Problem 6 Time Based Billing: Pressure on the physiotherapist

 In POGO Partners™

In the previous post I explored the fifth problem that the time based billing model of physiotherapy can produce; reduced commitment. This is the reduced commitment that the client can have to achieving their outcome due to their ‘buy in’ being only sessional under the traditional session to session physiotherapy service delivery model. The post explored how this reduced buy in can potentially minimise commitment to achieving the very best outcome possible with rehabilitation.

To read more about Problem 5 click HERE>> (Time based billing: reduced client commitment).

The 6th Problem of time based billing

In this post I’ll explore what I believe to be the sixth problem that a time based session to session model of physiotherapy produces, and that is the problem of excessive or heightened pressure on the treating physiotherapist.

‘Fitting’ it all in

When treating under a session to session model there exists an innate pressure as a physiotherapist to try and ‘fit it all in’ during a client’s consultation.

What does ‘fitting it all in’ mean?

There is (or at least should be) a driver for every treating physiotherapist to deliver more in value than what the client pays for in terms of their consultation fee. The aim being that each client will complete a consultation feeling like the value received through the treatment delivered surpasses the cost of the consultation.

There is a driver for every treating physiotherapist to deliver more in value than what the client pays for. #performbetter @pogophysio Click To Tweet

In addition to this innate drive to provide clients with value there also exists the innate drive of truly wanting the client to get what they want out of the treatment they receive. Most of the time the in pain or client rehabilitating an injury will want to finish the consultation feeling better than when they arrived, with a noticeable reduction in their pain or symptoms.

One sure fire way to achieve this reduction in pain and meet the client’s expectation is through the administering of manual (hands on) therapy. In wanting to meet client’s expectations around ‘feeling better’ after a treatment often times during physiotherapy treatments disproportionate amounts of time can be spent with the treating physiotherapist performing hands on treatment on the patient, aiming to provide the pain relief the client expects.

Typically when this hands on treatment is administered and pain relief ensues (the client states it ‘feels better’) the client will be happy at the end of their treatment.

However I believe that often some of the time taken in administering this hands-on therapy for the client, could have been better spent educating, coaching, testing, measuring, or even planning the client’s rehabilitation journey, yielding even better treatment outcomes than the treatment with predominantly hands on therapy.

By ensuring one or more of these non ‘hands on’ function are administered the client’s treatment success, the overall success of the client’s rehabilitation will typically be heightened.

However with such a strong driver existing for making the client feel good the non hands on yet essential treatment components are typically given little or no ‘air time’. The result being the client’s overall rehabilitation outcome (Finish Line™) is diluted.

In addition to the potential dilution of client outcomes due to the therapist bowing to the pressure of wanting to deliver the ‘feel good’ part of the treatment (hands-on) and sacrificing the non hands on components, another problem results relating to pressure and that is the well-being of the therapist.  

Physiotherapist well-being

If the therapist is not ‘well’ at their best the client’s outcomes can be jeopardised. Over my 12 years in the industry I have observed disengaged therapists who have let the pressure of time based session to session practice life erode their well-being. While the therapist ‘suffers’ obviously so too can the client results.

Here’s some of the effects that pressure on the therapist to deliver under the session to  session treatment model can produce:

  • Less energy: delivering great results, exceeding client expectations, problem solving, clinically reasoning, treatment planning, liaising with other stake-holders involved in the client’s rehabilitation, being attentive and caring, all require energy. A popular and in demand (ie good) therapist needs lots of energy to consistently output great results.
  • Less focus: a drop in energy with the onset of fatigue can result in less focus. The problem with less therapist focus is obvious: important details can be missed, the extra care that would make a great difference is not given, and the overall treatment effectiveness may be diluted.
  • Less effective communication. We say at POGO ‘communication is the glue between the therapist and patient’. When a therapist is fatigued or under pressure optimal communication may be compromised, resulting in sub-optimal patient care. An example may be the fatigued therapist not having a difficult conversation with a client about compliance with their rehabilitation program, simply because the extra energy required for such a conversation is depleted after a day of back to back session to session pressurised consultations.

A solution: our fixed fee unlimited access model of care

While there may be many solutions to reducing the pressure on treating therapists, over the last year of delivering Finish Line™ outcomes to our clients via our fixed fee unlimited access Finish Line™ Programs our therapists  have enjoyed reduced pressure.


The beauty of the fixed fee unlimited access model is that the client gets the treatment that they need, as opposed to the treatment that they can fund of afford on a session to session pay as you go model of care.

The benefit being that the client get can the sessions and treatment that they truly need (eg daily, or multiple times in a week) and most benefit from. In addition to the best possible treatment outcomes being achieved under the unlimited access Finish Line™ Program model of care, the treating physiotherapist has the margin to do the non-hands aforementioned important interventions that so strongly contribute to the best clinical outcomes.

The pressure of ‘fitting it all’ is relieved and the therapist is free to focus on just one thing-getting the best treatment outcomes and ensuring their client crosses their Physio Finish Line™.

To learn more about our Finish Line™ Programs

For more information around the journey we underwent to launch our Finish Line™ Programs click HERE>> (Challenging the Way the Physiotherapy Industry Charges) to listen to a podcast interview.

For an example of how POGO’s Finish Line™ programs achieve great client outcomes click HERE>>  (Finish Line™ Case Study-Tom Bowie) to read Tom’s story of overcoming debilitating lower back and sciatic pain.

In the meantime if you are physiotherapy practice owner looking to get more respected results through heightened trust levels with your clients be sure to subscribe for our POGO Partners™ updates HERE>> POGO Partners™ Program.

POGO Partners

If you are a physiotherapy consumer looking to benefit from the best in treatment outcomes schedule your initial appointment (Discover Recover Session) HERE>>.

Physio With a Finish Line™,

Brad Beer physiotherapist gold coast

Brad Beer (APAM)

Physiotherapist (APAM)
Author ‘You CAN Run Pain Free!
Founder POGO Physio
Host The Physical Performance Show

Featured in the Top 50 Physical Therapy Blog

pain free performance Gold Coast physio

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