The 4 Key Components to a Thriving Caseload

If you’re a new grad there’s a constant, wake-up-at-night, pressure to create and maintain a caseload. You’re not immune to this pressure if you’re a therapist that has been practicing for some time. Developing a new practice focus or moving to a new geographic area will increase the pressure to create a full caseload. And if you’re a clinic owner, you want your therapists to have a full caseload because you are all too familiar with the never-ending costs that are associated with having a bricks and mortar business.

So whether you’re a new grad, a seasoned clinician or a clinic owner, a full caseload is an important topic and I don’t think we talk about this enough.

My question is… should a full caseload be the main focus? Does it make us focus on just part of the equation to a healthy clinical practice?  In this article, I explain why we need to look beyond a focus on only quantity, and focus on the four components that are necessary to create a thriving caseload.

When talking with new grads, it’s not uncommon to hear they’ve received simplistic instructions to build their caseload. You may have given or received these recommendations before: “…just call patients you haven’t seen in a while” or “…just book people more frequently”.

Unfortunately, that advice falls far short of what is needed to attract and maintain a healthy patient caseload.

To help clinicians with this topic, I spent a lot of time this past summer interviewing physiotherapists from across the country. With more than 15 hours interviewing over 25 therapists (both in public and private practice) and clinic owners from across Canada, I was able to define some key themes around what it takes to develop a thriving caseload.

Our Language Matters When Talking About Caseload Management

Language matters. The words we use shape our perceptions, beliefs and our focus. We know the importance of language with our patients, but we need to be equally concerned about the language we use around our own practice.

Here is the problem with focusing on ‘full caseload’:

  • Its only emphasis is on quantity of patients seen and not on quality of care provided
  • It may result in therapists, especially new grads, seeing too many people for their skill and comfort level
  • It does not include an emphasis on the patient experience or patient care

In my interviews with seasoned therapists, a common caution was ensuring that new therapists avoided focusing on a full caseload, as that may not be the best objective early in one’s career.

Physiotherapist, Cheryl Blahut encourages new grads to take the pressure off. She shared that when you’re starting out, it’s not normal to have a full caseload right away. And she encourages new grads to be okay with that.  

Having a full caseload can feel imperative, as a new grad, given the realities of school loans and the desire to move past the life of a student. But it’s important to realize that filling up your caseload too quickly with too many patients can be counterproductive on a number of levels.

Let’s Define the Word ‘Thriving’

Recognizing the limitations of  the language regarding a ‘full caseload’, I explored a more holistic term. I believe that ‘thriving’ is a much stronger descriptor and allows us to move beyond the one-dimensional nature of a ‘full caseload’.

Merriam-Webster defines thriving as something “characterized by success or prosperity”. Whether in our professional or personal life we recognize that success is the culmination of many factors. This definition allows us to incorporate multiple variables that are necessary for quality patient care and the long-term job satisfaction.

Thriving implies a healthy caseload which requires a balance between quality time with a patient, but also sufficient time for a therapist to reflect on cases, and interact with colleagues while still feeling energized and not overwhelmed.

The 4 Components to Define a Thriving Caseload

With this in mind, the four components to a thriving caseload include:

A caseload built predominantly of the therapist’s desired patient caseload

Obviously being busy a good thing. A therapist’s caseload should be full at their desired level. It’s important to recognize that a therapist’s target busyness is dependent on a number of different factors, including their experience level and career stage, personality and clinical environment and supports.

A caseload built predominantly of the therapist’s desired patient caseload

This component recognizes the therapist’s desired and/or target patient demographic. If focusing on just quantity, you may end up being full, but with a patient caseload that isn’t in line with your growth goals and career direction.

A caseload level that supports the therapist’s ability to deliver exceptional quality care

Exceptional quality care is critical to building a thriving caseload. Quality care, including our assessments and treatments, needs to be at the foundation of our physiotherapy care. But we need to recognize that this is only one component, albeit a foundational one, to developing an exceptional experience for our patients.

Creating an exceptional experiences requires us as therapists to build a strong relationship connection with our patients and go beyond the normal standard of care. We need to stand out from the crowd.

By delivering an exceptional patient experience we build the traction for developing a strong word-of-mouth practice that will fuel your practice for years to come.

A caseload that allows a therapist to meet their personal financial requirements

Each of us as therapists have specific financial goals for our clinical practice. It’s important to not ignore this important component, but also recognize that it can’t be the only variable necessary for building a healthy and successful caseload.

Putting all of this together, I define a thriving caseload as:

A caseload that is consistently full at a therapist’s desired level with their desired patient population where the therapist can regularly deliver exceptional quality care while allowing the therapist to meet their personal financial requirements.

Take a Step Back And Ask Yourself These Questions

Having now reviewed the definition of a thriving caseload, it’s worthwhile to ask yourself these questions:

  • How many patients per day and per week would you feel comfortable with to deliver exceptional value to your patients?
  • What patient population do you want to be working with and how reflective is your current caseload of this goal?
  • What are your current financial requirements and are you currently achieving this objective?

An Important Follow-up Question

An important consideration in properly answering the above questions is the environment you’re practicing in.

Even though you could come to believe that 30 minute appointment times with a sufficient lunch break is necessary, it is necessary for your clinic employer to also be supportive of you.

If you’re a clinician working for an employer, ask yourself: “Does my employer enable me to deliver exceptional quality care?”

If you’re a clinic owner, ask yourself: “Do I enable my therapists to deliver exceptional quality care? Does my clinical environment support my therapists sufficiently?”

Seasoned clinician Jenny Li from Calgary encourages new grads to not be bullied into a work environment where they are pressured to focus on patient volume. As she shared,

“You’re at risk of delivering subpar care, reducing the quality of your outcomes and limiting your ability to build a self-referring caseload.”

She encourages therapists to work in a practice that is congruent with your personal values.

You’ll find yourself continually frustrated by a clinical environment and employer who is working against the values and goals you value. Unfortunately you’ll end up perpetually frustrated and disillusioned with your profession. Stand your ground or find an employer that better aligns with your values.


Building a thriving caseload takes hard work, patience, strong clinical skills and supportive coaching. As healthcare providers we need to look beyond the numbers as the only defining factor in having a healthy, sustainable caseload. Let’s make sure we explore the other key factors involved in building a healthy and successful caseload for the long-term.

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