Bad Start to a New Career

I’m not kidding you, this was a conversation that one of my colleagues overheard recently on a train.

Student 1 (let’s call him Jason): I’m going to start my own business.

Student 2 (let’s call him Mateo): Me too—I’m never going to work for someone else.

Jason: I know, right? And here’s what I’m going to do—I’ll get all my friends and family who have extended benefits plans to come to me and then invoice them for the maximum for each of their plans.

Mateo: Right. You don’t even need to treat them.

Jason: You don’t even need to see them!

(Both laugh)

I hope this conversation makes your flesh crawl a little. I hope that you think, like I do, that there is something terribly wrong when newcomers to the profession are planning to use their education and credentials to make as much money as possible without thinking one thought about patients.

I know that the financial pressures continue to grow year after year, and that it’s much harder to earn a good living as a physiotherapist today than it was in your parents’ time. And yet, I want to believe that physio students go through the incredibly competitive process of getting admitted to a university physical therapy program because they truly want to treat patients, to make people well, to keep people mobile.

Shari Hughes and I met two amazing groups of PTs at the Ottawa Hospital last month. They told us that there aren’t enough hours in the day, or dollars in the budget, to provide the care that they want to provide for their patients—and it’s breaking their hearts. I would trust that group of PTs with my mom or my children without a doubt.

It’s hard to imagine that with the kind of attitude those soon-to-be health care professionals displayed on the train, that they will make caring for patients or quality care a priority. I hope my children or mom doesn’t see one of them: What a waste of time and money that would be.

I’ve spoken with many of you who are able to balance making a nice living with providing high-quality care. So this blog is addressed to you: Make those students on the train understand that even if they were only joking, every time someone acts or talks like that it makes the profession look bad. A patient’s access to care depends on a pool of worthy, qualified and ethical physiotherapists.

Showing my age, and (mis)quoting The Jackson Five: Don’t let one bad apple spoil the whole bunch.

How about you? What would you say or do if a student or colleague said something like this to you?


College of Physiotherapists of Ontario
Standard for Professional Practice—Fees & Billing

22 thoughts on “Bad Start to a New Career

  1. Finally!!! somebody from the college heard about what is going on in the “real world”. I have been mentioning something along this line from last one year. Insurance sharing incidences are happening mostly in non physiotherapist owned clinics. We have to take steps to regulate them, than only some improvement can be expected. There are so many physiotherapists who are working at more than two physiotherapy clinics just because there are only part time jobs available now. These clinic owners hire physiotherapists to bill under their license number and run a scam of insurance sharing. Whole GTA is full of them. People who are involved in such practices are enjoying full bank accounts and physiotherapists who provided real, sincere physiotherapy care to their patients but did not write the “goals” in the assessment (just to save some time from paper work so that more physiotherapy care can be provided) are getting the brutality of College of physiotherapists of Ontario by going through reprimand, fine and suspension etc. During course of three years of clinic ownership, I have been asked by so many people about billing insurances under my license number and share the money. Most interesting thing you hear from them is, they tell you who else is doing the “shady” business around your clinic just to motivate you to do the same. Sometimes it feels like I should kick them out of the clinic right away but cannot behave in such a harsh way in order to maintain professional attitude. And yes…. Shenda!!! welcome to the “real world” of a physiotherapist.

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    • thanks for d reply. what is insurance sharing? to have my client go to another clinic that i dont know about while my boss has kickbacks from another business owner (on each treatment patient gets using my licence no.)
      shenda, you realize those kids talked the way we all did: we thought that there’s pouring wealth in this profession but i actually took d oath to poverty, i realized. and those PTs u spoke were sincere, i guess, but they were taking to you guys.

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      • In the writing above, insurance sharing means….something like, those two guys are talking on the train; billing the insurance when no treatments are occurred. Physiotherapist and patient shares the money.

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  2. Every profession has its black sheep…even ours, it seems….so boot them out of your Clinic, polish your personal ethics and remember that the cream always (eventually) rises to the top.
    If you are running a gold-standard clinic, you’ll attract like-minded physios and grateful patients and will do well. Maybe new grads need more education about avoiding the Fagins’ slimy clutches.

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  3. Yes!! lets hope I survive in this competition till I rises to the top…. The condition is so bad that about eighty percent of patients (who are well to do) do not want to pay deductibles and somehow they manage to find clinics which can manage the numbers for them.

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    • Yes, and the way these clinic owners portray themselves is that they are the heroes or the robinhoods for these cheap clients who don’t want to spend a penny for their health. But when crisis arises, it’s our misconduct, even if the dishonest admins keep the financial information from us. Managers say they are the owners of the clinic but I talk back to them. I say “you don’t own me”.

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      • Making the rich richer….not just a physiotherapy problem. It’s amazing that our society values the “right price” more than anything.

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  4. I would suggest to the students making such comments that they should not have the privilege of calling themselves registered professionals. It is disheartening to think of all the well intentioned students who attempt to enter Physiotherapy programs and are unsuccessful. Perhaps the acceptance criteria need to be reviewed to ensure that students not only meet academic standards but possess the qualities that our profession prides itself on.

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    • If life were like this (that we screen students for susceptibility for profssional misconduct of corruption), we would not have corrupt politicians in every country. Not every well-meaning students would turn out the same as well. The only way to know if you were honest is to look back as a retired PT, but for now, we do our best not to sacrifice the quantity and quality of our service while abiding the rules of the CPO. Students are not professionals but once they become one, hopefully they become more conscientious as they enter the independent practice.

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    • Wait a minute, how did this PT know that (s)he overheard PT students – and not chiro, osteopath or any other students, even possibly business or law student?

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    • An excellent observation. There are some amazing 75 per cent students who have well rounded lives who would be an asset to our profession who don’t even come close to making the cut. We have focused on marks and the “business” of physiotherapy rather than on the role of care provider and all that entails. Whoever told an A+ student they would become rich as a physiotherapist had it all wrong. It is an amazing profession that I am happy to have been a part of for over 28 years. It is disheartening to hear such comments and practices actually occur.

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  5. Same song from me, “PT clinics to be owned by PTs”. I am again singing it in the ears which are deaf to all advices.

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  6. Ok let us see if the college takes down one NON- physiotherapy owned clinics then we can talk about this kids. What can physiotherapist do when they are offered
    1. 25 dollars an hour as Resident or 30 dollars as independent registered physiotherapist
    2. you need to come only for assessment and all the treatment will be done by PTA
    I think I feel like we are bunch of highly qualified professionals with no guts to clean the mess. We are just interested in making awesome rules and regulation pulling each other legs.

    Sometimes i think the guy who does 40 dollar oil change is smarter than me without all the fancy education.

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    • Well said…. we are good at making fancy rules, keeping transparency etc. but it is all limited to CPO website. When a physiotherapist get caught doing a small mistake, will be punished for months but what about the non physiotherapy clinic owners who are running scam openly? It is very easy to say, “Don’t work at the places where unethical practice is going on”. Ask a physiotherapist who changed three jobs in less than couple of months just because all places were running some kind of scam. The first one was selling glasses from physiotherapy coverage, second was providing massage and chiropractic from physiotherapy coverage and third one was providing only ten hours a week with daily load of 30-35 patients (PTA provides treatments, PT only performs assessment in 10 hours). Recently attended two interviews. One is asking if I am comfortable to provide gym exercises from physiotherapy coverage and second is offering the job only if I am comfortable with his providing massage therapy, acupuncture or osteopathic treatments from physiotherapy coverage (He specifies as “sometimes only”). Still haven’t paid undergrads debt. Rejecting 5 places in a month!!!! How many more jobs are out there?

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      • Good for you for sticking to your guns! As a recently graduated physio student on the hunt for my first job, it makes me sad that my fellow peers would have such a conversation, let alone in public. Clearly they did not learn much from the “professional practice” courses we take during our education. I can also appreciate that money is at the forefront of many students’ minds coming out of school with large student loans to pay off, myself included, but I also feel that I have a set of personal values and professional responsibilities to take into consideration when searching for a job. Your post re-assures me that there are those in the profession setting an excellent example for students like myself! I commend you! True, there will always be someone who will take advantage, but I also have the privilege of knowing many intelligent and caring physio students entering the work force.

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  7. I am surprised that you didn’t just go ahead and revoke their future license right there on the train. The CPO doesn’t seem to really care about the public, they seem to only care about stringing up members with little to no actual evidence and showing they are ” protecting the public”. Self governing is a privilege and acting as God over the members is an abuse of authority like no other. How much do you “earn” as Registrar ?

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  8. I have recently entered the profession as an independent practitioner and was confronted with ethical issues pertaining to billing, fees and the provision of physiotherapy services. It was very difficult to be faced with the following issues:
    – Being pressured to utilize as much of a patients extended health care benefits as possible.
    – Being pressured to utilize my registration number to delegate treatments which are primarily exercise training
    – Having my registration number used without my consent so that treatments are provided from support staff to increase the margin of the clinic owner.

    I was surprised initially but quickly realized that within a private practice, revenues and profits sometimes trump quality of care and fly in the face of a treatment plan that is based on objective evidence, the patients beliefs and values and the experience of the practitioner. This can occur whether a clinic is PT owned or not.
    I’ve searched endlessly for positions that would not have this potential conflict of interest and profit decision-making scheme. I quit my job in private practice and I am very hesitant to ever move into this area again. Hopefully, the cream does eventually rise to the top.

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    • I am a clinic owner and our clinic does not partake in any sort of unethical or fraudulent billing. Our PTs only see 2 patients per hour and are not rushed with 1 hour assessments and we do not use support personnel. From time to time, we do get patients asking us to bill insurance in another family member’s name or for another service and our answer is simply “No, that is fraud. That is illegal and unethical.” Although our session rates our higher than many of the clinics around us, we are busy and our patients and referring practitioners recognize our high quality of care that comes with this price. As well, we only hire passionate, ethical, competent and motivated PTs who are committed to continual learning. If you are a PT of this stripe, you will have no problem finding a similar PT owned private clinic to practice in but you need to do your research. Revenues and profits do not have to trump the quality of care as you say if you have the clinical skills and knowledge to justify what you bill and educate patients that if they want quality care from qualified PTs, this comes with a fair price for both parties. PTs need to wake up and realize that competing on price is not good for the patients as it compromises the quality of care delivered. Just like dentists, we should all stick to the same fee schedule (perhaps adjusted geographically due to varying overhead) and any “competition” should be based on quality of care delivered, skills, convenience of location, hours, advanced skills/credentials etc. And OPA needs to wake up and produce a recommended fee schedule that adjusts annually with the cost of doing business like many other professions eg dentistry rather than a fee schedule that hasn’t been adjusted since 1999!!

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      • More and more I hear from friends and clients how they received sub standard care at private clinics. The more that occurs, the more we dilute what used to be a highly respected profession. I feel sorry for new graduates coming out into the field now at a time when hospital physiotherapy departments are being downsized and specialized programs cut. They are going to have to fight an uphill battle to earn the respect we had by the public and other health professionals in the past.

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  9. I’m not surprised to hear such comments since physiotherapy ceased to be a public good provided by publicly funded institutions. Physiotherapy services are now a marketplace where the motivation is money not healthcare. Perhaps the same sentiment can be applied to our universities. They no longer function for the public good but now sell education as a commodity to those who can afford to pay. This is the triumph of the free market that puts a price on everything and doesn’t know the value of anything.
    I find it very telling that Shenda’s example involved physiotherapists in a publicly funded facility.
    If we physiotherapists truly valued patient care we would be fighting strongly to have public fully funded
    within public hospitals. Currently many people are denied physiotherapy due to financial barriers. Moreover many private clinics spend too much time fighting with insurers about reimbursement.
    It is a bad situation all around.

    Paul Stackhouse P.T.

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  10. I recently heard that there are Physio companies offering Less hourly pay and limited hours to work in LTC homes!!!!. Is there any standard pay scale or schedule set by college so that new PT’s know what is happening now. Being a regulated profession I think there should be standard rate.

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