Does your physio body assist the private practitioners?

This is a general question about the roles and responsibilities of the Physiotherapy Associations in relation to the Private Practitioner sub group.

Is it, perhaps not well, appreciated that the private practitioner is the general public face of physiotherapy. Most members of the general public would not really know about all the varied roles that PT's play unless they find a loved one in hospital who is suddenly introduced to the wards physio team.

That said not many of use have loved ones in hospital and therefore most of the general public consider physio to be about treating an outpatient population. This puts our profession in the group serviced by osteopaths, chiropractors, kinesiologists, Bowen practitioners, even personal trainers! The public have a huge choice in which they choose to assist them in their health management.

Do you feel that this reality could be better addressed by your national association or group? Do you think it is party their responsibility to assist the private practitioners education of the public in a widespread manner about why they should choose a PT and why? They certainly do a lot for union style organisations within national health systems but what are they doing to promote to the general public in your country.

Offering a leaflet that the private practitioner has to buy to leave on their coffee table is not what I would call assistance. A wide spread media campaign on TV and perhaps main stream media (via television programming, soap operas etc) would be a far greater help.

Rumour has it that many private practitioner subgroups talk about going it alone as independent organisations. Unfortunately for many the membership numbers are so low that the viability is questionable. We have seen some moves in Australia on this front but what is going on in your area. Please do comment freely, in a positive or negative way. 8o

Hi.

I appreciate that physio has many faces but i do agree that the outpatient physio is the "public" face of physiotherapy.

I would push for stronger representation in mainstream media - like they did in Aust during the 2000 olympics (no matter how misguided the hunchback was!!!).

I think pointing out that physios have similar skills to chiros and osteos etc is important but that we are the experts at specific exercises for the rehabilitation of these problems (whereas the other professions treat problems then use passive treatment or general exercise as prevention).

When interviewing potential receptionists over the phone, a question was: "What is the difference between physios and chiros?". The most common answer (greater than 95-99% of respondents) was "physio do muscles, chiros do your spine".

How bad is that considering we are world-leaders on core-stability research???

Even my receptionist the other day called in sick (Wed) because she had dizziness, headaches and couldn't drive or anything. When i offered treatment to her, she asked "what can you for it?" This despite me telling her in the past that I can do pretty much anything her chiro can and she has seen patients with the same symptoms walk in bad and walk out great. She had seen the chiro *3 doors up the road from me* but didn't think or know we can help.

Even people who come for massages come in because they have persistent muscle soreness that they think will be "fixed" with massage. They didn't ever consider that a physio can find out the cause of their muscle spasms and so prevent the need for regular massages.

Unless we can change the public's perception of what we can offer, it seems that chiros (in particular) and other health professionals are more savvy in their marketing.

This is where we need more resources directed to educating the public. It is important to educate them about other aspects of physio but unless their perception of what private and public outpatient physios do, they won't find out what the others do...

Exactly, I think you have further highlighted the numerous dimensions of this issue. It appears that many PT's are asked this question, but only once the client is on the plinth. How many never made it to the plinth? I feel it is up to our mainstream organisations to assist in the public education of not what the differences are but what is the full spectrum of our profession.

Perhaps they could make a great PR answer to your receptionist question as i think most of our receptionists wouldn't have a great answer. 8o

Yup, I agree.

However, I have used "scripts" in the past for many questions.

The receptionists are trained to answer that the physio can probably help that if they recognise the condition (since they see so many different conditions and chat to the patients).

If they don't know the answer, they get me on the phone straight away or get a number for me to ring the person back if i am not there.

You are right. Pointing out the differences is probably not the way to go. Pointing out what we can do is...

well when one talk about the public awareness, it does certainly highlight the importance of marketing. i.e. making public awareness of key points of the profession what the physio can do for the patient. And I agree that there is certainly a lot of work that our profession has to offer to the public. And what the professional associations have done in this regard? That is really a question of concern for today. Is there any sub group among the physio associations or have they done any thing in this regard? These are points to ponder. It may differ from country to country as far as the activities of different professional associations are concerned.
Dear colleagues kindly highlight upon that. What is performance of physio associations in your countries?

Excellent topic.
Some of you that have read my previous posts will know my opinion on this subject. Unfortunately, in Australia, I am very disappointed with our Associations representation of members on a number of fronts. For a long time, hospital based therapists were better supported, as our representatives came from the public system. There is still an element of this occurring.
The main problem appears to be a reticence to offend any group by demonstrating in a very positive manner to the public that we are better therapists than the opposition. This can be achieved without pointing out the oppositions negative aspects ie being proactive.
The TV advertising using the Hunchback was a very negative step, and our opposition in the market place would have had a good laugh at our expense. I warned the profession in very strong terms against proceeding with the Hunchback, and was ignored. The Association even attempted to defend the advert, but later reluctantly admitted that there were problems. Der.

Marketing is currently a big focus of the APA, but more in relation to obtaining money from suppliers via advertising promotions rather than supporting members in the clinics. There are some moves to provide better information, plus lobbying of Government, which is good, however it is insufficient.

As a vocal member of various groups, my input has not been viewed as welcome, despite the curious fact that I have actually supported 'policy' more than those making the policy. The APA currently does not like criticism, and suggestions to change course or become more aggressive in supporting private therapists is not viewed kindly. APA responses to some of my previous posts are a good example, and I have many more examples outside of this site.

Current policy is moving more quickly toward an inevitable situation where Australian physiotherapists will be unable to compete against our marketplace opposition.Why? Because the APA, with good intent that I understand, is trying to position us as the best evidence based ethically sound therapists. To achieve this position, the APA is putting into place various constraints, rules, guidelines, and penalties that will mean that all therapists will be required to operate at the highest level possible, according to the available research, or be deemed to be unethical. Our opposition in the market place have no such strict compliance rules. WE may be the best, but that will not be of any benefit if we are priced out of the market due to compliance costs, at a time when the market is not even minimally informed of the differences between types of therapists.

In other words, the timing is wrong. Educate the public more fully, then ensure our position regarding optimal performance is maintained. At a time where slapping dead fish or aligning shakra hot stones is paid for by health insurance companies, plus while slipped discs are regularly adjusted into place, we are expected to further upgrade our training, with APA backed accreditation programs etc.

The focus is all wrong, in my opinion, and will cause us to lose market positioning. History needs to be heeded.
There are many examples of the current accepted science being proven incorrect. Evidence based medicine at present is open to being skewed by vested interests (insurance company interference), and the overseeing databases examining research regularly review 200+ research articles, only to throw out 195 of them due to criteria problems, then more closely examine the 5 left, with a decision to accept 3, then state that no conclusion can be drawn, or that the treatment examined cannot be supported on the 'evidence'.

Insurers may then use the lack of evidence base to refuse or restrict payment for the service, or claim that physiotherapists using the technique is ineffective. Logic tells us that a particular treatment, viewed in isolation, can only be excluded when implemented EXACTLY as per the experiment. Variations in treatment application may make a particular therapy relevant. That is why medications have dosage guidelines, which vary according to age, sometimes gender, and whether the medication is used combined with other medications.Much of what we do in the clinic every day is not replicated in a research laboratory. Excluding all therapy unless it has a research support base will stop innovative treatments developing, plus tie our hands behind our backs when attempting treatments we know actually have good effect.

For the APA to tie itself so closely to this paradigm when our competitors do not, is not a market advantage, but potential suicide. The APA is more recently accepting Branch councils (Vic Branch is a case in point), where a significant number of councillors are self confessed professional students. These people are making policy which is inflicted upon those of us working with people everyday. Highbrow impractical policy decisions are the result. The bulk of hardworking therapists cannot be expected to have their abilities 'raised' to that of the professional researcher/ academic, nor would such a change be for the professions greater good.
I am not saying that research is to be ignored. I believe in the scientific method. However, throwing out the baby with the bathwater needs to be resisted.

As this is a long post, I will stop here. Further debate is welcome. A greater fleshing out of my opinions could be undertaken, should forum participants indicate they would like me to do so.
Thanks for the opportunity.
Regards
MrPhysio

Here Here..... well said. Perhaps this is a point that should be well used by the smaller off-shoot of the APA as a reason for joing them. I feel a presidential election campaign coming on! Perhaps with a more well thought through position and a stronger marketing campaign the Australians physios may see a change of government? :eek

Mr Physio,

I must agree with you on many areas, perhaps not as emotionally - I am still relatively young and not as frustrated yet!!!

It would seem to me that a lot of "marketing" is targeted at physios - this, I presume, is to maintain and increase their base of funding. I do not mind sponsors although they can be annoying - the best is the 5% discount at Rebel!

I would like to see promotion of Private Physiotherapists as the "Public Face of Physiotherapy". I am not saying that Private Physios are in any way better, more superior, more worthy of the title; it is just the plain facts that the general public have most of their physio encounters with their local private physio.

Lets use this fact and get the word out there that physios can do so much more.

My practice is based on repeat business and word of mouth referrals. Medical referrals, yellow pages and walk-ins account for less than 30-50% of my new patient referrals. This is because I market to the client, not through the GP, yellow pages or signage. I find that the client will tell their GP if I do a good job (better than me telling the GP if i do a good job!), they will tell their friends and family, they will do my marketing for me. Letter drops have been shown to have a 0.1-1% response rate (not conversion rate), Media ads have good recall but don't necessarily drive "action". Yellow pages account for around only 40 new patients per year across 2 practices. I can continue but it becomes even more boring!

My point is that we need to focus our strategy in marketing. The people we want to target are the people who can afford to pay for physiotherapy. I say this because these people are the ones who will use Private Physios, bring their relatives who cannot pay and pay for them, and are generally in the "decision-making" role. These people "network" and will do marketing for us.

An example of the demographics i am speaking of are:
1. Mothers with new babies - most stay home for nearly a year and watch a lot of TV, especially late at night.
2. Professionals and their associated staff. They earn good money and want the best their money can buy.
3. Baby-boomers. They have made their money and are now retiring. It is reported that they will spend their money rather than pass it on to the next generation. Let them spend it on us! Have them influence their friends and family.
4. Children. This is tricky. Going to a health-professional is not what you generally want children hankering for. But if it the difference between a chiro or a physio being chosen by the parent, we might as well have something in place (such as a spinal checking service).

The point about the focus on the marketing is right. I believe and I have stated elsewhere in this forum that Chiros are the best marketers I know in the health profession. They dress in suits and ties, recommend regular check-ups (like a dentist) and charge more per minute than a physio ($40 for 10-15 minutes compared with $50 for 30mins (my rates)). I am actually about to put up rates next year and when people ask why I am more expensive than the person up the road, I will tell them that I don;t know about the other person's quality but I know our quality is very high.

In summary (because i tend to ramble):
1. Use private physios as the "public face" of physio and use it as a gateway to tell others about the other facets of physio.
2. Target more effectively the demographics which are most likely to drive change.

Alophysio,

It looks like you're getting your head around the marketing of physiotherapy. You can't underestimate the benefit of differentiation and target marketing. Choosing a few clearly defined target markets and demonstrating your niche "key value proposition" to that target market is a very powerful strategy. I guess we might see you at the Marketing lecture's PBA are running nationally this year.

Part of the reason that Chiro marketing has gained recognision is because they target market a very specific niche - adjustment of Backs. Dentists do teeth, Opto's do eyes etc - really clean and clear scope of practice and simple messages. Conversely physio is so diverse that it's difficult to deliver a single highly targeted message of what a physio does. Once the message says come and see us for "exercise and musculoskeletal conditions (question whether the average consumer knows what this means) and knees and rehabilitation and continence and ageing and cardio related work and ergonomics and occupational health and by the way, hows that race horse of yours going" - we struggle to retain the same level of 'clear and simple' as other consumer based marketing campaigns. At a micro level, the best way to address this is to get individual practices to determine thier own preferred niche and to support the practitioner to market that niche (hence marketing solutions launched this year). This shifts physio away from being a generic product that is easily compared and purchased on price alone.

As for associations, they can either run 85 concurrent and well funded niche campaigns (and tripple the membership fee) or they risk running something that's generic and doesn't totally satisfy anyone (this may ring a bell for those that remember the hunchback - all puns aside).

At a macro level, I understand associations around the world get an equal number of members asking for support with workforce shortages as they do marketing. 1/2 want help creating supply and 1/2 want help creating demand. This suggests that associations are actually getting it about right.

Thank you for replying Damien.

However, are you going to focus your marketing strategy via the private physios?

Honestly, the public doesn't need to know that physios do all that hospital-based stuff because it is highly unlikely that the public will ever need their services unless they go into hospital. After going into hospital, they will then know to contact the appropriate outpatient follow-up.

I don't think we have enough money just to "educate" the public that we are actually quite diverse. We need to focus on the strength of private practices and then help us educate them about our diversity once we have them in.

Alophysio,

The last lot of APA media releases have included a focus on back care when gardening, back to school and the productivity commission report where we're arguing for better physio access to Medicare. These are all private practice issues designed to drive profile, demand and revenue. Press releases are often PP centric as the issue in the public sector is demand management not demand itself.

PBA's role is to focus on private practice, thus PBA will focus on PP issues. Our focus over the coming year or so will be developing ways to assist PP's in marketing into their own niche.

By the way, all of the areas above (other than cardio) are being done in PP. PBA has members who run niche practices in Neuro, aged care, private and public hospital contracting, paediatrics, sports niches (down as far as dance), occupational rehab and ergonomics, hydrotherapy. Then we have members that have an interest in these areas but who also run a relatively general practice and those that run broad based general practice. Thus we'll be delivering customised materials to practices that will hopefully allow them to target their particular niche.

Of course, we also have a listing of PBA members on Australia's leading health consumer web site (audited at 70,000 unique hits per month on the site) and in the two leading script writing packages for GP's.

I am just a little confused here. Sorry for my ignorance on this subject. I have lost my way as to whether the PBA is an interest group of the APA or is it part of a seperate group that includes the likes of Jenny McConnell?, Francine St.George and Barb Hungerford? Has the PBA got a website we can direct people to look at for more information?

Many thanks 8o

That one I can definitely help with.

Physiotherapy Business Australia is the private practice special group of the Australian Physiotherapy Association.

www.physiotherapy.asn.au/pba

PBA is the APA's expert reference group on private practice matters and thus it is involved in the wide range of activities undertaken by the APA. This includes:
:D Working on private practice related advocacy (Veterans affairs, health insurance, workers compensation).
:D A quarterly magazine focused on the business of physiotherapy
:D A monthly email newsflash keeping people up to date with private practice issues
:D Annual research on market rates

Practice owners can also get access to:
:D An industrial relations telephone support line
:D 1800 advice line
:D Business related hot topics and advice sheets
:D Marketing solutions (Directory for referrers, searchable listing in Medical Director & eMIMS software, searchable listing on Australia’s No. 1 health consumer website. We've also introduced late last year a service that delivers fortnightly customised brochures, signs and marketing materials via email.

As for other groups, I'm not even sure that any other group still exists. They certainly don’t have a seat at any of the health industry advisory panels for organisations such as Medicare, DVA, Health Insurance Association, Workers Compensation Authorities, Australian Council of Physiotherapy Registration Authorities, Health Professionals Council of Australia. They haven't done any submissions for fees that we're aware of (all the recent increases - including the current DVA increases and the NSW Workcover increase that should be published tomorrow - have been done by the APA with PBA's support as expert reference). They haven't contributed to any major reviews lately (Review of the Privacy act, Trade practices act, productivity commission review of health workforce). I haven't heard much about splinter groups in the last 2 years and I suspect that many members of splinter groups retain thier PBA membership anyway.

Thanks for the clarification 8o

I agree; excellent topics.

There appears to a high level of focus amongst our profession on what our association can do for us with effective marketing. I know it’s a cliché, but my experience showed me that we will achieve a lot more focusing on what we can do for our association and marketing our profession.

I commend our association for achieving everything they do on an extremely low budget. The type of marketing results that are being discussed would require increased funding by a couple of orders of magnitude. It seems to me that the energy spent on these issues is distracting from real forward progress that is possible.

I propose we focus on what really matters, for both increased marketing and higher outcomes with clients simultaneously; and that is money.

Other professions such as dentistry and accounting offer us insight into what good business, and a lot more money, can achieve. It is clear that when done well, businesses with a lot of money achieve both a higher level of effective marketing and higher client outcomes simultaneously.

I perceive us to be a smart group of people, and it’s time we open our eyes and use our intelligence effectively by establishing good business principles like many successful professions already do. Is anyone else willing to face the challenge?

Regards,
Michael.

Hi

I am not a private practitioner so private practitioners may disagree. My impression is however that in our small country our association NZSP has a pretty united front and represents the interests of private practitioners very well. All of the recent presidents and the current one have been private practitioners. the society has been very active in lobbying over better and continued funding by out national accident insurer and providing continued public relations info on the benefits of private physiotherapy - just two examples of continued focus on private practitioners.

As issues become more commercial in nature these need to be picked up the private practitioners group that works in cooperation with the larger body. That is only fair; public sector physios contribute to the funding of the Society at the same rates as private practitioners.

In New Zealand the Society is a broad church with a very diverse areas of practice and the public/private divide is just one example. For example we have a special interest group for the older adult - it's members include both private practitioners specialising in this area and physios working in the public sector. And this would be typical across the interest groups. These interest groups are more united by their patient focus than divided by their source of income.

Obviously private practitioners are in more direct competition with complementary health providers than public sector practitioners. However even here it isn't so black and white. For example we have government funded primary health organisations who will often employ personal trainers or massage therapist in preference to physios - so it is a concern for all of us. One of our biggest threats is the broadening of govt body that regulates the standard of physiotherapy may be expanded to include massage therapist and the like. this could in the long term end up pushing physios out of main stream medicine, which could be very destructive to the development of the profession as a whole, both in public and private sectors.

So may be in larger countries a split is more feasible but to me it sounds short sited. We have much more that unites us than divides us and as such we have to accept that our professional associations won't always be solely focused on our own particular sector's wishes. - this is a two-way road; Public sector members can also feel marginalised at times.

One of our biggest problems is our lack of political power to influence health policy - this is so even in larger countries with highly developed physiotherapy workforces: USA, Australia and the UK. to me in would seem unhelpful to split ourselves up.