Ultimate Physio

10/09/2026

The highest value care you can provide in physio private practice

Immediate pain relief for severe or long term pain

When pain reduces function improves

But you can't squat and deadlift your way through severe pain ( sorry young physios and non manual therapy gurus/influencers)

My story - herniated lower lumbar disc 15 months ago

3 months slogging it out initially, can do everything now, but my back always stiff

Enter my friend James Schomburgk

Quick but specific assessment and 2 mins of manual therapy

My back feels the best it has today in 2 years!!

What is this worth to me?

Thousands

I have been avoiding barbell squats and deadlifts due to the constant feeling of lumbar stiffness

Next gym session I am doing them again

Stop this bu****it narrative that manual therapy is low value

It may be for you the therapist, but I assure you it isn't for the patient

Get out of your head and focus on the person in front of you and what they want

And deliver high value care

Remember - those of you reading this most likely work in Australia, in private practice

Don't learn to be a British hospital physio if you are an Aussie private practice physio

Providing pain relief > quoting research papers

Follow the best people in OUR HEALTH SYSTEM, not someone else's who has no relevance or experience here

26/05/2026

Early career physios and physios students in Australia - this blog is for you.

Although I know it will mostly be read by clinic owners as this is my usual audience.

So, we have a major problem that is hampering your career drastically.

Yesterday the APA published proof of this problem, in it's 2025 workforce census report.

I will share this report at the bottom of this post.

Here is the major issue:

Only 35% of early career physios state that their training prepared them well for the workplace.

This is down from 61% in 2023.

This stat has literally dropped off a cliff.

At the same time, private practice in 2025 employs 64% of physios in Australia.

This is up from 57% in 2023.

In the same timeframe, public hospital employment of physios has dropped from 16% to 13%.

2 in 3 physios work in private practice

1 in 3 early career physios feel their training prepared them for the workplace

1 in 7 physios works in a public hospital

Herein lies the problem....

OK, let's add to this whole scenario that the Government has rebuild the employment laws which govern our profession, to give females more pay equality (or so they say)

Prominent commentators in our industry are speculating that this rebuild will result in physio new grads being paid wages of $90k PA plus!

The final piece of the puzzle is that, for the first time in many years, the unemployment rate is rising

So we have a dangerous cocktail of:

1. Physio grads who don't feel prepared for the workforce
2. An industry where private practice employs 2 in 3 grads and public hospitals employ 1 in 7 grads
3. An IR reform climate where physios are being paid more
4. An economic slowdown (recession) where patients have tight personal finances
5. A period of increasing unemployment

The absolute root cause of the problem is this:

- There are not enough private practice work specific skills being taught in universities in Australia

Some of the basic include:

- how to connect with a person
- how to help a patient achieve their goals
- manual therapy to provide pain relief
- how to treat acute (or an acute flareup of a chronic) conditions
- treatment planning for common conditions in private practice
- how to handle difficult patients
- how to build a patient list
- how to maintain a patient list

My clinics don't hire grads

And I'm glad

Because we provide high quality physio to predominantly private patients who pay the bill themselves

And these patients simply won't tolerate paying good money for a therapist who lacks skill, experience and competence

Who's door do we have to bash down for the universities to wake up and realise they are training the least job ready physios who have ever existed?

Universities in Australia need to know that private practice employs 2 in 3 physios and they need to pull their fingers out and rework their curriculums so new grads feel ready for the private practice environment.

And young physios - don't be so focused on burnout.

Most private practice jobs come with high support and mentoring, and you don't see clients for more than 30 hours in a 38 hour week, until you are competent.

Yes, the first year is tough. Every patient and condition is new. But this is every job.

My first job was picking lettuce on a farm in 40 degree heat. I can tell you being in an air conditioned room beats this every day of the week.

Have a read for yourself and keen for your thoughts.

11/02/2026

More private patients = more manual therapy?

This debate is so hot, and we need to find ways to simplify it.

I spoke to a physio who, at their last clinic, started with a caseload of 3% of private patients.

How much manual therapy did they use?

Not much.

One of my clinics has 80% private patients. How much manual therapy is used? Virtually on every new patient, intensively during their acute phase, and less often as they recover.

In systems where the patient doesn't pay, and the workplace dictates the kpis, for example getting people off the books, reducing dependency etc, it is only natural that little to no manual therapy is used.

These systems are common in places like NZ and the UK. They are publicly funded systems.

So what type of patients do you see?

In Australia, and if they pay the bill from their hard earned, they are gonna want at least some manual therapy.

If an insurer or the government pays the bills, they will dictate for minimal or no use of manual therapy.

Think manual therapy sucks, like some gurus?

Prob cos they don't treat private fee paying patients.

Don't take advice from someone who doesn't understand the system you work in.

If you work in private practice, in Australia, and treat private patients, they expect manual therapy.

If you don't do it, they will go elsewhere. Simple as that.

02/11/2025

The new age "guru" physios aren't manual therapists.

They are research paper and exercise only "hands off" physios who believe they can see someone once or twice, tell the patient they will get better on their own, prescribe squats, and believe that the person will somehow recover on their own despite what mounting and recent evidence suggests.

15/08/2025

Private practice physios - here is a tip when choosing which mentors are credible and which you should listen to.

Credibility 101 - if said mentor has not practised in the setting you work in, which for the bulk of us is Australian private practice physiotherapy, they simply do not understand the nature of how you work, the patient types you see, and the systems you operate under.

Use this discernment of their level of credibility before believing every word they say.

14/08/2025

Yesterday my good friend James Schomburgk did a post saying he wouldn't employ a physio in his clinics who is anti manual therapy ( I paraphrase as James cited the physio in question was sceptical of manual therapy research findings but not other research findings including exercise therapy).

I'd like to double down on this sentiment.

We practice in the Australian private practice system.

Most ( but not all) patients have acute pain, or an acute exacerbation of a chronic problem.

These problems respond to manual therapy. There is evidence these problems respond to manual therapy.

If you are a physio who does not use manual therapy you should not be working with patients with acute pain in a private practice setting.

Patients with acute pain want pain relief!

This is why they come to physio.

They do not want to be told they will get better on their own and sent on their way. They do not want a know it all physio quoting studies at them.

After all, what is their biggest complaint from their GP appointment?

"The doctor didn't even touch me!".

If you don't believe in manual therapy, don't work in Aussie private practice.

For those who think manual therapy sucks?

Try asking your patients in acute pain what they actually want...

For those operating a second opinion service with chronic pain patients only don't drop your bs opinions here as they aren't relevant.

If you work in private practice physio in Australia you need to stop treating everyone like a chronic pain patient with yellow flags galore, because I can tell you after 20+ years practising in this setting this is one of the most harmful things you can do.

Mismanagement of acute pain and injury is rife in physio these days, let's draw a line in the sand and stop it in it's tracks.

28/05/2025

I don't do many posts for employed physiotherapists ( my main clients are clinic owners), but here's an important one.

I hear lots of people talking bad about our profession right now.

But most of them are talking garbage as patients need physios more than ever.

I'm going to show you some simple steps as a therapist to get to the point where you earn a $150k pa package, working 4 days a week, fulltime, with no work at home.

What you don't know is that this salary package will have you out earning around 50% of clinic owners, and earning a higher hourly rate than around 2/3rds of clinic owners ( who earn a higher amount but do far more hours).

So here goes:

1. Find a clinic who values you, designs an employment package for you where if you bill more you earn more, and has clinical philosophies you align with

2. You have to commit to that clinic for 5 years to get to the salary and hours you desire

3. Your billable consult rate has to average more than $240/hr for private patients for follow up appointments ( ie $120 or more for 30 minutes follow up consults)

4. You need to get really good at your physio skills- manual therapy, building therapeutic alliance, exercise prescription, practical education, diagnosis, prognosis

5. You need to give every single new patient a treatment plan

6. You need to do extra learning in advanced communication ( there are plenty of good physio specific mentors for this)

7. You need to follow up every single patient who no shows or cancels! ( you, not your admin team)

8. You need to maintain a clinical philosophy of helping every single patient under your care to reach their goals

9. You need to work on your own limiting financial beliefs and not project them onto patients, other staff, or the clinic owner

10. You need to use an ai note taking software so you don't do paperwork at home

11. You need to be efficient - you don't need more than 30 mins a day to do admin. If you believe you do, go and google something called "Parkinson's Law"

12. You need to do your notes in the session with the patient ( that's what Doctors do!)

13. You need to treat around 50 patients a week or have 28 to 31 hours of treating time a week for a fulltime role

14. You need to take your 4 weeks of annual leave a year to keep you fresh - don't bank it

15. If you take leave of more than 3 weeks at a time, when you're back you need to work hard to rebuild your list ( see point 7 above)

16. You need to actually give a s**t about your clinic owner - they hold the keys to what you want

17. You also need to care about the profitability of the business you work in. If its profitable it can pay you more and train you better, and if it's not, it can't

And

If you do the above:

After 3 to 4 years you will have what you want.

But here's the real problem:

Many of you reading this aren't patient enough to do the above.

You will stay in a job 2 years, get "burnt out", hope to the next one, and start again.

Then you complain you can't afford to buy a house.

I will bluntly tell you that not many people earning $150kpa can't afford to buy a house ( depending on where you want to live).

What is the magic feature that happens after 2 years in a job that you can't get if you job hop??

It's called repeat business.

Old clients returning with new injuries, or referring family members and friends.

Stay in the right job and earn $150k for a 4 day week after 3-4 years.

Or job hop to your doom, and quit the profession to become a medical sales rep, or go back to uni ( for what?)

The choice is yours.

For those who are serious - show this to your clinic owners and work together on a plan to go and do it...

My challenge to you - be patient, work hard, and enjoy the process.

27/06/2024

Here's a simple way as a therapist to be eligible for never ending pay increases. Your boss will also be OK with this:

1. Determine how to measure your performance in your core role right now
2. Improve your performance
3. Prove it by going back to step 1
4. Sustain it - 6 to 12 months ideally
5. Ask for a payrise using steps 1 and 3 above
6. Repeat forever

16/04/2024

Here's a short video I posted this morning for allied health practitioners in private practice, regarding minimising patient cancellations. (15 min watch)

Here's a video I shot on the 3 key things you need to do as a physio, psychologist, remedial massage therapist, or any type of allied health practitioner

07/02/2024

Happy Birthday Jess Prestedge - our Google Ads, SEO and Website Builder!!!! Hope you have an awesome day!