Once again, the readers at The PT Project have asked me questions that reveal the need to expand on a particular topic. Here was the question:

I agree with everything you are saying and have thought about the viability of a cash based business. The ability to combine skilled manual therapy with exercise prescription has potential on both the rehab side and fitness side of health. Anyway, just curious is your “niche” manual therapy? Are you one of the few certified manual therapists in your area? If possible, expand a little on your niche because I actually think that is the question holding up several PTs from doing a cash-based practice. Great posts!

And here was my response:

Hey Andy,
Thanks for the compliment and the questions. Yes, my niche is Manual Therapy, but I’m certainly not the only Manual Therapist in Austin. There are A LOT of Manual Therapy trained and certified PTs in my area. There is even an accredited Manual Therapy Fellowship program here (where graduates get the awesomely long credential “FAAOMPT”). With the caliber of PTs in the Austin area, I honestly think there are many more who could successfully convert to cash practices (there are at least 4 or 5 I know of).
It’s not about being Manual-trained. It’s about offering something substantially different than the average insurance-based PT. For me, I stand out in the results I get for my patients and the fact that I spend an hour with each one individually. Since starting these posts, I’ve come across other cash-based PTs who barely touch their patients, and specialize in post-op rehab and return-to-sport. They, like me, differentiated themselves and effectively got the message to their target market.
When starting, adding, or converting to cash PT services, try not to think of your niche as “Manual” or “sports rehab” etc. Think of your niche as “PT that gives the consumer a substantially different and better experience than your competition”… and that experience can vary greatly depending on the Therapist and their specific approach to treatment.

Andy’s comments and questions got me thinking about this idea of “Niche” in the Cash-Based PT world. As I implied above, you don’t have to be the only PT in your area with specialized training in a niche like Manual Therapy. Having a “niche” in PT, whether insurance-based or cash-based, is not just about the type of treatment you provide. So I’d like to give some suggestions of other types of “niche markets” and how you can target them. This is only a list of the first three that came to mind. If you’re creative, there are more patients in niche markets for your services than you could possibly have the time to accommodate.

Youth Sports

Choose a local youth sport in which a lot of kids are involved, and aggressively build your (or your clinic’s) name as the expert in treating that sport’s most common injuries. Then repeat the process with other sports. Offering free seminars and presentations is a great way to ‘get in’ with just about any athletic or parent group. Some examples of this might be to offer “Ankle Sprain Prevention in Youth Soccer – What Every Coach Should Know”  Or  “ACL Tear Prevention in female Soccer players – What Every Coach Should Know.” Again, to go into details on all the different seminars you could create is beyond the scope of this post, but you get the idea … be creative.

I would also suggest targeting the parents directly. Create an informative brochure that you offer to the sport’s Club/Association as something that all parents receive at the beginning of the season. In my experience, many parents will pay cash for their kids’ treatment far faster than they will for themselves. I have patients whose parents are in all kinds of pain and won’t pay cash for treatment themselves; but as soon as little Johnny hurts his knee, they’re willing to pay $200 for an after-hours visit rather than wait till next week to see me.

Running Community

Simply put: Runners are nuts. I say that in the nicest possible way, but those of you who treat runners or may be an avid runner, know exactly what I mean. They will push through nearly any pain to continue running, and if they have an injury that sidelines them, they will pay massive amounts of money to get back to it. Rather than describe more Free Seminar ideas (which you should do as well), here’s another possibility. Join a local running group, if your body is up for it. You’ll get in shape and surround yourself with potential patients.

Running not your thing? Create a brochure titled something like “Are you set up for success or injury?” and provide it to all running shoe/equipment stores, running groups, and running or tri-athlete coaches. Go through the common injuries of running, the primary predisposing factors, and info on how to self-determine if they have these issues. If they find that they do and want to get professional help in addressing them, who do you think they’ll call?


Need I say more? It’s an expensive hobby about which many of its participants are just as fanatical as hardcore runners. Take some “Back to Golf” continuing ed courses http://www.backtogolf.com/ or something similar, and start marketing to the local golf and country clubs. Offer free seminars to every country club and golf equipment store (or general sporting goods store) in your city. Use catchy titles, and teach participants to identify tightnesses or weaknesses in their own body that keep them from having an optimal swing. Then take them through the stretches and exercises to address all the main issues they identified in the first half of the course. You’ll be viewed as the Expert PT for Golfers by the participants, and many of them with more than minor issues will figure “well, I’ll just have him/her fix me.” “Do you take insurance? No? … OK, how much do you charge? I need to get my swing in order.”

Offer to do these seminars on the weekends so many can attend. Don’t want to work on the weekend? Long term, neither do I; but you’re gonna have to put in some serious and consistent effort as you get your cash-based business off the ground. As I write this, it’s early Saturday morning and my beautiful girlfriend is still sleeping in my incredibly comfy bed … do you think I want to be writing right now? Of course not, but we as a profession are already dealing with declining reimbursements and the future will only bring more. Positioning yourself and your practice to successfully deal with these challenges is going to take hard work, creativity, and a healthy amount of risk.

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