]

Originally Posted by Bas Asselbergs

The idea that in a real free market, quality care is enough to be competitive is a pipe-dream. In our gullible society, trash is being sold at higher rates that quality.

Barrett's posting this morning is illustrative of your point.

Respectfully,
Keith

[Barrett Dorko]

Brent,

I kept a clinic going that way for 28 years, so I know it can be done -at least until it can't be done any longer. As I enter into this arena again after 5 years out I find it has changed in my region, and not in the direction I prefer.

I'm going to plug away anyhow, and we'll see what happens.

[ste5e]

Am I the only 'state' physio here?
The altruism of the state through the NHS funds me and offers me a protected existance. I feel blessed by the states largesse. It is not the real world it is a bubble. I have opted out of competion and subsist on what the state is willing to provide me now and to my old man self into the future. I was lucky to join the NHS when attaining a decent wage was possible. I work hard, put the hours in, and know that I make a difference to people with pain problems.
I cherish being able to treat people for as long as they need it. State altruism entrusts me with that choice and I try to use the resource I am prudently. I am free within the choice I made to not pursue greater earning potential.
I see capitalistic medicine exploiting the suffering of the chronic pain people time and again. False promises, outrageous lies, grooming behaviour of a much more cynical variety then the social ape stuff we may practice. I chose not to walk down that path. Folk I trained with did and they have bigger houses and faster cars - values driven choices I believe. Or just me confirming my own socialist biases?
Kind thoughts,
Steve

[amacs]

I see capitalistic medicine exploiting the suffering of the chronic pain people time and again. False promises, outrageous lies, grooming behaviour of a much more cynical variety then the social ape stuff we may practice.

Wow, strong stuff there Steve, I do however agree that I do not like what I see at the moment in terms of the increasingly voracious appetites for personal profit that seems to be affecting our healthcare society.

regards

ANdy

[Sheffphysio]

Steve,

I am a state and private Physio. Best of both worlds.....

Brent, I'm glad your practice is going well. I too do some work a a very good private clinic where we are very ethical. Almost go the opposite way and talk patient out of needing to attend endless PT. We are steady growing as well. Maybe one day that will be the norm. What do you think?

[BrentC]

Originally Posted by Sheffphysio

Steve,

I am a state and private Physio. Best of both worlds.....

Brent, I'm glad your practice is going well. I too do some work a a very good private clinic where we are very ethical. Almost go the opposite way and talk patient out of needing to attend endless PT. We are steady growing as well. Maybe one day that will be the norm. What do you think?

Sheff- I am hopefull that one day this will be the norm. Unfortunately however I feel the direction of PT clinics in my area is moving towards larger corporate managed facilities. Many of the hospitals here are putting up many clinics around me and then instruct all of the MDs that work under their umbrella to only refer within the hospital network. Very discouraging when you try to speak with a hospital MD and are turned away because I am not affiliated with the hospital.

[Frédéric]

Interesting discussion.

I own a clinic, now 2 1/2 Y/O. It is a lot of hard work (>55 hours/week). Lots of initial investment ($$) and very little return thus far money wise. It has the potential to be financially profitable vs being an employee but up to a certain point. I would certainly still need to put a lot of hours to make say 80 000 - 100 000$. But it might (and probably will) never reach this point at all.

Now that being said, I started my own clinic for several reasons, (1) one of which was to be able to practice as I see fit. More time with patients, less total # of appointments and congruent with science. Generaly this means every patients spends less money in the clinic. (2) The second reason was the hope to, one day, earn more money than what I would earn as an employee. I personnaly find PT salaries to be too low in comparison to the university degree required, the time constantly spent in keeping up to date with science and the amount of hours one needs to work per week. Not to mention the inherent difficulty of the profession and emotional load it puts on us. (3) Work less, treat less patients per week while achieving (2) to better my quality of life and free time with my family.

Now, it so happens that (1) gets in the way of (2) and thus the potential for profiting from one clinic is somewhat limited depending on the town you are in. Which make (3) hard to reach.

I hope that I will eventually be able to
A-Work less hours with patients. Such that by 50-55yo 0 hours is an option.
B-have time to go back to school to do a masters, do research,...
C-Bring a better quality of life to my family (which implies more money - equating with more time).

If I could have multiple clinics (2-3) and generate a decent profit from each of them, these objectives could become possible. Not with only one. For this reason I am contemplating the idea of one day owning more than one. And if it so happens that it becomes possible to make them profitable enough to have the possibility to stop treating while respecting the ideals in point (1) then it would be a nice financial success. It would be like having earned an early retirement, or the possibility to only treat part time and enjoy life, travel,...

If I had the possibility to earn, say, 60 000$ a year without treating a single patients I would certainly consider it. Not because I don't like my job. But because I like other things better. Such as playing music, being with my kids, traveling, reading, ... That being said, completly stopping treating is not one of my goals but treating less is certainly one and doing research with no financial pressure is another one. Thus I understand why 90% answered as they did in the survey from the initial post. It's a bit like earning a financial independance and an early possibility of retirement while adding some re-sale value to your buisness (it works even without you).

The thing is, the way things are right now I am not sure this is a realistic goal without selling my soul and turning my back to my actual philosophical ideals. Thus the contemplation of multiple clinics might certainly turn out as a dead end. One thing is for sure, once you cross the fence and become an owner you will be faced with pressures that go into opposing directions and you quickly find yourself in a situation where one of the directions puts more pressure than the other and this is where the risk lies. An equilibrium is the goal but sometimes the equilibrium is below the expectations of financial profits. So then what to do : quit and become an (unsatisfied) employee again or make greedy decisions ? I don't see any of the two as a fair solution.

[advantage1]

Frederic,

I also own a clinic. I have thought of the idea of opening a second clinic. However, running one is certainly more than enough work for me. One reason why I don't think I could own another clinic is because I know it would be hard to ensure quality care if I am not present. I know that it would be vital that I hire a PT that I feel is ethical and understands current research. However, in my opinion unless the PT owns the clinic they will never work at the level I would be satified with. Also, it is hard to dictate to an employee how they practice. For instance, telling them not to diagnosis leg length discrepancies or to not use ultrasound on a lumbar spine. Unless I could clone myself I think it would be hard for me to trust someone else with a practice I own and has my name associated with it.

[Frédéric]

Originally Posted by advantage1

Frederic,

I also own a clinic. I have thought of the idea of opening a second clinic. However, running one is certainly more than enough work for me. One reason why I don't think I could own another clinic is because I know it would be hard to ensure quality care if I am not present. I know that it would be vital that I hire a PT that I feel is ethical and understands current research. However, in my opinion unless the PT owns the clinic they will never work at the level I would be satified with. Also, it is hard to dictate to an employee how they practice. For instance, telling them not to diagnosis leg length discrepancies or to not use ultrasound on a lumbar spine. Unless I could clone myself I think it would be hard for me to trust someone else with a practice I own and has my name associated with it.

I certainly tend to feel the same way. But I just hired a PT and we'll see how it turns out here at the current clinic. If it proves successfull, and one day I can free enough time to work 2 days a week in a second one and then try to imprint my knowledge in a second place. But I see this as a potential for many pitfalls and lots of risk with highly unknown financial benefits.

[PatrickL]

Also, it is hard to dictate to an employee how they practice. For instance, telling them not to diagnosis leg length discrepancies or to not use ultrasound on a lumbar spine. Unless I could clone myself I think it would be hard for me to trust someone else with a practice I own and has my name associated with it.

Why not hire new grads and teach them?

[Frédéric]

Exactly what I did!

[BrentC]

I've hired two "experienced" PTs to join my clinic and you'd be surprised how quickly those therapists will change their treatment habits if they are just presented with current research and modern pain science. Afterall, we are all currently in the process of crossing the chasm ourselves aren't we? We have weekly rounds at our clinic to discuss articles and treatments. We challenge each others thought processes and make sure each one of us is able to articulate why we are doing certain treatments.

Whether its a new grad our an experienced PT that is hired it is up to the owner to present the current research (since we know most PT's dont want to do the leg work) and ensure that our patients are receiving the best care possible.

[Sheffphysio]

Brent, I can imagine how frustrating that is. Which brings us back to the question of capitalism. Is that capitalism due to the fact that once the rich get wealthy they can dictate what they do and skew the market. Or is that socialism for the rich and capitalism for the masses which seems to be where we are

[ste5e]

Hi Dave - Best of both - I think you are right. Having had a look at your practice's website you are in a good place. If only they were all as honourable, principled and well-informed. Having a foot in both camps not only gives you a unique perspective but also I imagine a bit more security. In comparison my eggs are all in one basket. And after this current round of 'reform' that may well become one 'basket case'.

Hi Frederic - I feel for you. Your values seem to tug you in opposing directions. Be aware of this conflict as it is a big risk for deep sadness in middle life. Do people in private practice ever go into co-operative practices with other PTs (other than spouses)? Shared values and shared risks and costs. Also I suppose it would expose you to different risks too.

What determines saturation in a local market? I only ask because up until a few years ago in the UK all physios who wanted to work for the state could and it gave a fair graduate level wage to take through life with a generous pension at the end. However the NHS has suddenly stopped taking PTs in and graduate unemployement is now a reality for lots of graduating PTs. So, naturally, they are taking positions in private practice. There has been a proliferation of clinics. And they are 'competing' with all the other, traditionally non-NHS, high street purveyors of care and cure.
Its not like its a franchise and no-one will open up a store in your patch. Someone sees you doing well and they can open up on the next street, even next door! Harsh realities.

I recently tried to get approved by a major healthcare insurer to provide a few sessions to a patient who did not meet our team's acceptance criteria (too young). Their parent had cover which covered them. The insurer said they were not accepting new physios and had not been doing so for many years. So that again is an artificial bar to practice - if you can't get paid by privately insured patients, can't get work in the NHS - stuffed. A bad time to be graduating.

Any thoughts?
Steve

[amacs]

Any thoughts?
Steve

Change jobs?

ANdy

[PatrickL]

I recently tried to get approved by a major healthcare insurer to provide a few sessions to a patient who did not meet our team's acceptance criteria (too young). Their parent had cover which covered them. The insurer said they were not accepting new physios and had not been doing so for many years. So that again is an artificial bar to practice - if you can't get paid by privately insured patients, can't get work in the NHS - stuffed. A bad time to be graduating.

I still think there is a third option- the client pays with their own money. But patients aren't on board with this. I've noticed this in the USA vs australia. There is a strong sense of entitlement that is derived from the financial investment in health insurance. This happens in oz too but its more with workers comp patients. I spoke with a PT here in ny, who has been in the U.S system for +30 years. His perspective was that, the PT profession jumped on the insurance gravy train when the going was good, and now the profession is hurting because insurers are paying out less, and patients dont want to pay twice for treatment. What a mess.

My thought is that a third party payment system leaves the door open for unscrupulous practitioners and creates a more passive "fix me" mindset in patients. I think the profession would be better off if we could move away from that system... It would, i think get the client more interested in getting better because every session hurts the wallet a bit, and would make therapists more accountable for everything they do, because the client will be judging more closely. The chiros manage to do this, they have never been helped by third party payers, but they continue as an industry. I think PT could do this too, but in an ethical manner (not over servicing) / adhering to a decent set of values. It would mean stepping away from the shadow of the medical world though, which would be a risk in itself, and having the confidence to market and promote what we do, which doesn't sit well with many PTs. I plan to have a cash only clinic one day. Naive of me perhaps, but I only want to treat people who want to see me, and their willingness to make that transaction, symbolizes to me their trust in me and an investment in getting better.

P.s. I do realize that third party payers provide access to services for those who can't afford it otherwise. This is a real dilemma for me. My plan is to set up my operation in a way that allows me to do one day/week or fortnight of free treatment to this who can't afford it. Again this could be very naive, but that's where I'm aiming.

[Diane]

I've been cash/check only for a long time, more than a decade. It works great. The patients pay a lot closer attention to you when they come of their own free will, and are paying directly to get the information you are providing, than if they are there because somebody sent them, or they're there because being injured and off work and rehabbing is now their "job".

[Frédéric]

Hi Frederic - I feel for you. Your values seem to tug you in opposing directions. Be aware of this conflict as it is a big risk for deep sadness in middle life. Do people in private practice ever go into co-operative practices with other PTs (other than spouses)? Shared values and shared risks and costs. Also I suppose it would expose you to different risks too.

Well, my values actully pull me in one direction but the financial obligations are the forces pulling away form what my values dictate. So all is well until both are two far apart. That's the thing with buisness and capitalism, the system works in such a way that you have to play a certain game to truly profit financially. But there is a cost. Physical therapy's core values don't fit really well with the traditionnal buisness model where you'd like to attract the same people more and more to spend more and more. In fact, it should be just the opposite. Why schedule only 1-2 appointment a week when you can fix 5 in physio, 3 in OT and 2 in acupuncture? Why make the patient independant in his pain coping behavior when you know he'll come back to get ajusted? Now that is more congruent with the typical buiness strategies, thus I think another reason why we don't see the change we want happening faster.

I rarely schedule more than 2 appointments per week. I could fill up a second schedule (other PT) just by changing my scheduling habits and double my incomes. I won't. But I'm sure when you've invested 175 000$ or more that many will. I guess I'm still too idealist to do that. I hope that won't change.

[ste5e]

Hi ANdy,
I feel for the graduates coming through. I notice a reduced throughput of students so I think the colleges are taking less on but that is too late for those who graduated over the last few years or who are in the system now. Hard times indeed. And I especially feel for those who have a vocational calling to therapy.
With regards the young man our service would not see - I am pushing for our team to re-evaluate its acceptance criteria.
Hi PatrickL,
First off - A big thanks for your contributions to the site - I have really enjoyed reading your posts. This one is another - true and well said. The patients getting top notch care from 'state' provision do not value what they get free (two hours of DNAs today). Those insured tie themselves in to what the insurers will provide. And the ideal would be the honest cash - transfered hand to hand ( taxes paid ) where your expertise is being brought by their choice to purchase.
Hi Frederic,
You Sir, are a strong, moral man. I know that for me the lure of over-treating for financial gain would be sweetly self-justified and I would not notice myself saying 'One more session' to the dependent, fear and anxiety driven individual. The little Macchiavelli in me would even make me feel good about it.
Kind thoughts all,
Steve