S10 E4 - The Business of OT: Costs, Recruitment and Sustainability

Running an Occupational Therapy business has always involved more than delivering great clinical care. There are people to employ, systems to manage, invoices to collect and countless decisions about where limited time and money should be spent.

For OTs working within the NDIS, those decisions are becoming increasingly important. Changes to pricing and travel, alongside uncertainty about the future direction of the scheme, are prompting many practice owners to look closely at what it actually takes to run a sustainable service.

From payment processing and recruitment costs to workforce planning and advocacy, understanding the business behind Occupational Therapy has never been more relevant.

The true cost of running an OT practice

One of the challenges of running an allied health practice is that seemingly small costs can add up quickly. Payment processing is a good example.

Offering convenient card payments creates an additional expense for a business. But removing that option may make it harder for clients to pay, particularly families managing regular therapy expenses.

This creates an important balancing act. A payment system might carry transaction fees, but if it means invoices are paid promptly and administration staff spend less time chasing outstanding accounts, that cost may be worthwhile.

Rather than asking only, ‘How much does this system cost?’, practice owners need to consider the bigger question: ‘What does this system save us elsewhere?’

Administration time, unpaid invoices and payment follow-up all have a cost. Looking at the full picture allows practices to make decisions based on the actual impact on the business rather than focusing on one fee in isolation.

Making payment easier can support cash flow

Payment systems are not only a business consideration. They can also affect the client experience.

Families attending weekly or fortnightly therapy may be managing significant expenses. Removing convenient payment options could create additional barriers, particularly for people who rely on credit cards to manage their household cash flow.

At the same time, practices need reliable systems for collecting payment. A busy clinic can have dozens of appointments in a single day, meaning even a small proportion of unpaid invoices can quickly become a significant administrative and financial burden.

There is no single payment model that will suit every practice. The important thing is to understand the trade-off between transaction costs, convenience, administration and the risk of unpaid accounts.

Practices should also check current NDIS and consumer requirements before introducing surcharges, changing payment methods or passing additional costs on to clients. Business expenses cannot automatically be added to an NDIS participant’s invoice simply because the practice incurs them.

Recruitment is another significant business investment

The same cost-versus-value conversation applies to recruitment.

In a competitive OT employment market, recruitment agencies can provide access to candidates and reduce some of the work involved in finding employees. However, that convenience can come with a substantial price tag.

When recruitment fees are calculated as a percentage of a clinician’s first-year salary, the cost can quickly reach thousands of dollars. For a small allied health practice, that money might otherwise contribute to salary, supervision, onboarding, professional development or other supports that directly benefit the new employee.

That doesn’t mean recruitment agencies have no role. A practice that needs to fill a position urgently, has struggled to recruit independently or does not have internal hiring capacity may find considerable value in using an agency.

The key is to understand what you are paying for and whether that model makes sense for your business at that particular time.

OTs can look beyond recruitment agencies too

Understanding recruitment from the employer’s perspective is equally useful for OTs looking for their next role.

Recruiters can provide a helpful overview of available opportunities, but they can only introduce clinicians to workplaces within their networks. An excellent smaller practice may never appear in that search.

For OTs considering a new role, approaching practices directly can therefore be worthwhile. Even if a business is not actively advertising, a conversation may uncover an opportunity that would otherwise have been missed.

This can also give clinicians more control over their job search. Instead of focusing solely on salary or advertised benefits, they can explore the practice’s values, clinical approach, supervision, workload expectations and workplace culture.

Those factors can have a significant influence on whether a role remains satisfying and sustainable over time.

Good recruitment is about relationships, not just vacancies

Finding the right employee is not always about filling a vacancy as quickly as possible.

Sometimes an Occupational Therapist interviews with a practice and is an excellent cultural and clinical fit, but the timing simply isn’t right. Circumstances change. The Occupational Therapist develops new skills, the business grows or a different role becomes available.

Maintaining those relationships can create opportunities later.

The same principle applies when a valued employee leaves. Moving into a hospital role, relocating or exploring another area of practice does not have to permanently close the door. An employee who leaves on good terms may eventually become exactly the person a practice needs.

This shifts recruitment away from being purely transactional. Instead of asking only whether someone can fill today’s vacancy, practice owners can build genuine professional relationships with clinicians who share their values and approach to Occupational Therapy.

Clinical fit still needs to come first

For clinically led OT practices, being closely involved in recruitment provides another important advantage – the opportunity to understand the clinician behind the CV.

Qualifications and years of experience matter, but so do clinical reasoning, communication style, professional values and supervision needs.

Direct conversations and thoughtful referee checks can provide valuable information that may not be obvious from an application alone. A recruitment process should not simply establish whether someone can perform a role. It should help both parties determine whether the clinician and practice are genuinely a good match.

Hiring someone who is not suited to the role can be costly for a business and disappointing for the clinician. Being transparent about workload, expectations, support and workplace culture before someone accepts a position gives everyone a better chance of making a sustainable decision.

Business sustainability is connected to the NDIS

Payment processing and recruitment might sound like internal business issues, but they sit within a much bigger conversation about the sustainability of allied health services.

Changes to NDIS pricing and travel arrangements affect providers, but the consequences do not stop at business margins. If certain services or models of care become financially difficult to deliver, participants may ultimately have fewer choices about who supports them and how that support is provided.

A sustainable OT practice needs enough financial capacity to employ and support good clinicians, provide supervision and professional development, maintain accessible systems and continue delivering high-quality services.

When one part of that equation changes, the effects can flow through the entire practice.

For clinicians, understanding this business environment can also provide useful context for decisions employers make around salaries, recruitment, workloads and service delivery models.

Why OT voices matter in NDIS advocacy

The connection between business sustainability and participant access is also why advocacy matters.

The NDIS has supported greater participation of people with disability across Australian communities. Children and adults with disability are participating in schools, workplaces, recreation and community life, and access to appropriate supports can play an important role in making that participation possible.

When policy decisions risk affecting access to services, OTs are well placed to explain what those changes could mean in everyday life.

Clinicians see the practical consequences of policy. They understand what happens when someone receives the right support and what can happen when that support becomes harder to access.

That knowledge is valuable to policymakers.

Making advocacy practical and effective

Contacting a local MP or contributing to a government consultation can feel intimidating, particularly if it is unfamiliar territory. Advocacy, however, does not need to be confrontational or complicated.

The most useful starting point is to make the issue easy to understand.

Before meeting an MP, a short written brief can provide context and clearly outline the issue. Where several professions are affected, bringing together OTs, speech pathologists, physiotherapists, exercise physiologists, dietitians and other allied health professionals can also demonstrate that the concern extends beyond one profession or individual business.

During the conversation, focus on consequences rather than simply stating that a policy is problematic. Explain what the proposed change could mean for a participant, family, clinician, local service and community.

Following up with a concise written summary gives the MP’s office something tangible that can be referred to or forwarded to relevant ministers, departments or colleagues.

You don’t need to be a policy expert to advocate

It is easy to assume advocacy belongs to people who understand government processes, legislation or policy language. OTs already bring something important to the conversation – firsthand experience.

Occupational Therapists understand participation in everyday life. They see the relationship between support, independence, capacity and community inclusion.

The goal is not to arrive with every answer. It is to clearly communicate what you know, why it matters and what the likely real-world consequences of a decision could be.

Professional, respectful conversations supported by practical examples can help policymakers connect decisions about funding and legislation with the experiences of the people those decisions ultimately affect.

Building more sustainable OT services

Payment systems, recruitment costs and NDIS advocacy might initially seem like separate issues, but they all come back to sustainability.

Practice owners need to understand their numbers and be willing to question whether established ways of working still make sense. Clinicians benefit from understanding the business realities behind employment and service delivery. As a profession, OTs also have an important role in communicating how broader policy decisions affect access, participation and choice for people with disability.

Sustainable allied health businesses are not simply about protecting profit margins. They are part of maintaining a workforce and service system capable of providing high-quality Occupational Therapy into the future.

Key takeaways for OTs

• Look at the total cost of payment systems, including transaction fees, administration time and unpaid invoices.
• Consider client accessibility and cash flow when reviewing payment options.
• Check current NDIS and consumer requirements before introducing surcharges or changing how clients pay.
• Assess the true cost and value of recruitment agencies rather than treating them as the default hiring pathway.
• If you’re looking for an OT role, consider approaching practices directly as well as exploring advertised opportunities.
• Build long-term recruitment relationships rather than focusing only on immediate vacancies.
• Keep clinical fit, workplace culture, supervision and professional values central to recruitment.
• Consider how NDIS policy and pricing decisions may affect both provider sustainability and participant access.
• When advocating, focus on practical consequences and real-world examples rather than policy language alone.
• Remember that sustainable OT businesses help support sustainable Occupational Therapy services.