So you are living the dream of being a private practitioner, but ... actually finding it all pretty stressful

What is happening to me? The transition from university to private practice can be an abrupt jolt. From having a few clients, hour-long assessments, and a supervisor on tap to guide you through unknown situations at Uni, you suddenly find yourself in a room, just you and your client. Client-after-client. All the clients have expectations because they are paying you for your professional services. You are presented with a range of conditions you don’t fully understand, struggle to stay on time through the day, and perhaps work long hours. On top of that, you are expected to build a caseload and have marketing requirements to fulfil. That is a jolt. Sometimes, so much it puts people off their profession but we understand and have developed some great tools to help ease your transition and assist you to grow as a private practitioner.

You are not alone. In a recent survey we conducted, the common difficulties expressed by newly qualified clinicians included;

• Feeling out of depth and a bit overwhelmed
• Trouble developing a logical sequence of assessment
• Struggling with knowing what were the right questions to ask
• Feelings of anxiety, stress, and time-poor
• Experiencing poor client compliance with set-home programs
• Lurking questions about missing red flags

Some Benefits of These Clinical Resources

1. Learn to effectively communicate with your client and understand what your client is asking you
2. Learn and use language that resonates with your clients
3. Identify and quantify the meaningful outcomes for your client
4. Become aware of and develop a heightened detection awareness of tumours in your daily practice
5. Develop efficient, effective, and up-gradable home programs - easily

Clinical Resources to Solve Your Problems

1. eBook: The 7 Key Pillars - Being Successful in Private Practice v2

With the subtitle, ‘What you didn’t learn at Uni’, this 43-page resource addresses areas that I would have appreciated knowing when I was in my first 10 years of clinical practice. This resource is ideal for recent graduates and early-stage practitioners. Mind you, it is never too late to improve your clinical and non-clinical skills!

The 7 Key Pillars discussed are;

• Pillar 1. Effective Questioning
• Pillar 2. Confirm Client Expectations
• Pillar 3. Deliver on Functional Outcomes
• Pillar 4. Consider Red Flags
• Pillar 5. Clinical Follow-up
• Pillar 6. Understand & Measure Yellow Flags
• Pillar 7. Memorable Home Programs
• Bonus Section

We are told that we live in the "Information Age", but I think that we have well and truly roared through that age. Every test, procedure, or disease - our vast body of knowledge, can be found on the Internet. All the information is out there in a variety of forms. In much the same way, each client is an Internet - they are the body (quite literally) of information all about themselves. I believe we are now in the "Synthesis Age." As clinicians, we need to type in the correct search parameters (a.k.a. ask the correct questions) in a logical sequence. In this way adding or subtracting to our developing clinical hypothesis - I call this process the ‘Solution Funnel’ and discuss this unique concept in Pillar 1.

We need to be ‘manual-sleuths’ before we can be ‘manual-therapists’.

"I just read 7 Pillars, and I think this is fantastic and extremely relevant to my current situation. The information you have presented has eased a lot of my anxieties by simplifying some of the hurdles I have already encountered in my 3 short months of working as a new grad and has given me very helpful tools to take on board. For me personally, pillars two and three about confirming expectations and functional outcomes were the most helpful. In particular, the way you have explained the importance of the way intervention should be communicated (in a language that resonates with the patient and their functional goals) is excellent. The way you have explained things has made me realise that good communication with patients is vital to help maximise their compliance and motivation to achieve their personal goals. Just like you have mentioned with a few good examples, we need to communicate in a way that speaks our patient's language, which resonates with their goals so they feel validated and they are much more likely to buy in. Great advice!"       Leah Noonan (Physiotherapist)

"Hey, Doug - Thank you for giving me this opportunity to read your insights into private practice. Strictly speaking, I'm not much of a private practitioner. I work full-time in an acute neurology unit (public hospital) and see the occasional private patient for a home-visiting service. However, I can relate to most of the ideas in Pillars 1 to 7 (except Pillar 4). Pillar 4 went over my head as my MSK diagnostic knowledge was a bit rusty. All the ideas about reflective questioning and talking to patients in their terms are so applicable to stroke rehab and I wish I'd known these ideas as a new grad. I feel like I've only started getting the knack of educating my patients effectively two years into my career (I'm now in my sixth year of practice). Specifically;

Pillar 1: The "zoom in zoom out" concept nicely portrays how to approach provisional diagnoses.
Pillar 2: Nicely elaborates on how to conduct client-centred, rather than therapist-led treatment sessions.
Pillar 5: I like how you reassured the reader that they're not being pushy by following up and you emphasised that it is the practitioners' responsibility to market themselves so clients know who to go to when they need help.
Pillar 7: Great, there's an app for this! I've been videoing patients doing their exercises with their own phones! Watching themselves do their exercises (similar effects as mental practice) is such a powerful tool in promoting neuroplasticity." Yee Ching Wong (Physiotherapist) 

2. Audiobook + Video: Masqueraders - Seeing behind the mask 

Would you expect a client to come in and say?

'I have a tumour, please treat my pain!'

Unlikely. No, they are more likely to say,

'My knee has been sore the past couple of months. I may have knocked it while shifting home or playing soccer, not sure but the swelling just isn’t settling'

How and at what point in the clinical progression do you determine the swollen knee is a chondroblastoma?

Includes 40-minute audiobook + video covering;

• Background information on the 10 most commonly diagnosed cancers and the 10 most fatal cancers. Given some assumptions, I will show you how to calculate on average, how many tumours will be coming through your clinic's doors every year presenting primarily as musculoskeletal complaints.
• A case study is then presented detailing the difficulties of determining the presence of an underlying tumour, especially when there has been a history of direct trauma.
• The third section of the video focuses on younger clients and tumours. Difficult to pick tumours in adults, and children can be that much more clinically challenging. This section looks specifically at 2 types of benign and 2 types of malignant tumours.
• The final section synthesises all the information, into a process of developing a healthy index of suspicion, guided by signs and symptoms. This section also details a clinical cluster of 4 signs that is 100% sensitive to the presence of a tumour.

3. eBook: Masquerader: 3 Case Studies v2 

Less than 5% of primary care physicians routinely examine for red flags during their initial screen (Bishop PB, Wing PC. Knowledge transfer in family physicians managing patients with acute low back pain: a prospective randomised control trial. Spine J. 2006;6:282–288)

This resource details three clinical case studies that presented as primary musculoskeletal complaints initially but were later determined to be tumours. In each case study, the eBook leads the reader from initial examination through to the point of resolution. Each case study details initial examination findings, manual therapy management, investigations, and medical intervention plus reflective thinking at key points as each case study develops. Following each case study is a detailed discussion section about the specific tumour highlighted, for background information and to enable greater understanding by primary contact practitioners.

Tumours under the microscope include; pancoast, meningioma, and osteosarcoma.

4. Masquerader Master Bundle for Private Practitioners

Gain the benefit of both the 40-minute Masqueraders video/audiobook, plus the three case studies with associated background information, clinical history, and outcomes.

5. Premium Bundle for Private Practitioners

This Premium offer for Private Practitioners now contains;

1. 7 Pillars of Private Practice
2. Masqueraders - 3 Case Studies
3. Masqueraders - What is hiding behind the clinical mask resource video
4. Masqueraders - What is hiding behind the clinical mask audiobook 

Frequently Asked Questions

Where do I access these resources?

These resources are available as single items or practitioner bundles via our AAP Education Online Academy.

Who would benefit most from these resources?

These resources have been designed for primary contact practitioners. This could be a physiotherapist, doctor, podiatrist, myotherapist, occupational therapist, osteopath, or chiropractor. If you are a recent graduate or experienced therapist, any primary contact practitioner whose opinion is being sought in regards to treating musculoskeletal complaints will benefit from this information.

How would these tools help me be successful in private practice?

Different people measure success in different ways. For me, it is being able to stay on time throughout the day, help my clients positively improve their health, and walk away looking forward to coming back tomorrow. These resources cover key areas that I was unaware of as a new graduate, and now help me achieve what I consider ‘success’.

Is this information relevant to me as an experienced private practitioner?

Most certainly. While these resources are primarily aimed at new & recent graduates, I consider myself an experienced practitioner and constantly need to remind myself about those conditions that I see infrequently. Red flags are one such area. Another area is effective questioning and communication. The more efficient we are in our communication, the faster we can see clients. You would only need to see one extra client a week and you will have paid for these resources in a fortnight.

Who wrote these resources?

Our clinical director Dr Doug Cary wrote these in association with his wife and practice partner. Between them, they have worked in private practices; small, large, country, city, interstate, and overseas for over 60 years. They have post-graduate qualifications in Musculoskeletal and Sports Physiotherapy, Doug is a specialist Musculoskeletal Physiotherapist and completed his PhD at Curtin University.

P.S. It is without a doubt that being a recent graduate and moving into private practice is a tough gig. However, with a willingness to improve (you have already demonstrated that by getting this far down the page) and with appropriate training, you will not only be a better clinician, but you will enjoy the challenge all that more. AAP Education is looking forward to helping you in that transition.