Starting out in private practice - advice and tips please!

[physiofi]

Hi all,

After much thinking and research, I have decided to look at going self-employed and setting myself up as a private physiotherapist. I graduated in July 2010 and after 7 months of being rejected for numerous NHS jobs (what an awful climate for any kind of jobs, let alone physio at the moment!), I managed to get bank work in a trust in North Wales. Luckily, this was extended and I ended up on a temporary contract for 10 months in a static post on outpatients. I worked across two sites, both in an acute large hospital and a community hospital - I was lucky enough to see lots of acute sprains and fractures, as well as many chronic conditions, particularly low back and neck pain etc. I feel confident working independently on outpatients now, and do have several close friends who were my seniors in my previous workplace who I know I can refer back to if needed for supervision and to discuss difficult cases.

I'm aware that I've completed nearly 3 rotations as a "junior" which most juniors wouldn't have (although I haven't done other areas other than as a student). Running a business does seem daunting but I feel I've been left with no choice. My contract in NW wasn't renewed and they could only offer me bank work, which I couldn't accept at the time due to renting commitments and the uncertainty of not knowing if I'd have work, no paid sick leave, job security etc. I've now moved back home and am living with my parents. Unfortunately, I can't afford to and don't want to move miles and miles away again, so that leaves my job search pretty limited. I have applied to all relevant NHS posts that have come up, in addition to agency/locum work. I've contacted all nearby private practices but most seem to be sole traders who won't take anyone on, even on a voluntary basis.

Initially, I intend to do domiciliary visits and treat people in their own homes as I have no space in my house to do so in a professional way with a view to eventually renting a treatment room locally once I have built a large enough client base. I have a portable plinth already and full insurance cover via the CSP, who I've contacted and read the guides that are written to help physios starting out in private practice. I intend to register with the information commissioner in order to comply with the data protection act and keep notes encrypted on my laptop and also locked away safely at home. I know I need to register as self-employed with the HMRC and have researched everything with regards to tax/self-assessment and so on. I'm in the process of drawing up blank assessment form/note sheets, appointment and business cards and leaflets.

Could anyone offer any advice/pointers or tips on things they think I may have missed? I found it so hard to get all the information to make this decision and there's so much to take in and plan...I am aware of my limitations as a businessperson (and as a physio!) but I feel quite positive about this all, even though I know it will be difficult at first. I don't feel like I have any other options if I want to stay local at the moment.

Sorry for the long post - I look forward to hearing people's ideas!

Thanks,

Fi.

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[quitefrankey]

My immediate concern for you would be the lack of experience. You have been qualified for 18 months & have just 10 months of NHS working experience. In private practice you really are alone & need to have the clinical reasoning, skills & expertise to work confidently & independently with anything that you may encounter. Patients expectations are often higher in private practice than they are in an NHS environment. In addition, some private health insurance companies will not allow you to treat their patients with less than 5 years experience, most notably BUPA. As far as I know AXA PPP are still not recruiting physiotherapists to their register (this has been the case for several years) so you are currently unable to treat patients from the 2 largest insurance providers. This means you are limited from the outset, & as you plan to start on a domiciliary basis your target patients are those that can pay for themselves (there are further difficulties in getting health insurers to pay for domiciliary visits). In my experience self-payers make up approximately 20-30% of an established clinic patient base. So you will be competing with established local clinics who are fully equipped - you need to be offering something different / special or be particularly competitive in your pricing to attract your first patients. Working in the community is also much more time consuming so the number of patients you can see each day is considerably less than in a clinic. And you will need to advertise, advertise, advertise.

Consider perhaps renting a room on a hourly basis within a gym/sports club or complementary health centre so that you only pay for the time that you are using the room. And I would suggest that you ask your patients to give brief written feedback at the end of treatment that you can use within your advertising, & encourage recommendations by handing a few business cards to each patient.

I'm sorry if my view is rather negative as I understand & respect your desire to be working & using your skills, & the difficulties you (& so many others) have encountered in the job market in this climate. You have clearly done a lot of groundwork & if your heart tells you to go for it, then do it! I wish you the very best of luck.

[violablue]

A website, so people can look you up and find you easily. I'm not sure about practice regulations your way, so I won't comment on any of that. But a website is a great way to advertise yourself.

[jools987]

18 months ago. I did pretty much what you're proposing. I qualified in 2005 and was unable to get a junior post. I did a small amount of bank work and then departed physiotherapy for a while to do other stuff and have a baby. Post-baby, I decided that being self-employed was an ideal way to work, despite (I felt) my lack of experience. I did a full-time 5 week course in Sports Therapy to get me back into something related and did a couple of weeks shadowing at an NHS out-patient department. I rented a room from the outset as I'd guessed about the drawbacks (hightlighted by quitefrankey) of working mobile. I guess I was lucky to start with in that I needed to do little more than cover my costs and childcare. My business has grown very slowly but I'm now seeing up to 15 patients a week, all self-referring, no insurance work for the reasons also hightlighted by quitefrankey. My physio skills are basic, I'll admit, but they are there, and they're complimented by massage and soft tissue work, something which I feel is vital and missing from many physio's approach. It's scary working on your own with little experience but I recommend sticking to what you know, read read read learn learn learn (fear of messing up and the responsibility is a great motivator I've discovered!) and follow your instincts. My business (I rent a room within an existing business in the centre of a small semi-rural town) comes mainly from my website which is simple and searches reasonably well, and from word of mouth. I've spent almost nothing on advertising, bar some business cards, as the general consent locally was that it didn't work and that was also my experience based on the little I have tried. Be likeable and honest and offer good value for money (I do) and people will recommend you. CSP membership - great, HMRC - great, HPC registration I assume you have. Read, study, learn, do courses as much as you can. Fix your own physical problems too - that's a wonderful incentive and way to learn and I've found out about so many new areas of physio and methods that compliment physio by doing this. Hope that helps, do ask any more questions if you want and I'll see if I can help. It's interesting to hear of someone else doing the same - let me know how you get on!

[physiofi]

thanks for your replies quitefrankey and jools.

I have been giving it a lot of thought and am still doubtful about whether I am actually going to take the plunge, or maybe keep up some skills by doing some ad hoc private work and then get a temp job to pay the bills etc. I really feel like I have no other options at the moment if I want to stay as a physio, because there are really no job opportunities nearby and being repeatedly rejected or coming 2nd place for 1 post out of hundreds of people is even more demoralising. It's encouraging to hear your side of it jools - good to see that you can prosper even in the current climate. I'm hopeful something will come along soon...I'll keep you posted!

[Crystal R. Westergard]

Dear physiofi,
Very good advice so far, and I'm delighted to see you are seriously considering the downside, as I find when people want to go into business there is often no way to talk them out of it, even with the facts!
If you can move, I highly suggest you try Canada or US, as you could get 2-5 years experience here and save enough to open your own clinic when you got back. If coming over is not feasible, I would say I concur with those who warn against buying ads or sponsorships.
If you can't afford the website, try a facebook site, that will come up on google when people search you. Then people can post feedback and encourage you, and their friends can read it.
The idea of a part time job for a while is very good, but I think if good part time jobs were easy to find in Wales, you'd have gotten two of them together and not be in this dilemma, eh?
The person who said the standards of expectation were higher in private practice, wow, they said a mouthful!!!! That is so true. Your learning curve will be steep. Good Luck whatever you decide.

[physiotherapist_paul]

I very well understand your situation. don't be disappointed though. Well all that has been contributed above is true but you need to take those negative points to build up a better strategy and defence.

[physiotherapist_paul]

Sometime back I found myself in a similar situation as that Of yours. And decided to venture into house visits. I began with lots of obstacles and negativity from all sides but I just jumped into it and today I am in much better position. I earn far better than my peers. Initially it was extremely tough but after some good research and lots of hard work I am pretty much ahead of others. It looks like a gamble but once you venture into it you will realise that there's nothing much to lose. all you gotta do is do a strong online campaign and make contacts. small investment is required but I am sure you would be able to get it back.

[physiotherapist_paul]

It's always good to start something on your own, the only concern here would be your lack of experience. Anway since you plan to take help from your seniors , it's ok. where there's a will there is a way. for tips and tricks on online campaign private message me. best luck

[Darren Rieck]

Hi Fi,
Thanks for the post. I started my own practice 10 years ago here in Australia and now have built it up. One thing I would change if I had my time back again is to monitor and record things like where my referrals are coming from, my revenue, patient numbers etc...the business side of things (from a practice management system), in order to help you know where your business/revenue is coming from. In terms of this I have helped develop a software system (that is web-based...so you can access from your laptop) called Nookal. Have a look and see what you think, its starts from only $55 AUD per month.
Thanks
Darren

[PrzemJac]

Hi everyone.
I have similar question as I have jut started my own practice in the UK.

I would like to find out how to approach solicitors to start getting injury clients from them (to be on their panels).

Please write what is your experience about starting with them/ how would you approach their practices?

King regards PJ