Doing It Scared: How Nicole Built a Cash-Based Pelvic Health Practice | Nicole Salge

If you are new here, my name is Morgan Meese. I am a physical therapist and business coach who helps clinicians build sustainable businesses outside of the traditional insurance-based model.

Through this interview series, I share real stories from clinicians who are navigating physical therapy entrepreneurship in real time. These are not overnight success stories. They are honest examples of what it looks like to start a business, make mistakes, learn systems, and grow with intention.

Today’s conversation features Nicole Salge, a pelvic health physical therapist and owner of Catalyst Physical Therapy & Wellness in New Jersey. Her journey shows how to build a cash-based physical therapy practice. She started before everything felt perfect and learned as she went.

Nicole’s experience will feel familiar to many clinicians, especially women entrepreneurs and those navigating business ownership with limited guidance or support. Interested in seeing firsthand how she got to where she's at? Click below to join!

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Leaving a System That No Longer Fit

Nicole graduated from PT school in 2020 and began working in an insurance-based outpatient clinic. She treated a mix of pelvic health and orthopedic patients and quickly realized she loved the patient care side of the work.

What became difficult was the structure.

High patient volume, limited one-on-one time, and constant schedule pressure made it challenging to deliver care in a way that aligned with her values. This experience is common for clinicians who later explore cash pay physical therapy or alternative practice models.

After several years in that environment, Nicole began asking a question many clinicians eventually face:

Is this sustainable long term?

That question often marks the early stages of owning a physical therapy practice outside of traditional systems.

Transitioning Into Business Ownership

Nicole did not immediately leave her job. Like many clinicians looking to start a cash based practice, she explored small steps first. She considered offering services on the side while maintaining employment.

Eventually, she realized that partial commitment was limiting her ability to build momentum. Once she established her business legally, the final step was finding a space to practice.

As a pelvic health provider, Nicole found an opportunity to rent a room inside a local OB/GYN office. The physician wanted an independent provider rather than an employee, which created a referral-based relationship built on trust.

This early alignment served as an example of effective niche marketing before formal digital marketing systems were in place.

Nicole began with one room, limited overhead, and a small caseload. Like many clinicians entering cash based physical therapy, receiving direct payment from patients initially felt unfamiliar. Over time, that discomfort shifted into confidence as she recognized the value of her services.

Growth Through Strategic Opportunities

Nicole expected to remain in the OB/GYN office for several more years. The setup was working and overhead was manageable. Then an opportunity arose through a networking connection. A larger space became available, one that offered room to grow and the potential for collaboration.

Her first reaction was doubt. Financial concerns surfaced immediately. Instead of dismissing the opportunity, she chose to evaluate it carefully. After reviewing the numbers and long-term potential, she realized the move was feasible.

Nicole transitioned into her own space earlier than planned. Today, she shares that space with other wellness providers, creating a collaborative environment that supports both patients and practitioners. This is when she saw her dream truly coming to light.

Her experience parallels other clinician growth stories, including From Leadership to Liberation: How Jaime Built a Neuro Cash-Based PT Practice for Parkinson’s & MS.

Fear as a Constant, Not a Barrier

A recurring theme in Nicole’s story is fear. Rather than waiting for fear to disappear, she learned to move forward alongside it.

This approach resonates strongly with clinicians who identify as an ADHD entrepreneur. New ideas, uncertainty, and change can feel overwhelming, especially when paired with perfectionism.

Fear did not disappear as Nicole’s business grew. What changed was her relationship with it. She stopped allowing fear to dictate decisions and began using clarity and structure as anchors instead.

Letting Go of Perfection in Marketing

Early in business ownership, Nicole spent significant time trying to perfect her online presence. Social media posts took hours to create and often resulted in minimal engagement.

Over time, and with the help of Morgan, she recognized that consistency mattered more than polish. This shift is common for clinicians learning digital marketing for the first time.

Nicole also dealt with the belief that her voice did not matter. She thought others were already sharing the same information. The realization that no one shares the same experience, clinical lens, or communication style helped her move forward.

This clarity strengthened her physical therapy entrepreneurship mindset and improved how she communicated her services.

Sales Confidence Through Simplicity

Nicole described early discovery calls as overwhelming. She offered too many options, overexplained pricing, and made assumptions about what patients were willing to invest.

The turning point came when she reframed her role. As the clinician, she was responsible for evaluating needs and making clear recommendations. She needed to step into this role of authority.

Once she simplified her offers and led conversations with confidence, her conversion rates improved significantly. This shift mirrors challenges discussed in Why You’re Not Getting Clients (Cash-Based PT Fixes).

Confidence did not come from scripts. It came from clarity.

Systems Create Stability

Nicole described her first year in business as reactive. She relied heavily on networking and referrals but lacked systems to support consistent growth. There was no clear content plan, email strategy, or process for responding when her caseload dipped. This created stress and uncertainty.

In her second year, after joining DPT to CEO, Nicole implemented systems that brought predictability. Content became intentional. Leads were tracked. Data informed decisions rather than emotion.

This transition aligns closely with What Systems You Actually Need as a Solo Cash-Based PT.

With systems in place, fluctuations no longer felt destabilizing. Nicole knew how to respond.

Starting Before You Feel Ready

Nicole’s advice to clinicians considering business ownership is straightforward:

Start before everything feels perfect.

You can adjust services. You can refine messaging. You can explore different delivery models, including telehealth physical therapy or mobile physical therapy.

What matters most is taking the first step and allowing the business to evolve.

Where to Find Nicole

Nicole is the owner of Catalyst Physical Therapy & Wellness in Clark, New Jersey. She specializes in women’s pelvic health and takes a holistic, patient-centered approach to care.

Her story is a reminder that building a business does not require certainty. It requires commitment, reflection, and a willingness to learn.

If you are considering your own path in physical therapy entrepreneurship, Nicole’s experience shows what is possible when you move forward with intention. And if you’re ready to build your own practice with clarity, structure, and support, DPT to CEO is designed to help you do exactly that.

Click below to take the next step toward a business that supports both your life and your career.

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