Today we are going to be talking about location, location, location! What is the best location for cash-based physical therapy services (or fitness services)? I'm going to be coming from the perspective of a physical therapy clinic (obviously). Let's look at the different options first because I feel that a lot of us are typically just used to an outpatient clinic, hospital, or a rehab facility. Those are kind of the only ways we really know how, but there are actually a lot of different locations or delivery methods that you can work with your patients. I've had experience with all of these except one.
Right off the top, if you want to start your own cash based practice what are the options for where you can practice? You might think that you can only rent a space, but that is not the only option. A lot of people when they are first starting their own practice will start in a Mobile setting. That means you are going to the patient's home, to their gym, to their work, you are meeting the patients somewhere versus something like being Home based. Currently that is something that I am doing right now. Patients come to my home and I have a garage gym where I work with patients out of there.
There's also Telehealth. That was huge a few years ago after the pandemic. I think a lot of people got really comfortable with doing Telehealth. It might not be their preference, (whether you're a patient or a clinician), but a lot of us got accustomed to seeing medical professionals online. I'm a big fan of Telehealth.
Another option is being Gym based. That is something else that I also currently do and how I got started. You can of course Rent a space or Own a space. You can work out of your home or, for example, I also worked with patients in my apartment complex gym when I lived in an apartment complex.
Choosing a Location for Your Physical Therapy Clinic
"As a physical therapist, where are you currently working or planning to work out of?"
I had asked the Facebook group this question last week, where a majority of the owners are cash pay or hybrid. Out of the people who responded 44% (majority) said that they were mobile. Second highest was being gym based, followed by being online tied with renting a physical location. After that was owning a physical location. Then, at the very bottom was home based. Like I had mentioned earlier, mobile is a really popular option, especially when you're first getting started.
How To Choose A Location
When it comes to choosing a private practice location, there are several factors to consider and in this blog post, I’ll go over with you the pros and cons of each location in my own experience and in working with other therapists who have started their own businesses. These factors can include how you want to treat patients, collecting payment and/ or how the patient pays, time of service, and how it’s best to reach patients. There are a lot of ways you can structure your services in the cash based PT world, but definitely prioritizing patient care is important.
So, why is this the most popular? I listed out the pros and cons that I could think of from my own experience.
Mobile practice offers several advantages that make it an appealing option for physical therapists. First and foremost, it boasts low overhead costs, making it a financially viable choice, especially if you already own a car or have access to transportation. In larger cities, where public transportation is readily available, you can efficiently navigate the urban landscape to reach your patients. The core benefit lies in the ability to meet patients in their comfort zones, whether that's at home, their workplace, or their gym.
Moreover, mobile practice enables you to immerse yourself in the patient's environment, allowing for highly targeted and functional interventions. You can assist them with specific activities they encounter in their daily lives, providing valuable insight and guidance. This real-world approach is often challenging to replicate within a clinic setting, limited by available equipment and controlled environments.
Additionally, starting a mobile practice is relatively straightforward. While individual circumstances may vary, it's generally one of the easiest options to initiate, perhaps rivaled only by Telehealth. By simply arranging a meeting time and location with your patient, you can kickstart your mobile practice without the need for elaborate preparations. The flexibility to work in a private setting, whether at a patient's home or their office, enhances the patient experience, especially for those with constraints such as childcare responsibilities. This level of accessibility exemplifies the core mission of healthcare providers – to maximize access to therapy and positively impact people's lives. Plus, it offers you the freedom to take breaks between appointments, enjoy a cup of coffee, and maintain a balanced schedule without feeling rushed or overwhelmed.
While mobile practice offers undeniable benefits, it does come with its set of challenges that became apparent in my experience. As your caseload grows, scheduling patients efficiently becomes increasingly complex. The key is to avoid crisscrossing your city or town, which can lead to lengthy drives of 30 to 60 minutes or more between appointments. To overcome this, I devised a systematic approach, creating a grid dividing my area into Northwest, Northeast, Southwest, and Southeast quadrants. I exclusively scheduled patients in a clockwise or counterclockwise manner, significantly reducing commute times to about 20 minutes.
However, the constant driving is a notable aspect of mobile practice that may not suit everyone. Preferences vary, with some individuals enjoying the time spent behind the wheel, while others find it less appealing. Moreover, as you strive for efficiency, your caseload might become somewhat limited due to time constraints. Deciding on the duration of your workday becomes crucial. For instance, if you prefer shorter work hours, like 12 to 6:00, this choice may restrict the number of patients you can see, which can be acceptable depending on your goals.
Furthermore, it's essential to factor in business hours into your schedule. Documentation, marketing, sales, and other business-related tasks demand dedicated time slots. Ignoring these aspects can lead to complications in managing your practice. Finally, the limitation of equipment is a challenge worth noting, particularly in terms of client needs, manual or exercise-based approaches, and modalities. To address this issue, a gradual equipment acquisition strategy can prove effective. By prioritizing essential equipment and planning sessions based on specific needs, you can efficiently manage your resources and provide high-quality care without the need to transport an entire gym to each appointment.
This is where I first started and I think that it definitely has a lot of benefits starting in a gym.
Working out of a "boutique fitness gym" offers several advantages that can expedite your practice's growth. Firstly, you gain immediate access to a wide range of exercise equipment without the need for personal investment, unless specific items like modalities or tape bandages are required. This convenience eliminates the financial burden of acquiring equipment upfront, enabling you to focus on providing quality care to your patients.
Moreover, these fitness gyms provide an instant pool of potential patients. Whether it's a CrossFit gym, Pilates studio, dance studio, yoga studio, or an establishment like Orange Theory, you have a readily available audience to engage with. This built-in community offers opportunities to conduct workshops, seminars, and even promote your services. Additionally, you may have the chance to display signage within the gym, enhancing your visibility and networking capabilities from day one.
Furthermore, hosting workshops becomes more straightforward when you're based in a gym. Unlike a mobile or online practice, you won't need to search for external spaces or businesses willing to accommodate your events. The gym environment naturally fosters such activities. Renting space within a gym is typically more cost-effective than owning or leasing a separate location. Furthermore, you can explore flexible rental agreements with gym owners, gradually increasing your monthly payments as your practice grows. This approach eases the financial strain on your business in its initial stages, providing a more accessible entry into your chosen location.
Finally, starting within a gym you've been a member of for an extended period offers a unique advantage. The trust and rapport you've already built with fellow gym-goers can be leveraged to quickly onboard patients. This existing relationship significantly expedites the process of building a caseload, as you're already a respected figure within the gym community.
I really liked working out of both of the gyms that I've been at, but one con that can come up sometimes is having to work around the classes in the gym, the other gym members, and making sure that you're not in the way of the main thing that's happening there at the gym. Especially in my gym too the music can be really loud so there can be a lot of distractions, it can be difficult to hear your patient, difficult to talk to your patient, for them to hear you. Having a private room in the gym can be really helpful, but the speaker at my gym is right on top of the room so it'll still vibrate the walls so it's not ideal.
It's better than nothing, but that can happen and that can make it a little bit more difficult to work with people. At the first gym I was at I didn't really have a private room, so of course that made it hard to do anything privately. You would have to schedule outside of class hours or try to maintain some kind of semi-private area or corner of the gym. If you're doing something potentially more private, like working in the pelvic health realm, you might have to consider whether that is a good option. Also sometimes people just want to be in a private space with a professional and not have a whole bunch of other people around.
During the pandemic, probably in March of 2020 throughout most of the Summer, my practice that had started being gym based transitioned to being a Telehealth. I've always been a computer person, so I didn't have a lot of doubt that it would be fine, but I wasn't really sure how it would work out with athletes. It ended up working really well. I work with a patient population who already know their body. They know different movements, they know how to move properly, in most cases you could name off exercises and they know what it is that you're talking about. That worked really well on Telehealth. For the different exercises and movements they had questions on and we wanted to look at. I was still able to see them and correct them in real time being online.
Telehealth is probably the lowest of overheads because as long as you have a computer and an internet connection you can make do, and you can see patients versus Mobile practice.
You also have the opportunity to work privately with a patient depending on what they have going on their end. You can be in your own office at home or in a private room somewhere versus maybe the semi-private setting in the gym.
Patients can be home with their kids or other people they are caring for. I've had people tell me that it was really helpful to be able to do it online because they are taking care of people and didn't have time to drive to a clinic. Online was a really great option for them.
Overall, it is easy to start, pretty easy access in most cases, there's no commute so if you're not interested in driving all around town you can stay at home or stay in a place where you have access to the internet, and you also potentially have the opportunity to see more patients throughout the week than if you were doing Mobile. You have a little bit more flexibility in terms of the time that you're spending with people so pricing might be able to change with that.
The other great thing about Telehealth is that it doesn't have to be a standalone. It's really easy to add in around other locations and other delivery methods. There are lots of practices out there that do Mobile and Telehealth, or like myself do gym based, home-based, and offer Telehealth sessions too. As long as you're really comfortable getting onto a computer you can have no problem just adding Telehealth as an option. It doesn't have to be the main thing that you do, but it is a nice option to have available for people.
I know that this has come up a ton for therapists over the past couple of years, but if you are heavily manual based, you really want to have your hands on the patient, of course you're not really able to do that online. You can always instruct the patient to do whatever manual technique on themselves and ask for feedback, (what they feel). I feel like that is totally feasible, but I know that threw a lot of people for a loop when it first got rolling after the pandemic.
This is not necessarily a con, but it is something that I think you have to be good at or willing to practice: learning how to communicate and be creative. You are online and you are just really a talking head, so you have to learn how to instruct with your words. Not being able to always physically demonstrate or position somebody manually can be a challenge. You also need to learn to be creative with whatever the patient might have available to them at home as far as equipment goes. When it comes to Mobile you can bring some of your own equipment, but Telehealth they may or may not have the equipment around. It is a kind of a fun and unique challenge and goes back to the helping the patient in their actual daily environment which can be great.
I mentioned I've been working out of my garage gym. I have a whole bunch of exercise equipment down. We have a plinth table, squat rack, a bunch of free weights, a rower, a bike, a treadmill, bands, a bench, rollers, a bunch of different stuff that we were using a ton ourselves during the pandemic and it has dual function to also help with the little baby clinic that we have.
This also can also sort of be low overhead. Of course you're paying for where you're living, you're paying for the equipment, but you don't have to pay any additional rent on top of that. You don't have to pay for gas to go somewhere. You might have to pay a little bit more on homeowners or renters insurance. Just contact your insurance company and discuss with them what you might need to do. However, pretty low overhead.
Just like being Telehealth or Mobile, you can do private work with the patient. You probably don't have a ton of distractions if you have a private space, whether it's an office, a garage gym, or a gym in your home. You have a private space to work with a patient. You might have distractions like I know my dog always loves to be involved with everything so that's something to consider.
The thing I want to stress here is I would really suggest contacting your city. I contacted the business department at my city hall and told them this is what I'd like to do and operate out of the home, and I asked if that was okay. For me they said it was fine. It might have cost a little bit more for my city business license, but not significantly. Just make sure that you check in on that.
Another pro here is of course there is no commute!
There might be other people in your house: your family might be home, your spouse, your pets. That may or may not impact working out of your home. You also need to make sure if patients are driving to you that you have parking available to them.
Renting a space
This isn't one that I've done myself per se, but I did pay rent at one of the gyms that I was out of so it was a little bit similar. I've worked with other therapists who have rented spaces though so I have gotten some feedback from them.
I think some are kind of similar to being Gym based:
You might have access to equipment, you might not depending on the kind of building that you're in.
You'll have private space to work with the patient.
This next one might be a limiting belief, but it might add some credibility to your practice for those that have a more traditional value of where you go see a medical professional. I think people are getting more comfortable with these alternative ways of working out of a gym, online, or they come to your home, but I think being a professional in an office building can lend some kind of credibility as well. Don't let it limit you though.
It can be nice if you find that you have a hard time concentrating at home or separating work at home. It can be nice to be able to go to an office and then come home and leave work at work.
There are potential networking opportunities. If you are in an office building with other professionals even outside of this industry it could be a great networking situation, similar maybe to being out of a gym. You can get to know other people in the building and become a referral source for each other.
You probably will have to pay rent whether you have patients or not, and it's probably not really up for negotiation. That would probably be rare to find somewhere that's able to be more flexible than a Boutique gym could be.
You might be working with neighbors. For example, if you're somebody who likes to practice with music on, but your neighbors in the building don't appreciate the music being on, that could cause a conflict. You do have to be conscious of the other professionals working in the building.
Potentially limited business hours. I'm not sure how big of an impact that would have, but if you only have access to the office building or to the gym for certain hours it might limit when you're able to see a client.
The only setting that I am not really able to comment on is owning a space because I have not done that. I've had experience with all of the other ones. Hopefully this was helpful to go through a few different options and why it may or may not be the right direction. I wanted to be able to share with you the things that I found that are really helpful and the things that are not so helpful. My hope is that it will help you decide what is going to be best for your practice. This is something that we will talk about in my coaching program. If you are interested in getting more guidance and figuring out what is best for you we can talk further about if the program is a good fit for you!
As I had mentioned most people start mobile or at least give it a try and figure out if they like it or not. Then they're able to pivot to other locations or other opportunities around them and go from there. If you are just getting started, check out my blog post The Simple Guide To Starting A Cash-Based Physical Therapy Practice. It is a great resource to help guide you in starting your own practice.
Listen to this episode on my podcast!