Why hospital staff leave and how to understand why
Nurses, doctors, technicians and support staff leave hospitals for different reasons. How to run a respectful exit conversation, spot patterns and act.
7 min readRead articleA physiotherapy practice sells recovery in sessions, so its income depends on therapists who retain patients for the whole plan. This page covers the people side: therapists, assistants, home visits and the package model.

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Share your requirementsPhysical therapy and physiotherapy practices treat bone and joint problems, back pain, sports injuries, neurological conditions, post-surgery recovery and elder care, in clinics, at hospitals, in gyms and at homes. Patients usually buy a package of sessions, so continuity matters: the therapist who begins a plan should usually finish it. The team includes qualified physiotherapists, therapy assistants, exercise trainers in some set-ups, a front desk and billing staff, and home visit staff who travel by bike or car. Qualified physiotherapists are numerous but good ones are in demand, and many dream of starting on their own. Income per therapist is tied to sessions delivered, which tempts clinics to overload. See also HR for hospitals.
These are the places the people side of this kind of business tends to give way. The rest of this page works through them.
HR here has to work for each of these groups, not only the office. The set-up below is written with all of them in mind.
GullyHR runs talent acquisition for permanent roles in physical therapy and physiotherapy. For each role we agree the job description with you, find and screen candidates against it, and support the offer through to joining. Tell us the role and the number of people, and we start there.
We recruit permanent employees. We do not supply contract or temporary staff.
Every business interviews, but few have a written process that works the same way for every role and every interviewer. GullyHR designs yours, from the role brief to the offer, trains your managers to run it, and can run it for you on the roles you hand us.
We agree what the role must deliver, the must-have and nice-to-have skills, and how each will be scored.
Screening call, assessment, interview rounds and decision points, sized to the role and the number of people you hire.
Structured questions for each role family and a rating guide, so two interviewers judge the same answer the same way.
A short briefing for your managers on what to ask, what to avoid and how to give a clear yes or no.
Who approves, how the offer is made, and how candidates are kept informed from first call to joining.
When a therapist leaves, patients drop out of their package, and some are taken to the therapist's new practice.
Back-to-back sessions give less time per patient, and quality suffers without anyone measuring it.
Travel time, safety on the road and visit records are managed by the therapist alone.
Untrained helpers handle machines and exercises without clear limits.
Patients stop after a few sessions, and nobody asks why or tries to recall them.
Clinic owners lose staff after training them, with no notice, no handover and no non-solicit clarity.
Calculations differ by person and are disputed at month end.
Beds, machines and exercise tools are cleaned when time allows.
Start with the topics that matter most here: Retention and Attrition Management; Compensation, Payroll and Benefits; HR Operations and Governance. Then work through the rest. Each topic is written for healthcare, not in general.
Who leaves, when, why — and which of them mattered.
Salary structure, payroll inputs and a month that closes on time.
An HR function that runs the same way every month.
How many people, in which roles, by when — and what they will cost.
Structure, reporting lines and who is allowed to decide what.
Requisition to joining, the same way every time.
A first day that is the same for the fifth joiner as the first.
Records, attendance, leave and the day-to-day HR that must simply work.
Goals, reviews and ratings that hold up in a conversation.
Training planned from need rather than from the calendar.
Named backups for the roles that cannot be vacant.
Communication, recognition and the conditions people actually work in.
Two routes — one for complaints, one for conduct — kept separate.
Policies a manager can apply, and obligations with owners and dates.
Induction, records, incident reporting and follow-through.
Resignation to relieving letter, in a defined order.
Records that survive people, and approvals that do not queue.
A short monthly pack management actually reads.
The pieces a physical therapy and physiotherapy business puts in place, in an order that makes each easier. Open any card for the detail.
A buddy therapist per caseload and a handover note when a patient moves.
A buddy therapist per caseload and a handover note when a patient moves. The attendance and leave process plans cover.
A maximum number of sessions per day with a minimum time per patient, reviewed monthly.
A maximum number of sessions per day with a minimum time per patient, reviewed monthly.
Travel time counted, visit records kept and a check-in routine.
Travel time counted, visit records kept and a check-in routine. The health and safety work holds the steps.
A written list of what assistants may do with training and sign-offs.
A written list of what assistants may do with training and sign-offs. The learning and development process holds the plan.
A weekly list of patients who stopped early and a call with a script.
A weekly list of patients who stopped early and a call with a script.
A clear calculation for fixed and per-session pay, with notice and handover terms confirmed by a qualified professional.
A clear calculation for fixed and per-session pay, with notice and handover terms confirmed by a qualified professional. The payroll process covers payment.
Before changing anything, find out what is true today. These checks take an afternoon and tell you which of the topics above to start with.
Share your requirementsConfirm with a qualified professional. What applies to you depends on your business, your state and your arrangements, and it changes. This page describes practice. It does not state a legal position.
The services below fit this kind of business best. Each starts by recording where you stand, and every later report compares against that. We do not promise outcomes.
Caseload cover so continuity survives leave and exits.
Clear per-session and fixed pay rules paid on a set date.
Assistant scope and a growth path for therapists.
A safer routine for home visits and clean equipment.
Start with a free conversation, or see the paid HR Diagnostic.
Understand the hospital, its workforce, current processes and HR challenges.
Find the missing, weak, inconsistent or person-dependent processes.
Create the structure, processes, policies, SOPs, dashboards and systems needed.
Help HR and department managers actually adopt the new system.
Digitise repetitive and approval-based workflows where it is worth doing.
Track hiring, attendance, employee cost, performance, training and attrition.
Strengthen the people-management system continuously, not once.
From the GullyHR blog: one on HR in healthcare, and one on each of the topics this page points to.

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Assign a buddy therapist to every caseload, share session notes and introduce the buddy to the patient early. A handover works better than a swap.
That depends on the condition and the therapist, and the clinical limit is for a senior physiotherapist to set. From the HR side, fix a maximum and a minimum time per patient and monitor it.
Write clear notice and handover terms in the offer and discuss growth openly. Confirm what can be enforced with a qualified professional.
A clinical decision for senior therapists. Write the scope, train to it and keep sign-off records.
Ask why people stop, call them within a week and watch which therapist or session the drop follows.
We would ask how continuity is handled, how therapists are paid and what assistants do. A good first project is a buddy system plus a clear pay rule. Scope is written down before work starts.
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