Adapting to Change Part 3: Reclaiming Our Value: Standing Up to Undervaluation by Insurers and Government Systems

A Five Part Series on the Business of Private Practice Physiotherapy in British Columbia

This article has been posted originally in the BC Physio Members App - join the discussion on the app.

We Are Primary Care Providers

It's time for physiotherapists to step fully into the role we already play: primary care providers. Every day, we assess, diagnose, triage, and manage complex neuromusculoskeletal conditions. We're often the first point of contact for patients. We catch red flags, prevent unnecessary medications, imaging, and surgeries, and keep people out of walk-in clinics and emergency rooms.

Yet despite these critical contributions, we continue to price our services like adjunct providers - on par with massage therapists, kinesiologists, and chiropractors. While these professions provide valuable care, they are not primary care providers in the way physiotherapists are trained, regulated, and expected to practice.

The Backwards Relationship with Insurers

The undervaluation of physiotherapy is structural. Most BC clinics set their fees based on what insurance companies will pay, not on the actual cost and value of care provided. Many reimbursement caps haven't even kept pace with inflation. This is a broken model and it's not how other regulated professions operate.

Consider dental hygiene in BC: Their association publishes a standardized fee guide each year, and insurers adjust their coverage to match those professional rates. Insurers don't dictate pricing in this profession, they respond to it. In automotive or home insurance, insurers don't set repair prices; they restore property at market value. Yet somehow in physiotherapy, we've reversed this relationship. We've allowed insurers to determine coverages and define our worth instead of the other way around.

This needs to change.

It's Not About Profiting from Illness

Aligning with the PABC fee guide isn't about profiting from injury or illness. Most clinics today are operating under severe financial pressure and barely breaking even (as we discussed in Parts 1 and 2). This is about long-term viability and aligning with the true value physiotherapy provides across the healthcare continuum.

But we can't discuss private fees without addressing public access. Currently, MSP pays just $23 per physiotherapy session for those who qualify. This rate is unchanged since 2001! That's far below the actual cost of care, making physiotherapy functionally inaccessible for patients relying on MSP coverage due to the large resulting co-pays. 

The Real Cost of Undervaluation

Too many people default to injections and surgery - the "free" route - because they can't afford early, conservative care. Yet we know exercise and education are the most effective, evidence-based interventions for most musculoskeletal issues.

Imagine this: If even a fraction of funding currently directed toward total joint replacements was redirected to early intervention physiotherapy, the health care system savings would be massive: fewer people getting injections, fewer surgeries, fewer walk in and ER visits, fewer disability insurance claims. This saves real money that should be reinvested into growing access to early intervention and community programs.

A Two-Pronged Approach

To truly reclaim our value, we need both private sector rate reform and expanded public funding:

Private sector: Sustainable rates that reflect our training, expertise, and impact and create viable clinic businesses.

Public sector: Improved access to public resources:

  • Increased MSP reimbursement rates 

  • More publicly funded physiotherapy in urgent care, outpatient, and community settings

  • Municipal support for physiotherapy-led group and individual chronic disease management and prevention programs

The Bottom Line

A fee increase isn't about lining clinic owners' pockets, it’s about sustainable business models that allow for reinvestment in staff, programs, and patient care and make clinic ownership a viable financial option. We provide primary care services that keep people healthy and out of expensive medical interventions and should be valued as such.

Reclaiming our value means refusing to let outdated systems at government and insurance company levels  define what we're worth. It means positioning physiotherapy where it belongs: at the front lines of healthcare, with funding models that reflect our true impact on patient outcomes and healthcare costs.

The current model isn't working. It's time to change the conversation.

Want to work together on redefining your clinic’s value and messaging? Get in touch, I would love to see how we can collaborate.

Next
Next

Adapting to Change Part 2: A deeper dive into the numbers of running a clinic