Running Physio Inside a Hospital vs Your Own Clinic

Picture a physio owner getting the call every physio dreams of. A 120-bed hospital in his town wants someone to run its physiotherapy department. Ready patients. Post-surgery cases every day. The hospital's name on the door. He says yes in the first meeting, on a handshake, at a 50:50 split.

Now say that two years later, the hospital hires a new administrator who wants the split moved to 60:40. Then the orthopaedic surgeon he works closest with leaves for another hospital. Then the hospital decides to employ its own physios. He has built a busy department and owns none of it.

A hospital unit can be a brilliant move. It just has to be a deliberate one.

What does a hospital rehab unit give you that a clinic cannot?

Known Doctors Get Booked, the second book of my trilogy, has a chapter on hospital visiting roles for doctors, and its first line fits physios perfectly: why build trust from zero when a hospital down the road will lend you theirs?

A hospital gives you three things on day one:

• Patient flow. In-patients after surgery, stroke, cardiac events and long stays. Post-discharge patients who need to continue.
• Credibility. The hospital's name and its doctors' trust.
• A referral network. Every surgeon and physician in the building is a potential referrer.

For a new physio, or one moving into a new town, that can mean a full diary in months instead of years.

What do you give up inside a hospital?

Control, mostly. And it matters more than people expect.

• Pricing. The hospital usually sets or approves your fees.
• Branding. Patients often remember the hospital, not your practice.
• Patients after discharge. They may continue with the hospital's own outpatient service or go elsewhere.
• Space and timing. You work in their space, around their priorities.
• Your future. One decision by the management can change everything.

That last one is the real risk. A practice that lives inside one hospital depends on one contract, one administrator and often one or two surgeons.

How do the two models compare?

Here is a side-by-side. Every arrangement is different, so treat this as a list of questions, not a verdict.

Which terms should you negotiate before saying yes?

Known Doctors Get Booked says it plainly: a handshake deal feels friendly until the first disagreement about fees or patients. Put these in writing, and have a lawyer draft or check the agreement for your situation.

1. The revenue share. What percentage goes to the hospital, and on what: gross billing, or after consumables? When is it reviewed?
2. Who employs the therapists. You or the hospital? Who pays salaries, leave and training?
3. Space and equipment. Who provides them, who maintains them, and who owns any equipment you bring in?
4. Billing and collections. Does the hospital bill and pay you monthly? How quickly? What happens with insurance cases?
5. In-patient and out-patient scope. Are you running only in-patient rehab, or the outpatient department too?
6. Continuity after discharge. Can patients choose to continue with your own clinic or home service if they wish? This matters a lot, and it must always be the patient's free choice.
7. Protocols and reporting. Whose protocols you follow, and how you report to the treating doctors.
8. Minimum terms. Is there a minimum monthly payment to you, or a minimum number of hours from you?
9. Exit. Notice period on both sides, what happens to equipment and records, and any non-solicitation terms.

How do the numbers compare?

Here is a worked example with made-up numbers. Your terms will be different.

Hospital unit: Say the unit bills ₹6,00,000 a month and the hospital keeps 40%. You get ₹3,60,000. You pay three therapists ₹1,05,000 in total. You keep about ₹2,55,000, with very little rent or setup cost.

Standalone clinic: Say it also bills ₹6,00,000 a month once it is established. You pay rent of ₹60,000, salaries of ₹1,30,000 including a front desk, and ₹70,000 for marketing and other costs. You keep about ₹3,40,000, but you spent money to set it up and months building demand.

On these made-up numbers, the clinic earns more once it is full. The hospital unit earns sooner, with less risk at the start. The real question is not which one is better. It is which one fits your stage, and whether you can build the second one using the first.

Should a physio do both?

Often, yes. Known Doctors Get Booked tells the story of a specialist who used visiting roles at two hospitals to build a practice fast, while building his own brand in the background.

For a physio, that can look like this:

• Run the hospital unit well, with your own protocols and a reputation with every doctor in the building.
• Build your own clinic or home service nearby, under your own name.
• Where patients freely choose to continue with you after discharge, care for them properly.
• Never pull patients away from the hospital for care it provides itself. That destroys trust quickly.

And track every location separately: patients, sessions and revenue. Known Doctors Get Booked suggests writing those three numbers next to every hospital at the end of each month.

What ends hospital arrangements badly?

The same things that end any visiting role. Missed days, vague agreements, and pulling patients away. Add one more for physios: never let one surgeon become your whole practice. If most of your patients come from one doctor and that doctor leaves, the unit empties overnight. Build relationships with every surgeon and physician in the building.

If you are weighing an offer right now, take your time and run both versions of the numbers. We sit on both sides of this table, with hospitals and with physiotherapy practices, and we think it through with owners in growth consulting. The visiting roles chapter of Known Doctors Get Booked covers the agreement in more detail.

The short version

• A hospital unit gives you patient flow, credibility and a referral network from day one.
• You give up control over pricing, brand and often patients after discharge, and you depend on one hospital.
• Negotiate the share, staffing, billing, continuity, minimum terms and exit in writing, checked by a lawyer.
• A standalone clinic is slower and costlier at the start, but fully yours.
• Many physios do both: use the hospital to build reputation while building their own clinic.