For premium physiotherapy clinics, I think we ought to consider using a Michelin star process.
Similar to that of the hospitality industry.
Zooming out and looking at the broader physio landscape, perhaps there is a need to differentiate quality over quantity.
Not every clinic is going to get chef’s hats from the Michelin man.
Many won’t even make the guidebook, and perhaps that’s not their aim either.
I spend a lot of time thinking about 2030 and what that might look like for premium physiotherapy businesses.
It’s nice to get a few years beyond COVID and the short term fluctuations in gas prices.
Private practice land has changed a lot since I started in 2012.
This evolution will no doubt continue.
The rate of change will in fact speed up especially with the development of AI.
I believe a completely different ecosystem is being built in Australia.
The fundamental philosophies are also starting to diverge.
This scares me but also excites me.
I love purpose driven practices and I see a great future for these businesses.
However, I also see problems for those stuck in between.
It’s an uneven playing field for the humble small business owner.
This is something I’m hoping to address with my services by the way…
Many of the big players have already started their tilts for market dominance.
Including large private equity and the health funds themselves.
How this dance plays out will dictate a large proportion of our industry come the end of the decade.
The premium physiotherapy clinic matrix
Let’s look at the four types of physio clinics operating in today’s market.
I will break these down via a juxtaposition with the hospitality industry.
I don’t mean to be nasty with this, it’s a broad generalisation.
There are great clinicians everywhere.
Even pubs have Michelin star chef’s these days.
One should never judge a book by it’s cover.
And perhaps this is my bias.
As a card carrying leftie I tend to be anti big business.
Do with that information what you will.
If there’s a paradox in me however, it’s that I’m pro individual social values but also pro enterprise.
These values don’t tend to sit together within the political landscape.
I’ve also spent enough time in the public sector to know that that is by far the answer to the worlds problems.
And I’m happy to declare that I tend to be biased towards boutique cafe’s and restaurants over McDonalds.
Please don’t take it personally if you are in the firing line here.
I used to work at McDonalds (literally), there’s always some upside – like free chicken nuggets 😉
McDonalds physio
This is pretty harsh.
But I can also see how easily this can happen (*cough* is happening…)
Several former premium physiotherapy clinics are now owned and operated by large private equity firms.
A number are also owned and run by the very health funds who’s clients frequent them.
It’s inevitable within these models to see a profit over people dynamic seep in.
They might be able to cover this up, but come reporting season on the ASX it’s all about the bottom line.
Purpose within physio can get completely lost within these ecosystems.
It has to be about making money – again money isn’t the devil here.
Money makes the world go around.
Operating at scale
For these firms, it’s about operating efficiency.
And it’s about market dominance.
The McDonalds franchise is one of the most successful across the globe.
It’s success is down to it’s reproducibility.
The stores are staffed by 15 year old kids and 19 year old managers.
If you’re on your P’s, you can lead.
This is a great goal in business, to have a service that is easily replicated.
It takes little to no training to be able to produce consistently, over and over and over again.
And I see this happening with mass market clinics.
Particularly with their leveraged position to be able to take over prime locations.
Hire and train new graduates at will, with sign on bonuses (yet to come… see child care industry).
At scale, they are unlikely to pay particularly good wages over the longer term.
Like McDonalds, they will revert towards the mean of award wages.
Particularly as the recession starts to bite.
They also can’t offer work-life balance to clinicians.
This is the opposite of corporate capitalism.
And the values that go with this.
More patient consultations, more dollars through the door.
Wanting lower cost price points for their own patients.
The money flows cyclically as the corporate machine awakens.
It’s hard to believe that the ACCC allows health funds to own the very clinics that service their clients.
It’s synonymous with Dracula and his blood bank.
Pub Food – Churn/Burn physio
Pubs tend to dominate the outer suburban areas.
They’ve often been around for a long time, they’re accessible and they’re cheap.
Twenty minutes in, a bit of hands on, some electro and a few exercises.
And then the next patient.
And the next.
Monday to Friday.
Morning until night.
Like a bain-marie, you just pick and choose what goes on your plate.
You can get a pretty good deal for a parma and a pot (apologies – parmi + pot for the QLD readers).
You’ll walk out feeling pretty good about life too.
And chances are it is far more cost effective for that dopamine hit.
These clinics exist for a reason, they cater to a mass market.
And let’s be honest, they are highly profitable, a great business investment.
My entrepreneur hat’s off to those who have built themselves a passive income stream.
But they lack something which I find hard to explain.
Similar to pubs with rooms full of pokies machines.
It’s pretty easy to make money from reverse ATM’s.
The local café
I’m a big fan of the local, owner operated enterprise.
It’s a premium physiotherapy experience, perhaps in a much cosier environment.
Traditionally these are small clinics with only a handful of clinicians.
Perhaps around 3 rooms and a small gym.
This was my enterprise, a powerhouse of only 84sqm.
The focus is very much on providing top quality service.
Ensuring the owners’ brand remains strong.
It’s cozy, intimate and the care that goes into the treatment is always top notch.
It’s the care one would give to their own child to ensure their hair is combed.
Shoes tied tight before heading off to school.
But that balance is hard to manage.
The owner tends to be head chef and also runs front of house.
Too often stuck between a rock and a hard place.
Balancing high quality service with putting out enough dishes to make ends meet.
And the barista’s tend to come and go a bit too often at the moment.
It’s a great dream to run a café, but it’s harder than it looks.
Especially when you pay all the penalty rates.
Premium physiotherapy clinics: Signature restaurant
This is the pinnacle of small business for me.
It’s still small enough to be niche but it’s champagne quality.
For an owner this comes with more financial freedom too.
She might even get a proper holiday every now and again.
The clinic is large, but not too big.
More robust in nature and able to ride the bumps of a few staff comings and goings.
The owner can enjoy working towards bigger picture, purpose driven goals.
As well as looking to systematise the business itself to one day step away..
Creating a powerhouse environment for long term success.
And the ability to never look over one’s shoulder at the local McDonalds.
This type of enterprise is what I drive people to producing.
Purpose built clinics.
Driven by values.
Ever evolving with the culinary trends.
Top clinics deserve Michelin stars.
But there is an irony to all of this.
As clinics get larger or start to scale, maintaining quality is very challenging.
And even if you do manage, there is only one exit strategy for larger brands.
The only people with deep enough pockets are private equity and health funds.
The path is actually a circle, round and round.
Michelin stars for premium physiotherapy clinics
The Michelin guide was actually developed by a French tyre company.
The goal was to encourage tourists to drive further in an effort to boost tyre sales.
It’s evolution as a culinary guide is quite random.
We ought to encourage patients to drive further too though.
Perhaps we need a little red book to point out the quality clinics.
I wonder what the Michelin man would say if he walked into your clinic tomorrow.
Would you get a mention in the guidebook?
And what are the qualities of premium physiotherapy clinics that deserve chef’s hats’?
Is it consistent client care?
Or exceptional customer service?
Perhaps it’s using interesting ingredients and pairing them with natural wines?
Food for thought nonetheless.
PS. I’ve started a YouTube channel – you can check it out here
