New Grad Guide to Physiotherapy : Starting Your Career
Starting Your Career
You’ve been offered the job and are extremely excited to start your career as a physiotherapist. Before getting ahead of yourself, it is important to be diligent before signing a contract. How does the company want to structure your position – as an employee or an independent contractor?
Usually reserved for larger companies and hospital positions.
- stability in work and pay
- employee benefits (dental, health insurance, etc)
- lack of flexibility in schedule
- lower earning potential long-term
More common in smaller physiotherapy clinics and small-medium sized companies.
- flexibility in schedule and place of work
- higher earning potential
- can deduct business expenses
- less stability in your job
- have to budget for income tax
- no benefits
Being hired as an employee is straightforward for most graduates, so we will focus on the independent contractor side of the business, since most positions function this way. Part 3 will cover the details of how being an independent contractor impacts your career as a physiotherapist.
As an independent contractor you have the right to decide where, when and how your work is done. This is extremely important to remember. With the added risk of being self-employed, you gain the flexibility in your schedule and hours.
Ex #1: You accept a job as an independent contractor, or consultant, and they expect you to be at the clinic from 8am-4pm regardless of the amount of patients you have scheduled. If you are paid hourly then it is in your best interest to stay (you’re getting paid to be there!) but most of the time you will be on a fee for service model. This means you are losing money when you are not seeing a patient! The clinic cannot dictate what hours you should be at the clinic and cannot force you to be present when there are no patients. A clinic can only dictate your hours if you are an employee. You can decide your availability, as long as it is reasonable to meet the needs of both yourself and the clinic.
Ex #2: You are hired by a clinic as an independent contractor. The clinic tells you that they need you every day of the workweek and you are not permitted to work at a second clinic. As an independent contractor, they cannot prevent you from working at another clinic. To be an exclusive practitioner at one clinic is one of the criteria in favor of an employee-like relationship. What is more commonly seen in a contract is a non-compete and non-solicitation clause within a certain radius from the clinic (usually 5-10km). This is perfectly acceptable and protects the clinic from a therapist poaching their clients.
TIP: Before accepting a position and starting your career, it is highly suggested that you shadow another physiotherapist at the clinic during a busy day. This is good for two reasons:
- To observe the flow and atmosphere of the clinic
- To observe the amount of patient traffic
If you sense an unfriendly atmosphere, an inefficient clinic operation, or a lack of patient traffic, don’t assume it will change once you accept the position. Unfortunately, building a full caseload takes a lot of time and effort, and the location and reputation of the clinic plays a large role in the amount of new patients that walk through the door. Don’t expect to start off extremely busy right away as a new grad until you build your reputation as a clinician. Also, the time of year you start your career will impact how busy you will be. Many physiotherapy clinics have slow periods, such as right after the holidays and during the summer months. Also, there will be many days where a patient will not show up for an appointment or will cancel at the last minute. Remember, as an independent contractor, you only get paid when seeing a patient.
Independent contractors usually receive a higher salary due to the lack of: benefits, job security, vacation and stat holiday pay, bonuses, and consistent work hours. As a new graduate, your pay will likely be structured as a fee for service. This model means you are only getting paid when you see a patient. Typically the fee split is percentage based and can range from 35-50% or higher. New graduates normally receive a lower percentage to start. Percentage will increase with experience, continuing education courses, and negotiation skills.
To determine if you are receiving fair pay compared to an employed physiotherapist position, it is helpful to consider a few variables and run the numbers:
- Clinic location (busier clinics will be able to bring in more new patients)
- Service fees (see how much the clinic charges for initial and follow-up sessions; you will make a percentage of this amount)
- Hours of work (most new grads will start on a part-time basis and may want to find a second job)
- Adjunct services (determine if you receive a percentage of sales for orthotics or therapy equipment)
- Employee cost
Employee cost is the cost to the employer of hiring an employee instead of an independent contractor. Typically, an employee will cost the company ~25% more. This is due to:
- Benefits (health, dental, etc)
- Vacation pay (4%)
- Canadian Pension Plan [CPP] contributions (4.95%)
- Employment Insurance [EI] premium (1.88%)
- Job security
In general, an independent contractor should charge 20-30% more for their services compared to a full-time employee. Therefore, if you could accept a position in a clinic at $35/hour as an employee, an independent contractor should be payed $43.75/hour (i.e. 25% more) for that same position.
Scheduling and Invoicing
Some clinics may ask you to take care of your own scheduling and invoicing. Small companies that don’t have a receptionist will ask you to handle scheduling patient appointments and accepting payments on behalf of the company. Although uncommon, if you decide to work at a clinic that operates without front desk staff, it is important to remember that this should be factored into your negotiation when determining a fee split percentage. Don’t forget that the other half of the fee split is going to the clinic, so think of it as you paying the clinic to provide a service (equipment, marketing, patients, admin staff, etc). If you now have to handle admin duties, then that should be a factor when negotiating a higher percentage.
If you end up taking care of the scheduling, it is best to use a good system to make it easier for yourself and your patients to book appointments. A freemium online appointment scheduling software such as SetMore is useful.
As an independent contractor, you will likely have to invoice the company you work at in order to get paid. Some larger companies will handle this internally and issue you a paycheque, however it is still important to audit these billings to make sure they aren’t forgetting to pay you for certain patients or hours worked. Most clinics will give you a sample template to fill in your hours worked, number of patients seen, fee split percentage, and dates. However, using an online invoice software application such as Wave Apps is a better way of creating and keeping track of clinic invoices.
Carefully read this section of the contract before starting your career. Most places will stipulate that you give 30 days notice before terminating a contract. If you start at a clinic and realize it is not for you, then you must refer to the contract to determine how to properly terminate the agreement. If you decide to terminate the agreement, send a formal written notice by email with all the details as well as the date of termination. Both parties may mutually agree to terminate immediately without notice as well.
Protecting your Practice
As a new physiotherapist, it is imperative that you understand the College guidelines and protect your practice above all else. There are always stories of shady clinics using your billing number inappropriately. It is your professional responsibility to make sure that it is used correctly. This means auditing your billings every so often to ensure nothing sketchy is happening. The College has more information on how to protect yourself from Provider Identity Theft.
Another issue involves the services you provide. If you decide to take an Acupuncture course after graduating, note that your workplace cannot bill separately for this service, regardless of what they or the insurance companies will say. It goes against the College guidelines to charge for a modality that should be considered an adjunct to physiotherapy treatment (ie: not a separate service).
The Practice Guidelines published by the College should be required reading before starting your career.
Don’t forget that a contract is negotiable. You can have parts re-written or removed. Make sure that the wording is in your best interests as well, because if there are any conflicts or disputes, the contract will serve as the final word. If contracts are overwhelming, it is best to have a lawyer review the documents.