Adapting to Change for Clinics and Practitioners: Part One: Time for a Raise for BC Physios
A Five Part Series on the Business of Private Practice Physiotherapy in British Columbia
By Danielle Boyd MPT, BHK, PMP
Part One: Time for a Raise for BC Physios
As many members know, PABC recently released their fee guide for 2025 and it ignited quite the discussion among members and private practice physiotherapists.
The proposed fees are significantly higher than what many clinics in BC are currently charging and the fee guide itself got a lot of people thinking.
In order to meet the current fee guide, a lot of clinics would have to raise their rates 50-100% and the resistance to this is (rightfully and reasonably) strong.
Here’s a list of just some of the concerns:
Fear of losing clients
Not being able to provide quality care to clients who can’t afford co-pays
Losing valuable community reputation and trust
Creating chaos and potential conflict internally among staff
The time and energy required to educate clients
These are all very reasonable arguments for resisting the new suggested fees.
While I do recognize this is an incredibly nuanced conversation that I will try and address in this piece, it is very important.
This isn’t about passing higher fees onto our clients and patients or profiting off of injury and illness, it is about changing the public, government and insurance perception of physiotherapy and valuing clinic owners and therapists for the work we do.
PABC is working hard to advocate for the profession at the government and insurance company levels on items including scope of practice expansion, MSP fee increases, negotiating insurance contracts and enhancing the stakeholder perception of the profession.
This work has proven to be essential in laying the foundation for a fee restructure.
With that all said, the current state of clinic ownership in BC isn’t fantastic, and much of the resistance to change - especially the type of change that the Fee Guide seems to be proposing - stems from the fact that things have just always been this way.
And change is always hard.
But the reality is, the “way things have always been” isn’t working anymore.
Here’s just some of the issues that clinic owners face today:
Expenses are rising constantly and have been for years
Owners aren’t able to pay living wages to support staff
Profit margins are increasingly slim
Insurance companies are breathing down the necks of clinic owners
There’s been a sharp increase in wage and fee-split expectations from the new wave of practitioners (this is an issue that deserves its own conversation).
Many owners pay themselves last (if at all), and often subsidize business expenses through their own billings—essentially covering operational costs with personal clinical work.
What many don’t realize is that failing to separate personal billings from the business’s operational income not only leads to burnout, but also significantly devalues the clinic. When it comes time to sell, that owner-generated revenue disappears, and with it, a large portion of the clinic’s valuation.
While a raise in fees certainly won’t solve all of these problems, it is a necessary first step toward improving these conditions.
Let’s be clear, I am not advocating that any clinic cut corners or rush patients through, offer sub standard and outdated care or lack a client centered approach.
As a physiotherapist who has trained extensively (and expensively!) in a variety of modalities, I advocate on behalf of the other practitioners and clinic owners who value client centered care, encourage training and education and continue to strive to deliver the highest quality of care.
The profession of physiotherapy has changed significantly in my over a decade of practice and there are many clinics and practitioners who are leading the charge with advanced training, high quality one-on-one care and unique and innovative service models.
These are the clinics I advocate for.
We also need to acknowledge that there are many different models and different sets of priorities for some clinics in BC.
There are still absolutely clinics in BC that prioritize profits and maximize the number of patients seen in an hour. While this model has been around for a long time, these clinics are the ones that are pulling the perception of the profession down and fulfill the stereotypes of “physio-mill” clinics that provide out-dated care and cookie-cutter treatment plans. These clinics are not the clinics I advocate for where it comes to fee increases.
But for those clinics and practitioners who are constantly learning, spending quality one-on-one time with patients and who stay up to date with research and education, these are the ones changing the game and who are leading the charge in advancing the profession.
Physiotherapists as caring professionals in general tend to be very accommodating and kind. We’re “go with the flow” types who are constantly learning and adapting to changes big and small.
Unfortunately we are not taught any business principles in school and this creates a large gap in knowledge and boundaries for clinic owners when starting.
Physiotherapists as a people tend to be very relaxed and “go with the flow” type people. Given our generous and supportive nature, a lot of physiotherapists turned business owners start their businesses under-informed on the business side of things and through a lens of generosity, assuming that as long as the bills are covered they can pay the rest to their practitioners.
As a result, many new owners often find themselves early in business ownership feeling overwhelmed, underpaid, stressed and resentful because they didn’t have the understanding or support they needed to set their businesses up adequately and are now having to create margins from thin air because of hidden expenses and rising costs that they didn’t factor into their fee split calculations.
Here’s a short list of some of the other issues that physios and clinic owners face every day:
A massive shortage of physiotherapists in the province
Clinic owners take on all financial and legal risk when offering direct billing to insurers
Burn out is rampant in practitioners
Physiotherapy fees haven’t increased adequately in ages (don’t even get me started on the government-determined MSP contributions of $23 dollars/session that haven’t increased since roughly 2001)
That short list is just a snapshot of the things that keep physios and clinic owners up at night.
Who would want to open a physiotherapy clinic in BC right now? That question itself shows us that we have a huge problem.
Most clinic owners are one audit, flood, practitioner leaving, or other unforeseen issue away from closing their clinics entirely.
In the next 4 parts to this piece, I will break down the financials of running a clinic in BC currently, explain the relationship with insurers and government, propose smoother ways to introduce increased fees and lastly, paint a picture of an ideal clinic ownership landscape in BC.
We can do this! But we need to do this together!
I really hope to shed some light on a situation that affects all of us in the profession and all of our patients.
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This article has been posted originally in the BC Physio Members App - join the discussion on the app.
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