Perspectives from Across the Pond

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How the pandemic affected physical therapy in Scotland

By Steven McLean

When I graduated as an MSc physiotherapist in Scotland in 2005, I always envisioned working in private practice. However, I took the traditional (expected) path and went to work for the National Health Service (NHS), a publicly funded healthcare system in the United Kingdom that provides healthcare services to all UK residents at no cost to them at the time of delivery.

After five years of working in the NHS, I saw the positive side of this amazing free-access-for-all service, but I also saw the frustrating side. Government-run agencies do not tend to adapt quickly to change; there are many inefficiencies, and there is very little, if any, accountability based on performance. I quickly grew frustrated and knew it wasn’t the environment where I wanted to spend my career. I set up in private practice in 2010; at the same time, I had just begun my journey as an international soccer referee. This shift allowed me the freedom to travel with elite sports, begin my entrepreneurial journey, and still enjoy treating patients who enjoyed being active.

My first academic degree was in sport and exercise science, so I believed in joining the science of sport with physiotherapy. I was committed to helping active people over 40 get better and stay better so they could stop worrying about making their pain worse or needing surgery. Things grew organically and steadily over the next eight years, by which point I had expanded to two clinics and a team of five. I knew that if I wanted to take things farther, I needed to learn more about business. I found a mentor and started to network with other business owners in late 2019, and I reduced my international travel so I could focus on family and business.

Six months later, the COVID-19 pandemic hit and presented me with the most challenging two years of my business life. I have learned much more about the business, myself as a leader, and the grit required to succeed. During COVID-19, my clinic was closed for four months, and we have continued to deal with the mandatory restrictions still in place in healthcare within Scotland. We are still operating with two-meter (six-foot) social distancing requirements and restrictions that may never be lifted. Our business has changed, but we have continued to grow despite this. We introduced online appointments, bought our own premises, grew our team, added value to our clients’ experiences, and increased our rates. We reduced our insurance contracts and increased the self-funded clients in our clinics. The pace at which we made these decisions hastened, and we grew despite enormous challenges. This growth was only possible due to having a focused mind-set, intimately understanding our finances, being surrounded by other motivated business owners, and being agile. The agility of a small business is a real advantage when compared with the massive system that is the NHS. They are still struggling to adapt and remobilize, which has led to huge waiting lists (sometimes more than six months!). In many ways, the free-access service we compete with is now not worth the wait, so it is the best time to be involved in private practice.

We have exciting plans for the future, and our commitment to our patients has never been stronger. Throughout this whole challenging period, people now value their health more than ever, and we are in the perfect position to help them live a pain-free life with the freedom to choose whatever activity, holiday, or sport that they desire. I have learned that you need good people to leverage good systems, and my role is to be a leader at some times and a manager at others.

Ultimately, you have to believe in yourself, understand the risks, and be prepared to fail. That gives you the freedom to take more risks and the confidence to make big decisions quicker than your competition and enjoy the rewards of a different level of problems. Business and health are a journey, so I encourage my fellow private practice owners to keep believing better is possible, keep learning, and commit to being 1% better every day.

I’m grateful for the journey I’ve been on and am excited about the next chapter. Cost of living crises and recessions are looming, and the negativity in the media has created a lot of fear. I refuse to join the pity parties, and I’m confident healthcare will be one sector that will continue to be required in society and will, therefore, do well. The role we play in the local community is essential, and if we play that role with kindness, we can improve quality of life for our clients and be successful in business as well. 

Steven McLean, MSc (Hons) physiotherapy

Steven McLean, MSc (Hons) physiotherapy, is the owner of Optimal Physio Ltd, located in Clarkston and Largs, Scotland. He can be reached at

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