Your First Year as a Physiotherapist: Advice from our Team

To all the new Physiotherapy Graduates, the Royal City Physio Team wants to send you a big congratulations! We know the transition from university to the workforce is an exciting time full of mixed emotions, so we wanted to give you our best advice on what to expect in the first year of Private Practice Physiotherapy. 

Chris Chen - Private Practice Physiotherapist at Royal City Physio

As a general word of advice, enjoy the experience, this is what you worked really hard for. You get to treat people and do what you love so really try and enjoy the process. 

People often ask me what I look for when searching for a clinic. I believe it's essential to have your main pillars in mind and find a clinic that aligns with what's important to you. For me, my pillars were mentorship, community involvement, and a great space and team. I found that Royal City Physio met all these criteria, so I was excited to work here.

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Jayme Gordon - Private Practice Physiotherapist at Royal City Physio

Get good at the basics: Before you start trying to do fancy stuff focus on the basics. You learn so much within the program that you never really get a chance to get a good handle on it while you’re a student. Use your first year to really practice the foundational skills before taking additional courses. If you don’t have the basics down then additional courses will often seem overwhelming and you won’t know how to incorporate them into your current practice. 

Get mentorship: If you can find a workplace that provides mentorship/ the opportunity to shadow senior therapists and learn directly from them it is invaluable. At Royal City Physio we have a mentorship program that I run every Friday to get our new grads and hires up to speed. I’m here to ask questions, go over challenging cases, practice manual therapy skills, and discuss case studies. 

I’ve always worked in open-concept clinics and got the chance to watch other therapists practice and learn different exercises and techniques. 

Immerse yourself in the community: Get involved in the community you are treating. You have the opportunity to create your own caseload based on your interests and exposure in the clinic. I started working with a local rugby club 8 years ago and still treat some of those players to this day, along with their friends and family. If you have a patient population that interests you, get involved in that community!

Keep a close group of peers: Either friends from physio school or other new grads. It’s really helpful to have a network of people who are going through the same experiences as you. You will be able to celebrate your wins together and bond over the challenges. 

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Jamie Handfield - Private Practice Physiotherapist at Royal City Physio

I have experience working in Ontario & Quebec as well as BC and have noticed differences in the structure of practice. When taking my advice keep that in mind. Out East, it is very common to be on a salary as well as having benefits and courses included in your employment, versus commission here in BC.

Recognize that you are just starting: Be patient with yourself, with your manual skills and your caseload. It's important to recognize that building a caseload right out of school is a challenging task, and the most important thing to do is to stay on top of your bookings, plans of care, and follow-ups.

Take diversifying courses: Personally I think that the first 2-3 years is the time to really dial in on your skills and diversify with multiple types of courses (not just manual therapy or SPC). Don't just take a Mackenzie course and narrow your practice so quickly. Take free courses offered by SPC or online annual symposiums.

Create A network: Your first few years are also about creating your network - go to events (even if it's volunteer) - you'll be surprised at how many clients you gain from volunteered work and helping out in the community. This is a fantastic way to network a caseload and start a name for yourself. 

Don't get caught up on cancellations and no-shows: Things happen that we have no control over. On that same note, try not to view days off as "unpaid days" - it's so important to take care of our bodies and give ourselves rest. From experience, don't force yourself to run through a whole day without breaks. Give yourself adequate rest. Just because you're in control of your schedule, doesn't mean you need to be a workaholic.

Mentorship mentorship mentorship: It doesn't always have to look like structured weekly meetings, but when you see techniques you're intrigued by, ask questions. Stay longer hours after work. Education is key in the first few years and we are all lifelong learners.  

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Diego Grossling - Private Practice Physiotherapist at Royal City Physio 

Always be open to learning: Physiotherapy is a profession that is always changing, clinicians are adapting to new evidence, and there are a lot of opinions out there! Whether it is through mentors, co-workers, or friends in the same field, it’s always a great idea to ask questions if you are unsure or don’t know. Be comfortable not knowing something, be pro active and look at what research says, find different avenues to learn about something, and always be open to learning. 

Be personable: Everyday is a different day, as you are constantly meeting new people1 It is important to be approachable, engaging, and able to let a conversation flow naturally. Although this may not come naturally to some, it is another skill that you will gain along the way. At the end of the day you are meeting a new human being, not an MCL sprain. 

Believe in yourself: although everything may be new and you are unsure with how to approach different cases. You are where you are for a reason! Believe in your skill set, experience, and critical thinking that will only improve with each day of experience you gain!

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Taylor Gibney - Social Media Guru at Royal City Physio and Private Practice Physiotherapist

The first year was a big learning curve, looking back I wish I didn’t put as much pressure on myself to know everything. Often, people just want simple answers and a simple plan they can follow without all the bells and whistles. I didn’t realize how much I knew in my first year until later. I assumed everyone just knew how to foam roll and knew how to set up a bench press, which is not the case. Most times starting with the basics goes a long way. 

Enjoy building your caseload: Get to know your clients, I think that is genuinely the best part of the job. Building relationships with people in the community is what makes a caseload grow. I also found it helpful to drop off a little bio at the local doctor’s offices with what type of patients I was interested in seeing and what previous experience I had. This kept me fresh in the doctor's mind and helped me get referrals. 

Ask questions! I found brainstorming with other physiotherapists about treatment plans, differential diagnosis, and exercise options was really helpful. I learned how to be more efficient but accurate and thorough by getting ideas from more experienced physios. I leaned on this a lot in the beginning. 

Shadow: If you have breaks in your caseload - ask if you can shadow another physio's interesting case. The more people you see, the more injuries you get your eyes on, the more things you will catch and notice. You just have to get the reps in.

Don’t take too many courses: I had a lot of friends in physio school who went straight into taking 4 to 5 courses the following year. I mean, to each their own, but getting the basics down right, like appointment timing, charting, following up with patients, giving good education, and understanding the billing process and paperwork are all really important. It takes a while to get the hang of and I think people underestimate how much brain power the first year takes. I had a lot of friends burn out trying to balance a full caseload while taking courses in the first year. Just enjoy it, ease in and fall in love with the job first.

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Stephen Baker - Private Practice Physiotherapist at Royal City Physio

You will overcome the first year: The first year of physiotherapy as a new grad is one that grinds you up and spits you out. Our education system ensures we are safe but it doesn't ensure we're competent. We graduate with a limited set of skills and inadequate experience in a private practice setting such that we're only capable of assessing, diagnosing and treating the most simple of cases. As a therapist new to a clinic, your schedule is free such that you get all the last minute assessments. These are mostly the people who are in acute pain and looking for immediate relief or the complicated pain presentations that don't fit neatly into categories like 'ankle sprain' or 'cervicogenic headache'. You often feel as though you can't help these people and it leads you to feel inadequate as a therapist. Know that you aren't inadequate as a therapist, you just haven't had the support or training required to flourish, but you can still succeed.

Hone your assessment skills: The best thing you can do as a new therapist is to develop a formulaic assessment. Know that you're going to listen to the subjective, identify the body area, timeline of symptoms and pain pattern. You'll rule out red flags as indicated and collect a general health history. Don't forget to ask them what they do for fun (activities) and most importantly, what they're looking for by coming to physiotherapy. Armed with this information, you'll have an idea of whether this person has a joint, ligament, muscle, tendon or nerve injury and your job during the objective is to differentiate between these types of structures and identify a diagnosis. Often multiple things combine to produce a pain presentation, so don't limit yourself to a single diagnosis! If you get through the assessment (subjective and objective) and it isn't adding up or you have a funny feeling about it, ask a colleague or send them to their family doctor. With decreased access to medical professionals, more and more people are bringing aches and pains of a medical origin to physiotherapy clinics. It is never wrong to refer to a GP or walk-in clinic to ensure something medical isn't being missed. If you refer to a medical professional, don't stop physiotherapy treatment unless you think it would be harmful! Prescribe pain free movement based exercises to keep them active and see them regularly while you wait for the medical opinion.

Consider the psychosocial components: There is a large focus on the biopsychosocial framework these days, with heavy emphasis on the psychosocial components. I encourage new graduates, and any physio, to not disregard biomedical knowledge. Pain is understood as a brain output, not a sensory input, but that doesn't mean there isn't a tissue related injury that's driving the pain experience. Understanding and acknowledging someone's psychosocial state can help explain their presentation but an assessment isn't complete without a sound biomechanical component. Both the bio and the psychosocial (or psycho and social) components are important. Comprehensive biomechanical knowledge can help determine which biopsychosocial component is contributing to what degree to the person's presentation.

You can’t help everyone: You can't help everyone. We go into this profession because we're interested in the body and want to be of service to others so they can live better and more active lives. Sometimes we aren't a good therapeutic match for that person. It's okay to acknowledge when we don't have the requisite skills or suggest to the person seeking treatment that they may have a better outcome with a specific therapist. If the barrier is more psychological than physical, acknowledge that person's difficulty and encourage activity as appropriate but consider a referral to another allied health practitioner. Recognizing our role in treatment and encouraging people to seek out other professionals is an important part of interdisciplinary care.

Mentorship: The most important part of practice is having a peer or mentor who you can regularly talk with. Ideally this person isn't the clinic owner or anyone in a position of power at your clinic; you don't want mentorship and performance evaluation mixed together. A peer can be as good as a seasoned physio. Talking cases over with a peer provides the opportunity for both of you to learn and teach each other. Consolidation of skills and knowledge is often best done when in the role of teacher. If you feel you're lacking clinical skills, seek out high quality courses that have ample opportunity to practice or regularly review skills with a more experienced physio. Mentorship is multifaceted and covers more than manual skills. Having multiple people who can provide mentorship in different areas will ensure you are exposed to a wide variety of opinions and 'best practices'.

We hope this helped ease the first-year jitters, and that you take something away to make your entry into private practice more comfortable. The common theme amongst all these pieces of advice is you are not alone in the beginning. Reach out for help, ask questions, and find a good mentor and good team to support you. At Royal City Physio we understand what it takes to feel supported and have put together an awesome mentorship program in our clinic. If you would like to join our team reach out to us at karen@royalcityphysio.com.