What pay equity means for practice

The Fair Work Commission’s gender-based pay equity decision has been described as one of the most significant industrial developments to affect physiotherapy in recent years. 

For a profession that has long advocated for greater recognition of its clinical expertise and contribution to Australia’s healthcare system, the decision represents an important milestone. 

However, as the deputy chair of the APA Business national group, David Giles MACP (left), points out, the reality for private practice owners is nuanced. 

The pay equity decision stems from the Fair Work Commission’s review of awards identified as potentially subject to historical gender-based undervaluation. 

The Health Professionals and Support Services Award, which includes physiotherapy, was one of five awards chosen for review. 

The Commission found evidence that work in the female-dominated professions had been undervalued when compared with work of equivalent skill and responsibility in more male-dominated sectors, says David, a dual APA Titled Musculoskeletal Physiotherapist and APA Titled Pain Physiotherapist. 

What it means for you 

David’s initial reaction to the Commission’s report was one of surprise that there was inequity and that it had been thoroughly documented and proven. 

‘When you read through the Fair Work Commission’s review process, the evidence does actually show that there was, and is, a clear difference.’ 

The proposed pay increases – estimated to be in the order of 24 to 25 per cent over the next five years – acknowledge the advanced clinical reasoning, professional judgement and extensive education required of physiotherapists, David says. 

Importantly, the Commission also recognises a workforce in which women represent a substantial proportion of clinicians. 

For private practice owners, the decision brings opportunity and some complexity. 

‘I think most of us accept that physios deserve an increase in pay,’ David says. 

A private practice director himself, of the Injury Hub in northern Adelaide, David says the ramifications of the wage decision will necessitate a review of many practices’ operations and business plans. 

The phased implementation – which begins on 1 October, with subsequent annual increases on 1 July from 2027 until 2030 – offers business owners some breathing room. 

The rise will come on top of an expected 4.75 per cent CPI increase this year. 

David says the pay equity decision will affect all physiotherapists but perhaps one group in particular – new graduates. 

At the graduate level, the increased remuneration may improve the profession’s attractiveness relative to the other health disciplines competing for the same cohort of university graduates. 

Entry-level physiotherapists can expect stronger financial recognition as they transition into clinician practice, David says. 

He cautions, however, that graduate salaries intersect with another issue already familiar to many private practice owners: readiness for practice. 

‘We know that new grads are pretty well trained in lots of respects but the demands of the private practice environment and billing productivity, case load management, patient communication… there are lots of skills that take time to develop.’ 

The transition from university to autonomous clinical practice requires intensive support. 

New graduates often need mentoring in consultation efficiency, treatment planning, documentation standards, exercise prescription progression, communication strategies and managing the complexity of patient expectations. 

David says they must develop competence in musculoskeletal assessment and evidence-based interventions and in the commercial realities of private practice. 

‘The cost comes to the clinic for all that supervision and mentoring.’ 

The reforms include changes to classification structures and progression criteria. 

While simplified frameworks may improve transparency, they may also alter how clinics approach recruitment, professional development and retention strategies. 

‘As a business owner, you’ve got to do your sums because those pay points will progress a lot quicker now.’ 

Another significant change relates to the progression for part-time employees. 

Previously, advancement through pay points relied on accumulating a specified number of hours. 

Under the revised framework, progression will instead be linked to years of experience and years working. 

For physiotherapy practices, many of which employ clinicians returning from parental leave or working reduced hours to accommodate caring and family responsibilities, this has important implications. 

‘There’s a lot of women who have been on parental leave and then return to work but not full-time due to family commitments, so that’s the main reason why they’ve done that.’ 

Impact on the bottom line 

David Giles says the Fair Work Commission’s decision on gender-based pay equity recognises the value of physiotherapy..

David says that many private practices are already operating in an environment characterised by escalating overheads and increasing administrative demands. 

Wage growth is occurring alongside changes to superannuation obligations, persistent workforce shortages and limitations imposed by external funding models. 

Many practices continue to deliver services under arrangements where fee increases have not kept pace with operating costs, David says. 

He adds that Department of Veterans’ Affairs schedules, Medicare rebates and recent changes affecting NDIS-funded services have all placed pressure on practice viability; while clinicians rightly expect remuneration that reflects their expertise, translating those increases into financially sustainable business models is another challenge entirely. 

This tension between valuing physiotherapists appropriately and maintaining accessible services underpins much of the profession’s current discussions. 

David says that in many clinics, especially those servicing rural and regional areas and those managing large Department of Veterans’ Affairs case loads, simply increasing consultation fees might not be a realistic option. 

David notes that the challenge for clinic owners and directors will be understanding exactly how the changes affect their individual business models. 

Practices employing award staff will need to review contracts, payroll structures and progression pathways. 

Those operating commission-based arrangements will also need to ensure that clinicians continue to receive remuneration above minimum award requirements as rates increase incrementally. 

The bigger picture 

As employment costs rise, some practices may reassess their graduate recruitment strategies, favouring clinicians capable of independent case load management earlier in their employment. 

That possibility highlights the importance of broader workforce planning. 

Improving retention remains critical, particularly given longstanding concerns regarding attrition within the profession. 

David says that while remuneration is undoubtably important, it should not be viewed as the sole solution. 

‘People talk about pay but we know that pay is not everything. 

‘I think clinic owners will still need to do other things for their employees to get that retention. 

‘If the clinic owners are thinking, “Well, I’m paying you more, you should stay around”, that’s unlikely to work. 

‘There will be other forms of recognition that I think clinic owners would have to tie in with it for retention.’ 

Professional development opportunities, mentoring programs, flexible work arrangements, leadership pathways and recognition of advanced clinical skills continue to play an essential role in clinician satisfaction. 

Practices seeking to retain experienced practitioners may need to invest more deliberately in career progression beyond simple salary increases. 

David suggests this may include supporting physiotherapists to pursue areas of clinical specialisation or titling, extended scope roles, leadership responsibilities or further postgraduate training. 

Putting plans in place 

For business owners, preparation will be essential, David says. 

Understanding the changing award structure, reviewing staff profiles and forecasting future wage obligations are immediate priorities. 

Clinics may also need to review fee schedules, productivity benchmarks and succession planning strategies. 

The broader objective, however, goes beyond wages. 

David believes genuine success lies in achieving a balance between fair remuneration, a sustainable business and patient access to care. 

Without adequate funding mechanisms, clinics may struggle to absorb increased costs. 

Without financially sustainable practices, workforce opportunities may diminish. 

Without accessible services, patients may face growing barriers to receive timely physiotherapy intervention. 

‘If you achieve one thing without the other, then we probably haven’t solved the problems.’ 

Despite the challenges, David remains optimistic about what the wage reforms represent for physiotherapy. 

‘It’s certainly a good thing overall for the profession. 

‘It’s just going to be a matter of navigating these next five years with the pay increases.’ 

For private practice owners, that navigation will require careful planning, honest conversation and a willingness to adapt. 

The gender-based pay equity decision acknowledges the value of physiotherapy in a way many clinicians have sought for many years, David says. 

The task now, he argues, is ensuring that this recognition translates into a stronger, more sustainable profession capable of continuing to deliver high-quality, patient-centred care across the country. 

‘We all want to make sure physio is valued in the right way,’ David says, noting that achieving that outcome will require the profession, funders and policymakers to move together. 

If they can, this landmark decision may represent a correction of historical inequities and an investment in the future of physiotherapy.