Dull physio career prospect in Australia?

[justwater]

I hope such title didn't cause any stir, but I know I have to ask.

I've been working as a community physio in Australia public healthcare system. Over the past two years, I've been frustrated on how the field of physio is squeezed and can't see the future any brighter.

I have many patients came to me with conversations of how skeptical they are towards effectiveness of physio. Disbelief from GPs results in less referrals. Insurance companies continue to keep hand tight in rebates. With a family to raise, I am under a lot of financial pressure. The idea of going to private practice came to my mind several times, but with what I heard from patients, GPs, and even shopkeepers, I am in doubt if private practice is an answer.

Is a stable career with 80k in Australia too much to ask?
I know there are some private physio out there just keep patients to come back week after week for the sake of good money. Even though it's financial rewarding, I don't want my conscience to drown like real estate agents.

Is any Australian physio out there with different experiences and views on career prospect, both position and financial stabilities would like to share their words of wisdom?

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[alophysio]

Hi - i am from the city. Your desire for 80k/yr can be achieved relatively easily if you went into private practice for yourself.

From the sounds of it, you are in the country.

Do you have any musculoskeletal experience? If not, i would get you manual skills up to scratch. Ain't going to earn good money unless you get people better.

I have the opposite experience to you it seems. The GPs send people to me even though there are physios within 300m of where they practice. Physio is usually thought of highly, esp in the community where i am where a lot of parents bring their adolescents in for rx.

You mention that your patients are skeptical about the effectiveness of physio yet as a community physio, part of your brief would be prevention - it is very hard to accurately measure prevention in a "sexy" way. It is kind of like insurance - you don't really like paying for it but boy are you glad when you need it.

As for insurance companies, they have a business to run. If they don't do it well, people will begin to shop around. A lot of my people in the community are just happy to get something back from them. They see the money they spend seeing me once or twice as being worth it because it saves them 100s in terms of lost time and productivity.

I wish my practices were bigger and busier but i have decided to keep it relatively small as a trade off for higher quality. I wil be raising my prices at my suburban practices soon to above workcover rates.

Let us know some more details - happy to share

[justwater]

Thanks, alophysio for your kind sharing.

You are exactly right, I work in the country. The past year I've seen the waiting list reducing from 8 weeks + till now, only 6 on the list. I wondered if it's more because of me or industry itself, and I realized it's the entire area after checking waiting list on other sites.

I am rather sharing more characteristics as private physio than rehab. I work on my own, that is in contrast to other physio in rehab team, which sees more subacute patient being discharged from hospital.

I see a lot of chronic cases and have seen a lot of neck (stiff, ache, dizziness), shoulder (tear, frozen shoulder, tendinitis, instability), lower back (disc, SIJ, spinal, muscle, instability), knees (arthritis, PFJ, and surrouding soft tissue).

I emphasize on patient education, exercise-oriented, with other electro equipments as supplement.

Although a patient of mine told me people in our catchment can be under financial stress, so they will drop anything other than the basic living- food. I am not sure if I should use such an excuss to comfort myself.

I haven't done a lot of course, and not sure which one will be most useful and valuable ie McKenzie or manual therapy. I am a full time employee, so that means to sacrofice stability for uncertain future, and having a family to look after, I can't be as adventourous like before. So a bit of sharing and advices will be much appreciated.

[alophysio]

Hi,

[apologies to others] I have posted elsewhere on what courses i think are helpful...I will again list them here for your benefit - hate searching for old things myself!

I started in the hospital system for 3 years in general rotations (med, surg, neuro, icu, ortho, outpt, etc) buty always preferred ortho and outpt. I wasted my first 3 years in that i didn't really do any courses. It wasn't until a patient asked me why i was doing a mobilisation - i.e. "what does this do?" and i couldn't really give an answer that was convincing. I then asked all the other physios in outpt who also couldn't really give me a good answer. At around the same time, a patient came to us post-surgery who had been seeing a private practitioner for someone else and wanted me to talk to her. She was fairly well-known and seemed quite reputable. I asked her what courses i should do etc and then mapped out a Continuing Ed plan that has led me here.

The courses i recommend are:
1. Certificate in Spinal Manual Therapy - Manual Concepts - www.manualconcepts.com.au - this course is what made me into a manual therapist. Great course, 8 days of intense learning, covered lots of topics and became a much better physio because of it. Also do NAGs, SNAGs and MWMs if you like but they are covered a bit in the 8 day course

2. MET of the SIJ and L/S Levels 1 and 2 and T/S and C/S with Barb Hungerford - www.amta.com.au - Great courses if you can get your head around it all. Not pure MET, more adapted by latest research.

3. Any courses by Diane Lee and LJ Lee - www.dianelee.ca or www.ljptconsulting.ca - These guys are great. LJ Lee is the best physio i have ever seen work - extremely good manual therapists.

4. Trish Wisbey-Roth's courses - again very good. Slightly different to Barb's MET - more Nordic style treatment. I use some of this stuff too.

5. Dry Needling - Andrew Hutton from the APA Acupuncture Group is a good contact. I did mine via Barb Hungerford's amta.com.au

6. Bill Vincenzino's Lateral Epicondylalgia course - excellent - he is from UQ

7. Dean Watson's headache course - again very good - from adelaide. Great upper C/S treatment WITHOUT manips

Craig Allingham, Lyn Watson, APA Sports Physio courses, etc etc.

I would focus on the first 3 on the list.

If you want, you could do a Masters in Manual Therapy at UWA - this is currently the best value course in Australia - excellent MAsters course, no research project, daily manual therapy classes, and only 3 months on-site cf 2 semesters at UQ and Curtin (i don't rate sydney or melbourne for manual therapy, ADelaide is not too bad but if i was to go to adelaide, i might as well go to UQ or Curtin). Also their (UWA's) approach to manual therapy is very broad and not at all hardline to one approach. You get good exposure to other techniques and clinical reasoning.

The 12 weeks loss of income is so much better than >32 weeks at the other unis...

As for Mackenzie - i am personally not a big fan. I think that the classification system and assessment is good. I think the method works for the people who fit into the classification system. I think it has been given a bad name by people who don't really know about the Mackenzie Method but give people "Mackenzie exercises". Personally, i would do the above courses before i did a Mackenzie course.
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Why would the financial situation in the country hurt someone who works for the govt in a hospital setting? That should matter should it? They shouldn't have to pay except for petrol...

As for the waiting list - what are you doing to promote yourself to the local GPs and surgeons? We write letters deliberately showing how much better the patient is feeling - of course, you have to do that!! Just the other day i had a lady tell me that no one was going to fix her neck and back pain because it happened at work >12 years ago and no one in the past has been able to help. She left after just one treatment technique (a SNAG into flexion for upper T/S) feeling more movement in her neck that she has had in years. Chronic patients are happy for ANY improvement. The trick here is to get her to rave on about how good the treatment was so the doctor can send more patients down.

You mention that you emphasise patient education and exercise based treatment, which is great, but do the patients actually feel better when they leave compared to when they walked in the door? If they don't, there is nothing really to encourage them to do what you say - pyschologically there is no improvement because they have just expended effort for no gain, only "theoretical" gain. What i am trying to say is that you may need to market yourself a little differently to ensure people *perceive* you as being a good and worthwhile person to see. After all, the fact that we put our hands on people has been shown to have a placebo effect - and that is good! Use the fact that people will start to feel better just because you did something (anything) to them!

Anway, i hope all that helps in some way. Let me know if you want more information.

Thanks