Private practice model of physiotherapy: professional challenges identified through an exploratory qualitative study

Ben Darlow; Gill Stotter; Eileen McKinlay

doi:10.1071/HC23150

RESEARCH ARTICLE (Open Access)

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Private practice model of physiotherapy: professional challenges identified through an exploratory qualitative study

Ben Darlow

¹ ^* , Gill Stotter ¹ ³ , Eileen McKinlay

²

+ Author Affiliations

- Author Affiliations

¹ Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, Aotearoa New Zealand.

² Centre for Interprofessional Education, Division of Health Sciences, University of Otago, Aotearoa New Zealand. Email: eileen.mckinlay@otago.ac.nz

³ Present address: Hutt Physiotherapy Centre, 50 Bloomfield Terrace, Lower Hutt, Aotearoa New Zealand. Email: gillstotter@gmail.com

^* Correspondence to: ben.darlow@otago.ac.nz

Handling Editor: Jenny Pringle

Journal of Primary Health Care https://doi.org/10.1071/HC23150

Submitted: 27 October 2023 Accepted: 19 December 2023 Published: 16 February 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction

Community-based primary care physiotherapy has developed through private practice, fee-for-service model in Aotearoa New Zealand where independent businesses operate in competition.

Aim

We aimed to explore how the private practice model of physiotherapy impacts patient care, physiotherapists, and professional behaviour.

Methods

Six physiotherapists managing musculoskeletal conditions in a primary care private practice in Aotearoa New Zealand were recruited using maximum variation purposive sampling. In-depth individual face-to-face semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using Interpretive Description. Inductive data analysis synthesised and contextualised data, creating a thematic framework that developed across interviews.

Results

All physiotherapy participants discussed concerns about culture and professionalism in private practice physiotherapy despite not being asked about these. Three themes were identified. ‘Competitive business model and lack of collaboration’ – participants thought that competition between practices resulted in a lack of trust, collegiality, and collaboration, and pressure on clinicians to maintain income. ‘(Un)professional behaviour’ – participants thought that physiotherapists were defensive and averse to scrutiny, resulting in reluctance to admit when they needed help, or to undertake peer review or seek second opinions. ‘Lack of support and mentoring’ – the professional culture in private practice was perceived to reduce support and mentoring, with negative impacts that affected physiotherapists at all stages of career.

Conclusion

This exploratory qualitative study suggests that competition dominates communication and collaboration in private practice physiotherapy and may have wider implications for professionalism and the quality of patient care. Competitive business models and an aversion to scrutiny may reduce collegial interaction and professional behaviour.

Keywords: economic competition, musculoskeletal, physiotherapy, primary health care, private practice, professional practice, professionalism, qualitative research.

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