Last week I had a little epiphany about physiotherapist working hours.
It’s something I’d thought about on a number of occasions, especially when digesting some of the challenges I had as an owner.
Particularly finding and retaining staff.
The job itself, private practice, is hard.
It requires a lot of care, empathy, talking, listening and taking on other peoples problems.
Having change conversations, guiding people into uncharted territories.
Dealing with slip ups, mishaps, regressions, flare ups.
With the addition of physical components that go with the territory.
Plus the learning, thinking, developing of skills – often outside of normal hours, lunchtime PD’s, evening lectures, weekend courses.
It’s a hard job, especially early in one’s career where a lot of these things happen concurrently.
As a young therapist it’s not really that likely you’ll be needing to go to bed early.
But as a parent with two kids under 3, this is my evenings dream.
To be tucked up in bed by 9pm, hopeful of a decent nights rest.
The late nights
One of the reasons I eventually did sell my business was that I couldn’t deal with the thought of returning to the grind.
If something went wrong, a few practitioners resigned in a short space of time, it would be inevitable that I’d need to re-enter the frame.
And with young children, a distorted sleep schedule at the best of times, and a questionable level of mental resilience to cope with another year of chaos, I decided it might be nice to leave this party whilst I was still having fun.
I think this decision said a lot about where my head was at after 200+ days in lockdown in Melbourne (2020/2021), two boys born in the space of 20 months and a change of scenery to regional Victoria midway through this process.
It also says a lot about what we expect of ourselves and others within our profession.
I did have one rule throughout my leadership, I would never ask anyone to do something I wasn’t willing to do myself.
The inconvenient truth
The hours we work as a physiotherapist in private practice are hard.
As industry standard, I’d say most people do at least one evening but more often than not it’s likely a couple per week, if not more.
Plus the odd early start and potentially even a Saturday morning shift.
When I opened my business in 2018, I was doing all of the above.
But I had time on my side and I had a pretty big goal to motivate me.
Plus, I’d been here before and my body clock was used to an unusual routine – caffeine was also always available.
Private practice physiotherapist working hours
It’s not exactly shiftwork in a blue collar sense – in fact it’s quite far from it.
But neither is it a set daily routine.
We may often have a sleep in one day, followed by a later night.
Followed by an early start.
This can be a bit unsettling at the best of times.
Back in 2014 when I was an employee in London, my shifts looked like:
A long day Monday A long day Tuesday, with an 8pm finish. A long day Wednesday Followed by a 7am start on the Thursday - which was my 'short' day. Followed by a short Friday evening shift
I was absolutely cooked by Wednesday morning, let alone Thursday.
I feel sorry for any patients that saw me on those Thursday mornings quite honestly.
But that was the way things were, and in a busy practice, there wasn’t opportunity to change shifts unless someone else left.
Fast forward 4 years and I carried these principles into my own clinic.
With great success mind you.
We worked until 8pm, sometimes even later to be honest.
And the culture was very much set as this is private practice.
Something I had learned from doing exactly that myself.
"We do these hours to be available for our patients." "To deliver the best quality of care."
But does this make sense?
Or are we actually prioritising our patients health over our own?
Then along came COVID
Before we go any further I’d like to let you all know that I’m currently waiting on a Bosch Heat Pump Dryer to be not just delivered to me, but essentially dispatched from Poland, sent to Australia, and then delivered to me.
At the time of purchase the wait time was quoted as anywhere between 2 and 10 weeks.
If you had offered to sell me a $1500 appliance 4 years ago with this kind of uncertainty, I would have told you where to go.
But today, in 2023, it’s the norm.
We’ve learnt to accept what is essentially delayed gratification.
Or delays to our ideal timelines.
We’ve learnt to reprioritise what’s truly important to us and to adapt to the new and forever changed world that we have been thrust into.
And during this journey, many of you have learnt that what is truly important is not what occurs during your 9-5.
It’s the life that exists outside this.
So the challenge I see for clinic owners is weighing up your own priorities:
Should you provide the ideal service for your clients?
Or
Should you provide a more idyllic lifestyle for your therapists?
Who wins in this debate on physiotherapist working hours?
As therapists have started pushing back against the traditional private practice lifestyle, it’s definitely leaving a bit more than a few holes.
There are currently 958 jobs available for physiotherapists in Melbourne.
I think the market is telling us something here.
And what are we to do about this?
Just as I argued with price and valuing ourselves earlier this month I’d extend that a step further and ask this question today.
Are we truly asking our clients to prioritise their health?
Or are we facilitating a good enough, I’ll squeeze it in type of lifestyle?
One thing I would say is that when it comes to where we sit in the pecking order of ‘squeezing things in’ we’re often below hairdressers; well I was anyway.
The amount of times my patients at Point Cook had moved their routine appointments around for a haircut really showed me where I was ranked.
The hairdresser, one of the busiest people to get in front of, and one of the top priorities on many peoples’ lists…
So let’s talk or perhaps let’s listen…
The consistent complaints from young staff about “work-life” balance.
The 38% of physiotherapists that leave the profession ‘feeling burnt out’.
The persistent queries around pay and feeling under valued and under appreciated.
The substantial drop off in physiotherapist working hours of females, who often exit private practice completely after children (*anecdotal – I’ve tried to find some statistics here to compare against personal observations but it’s not easy to find – I would be interested to hear your thoughts in the comments)
There are some things which are quite clear however.
For a female dominated industry, at close to 2:1, there is a pretty substantial difference in workforce participation on a gendered comparison – as per the graph below from the 2022 APA future of physiotherapy white paper.
Prior to COVID (ie. 2019) – the average male physio was working a 38 hour week whilst the average female physio was working less than 26.
This is broad data, across the entire profession, and perhaps not substantially dissimilar to national averages.
According to the ABS, as of April 2023 the average employed male physiotherapist was working 39.1 hours per week.
Where the average female physiotherapist was working 32.4 hours per week.
Nonetheless, I do ponder whether there is an underlying story here.
As a parent with young children, I’m reluctant to want to return to working private physiotherapist hours, and may well never return because of precisely this factor.
The elephant in the physiotherapist working hours room
My question for you to ponder today is simply – do we need to be open as late as we are?
Do our clients really have no choice?
At <4% unemployment, are their jobs so rigid that they can’t find an earlier finish once per week, or squeeze in a later start time somewhere?
I think with the transition to hybrid work for a large majority, this has become a bit of a moot point.
A lot of workplaces have become far more flexible.
A lot of workplaces have started to prioritise health and wellbeing for their employees as well.
No employer in Australia would stop you going to a doctors appointment at 2pm.
So why is the physio second rate?
Why is this reserved for after work times??
Or is it simply because we are open later?
We make ourselves available, and allow for this narrative to persist.
What sleep science tell us
I hear you, I’m making a big deal about nothing right?
Well, have you ever looked into sleep science?
Last year I read Matt Walkers “Why we sleep” – and it was a seriously good read, particularly for science nerds, which I know a lot of you are.
The key takeaway for me was really that the science definitely supports regular sleep schedules.
And, there is no shortcut, humans need approximately 8 hours of sleep per night.
It sounds obvious but it is generally best to go to bed and wake up at similar times each day.
Chronic sleep deprivation has a substantial role in health problems such as Alzheimer’s disease and can also have a significant negative impact on mental health disorders, particularly depression and anxiety.
When I finished the book, I really did wonder whether we were running our race incorrectly.
Asking therapists to sacrifice their, incredibly valuable, sleep routines to aid others.
Why are we asking our team members to prioritise someone else’s health, higher than what the individuals themselves prioritise it.
It’s a long bow to draw I feel.
We’re not exactly working in Medicine, doing 12 hour shifts and making life and death type decisions.
But perhaps that’s also why they get paid the big bucks?
It’s a pretty ugly side to our sick care system and we actually want to get as far away from it as possible – and we more or less are.
But for a median salary of about 80K, is there really justification in altering your lifestyle?
The world has changed
Right now, haters are gonna hate me.
Even Shane Guna the (former) business owner is hating on me.
And it’s ok, I accept it – and I hear your criticism.
It's about optimisation of hours, being more available for clients. Seeing mums who can't get to physio until the kids go down.
But life has changed.
The world has changed.
Are we doing a disservice to our staff by asking them to work to the calendar of old?
Should we, as health professionals ourselves, not be quicker to recognise some of these toxic behaviours for what they are?
Should we as a physiotherapist profession not be leaders in providing sustainable working hours and healthy work practices?
I’m not asking you to change anything in your practice today.
I wouldn’t ask anyone to do something that I wouldn’t do myself.
I’m just asking whether you can see the issue?
