I recently attended the Northeast Seminars con ed course taught by Brian Mulligan and Kevin Wilk themselves. It was awesome. I definitely plan to take more Mulligan courses because the techniques make such immediate substantial changes for patients. I’ve stated in my cash-practice guidebook and on this site that a huge part of my success in self-pay Physical Therapy comes from getting fast, dramatic results with most of my patients. I do not say that arrogantly. I say it because I need to really drive home an important point … success in a Private Pay PT Practice doesn’t come easy, and you have to set your practice apart in many ways; especially in the results you provide for your patients.
Building a successful cash practice is challenging
I’ve had a reader voice concern that I make the idea of starting/converting to a cash practice sound too easy, or that anyone trying it will be successful. If anyone has been given that impression from this website, I can assure you that it was not intentional and I do apologize. I would guess that the majority of PT practice owners (current or future) would have a difficult time building a fully cash-based practice (partial cash-based practices and private pay ancillary/fitness services are likely much more viable in most cases). The list of factors that will influence the success or failure of this type of practice is incredibly long and will vary from one practice to another.
Results matter
One of the most important of these success-factors is clinician skill and effectiveness. If you don’t get better-than-average results, why would people forgo using their insurance and pay out of pocket to see you rather than the PT who only costs them a $25 co-pay? With that said, I’d like to describe a bit about what I’ve learned and what I’ve found has made me an effective clinician. I went to the University of St Augustine which gave awesome training in joint-based manual therapy and had some good courses on soft tissue techniques as well. I earned a Manual Therapy Certification and the CSCS credential. I had great mentors who taught me a lot about aggressive myofascial release techniques. I even took a Craniosacral course (don’t laugh/judge) which has proven effective for some of my patients with headaches, concussions, and hard-to-explain symptoms.
I will always have so much more to learn, and I encourage you to adopt the same attitude if you haven’t already. Keep striving to improve your skills and to share what you’ve learned with others! The public deserves to get the best possible treatment available from whatever PT they end up seeing.
Cash-based physical therapy must create noticeable results
I can’t stand when I meet someone who has a long standing pain/injury and I mention I might be able to help, and they respond “Oh, I already had PT and it didn’t work.” I then ask them something along the lines of, “Did you go to a PT clinic where you spent a large amount of time on modalities like heat packs and ultrasound?; and then the PT would watch you do exercises, many of which you could do on your own at home?; and all the while, the PT was helping other patients get through their exercises?” If they answer yes, I tell them they didn’t really get PT, they went to an expensive gym. In most cases, if they received any hands-on treatment it was very brief and rushed. There are obviously cases (especially post-op) in which the needed treatment is much more therex-based than manual. Whatever the case may be, the treatment you provide must be top-notch and go beyond what they would receive from the average clinician.
If you are planning to add cash components to your practice or have a completely Private Pay practice, you cannot operate like a money-mill clinic and expect to succeed.
I’d like to end this post by starting a discussion about continuing education … what courses have you taken that really improved your skills and clinical effectiveness?
Interested in the cash-based private practice model?
Click Here to learn how to start your own Cash-Based Practice
Great post, Jarod. I think you have presented ways for PT’s to succeed in a Cash Based Practice, while keeping it real about the challenges involved. I think the biggest change that most PT’s are worried about/surprised by when they start a practice is that it takes 24/7 work to market, treat, document, bill, keep in contact with patients/referral sources…..and, you may still be scrambling to keep a steady flow of patients coming in. When I tell other PT’s that my goal is 25 treatments a week, they laugh, because many PT’s see 15 patients a day in an insurance-based clinic. PT’s are used to showing up for work and having 15 patients handed to them, day after day. When you go into private practice (especially cash-based) you realize how much effort/time it takes to build up your clientele.
I agree with you that you MUST set yourself apart as a clinician if you want to justify to patients why they should come see you instead of going to the large multi-site PT clinic that takes their insurance. One way to do this is through continuing ed/certifications. I always take continuing ed that will either lead to a certification, or provide a “niche” to add to my value as a clinician. I have my ATC (from my undergrad), as well as being a PT. I am a Certified Advanced Level Thai Yoga Therapist. I did over 100 hours of Yoga Teacher Training (didn’t get the RYT 200 b/c I didn’t do my student teaching, b/c I decided I had learned what I wanted to know and didn’t want to teach group classes), I have completed 350 hours of Pilates Teacher Training (need to complete my apprenticeship to test out for certification), and last year I completed certification as a Cert. Myofascial Trigger Point Therapist to add dry needling to my practice.
I am constantly learning through these certification programs, and I also spend my “free time” reading research, interacting in PT groups/social media, and doing the sports I love to keep in shape. Physical therapy isn’t something I just “do” 5 days a week – it’s my vocation and my passion. I want to be the best “equipped” clinician in my area, which is what brings referrals from patients, physicians and other PT’s/healthcare providers/Yoga Teachers/Pilates Instructors/Personal Trainers…..
Continuing education is how we set ourselves apart from the PT’s who just ‘”take another shoulder course” b/c it is local and they are free that weekend. Our CE should always be leading us somewhere with our skill set and practice.
Keep up the good work!
Ann
I really like your statement of: “I always take continuing ed that will either lead to a certification, or provide a “niche” to add to my value as a clinician.”
This is a fantastic point. People are impressed by letters behind the name. Of course we know that some letters are more valuable than others, but the general public will be more likely to call the person with more certifications (if all else seems equal).
Thanks for the great comment.
Hopefully we won’t be risking a 100-comment debate, but can you please provide a link to the company you used for the dry needling certification?
WOW! I’m so grateful to have stumbled upon your website with a plethora of information! I’m also a cash-based private practice PT, Comprehensive Pilates Certified, and working on my transitional DPT at the University of St. Augustine. I’m looking forward to reading your book and confirming/augmenting my own practice strategies!
Thanks so much for sharing your information!
Becky
Thanks for commenting Rebecca. If you have a cash practice, I’d love to interview you. Let me know if you’re interested.
Jarod, Great post.
Ann, great comments.
I began my career as a massage therapist and I’ve trained extensively with John Barnes learning and instructing in myofascial release, prior to becoming a physical therapist.
I believe the basic things that set a successful physical therapist apart from average are the ability and time to listen to patients and to provide skilled hands-on therapy. There is more value to the human touch than any modality, exercise or even certification.
It is very difficult to start a private practice and it doesn’t matter weather it’s an insurance based clinic or cash practice. One needs a passion for physical therapy. I would argue that there is less paperwork and administrative hassles with a cash based clinic, so probably easier to start, but you have to believe in yourself.
I do think continuing education is very important, but what patients want to know is what’s in it for them.
In marketing a practice it’s the Features vs. Benefits topic.
I don’t think they care much about all of a therapists credentials, as much as how will they feel after they see you.
Most of my patients are primarily concerned with getting better, not with the insurance aspect. I do think many of them come out ahead financially, although I have very close to no data to prove this. I would like to see a more definitive comparison, but I know that’s almost impossible. I can say that the local hospital owned outpatient therapy center bills over $300 an hr. $1000 deductible or more and that’s quite expensive, but this is not that topic. 🙂
An excellent therapist who has the ability to provide a superior service can excel in a cash model, but you do have to have this ‘thing’, skill, technique, ability, genuine desire to help people and most of us who are successful cash practice owners touch patients, which makes one stand out from the crowd.
Aaron
The hardest part for me is determining how much more debt I can take on in the quest for a dpt or other certification in less than 4 years (rather than budgeting it out over a longer period of time). I won’t get a return right away just because I got the dpt, but I will have more debt to pay each month.
Yes, that’s a question anyone considering any kind of degree these days. We’re at a point now where in many cases the cost of the extra education outweighs the potential pay out. This is a big topic, but of course things aside from money must be considered when assessing the value of another degree. I certainly hope our field hasn’t already “gone upside down” in the cost/benefit ratio with the transitional DPT. I’d like to hear what others think on this topic …
In considering a cash based practice (or simply reducing overhead) I thought about reducing staff hours. At times I would treat patients alone in office. I am concerned about this however due to potential liability/malpractice issues, including potential ‘boundary’ accusations. My malpractice carrier advised against treating alone in practice.
Any thoughts on this?
Gary
Good question Gary. This is a concern I have on a daily basis because at the moment I don’t have any front office staff to be around during treatments. It’s definitely a higher risk situation, so my best advice is to weigh the potential monetary savings of reduced employee cost against the potential risk and cost of defending yourself if “something happens.” No easy way to go about it. Definitely a question you should run by an attorney as well.
Jarod,
Love the post and this website! I recently 4 months ago began a small outpatient fee-for service based PT clinic and have struggled and am struggling to find all the time as Ann noted in the first post. I love the patients I have and am continuously involved with business networking/chamber events and a group called BNI who meets weekly. Summer is a hard time with vacations and patients schedules so I am hopeful the fall will really start spreading the word. So far I have had superior results as all the other clinics as as described (heat and stim). So keep up the work! Anything of value takes hard work!
Dave
Best of luck, Dave! Let us know how it goes. Don’t worry, those first few months will always be tough
I was curious if anyone can differentiate between the MTC from Saint Augustine program versus the Evidence In motion OMPT. I really want to get certified in manual and was wondering if anyone can lend me any information. Thanks!!
I really don’t know much about the EIM program so I couldn’t say how they compare. The Univ of St Augustine one is extremely thorough and certainly not a breeze to get, so you can be sure you’ll be well trained when you finish.