I Never Promised You A Rose Garden (or How to Nurture Your Solo Physiotherapy Practice)

By Lisa Bevan

It’s all about smelling the roses right?

Often perceived as the easy way out for someone to work whatever hours they want whenever they want with no accountability to anybody else; solo working is much undervalued as a way forward within the profession. However, for those working solo it’s not quite as easy as it may seem.

There is an awful lot of gardening that goes into producing those beautiful roses but if you work hard at it, prepare the ground, fertilise the plant, trim the dead wood constantly, nurture it, make sure it’s not being crowded by other plants and endure the scratches from the pruning, then eventually you will hold that rose and admire what you have achieved, constantly making sure that you are continually nurturing it so it blooms time and time again.

So the life of our solo venture is just like that of growing a single rose.

Spring is upon us and perhaps it is time to have a bit of a clear up around our physiotherapy garden.

There are many common themes of concern around the areas of solo working that crop up time and time again for the sole practicing physiotherapist. 

Isolation

Working on your own can feel very isolating. How many of us miss the opportunity to bounce ideas off of a colleague? The chance to just run a thought past someone is invaluable. We do it more than we realise until we can’t.  A bunch of beautiful roses looks so much more impressive than a single stem… Imposter syndrome seems to magnify the more you dwell on your own concerns and you start to wilt as you doubt yourself further. Sometimes the anxiety related to your clinical practice can become overwhelming and you are all too aware that your reputation can live or die by word of mouth.

So how can you address this and flourish?

It can be difficult to approach local colleagues to talk through patients because after all they are your competitors, are they not? Or are they? Might they be having the same self doubts? Perhaps if you had a monthly meet up with another couple of colleagues you might find the mutual support is beneficial all round.  Also when you take holidays you might find you develop a cross referral network so you can help one another out and you can take ‘guilt free’ holidays. All of those roses form a garden!

Join up to professional groups such as Physio First and see what they can offer you in the way of support. 

Take advantage of social media groups such as The Solo Hub on Facebook and join a ‘risotto’ group. Risotto groups are small groups of solo physios who each are a different ‘ingredient’ in the recipe that produces the risotto - all contributing to help their support group provide what they want from it.

Form your own online ‘staff room’ with former colleagues or other professional friends and literally have a working lunch once a month online. We did many things online over COVID and proved they worked - try making them happen and work for you - but set them in stone in the diary.

Remember - the more you fertilise your rose from the bottom up, the more it will blossom, so surround yourself with likeminded physios who want to share their experiences.

Paperwork and Regulations

Stifling everybody is the fear factor around paperwork and regulations. There was huge anxiety in summer 2023 over the updated HCPC regulations when more than a handful of us roses considered leaving the profession. It felt like being wrapped in cellophane and withering away.

This is just one example of how frustrating and difficult it can be to work alone. There is very little guidance of what we actually need in terms of policies and procedures.

So how do we help ourselves with this?

We literally help one another. Why do we need to rewrite policies and procedures when we can help one another? If we work together then we have a rose garden! 

We found we didn’t have a huge amount of guidance and support from professional bodies but as physiotherapists we are naturally team players so we came together under the umbrella of The Solo Hub and utilised fact sheets from Physio First, the HCPC and the CSP, and between us we managed to work out what was relevant to us as solo physios. We were a rose garden! We stripped back the cellophane, took away the fear and following that, the poll that we carried out on The Solo Hub proved that the vast majority of us were less fearful. We blossomed! 

Guilt

Guilt is like the black fly of the rosebush.

We have to cleanse ourselves of it. If we fail to do that, it will kill our practice. We will not be able to sustain ourselves. 

So what do we have to be guilty about? Why do we feel guilty?

The guilt factor that the majority of people appear to have in self-employment as solo practitioners relates to taking time off work and not seeing patients at patients' preferred times. This is a huge issue for us personally, but not for our patients. We must be really clear about this and set our boundaries. Did we ever feel guilty taking time off work for holidays or sickness or, dare I say, even for the death of a relative when we worked for somebody else? Is it unfair that we require time to be with our families/have our own hobbies or activities/need our own rest or relaxation time? No it is not. We have to prioritise ourselves and have dedicated ‘me’ time when we are working.

Failure to do so is like an infestation of black fly. Each of us needs to find a way to manage that for ourselves. Consider having a separate work phone with out of office replies for calls and emails and stick to only responding within set time periods. Use an online booking system if that works for you. Some folk find it helps to use a virtual receptionist or a separate admin person.

Whatever you choose and however you do it, you must have boundaries. Boundaries are our barriers that resist black fly.

Financial Instability

Oh if only we could predict the weather! Is it going to rain? Is it going to snow? Is it going to be icy? Are we going to have a drought? Is there going to be a flood?

My rose doesn’t like a drought, doesn’t like the snow, and doesn't like persistent rain. It is more like my physio practice than I actually had considered. Working in private practice does not provide a steady income and my income stream is incredibly variable. Working with a salary with annual leave, sick pay benefits et cetera is like putting my rose in a nursery with constant attention, but the reality is that my rose is in the Highlands of Scotland and not every rose is going to thrive here: sometimes I need to water it and sometimes I need to protect it from frost and snow. So I take little cuttings and I pop them into rooting compound and then into potting compost and I nurture them so that I have some little seedlings for a rainy day so that I’m never without my rose bush.

You have to make sure that you put some money aside each month for your tax, for your pension, for your sickness cover, to enable you to go on holiday without worrying about lack of income… 

Having looked at all these negatives of being a solo clinician, hopefully now you don’t feel like a single stemmed rose but more of a thriving rose bush so let’s remind you why you decided to go it alone:

• You can pursue the career and the direction you wanted to take

• You can work the hours you want and take leave when you want 

• You can use the skills you trained so hard to get without being told what you can/can’t do

• You can have as much time as you feel is necessary with your patients

• You can develop a real clinical relationship with your patients

• You have control over your professional development

• You can change direction with your career if/when you want to

• You place your own value on your career

• You make your garden grow and make your roses thrive!