Clinical skill, retention, and what Net Promoter Score tells you that Google reviews cannot.
Yes. Private practice rewards strong clinical capability, because patients decide whether to keep coming back. The owner’s part is to create the conditions in which clinicians develop it. That is the argument Culture of One founder Shane Gunaratnam makes in the video above, Episode 26 of The Business of Allied Health, hosted by Barry Nguyen and published by CliniScribe AI on 11 September 2026. The episode is theirs; we quote it with timestamps.
On this page: What clinical excellence means · What the owner has to build · NPS vs Google reviews · What to do next · Chapters · Full transcript
What clinical excellence means in private practice
Barry asked for a lesson that “gets swept under the blanket”. The answer:
“The most unpopular thing I can say, which is absolutely true, is you need to be exceptionally good at your craft. You need to be a very good physio, and the benchmark for being a good physio is much higher than what most people think.”
“The private sector is brutal because it’s efficient. It’s brutally efficient at getting rid of people who underperform, and that is purely just the market. That is patients coming through saying, I don’t want to keep seeing this person.”
The condition comes straight after: “if you’ve got through that degree, you can be successful in private practice. But you need the right environment around you” (12:20). A conviction, not a guarantee, and it puts the environment with the owner.
Good, in this sense, has three parts, and none of them is the clinician’s own opinion of their work.
- Patients judge it. When Barry pointed out that most physios think they are good, the answer was that it comes down to whether patients think so (12:40).
- Range. Being “developed as a clinician who can solve the multitude of different problems that present, rather than just giving a quick massage here and there” (12:45).
- No finish line. Getting better is “one of those infinity goals” that “doesn’t change after twenty years” (13:10).
A sustained caseload, returning patients and referrals are operating signals, not proof of clinical quality. They also move with case mix, access, referral supply, patient circumstances and communication, and more visits is not better care. Discharge on plan is a good result; the pattern to examine is unplanned loss to follow-up, read beside case review and outcome measures.
What the owner has to build
The interview ties this to the problem owners raise most, “finding good people to work in your practices and retaining those people long term” (07:28), and names a cause: “This is a developmental problem of not being able to execute core skills. People who are confident in their craft stay in their jobs for a long time” (11:03).
Development is one reason clinicians stay, alongside pay, workload, leadership, autonomy and the chance to progress (why good clinicians leave good clinics covers the rest). It is the one most often left to goodwill. For an established clinic with clinicians still building a list, we recommend five parts:
- Protected time in the week. A weekly slot for case review or mentoring that is not handed back to patients when the book fills.
- Observed consultations. A senior clinician sits in on real sessions, with the patient’s consent, and gives feedback the same week.
- A named person responsible. One person owns each clinician’s development, with the time costed into their week.
- Feedback tied to actual cases. The case that stalled, the patient who stopped coming: real cases, not general advice.
- A review of progress. At a set date, clinician and mentor read caseload signals beside case notes and outcome measures, and pick the next skill.
None of this is new to clinical education; what is usually missing is the owner running it as part of the business. What a new grad physio costs a clinic prices the development time.
Net Promoter Score vs Google reviews
Asked for the single metric that matters most, the interview names Net Promoter Score as the “north star” (08:00), then separates it from Google reviews (08:49).
| Aspect | In the interview | Our reading |
|---|---|---|
| What it is | “The percentage of people who come through who would recommend your services” (08:06) | One 0 to 10 question about recommending the clinic. The score is the percentage of promoters (9 to 10) minus the percentage of detractors (0 to 6); passives (7 to 8) count in the total, so it runs from −100 to +100 (Reichheld, Harvard Business Review, 2003). Willingness to recommend, not referrals received. |
| Who sees it | “Something you measure internally, inside your own business… fairly meaningless to the general public” (08:49) | An internal management number, read with the comments. |
| Comparing it | “A universal business measure. You can compare across sectors” (09:04) | Most reliable against the clinic’s own past results, asked the same way each time and read as a trend over months. Cross-sector comparisons are weak: wording, timing and who is asked differ. |
| Google reviews | “Extremely useful, but they can also be completely fake. That ecosystem isn’t something we have much control over” (09:21) | Public, hosted by the platform. Useful for being found and chosen; not a measure of clinical quality. NPS manages the service from the inside; reviews help a clinic be found from the outside. |
Two cautions. NPS is not proven to be the best predictor of growth: Keiningham and colleagues (Journal of Marketing, 2007) did not find it superior to other satisfaction measures. And small samples swing, so read the trend over months rather than week to week, with the response count and who was asked beside it. Following up a low score does not need to wait for the trend: it can happen the same week.
On reviews, the interview goes further: “there are, dare I say, average clinics who have hundreds of great reviews, because there are ways of getting people to give you great reviews, not all of them legal or reasonable to be doing under AHPRA registration” (09:33). Review volume alone says nothing about how reviews were gathered. What matters is the difference between reviews patients post independently on platforms the clinic does not control, which sit outside the testimonial ban, and clinical comments a clinic republishes in its own advertising, which sit inside it; Ahpra’s testimonial tool and its advertising guidelines set out where that line sits.
What to do next
- Read each clinician’s caseload for unplanned loss to follow-up, beside case mix and referral supply, and take it to case review, not a performance conversation.
- Put the five parts in the diary for every clinician still building a list, with a review date.
- Ask the NPS question the same way every time, read the trend monthly with the response count, and follow up low scores promptly.
- Hold the owner to the same standard. Getting better never stops, “and the same in business” (13:25).
Building that system around an owner’s own team and numbers is the work of our Advisory engagement with established clinic owners. Owners of clinics under $1M can start with People Community, our membership, which includes the Client Experience masterclass replay (August 2026).
Frequently asked questions
Does a low rebooking rate mean a clinician is not good enough?
Not on its own. Rebooking, return visits and referrals are operating signals, not proof of clinical quality. They move with case mix, access, referral supply and the patient’s circumstances, and a patient discharged on plan is a good result. A clinician whose patients often stop before the plan ends, with no reason recorded, is the prompt for case review and observed consultations, which is where a development need is confirmed or ruled out.
How is Net Promoter Score calculated for a clinic?
Patients answer one question, how likely they are to recommend the clinic, on a scale of 0 to 10. The score is the percentage who answer 9 or 10 (promoters) minus the percentage who answer 0 to 6 (detractors). Those who answer 7 or 8 (passives) count in the total but in neither group, so the score runs from −100 to +100. It measures stated willingness to recommend, not referrals that actually arrive, so track both.
Do Ahpra’s advertising rules apply to Google reviews?
The testimonial ban covers advertising. Reviews patients post on platforms a clinic does not control are outside it, and clinics are not expected to monitor or remove them. Sharing or republishing a review that comments on clinical aspects of care, such as symptoms, treatment or outcomes, in the clinic’s own advertising or social media is inside it; comments about customer service or communication style are not testimonials. Ahpra’s testimonial tool sets out the detail. This is general information, not legal advice.
Related reading
- Why good clinicians leave good clinics
- Why patients don’t come back
- What does a new grad physio cost a clinic?
- CliniScribe AI for physiotherapy, with Barry Nguyen
Chapters
Chapter start times are the host’s own. Timestamps beside quotations on this page mark the moment the words are spoken, so they can fall a little after the chapter starts.
| Time | Chapter | Watch |
|---|---|---|
| 00:00 | Introduction | Watch from 00:00 |
| 00:44 | Clinic ownership journey and partnering with Life Ready | Watch from 00:44 |
| 01:51 | Scaling from startup to profitability during a pandemic | Watch from 01:51 |
| 02:42 | The Life Ready acquisition and transitioning out | Watch from 02:42 |
| 03:44 | Why a partnership model beats the traditional bootstrap | Watch from 03:44 |
| 05:50 | The harsh reality of starting a clinic and the messy middle | Watch from 05:50 |
| 07:24 | The biggest challenge: staff recruitment and retention | Watch from 07:24 |
| 07:41 | The number one metric: Net Promoter Score vs Google reviews | Watch from 07:41 |
| 10:01 | The controversial truth: why clinical excellence is non-negotiable | Watch from 10:01 |
| 13:01 | Final thoughts: continuous learning and mastery | Watch from 13:01 |
Full transcript
The full episode, lightly edited for readability: filler removed, meaning unchanged. Chapter titles are the host’s; each speaker label and timestamp links to that moment in the original video. PVA, raised at 07:50, is patient visit average.
00:00 Introduction
Barry Nguyen 00:06
…series. I'm not going to call it a podcast, because it's just linked to the CliniScribe YouTube channel anyway. But we have Mr Shane Guna here. He's probably one of the loudest coaches on social media, but he actually ran a clinic very successfully, and this is about that: telling his story and some of the lessons you might not find in his posts. Hopefully unfiltered, and it might go viral if we snip it up. Thanks for coming to this session, Shane, and sharing your time.
Shane Gunaratnam 00:38
No worries, Barry. Thanks for having me, mate.
00:44 Clinic ownership journey and partnering with Life Ready
Barry Nguyen 00:40
So talk to me about not your coaching journey but your clinic journey. What happened there, and what did you start?
Shane Gunaratnam 00:46
My journey is, I'd say, short and sweet. I worked as a physio for about a decade, and I spent a lot of time building my physiotherapy core skills, my musculoskeletal skills, doing postgrad and everything. I think this is something I've understated with regard to why I was able to have a short and sweet journey in business ownership. I partnered with a company called Life Ready. Life Ready were a Perth-based company, and I did so because I could see that they understood customer experience. From my ten years as a physio prior, it was obvious to me that client experience, customer experience, is a massive portion of running a successful business, and I think this is a lesson that people are still coming to terms with. So with a high focus on customer experience and a strong clinical background, I was able to run a clinic from startup to profitability to maturity in a four-year period, during a global pandemic.
01:51 Scaling from startup to profitability during a pandemic
Barry Nguyen 01:52
Oh, wow. So from zero, absolutely zero?
Shane Gunaratnam 01:55
From startup in 2018, to feeling like we had a decent team with five therapists or so at the very beginning of COVID, to the absolute dip of 261 days in lockdown over two years, coming out the other side with a strong leadership team, retaining all of our therapists, building a great new-grad development structure, and having an overarching admin system in place that was helping us acquire and retain patients and grow our business as big as possible. Where that story really collides is that if it weren't for my business partner having sold their half of the business, I'd probably still be running that clinic and growing more clinics.
02:42 The Life Ready acquisition and transitioning out
Barry Nguyen 02:38
So how did you find your co-founder?
Shane Gunaratnam 02:41
It just came to a head, because what ended up happening was Life Ready sold their business to HBF. From my perspective, that reduced the commercial goals of our practices pretty substantially. HBF were running really great clinics, but they didn't have the same appetite as a bunch of guys in their thirties who were trying to grow businesses across the country. So that was an ethos shift more than anything. It was nothing disrespectful to how they go about running their businesses. It was purely that I had way more entrepreneurial drive than what was going to be possible within that ecosystem. So when it came to offers, with my business flying, doing really, really well financially, with good therapist retention, and having had two young kids in that space of time as well, I just took the opportunity to downshift, essentially.
Barry Nguyen 03:37
So did your partner have complementary skills to you, or similar?
Shane Gunaratnam 03:42
Pretty much complementary, and these are the skills I developed through that partnership. I came into business with very little fundamental business knowledge, just like everybody else. But I had access to this library of incredible resources: CFOs, CMOs, heads of operations who'd overseen twenty-plus clinics. I learned the lessons from the ten- or twelve-year journey Life Ready had as well, and what was really critical, essentially why some clinics do really well and why others flounder.
03:44 Why a partnership model beats the traditional bootstrap
Barry Nguyen 04:14
So do you feel some people will be more suited to a franchise type of model like that?
Shane Gunaratnam 04:20
This wasn't a franchise. It was a partnership model. You own half the business and Life Ready own the other half. If I'm honest with you, the reason I did this was because I could not see a path through the traditional bootstrapping path of being a sole trader, renting a small room, building up slowly. I just could not see that path being fast enough, and having spent a decade learning my craft, I just wanted to get to the point of leading a team and running a bigger business faster. It's a massive unfair advantage. It is a massive unfair advantage.
Barry Nguyen 04:54
That's very interesting. So you don't always have to do that kind of hustle story that I keep hearing, like building your own clinic, painting the walls.
Shane Gunaratnam 05:01
Yeah. Painted furniture. It's very, very hard to do that. You need a lot of things to go right for you. People who did it twenty years ago, it's a different environment. Competition is really high. The biggest constraint is just competition for employees at the moment. That's the thing that makes it very hard for people to grow.
Barry Nguyen 05:20
Interesting. So back then, that's how people were doing it, just renting a little room from a GP clinic and building up there, or from a gym, with a bit of cream and some tape and some Theraband.
Shane Gunaratnam 05:31
Exactly. And I think those paths are very hard now.
Barry Nguyen 05:35
Rent is very, very high.
Shane Gunaratnam 05:37
Operational costs are very high. Staffing costs are very high. You can't patch on a bunch of contractors anymore and grow something. You have to do everything by the book, properly, and that sequence is difficult.
05:50 The harsh reality of starting a clinic and the messy middle
Barry Nguyen 05:49
So in terms of your advice for someone who wants to just start out, what would you say? Find a business coach, find a partner, or…
Shane Gunaratnam 05:59
In today's market, I would have a serious conversation about whether starting a business is the right decision for you, knowing that 80% of physio clinics manage to get to a point where they're making some money, but they're not highly profitable. The majority of people look at this as a path to earning more income. The stats don't really back it up. One in five owners is better off, potentially substantially better off, but a lot of people find they arrive in what's called the messy middle. The messy middle is where you're working really long hours, you're paying your staff really well, but you have very little to take home other than the prospect of this thing growing. You need to come into business ownership with your eyes open if you are really thinking about it, because it sounds great in theory, but in practice it is hard. It is really, really hard. A big thing I do nowadays is take the knowledge I developed through Life Ready, through running my own clinics, and help people who are in that messy middle make that transition. And it's a select few who get the reality that you need to be coached through this stuff. You need to develop your skills in marketing, in recruitment, in being able to run your clinic operationally really soundly, to get out of that phase.
The 80% and one-in-five figures in this answer are Shane’s estimates at the time of the interview, not industry statistics.
07:24 The biggest challenge: staff recruitment and retention
07:41 The number one metric: Net Promoter Score vs Google reviews
Barry Nguyen 07:37
Interesting. Long term. And if there's one key metric you'd measure in terms of the success of the business… I know there's a lot of controversy around your posts, around PVA and all that type of stuff. What do you think that single metric would be?
Shane Gunaratnam 07:56
You can measure as many things as possible, but the north star, the one metric I suggest people focus their energy on, is your Net Promoter Score, which is the percentage of people who come through who would recommend your services. This is really shifting our industry from what has often, or always, been very volume-driven, "we need to get as many patients through the door as quickly as possible", into a value-driven model. That's the engine that's going to drive growth through the second half of this decade and into the 2030s. It is providing value to people so that they're comfortable to part with a reasonable sum of money. The days of running clinics on $80 consults and that sort of stuff are long behind us.
Barry Nguyen 08:43
Right. So what's the difference between, for example, a Net Promoter Score and a Google review?
Shane Gunaratnam 08:49
Net Promoter Score is something you measure internally, inside your own business. You don't necessarily show it to everybody. You can put it on your website if you want to, but it's fairly meaningless to the general public. But it is a universal business measure. You can compare across sectors to see what percentage of clients would comfortably refer friends to you. The reason that's an important metric is that it tells you a lot about the business's growth and the potential growth that's going to happen. Google reviews are extremely useful, but they can also be completely fake. That ecosystem isn't something we have much control over. And there are, dare I say, average clinics who have hundreds of great reviews, because there are ways of getting people to give you great reviews, not all of them legal or reasonable to be doing under AHPRA registration, et cetera. But that drives commercial practice, and you do need to have strong Google reviews. It's one of many, many things.
10:01 The controversial truth: why clinical excellence is non-negotiable
Barry Nguyen 09:55
Interesting. So, last question. What's an unpopular lesson you've learned in terms of running a successful allied health clinic that you haven't shared on social media before, or that gets swept under the blanket for whatever reason? Something that's probably unpopular, may even be a bit controversial, that everyone listening who is a clinic owner, or aspiring to be one, would need to hear.
Shane Gunaratnam 10:27
This will probably be controversial as well. The most unpopular thing I can say, which is absolutely true, is you need to be exceptionally good at your craft. You need to be a very good physio, and the benchmark for being a good physio is much higher than what most people think. That creates its own challenges, and this is a challenge we face in our field every single day, because most owners, like I was saying, struggle with retaining their therapists. This is a developmental problem of not being able to execute core skills. People who are confident in their craft stay in their jobs for a long time, because you've got a big list of patients, you're getting good outcomes, you're going to be getting paid well. That happens at most clinics. But the unfortunate reality is you do need to be a very good private practitioner. This isn't a job people can just walk into without a commitment to clinical excellence. It's something I've learned over the last fifteen, twenty years, and it was as true twenty years ago as it is today. It's just not talked about. Twenty years ago, when private practice was more cutthroat, because people didn't have that much money and it was a bit of a newer, fresher thing, people understood you've got to be a very, very good clinician to build a list, to have the lifestyle you want as an independent practitioner or as someone working in private practice. The private sector is brutal because it's efficient. It's brutally efficient at getting rid of people who underperform, and that is purely just the market. That is patients coming through saying, "I don't want to keep seeing this person." It's uncomfortable to think about, but at the same time, I'm a firm believer that anyone who's done a physio degree, if you've got through that degree, you can be successful in private practice. But you need the right environment around you.
Barry Nguyen 12:34
Well, that's very interesting. A lot of physios you hear, they think they're good, right? In general.
Shane Gunaratnam 12:40
It's not about what you think. It's about…
Barry Nguyen 12:44
…do your patients think…
Shane Gunaratnam 12:45
…that you're good at what you do. And are you actually developed as a clinician who can solve the multitude of different problems that present, rather than just giving a quick massage here and there?
13:01 Final thoughts: continuous learning and mastery
Barry Nguyen 12:57
Awesome. All right, thanks for your tips, Shane. That's a really interesting lesson there at the end, and hopefully many of the people can reflect on that and see where they're at. Thank you for your time.
Shane Gunaratnam 13:10
I think it's a goal. It's one of those infinity goals. When you arrive in private practice on day one, you need to be working on getting yourself better, and that doesn't change after twenty years. I think that's the most important point.
Barry Nguyen 13:23
Continuous learning, continuous improvement.
Shane Gunaratnam 13:25
Exactly. And the same in business.
Barry Nguyen 13:28
Awesome. Thanks. Love that.
Shane Gunaratnam 13:31
Very good, Barry. Thanks for having me, mate.
Barry Nguyen 13:33
My pleasure. Thank you.
About this information
General information about running an allied health practice, built on a published interview. It is not legal, regulatory or financial advice and does not take account of any particular clinic’s circumstances. Quotations are from the episode as published.
Sources: Barry Nguyen, The Business of Allied Health, Episode 26, CliniScribe AI, 11 September 2026. Frederick F. Reichheld, The One Number You Need to Grow, Harvard Business Review, December 2003. Timothy L. Keiningham, Bruce Cooil, Tor Wallin Andreassen and Lerzan Aksoy, A Longitudinal Examination of Net Promoter and Firm Revenue Growth, Journal of Marketing, vol. 71, no. 3, July 2007, pp. 39–51, doi:10.1509/jmkg.71.3.039. Ahpra and National Boards, Guidelines for advertising a regulated health service, in effect from 14 December 2020 (current at 23 October 2026), retrieved 23 October 2026. Ahpra, Testimonial tool, retrieved 23 October 2026.
Last updated 23 October 2026.
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