Interview with Pedro Borrego
Last week on Twitter a conversation started about Walk In or Urgent Care Centers for physical therapy, and quickly progressed to this question:
We had a great conversation of over 195 comments, which led me to believe it would be well worth interviewing Pedro to find out more about what he is doing. In 1993, Pedro started the first physical therapy clinic in his town in Spain, and has grown it into a business which serves as a revolutionary clinic model for those of us in the US. I have known Pedro through social media and email for about 2 years now, and I am blown away by what he has done. I hope you enjoy the interview!
Q: First, Pedro, tell us about the education process in Spain to become a physical therapist.
A: Spain has become one of those countries in which physiotherapy education has improved since I went to University: I got my degree in 1992, a three years education in a recently established program in University of Salamanca. At that time the University didn’t offer a Master or Doctorate, so I got a foreign upgrade in General San Martin University (Argentina) and finished my first Masters degree in Healthcare Management. Nowadays this permits to me to teach as professor in the main private Distance University (UDIMA). In 2006 I reached my doctorate degree and I am preparing today a new doctoral thesis to fix the degree about physiotherapy in pelvic floor infectious and not infectious chronic diseases based in biofeedback.
Before I got my PT degree, most of PTs in Spain were also nurses, as their education program was linked to that profession. Nowadays, the evolution from 3 to 4-years education degree leads on to an independent PT Grade and direct access to Doctorate and Master Degrees.
Q: How long have you been practicing?
A: At the very first time I was sure I didn’t want to be ordered or directed by an obsolete system. Although I prepared a public examination to succeed to what it was supposed to be my first job in the National Center for Disabled Patients (and I got it!) I decided not to agree to the offer and open in 1993 Fisiomed, the first Physical Therapy center in Salamanca owned by a PT. Its 22 years now.
Q: What got you interested in physical therapy as a profession?
A: Well, it wasn’t what PT offered as a profession but as an aim to discover new perspectives in Healthcare areas, particularly in PT.
Q: Tell us about your clinic. Where is it located? How long have you been in business? Do you own the space or rent?
A: Fisiomed was open in 1993 initially as a renting place with 60 square meters in Salamanca Downtown (Spain): an office, waiting room, bathroom, two separate treatment rooms and a small gym. No one could foresee a new and bigger clinic 3 years later and just half a mile away. Today, a 500 square meters centre offers Physiotherapy, Orthopedic Surgery, Ophthalmology, Podiatry, Aesthetic Surgery, Speech Therapy, Psychology, and 3D-4D ECO imaging for pregnant women. www.clinica-fisiomed.com
Q: Explain the model of the clinic. What other healthcare providers work with you? Are you all part of the same business? How do you all work together? Are the other HCPs contractors?
A: The clinic is sustained in two main business models adapted to Spanish laws: self-employed and LLC (limited liability company). Health Ministry only allows HCPs to practice as a self-employed in the field related to your university degree, but LLC raises the views to work with other HCPs. And that’s what I did: LLC was founded by just one associate as CEO… and the same one a self-employed in PT.
The offers came quite soon: A surgeon leading the aesthetics procedures in Madrid but born in Salamanca, was impressed by the new Center, and then we signed the first contract.
All administrative staff and Physical Therapists are hired directly by the LLC, and they work as employers.
The others HCPs can choose between three open models: they are self-employers which lend a service to the LLC by renting a limited space by a fixed but flexible schedule by week (monthly payment), a percentage in benefits, or both systems. We make a market survey before we close the agreement and we value the proper model based in the specialty and interests of both LLC and HCP. We never duplicate two same HCPs unless they come as a team (like Orthopedic Surgeons do) but hiring the PTs allows me not to have to apply that rule in that unit.
But all HCPs in the clinic, including hired ones, are free on their professional decisions and duties under a manager’s baton to make things work properly, helped by administrative staff and a complex computer program which controls agendas, payments, percentages, patients, clinical history, providers, stocks, and logistics. The success doesn’t come from that, but from a personal and humane treatment and careful relations with patients and providers.
Q: What is the payment model in Spain? Do people use health insurance? Private or government funded? How do you get paid for treatment?
A: Private clinics work directly with patients. Most of them, like FISIOMED does, attend patients which use their private health insurances. Some of them, like members of the National Police or the Army, use their government funded insurance companies according to yearly accords with public statements like Ministries or regional/local public boards. The insurances pay monthly according to fixed rates accepted by providers.
We do also receive patients from traffic crashes who don’t have to pay anything at all as we are in an agreement with National Insurance Union managed by a web-based app that register the accident, the injuries suffered by driver and occupants, authorizations for clinical procedures (Ortho, PT, Xray) and assure the applicable payments coming from the insurance of the involved vehicles.
Q: In what way are each of the HCPs paid? Percentage? Salary? Per patient?
A: It depends on the model we fixed: renting pays a monthly amount, percentages goes from 20 to 35 % of rates, and mixed model reduces the rent and percentages to minimum with variable sums in each months depending on HPC activity. PTs and office staff receive a fixed salary.
Q: How do you market your clinic and services?
A: The beginning was costly higher than now, but marketing and publicizing is a must to be on the crest of the wave. It has obviously been a radical change in this, as 20 years ago there were no Twitter or Facebook, but our main power is our own patients.
Q: Do physical therapists need a physician referral to see a patient in Spain?
A: No. We do receive patients in a direct access system. This changes if we talk about insurances or Public Health. Reimbursements are compulsory justified by physician referral; insurances allow referral from any medical specialty; Public Health requires a referral from rehab-physicians except from Primary Care which referrals to physiotherapy come from PC Physicians integrated in the called PC Team.
Q: What has been the biggest surprise about this whole venture?
A: ¿Positive or negative? Let’s mention the first choice: the daily satisfaction to lead a team whose work turns into results in a better life for our patients.
Q: Where do you see the business heading in the next 5 years? Any big plans?
A: My head is continuously working and we are right know involved in both projects about computer assisted exercise program and iris laser aesthetic treatment to be included in our services. We just want to keep our MVV set and offering our best to patients and team members.
Q: What is the best piece of advice you can give someone who wants to start this model of business?
A: Be yourself, set your goals, never underestimate your rivals, and have a head for everything you decide to do.
Thanks so much to Pedro for taking the time to answer my questions. What do you think about this clinic model? What questions do you have for Pedro? Please leave comments and questions below.