Lessons Learned When Starting My Cash Based Practice: An Interview With Dara Storch
We have a very special guest coming to us all the way from New Hampshire. Dara and I had met after she had already started her business, Seacoast Mobile PT, a mobile practice who provides services to parents. Being a physical therapist and a mom herself who has experienced different injuries as a result of parenting-life, Dara became the perfect person to treat this specific clientele. At the beginning of our time working together, Dara had to learn a few things in order to move her business forward. Check out our interview below to learn more about her journey.
What we will be covering:
Tell us about who you are what you do:
Dara: My name is Dara. I've been practicing physical therapy for over 10 years. I have worked in just about every setting: SNFs, inpatient, outpatient, post-op, post-acute, sub-acute, home care, Aquatics, cardiac rehab, vestibular rehab. I love all of those things. Now I get to do all of those things, but for myself which is really amazing.
I have a mobile practice, that's cash based. I go to people's houses. I get to work with people who've been completely overlooked by the therapy system, completely passed over because of complex situations, or because of the inability to get to their schedules. Majority of my patients are moms and dads who are my age, living in the crazy that I'm living in, (which is young kids and bodies that don't move the way that we expect them to). You have kids and then you age a little bit, and then hips don't quite work or you rake all weekend and your shoulders don't quite work. You think that will resolve itself and then four years later you have a six-year-old and your shoulders still hurt. I now get to go see them at their house on their lunch break, because up here most people are still working from home, and they're super compliant because they have enough time to be just compliant enough to get better. They don't want to deal with that thing anymore.
Morgan: I think that's really cool. I know we talked about niching when we were first getting started, but I love the fact that you're focusing on this group, parents. They really need the help. You're meeting them where they are and setting realistic expectations about what needs to happen in order to feel better.
Dara: Also, being a mom who's had physical therapy postpartum. Both of my kids came out in their own very special ways and messed me up. We don't do "mom's health" very well postpartum. We do baby's health really well! We do family health really well, but we don't necessarily do mom's health. Especially where we live in the universe now. You have this baby and your body gets blown apart a little bit and then, especially in New England, we're not taking public transportation a lot of places. I have a girlfriend who lives in London and she had a baby and she doesn't have a car seat because she doesn't have a car. The 30 pounds of additional weight on the right side of her body that she's not going to have to deal with is amazing. We cart a child around, then you put them on your hip, and then you get so busy that you just overlook it. All of a sudden you have this weird pelvic obliquity. You have this leg length discrepancy that's creating back pain, shoulder pain and neck pain. It's this amazing group of people who were very informed about their bodies, had kids, and they get totally out of whack. Compliance wise they're awesome. They remember what it feels like to feel good in their body. They're such a fun group to work with. Nobody's getting enough sleep. We're all just a little under rested and we're a little over stressed, so taking that load off of them is great. Relieving that extra back pain, giving them that extra sleep so they can get out of bed in the morning is awesome.
Morgan: That sounds really really rewarding. When we first met you had already started your practice. You had already got into things and I think you've had a few patients as well.
Dara: I think I may have had one or two patients, but I don't think I really settled in what my niche market was, who my clients that I was really passionate about treating were.
Morgan: Now you have this!
Dara: Yeah! Now I have this which is an awesome community. The online community that we built through our Facebook group and the resources of people talking to each other and finding out what works best and what people really need, it's been awesome.
Morgan: Yeah, that's super cool. It's really nice to be able to meet people online and create so much more accessibility to knowledge and knowing what exactly to do with that knowledge too.
What was the catalyst and the last thing that made you start your own business?
Dara: The mobile practice idea was something that I had been kicking around for years. I just thought, "Wouldn't it be amazing if you you didn't have to lose that time, (the time you're driving to the clinic)?" Because anyone who's worked in a clinic knows that you don't get to treat them the way that they should be treated and they need to be treated. However, I had a little tiny human and I was doing home care at the time. That was super convenient, the hours are really good, and the money was not bad. That's where we were and I thought maybe this is a five-year plan. Then we had this global pandemic, daycare shutdown, and my kids were home. I thought that was a good time. It was that simple. I figured this was a plan I was going to put in action and the universe has handed me an opportunity to put in an action earlier, so we did.
I think that's honestly something that I was so lucky that I did have time because I was home with my kid. There are only so many hours a day that you can do stuff with your kids. Sometimes they need to not be with you, they need to be on their own building trains, knocking things over, and fighting with each other. I did have some time here and there to think and plan and talk. I didn't necessarily have the other pressures. I didn't have to worry about those other things that you have to worry about when when the world is not on fire. Those 2019 things like 401K. Then I started it and I went in 73 different directions. I was lucky my husband helped me build a website, which is great to do that. I can't but it's great. Then I didn't know what I didn't know. How to get to people. I think that's where that niche market really helped zoning in on that. You really helped me figure out how to get to people because I don't just treat parents right. I have a variety of people that I treat because of the service that I offer which is great, but those people know about me because I was able to zone in on the people that I wanted to treat, that I have a special skill to treat. I think that is when everything fell into place. Before that, I spent money on brochures and mailers for doctor's offices. I wish I had spent the money on them before. I think that first piece for me of actually building a business was figuring out what my market was, who my people were, who were the people that I could best treat with my skill set, who I was passionate about, what I was most knowledgeable about. Because I do have this diverse history, so I could have gone in a multitude of directions and I think that's sort of why I floundered with that at the beginning.
What what do you think helped you bridge the gap or make the jump and finally realize that it's okay if you don't treat everybody?
Dara: You did. I'm pretty sure you made me do that. I feel like there are very few, very real conversations with you and they become that realization that although I could treat, I did not need to treat everyone. Having that specific group of people that I could really communicate to, that would be more clear I think about what my passion was and who I could treat. Having somebody to talk to and having an audience to talk to helped me sort of solidify my message which was a good broad message. When you're talking to the entire world nobody listens, but when you're talking to people who you're supposed to be talking to, your message becomes a lot clearer.
Morgan: I really like the way that you you phrased all of that because this is something that can be really scary to think that you need to narrow down the audience that you're talking to. You might think that you know better than everybody who talks about marketing and you know things that you can advertise a market to everybody and there could just be a lot of feelings and a lot of resistance there before like you finally decide on one group. You and I have talked about this and I try to tell a lot of the the practice owners I work with that just because you pick a niche, you pick a group of people, that's literally just for all your marketing, you can treat whoever you want.
Dara: Yeah, I think you and I had probably multiple conversations about that before it clicked . You're not defining who you treat, you're defining talk. I think it's a really different distinction because in any other setting if I was giving a talk to a group of people about pelvic floor health, does that apply to men and women of all ages? Absolutely, but if I'm trying to describe pelvic floor health I'm probably talking to women in their 40s to best get the most simplistic and understandable view of how to control your pelvic floor. Now that's not to say I'm not going to capture a 25 year old guy, a seven-year-old girl, and an 85 year old grandma, but I can't properly address in the best understandable terms unless I'm talking to a specific one. I think the same thing happens when you're advertising. It's not like your group is not going to be smaller, but your message just becomes clearer.
Morgan: Absolutely and there's so much power in creating a specific message like that that people can self-identify with. The more that you put wording into your messaging that allows people to visualize themselves and see that you know exactly what they're going through. There's so much stuff that you could help people with. When it's a specific group of people you can treat everything and that's just fine, but people will be able to relate to you and say, "Dara is the PT for me because she knows and understands" versus not really specifying those real life things that parents go through. Making it general and vague, people won't really know if you're the right fit or not. Then that helps your conversion rate down the road as well because people want you.
When you started, picking a niche was a bit of a hurdle. Are there any other big challenges or barriers you felt like you faced since you started?
Dara: I think in that first year you have a way that you see it going. That almost naturally and inherently goes against everything that your business coaches are telling you. I'm sure you've seen it with all of your clients. There's a very real visceral, knee-jerk reaction. They're the people that you've chosen in your life to know better. They know how to get you there but the steps are not the steps that you thought at all. I think sometimes you just need to make sure that the person that you're working with can understand that maybe you're not there yet. There are some very real inherent knee-jerk reaction hurdles when you first start a business and there are some things that you don't know you should know until somebody tells you.
Morgan: Do you have any specific examples?
Dara: Paying yourself, so beneficial and not something you think about when you're spending money on pamphlets instead of instead of paying yourself. That was a huge one, just setting up your finances so that if you have a slow month you're covered and if you have a busy month you get the benefit of that without spending all your money. You need to understand where your finances are coming from and going to. Also thinking about setting up how I was going to pay myself. In my mind I was coming from a weekly paycheck so I was going to get paid weekly, and that made total sense. It turns out though that doesn't make sense and I think I probably had a conversation with somebody early on about how they get paid monthly. I was not ready for that part of the conversation yet where it was a realistic overview of how the finances work.
Morgan: I know that's something that I've run into with other business owners, and I'm guilty of it as well. People will either pay themselves everything that they make, all of their gross sales, or they don't pay themselves at all for 6 - 12 months. It's like, "Well, you went into this to make money. Otherwise you'd just do it for free." The sooner that you're able to get into that habit of paying yourself, the better. When the numbers are smaller, a few hundred dollars instead of several thousand, it lets you figure out your systems in a small way so that later on as you're growing and scaling it's easier to comprehend. Then you feel the least amount of stress possible.
Dara: Talking about setting up your systems, I had to learn the computer, I learned spreadsheets, but that's another thing that I wish I'd done sooner: putting systems in place. Every time:
I did something
I had a conversation with a patient that felt like it was probably a conversation I was going to have on repeat
I had a follow-up with a patient that felt like it was probably a conversation I was going to have with another patient in the future
the first patient that called out
the first patient that had Covid
All of those firsts are so useful in recording how you reacted to it or how you interacted with it so that you have an immediate reference going forward. Even how do you start your day every morning: I open my computer, I check of the clients that I'm seeing, I text tomorrow's patients, I go through my mileage log, all of the things that you're doing as you're first learning just having a running tally so that you can see what you're repeating so you can get those systems locked down. It's so incredibly useful to have that information data bank to refer back.
Morgan: Even the mental load that it takes off of you! Having to remember all those routines and procedures in your brain. You don't have enough space in your brain to remember all those things. It's so helpful to be able to pull up and see.
Dara: I think that's something that you probably tried to tell me very early on and on repeat that I should be doing those things. The value of that became so clear as I got busier because that's something again I kept running into. Now I'm so busy that I don't have the time in my day to remember what it is I did last time. Whereas when you have those levels, or if you can do it right out the gate, it's so incredibly helpful to be able to refer back to it.
Morgan: It doesn't need to be fancy either, it could be a notebook and a pen. I probably wouldn't recommend that, but I'm more of a tech person anyways. You could use a Microsoft Word document or a Google doc. It doesn't have to be anything super crazy.
Dara: I have a spreadsheet that's got links to all of my little things and it's an easy reference. I know where they are. That's not to say that once a month, once a quarter, I don't go through and get rid of something I'm not doing anymore or it's become second nature. It's not written in stone, but it's really useful to be able to refer back to so quickly. Also then you're not caught off guard when you have systems in place that you can refer back to because then you've done this and you know how to do it. Also, when you're writing those things down, sometimes you think of a scenario that come up or you're most likely to have and you can prepare for it so that you have an automatic reference when it does come up.
Morgan: Exactly! It's so much better to operate from that and emotionally easier to operate from a place of objectivity because of your standard operating procedures manual. Having those policies in place rather than whenever some kind of situation comes up, whether it's expected or not is easier. You don't have to react to it and figure things out in the moment.
The other thing that I wanted to point out too, if you ever want to hire anybody you can say, "Here's the way I do it." It's a lot easier to have people join in on the run and like hit the ground running when you already have everything written down. Pro tip there for anybody who wants to hire somebody, whether it's an administrative assistant or another therapist, write the processes down or record yourself.
Anything else you can think of that was a surprise that was was helpful?
Dara: It is incredibly important to have boundaries. I think part of the like stress and anxiety about starting a business and and going out on your own is making sure that you can make it. I honestly don't know if this is something that you can actively do in the beginning, but make the time and space for yourself. Set up the day the way that you want it. Say no if you can. Price yourself correctly. All of those things feel really scary at the beginning, "If I don't price myself at the right place are people gonna think that I'm worth it?" That's not from a "are you actually a genuinely good therapist who's worth all of the services", but that is unfortunately a healthcare mindset that we've been told over and over. We're only worth what the insurance companies are going to pay us, which unfortunately in the last 10 years has gotten less and less. We get restricted by all of the things that we get restricted by and so there is that very real pause in looking at how much you're charging for your services, especially in a cast cash based environment. Give yourself the grace to address it in six months because the reality is that's another one of those knee-jerk reactions, you're not going to want to hear it.
I think building in to the conversation with yourself that you can have the grace to change this in six months and that's okay. It really is helpful, but also same with your schedule. If you want to give yourself six months to say yes to 8 A.M visits, the occasional weekend visit, and working later at night, doing notes after the kids go to bed. Do that with a very conscious mindset that in six months you draw a line for yourself. Once you have some established faith in your skill and ability, you decide that you're going to make the business work for you and you're not going to work for the business. Then you can set those morning and evening boundaries, you can set your documentation time, you can set your administration time. You can really block it out in your schedule so that you're you're treating people when it's best for you to treat them. I don't think that's something that people can inherently go right into. I don't know what your experience of that has been.
Morgan: It's taken me three years to figure out a good schedule, so there's that. I love that you brought that up. The concept of "you're allowed to change things at any time". Would I recommend changing your prices every single day? Probably not, but you could if you wanted to. Same thing with your schedule. You're allowed to change it. I feel like going from being a staff clinician where everything is very structured and there's a certain way to do everything, and you have to be somewhere at a certain time on a regular basis to you now have to create all that structure for yourself, a lot of us haven't really had that freedom, professionally.
Dara: It's pure chaos. We thrive on the scientific process. We're not out here thriving on just winging the schedule. That's not how our brains are built. It's just learning to impose it on yourself but a reasonable imposition.
Morgan: I think it's okay to take it one thing at a time, especially when it comes to setting boundaries. Don't feel like it has to be an all or nothing: "my schedule is this. My pricing is this. Number of patients is this", all at one time. That's really hard to do when you're first getting started. You could always break it down and think what's the earliest that you want to start appointments. You can start with that as a boundary.
Dara: Even if somebody asked for earlier, you ask yourself if that's okay. At the beginning it might be. You might be a little panicky and it might be okay. Then you do it twice and realize either that you don't mind starting your day at 7:00 A.M. and you readjust that or it does not work for you at all. You fill that slot with sleeping then!
Morgan: I think that those are really good things to bring up. I love the fact that you brought up the concept that so many things were unexpected. You thought it was going to go this way and these were the things to pay attention to, I'm sure some of those happened not all of them. Then in actuality a lot of things that maybe your business coach, "Dara we should prepare for this."
Expect the unexpected. Like you said, give yourself the grace that it's going to not go the way that you think, and that's okay.
Dara: If you're trying to build something and you find that you have a visceral reaction to something somebody's telling you, you should probably revisit that. If you find yourself getting infuriated by a conversation and even if it's a conversation from your mom who can get those buttons anyway, there is most likely some validity that you don't want to honor in that. You should probably think about it tomorrow. It's either because it's brought up something that you had not thought about, you did not want to think about it, and it's really irritating that you have this great plan and you missed something. Or you're overwhelmed because all of it is new because you're a clinician and you are not used to doing all of the other things that go along with running a practice. Sometimes you just have to be like, "Okay I'm a little overwhelmed and that feels like a lot coming at me. Maybe I'll revisit that tomorrow."
Morgan: Taking the time to pause and choose whether or not to respond or process that right now or putting a pin in it. That's a skill that I feel like I had to develop too. Just an awareness that just because there's something in front of you doesn't mean that you have to make a decision, respond to it, do whatever you need to do right now.
Dara: You also don't have to like it. It might be 100% on point, but you don't have to like it. Sometimes you don't like the things that work out the best.
Morgan: In a nutshell, growing a business is I think more of an emotional and mental toll than I thought it was going to be. There was a lot more up and down and a lot more self-growth that happened than just treating patients on my own. I'd expect that for anybody who is getting ready to start a business, expect that kind of self-growth like a slap in the face because it's going to happen.
Dara: You are about to find out a lot about yourself that you may or may not want to know. Some of it's awesome and some of it needs some work.
For anybody who's newer to growing a practice or feeling like they're struggling to find patients, what have you done to find patients? What do you feel like has worked the best?
Dara: I know moms so that's been really helpful with my particular aim. This is a group of people that I'm in. These are people that I interact with on a regular basis at drop off and pick up, at soccer and swim lessons, ski lessons in the near future, so when you're hanging out with parents it turns out there are a lot of complaints about body aches. I have a very unique position to be so easily accessible for suggesting things to try or I can check them out quick. I think participating in that sphere is really helpful and whatever capacity you can do that.
I have a Facebook page, a Facebook group, a website, a YouTube channel. I think that for advertising, I tried a Facebook ad. I don't think it got me anything. I had you walk through on my Facebook, I watched many tutorials by you, I beat my head against a rock to get the concept of how to do it. I did it. I monitored it. I think it got me some people on my Facebook page. I think it got me some contact information, some people from my newsletter. It wasn't for nothing. I don't think it's the best way to get my demographic. I tried it and I'm not saying I'm not going to try it again, but I think you have to look at what your niche is and find out where your people are coming from and how to have those conversations. It's just getting yourself out there, being available to your community, to the people that you want to treat, letting them know that you have this service, and being beneficial and helpful in that setting.
We have Mom Expos out here a couple times a year, so having a booth at a Mom Expo. Being able to do a postural assessment, give information about postpartum care, have mommy and baby groups, that's really useful. Again these are my people, these are where we are, this is what we're doing.
Morgan: That special little thing that is going to turn the key to help unlock your successful practice is a mixture of:
you being part of your target demographic or knowing it extremely well
having this internal drive and passion to help this group of people or a particular problem
having your passion show up in
*the way that you talk about it
*the way that you communicate with people
*the way that you put content out there
You live and breathe being able to help these people genuinely. If you mix that all together and shake it up then it'll be the thing that will help get you where you want to go.
Dara: I couldn't agree more. I think the one part of that you're missing is that you have to be set up to do that. The things that we talked about in the beginning, all of those little steps of getting the emotional load out of the way. Finding your market, setting up your practice, your SOPs, getting your systems in place, making sure that you understand how your EMR works, making you understand the law right because we all have different laws. I'm licensed in two states. I'm licensed in Maine and New Hampshire because we live right on the seacoast, on the border. Those states have very different laws for their licensing requirements, their autonomy requirements, and their practice acts. Getting all of those little pieces of knowledge if you're looking at opening a practice on your own in six months. I think collecting that information and having some of those anxieties taken off your plate before you jump in is so helpful. Then you can be strong, passionate, and confident about the people that you're treating and the the group that you're serving because you're not worrying about what you did and didn't do because you're confident in all of those very basic things.
I have a system, I can take your information, of course I can treat you, I have a way for you to pay me, I have a place to put that money that is organized and thought out. I think getting those little building blocks, if you're looking to open something in the the near future, and fishing out those pieces of advice from people is huge.
Morgan: Feeling like you have a really solid foundation so that you really can go full throttle into it if you want.
Dara: Even if you're thinking about taking one or two patients after work or on the weekends. If you're trying to build a slow practice, the confidence it gives you and knowing that you have this thing set up. I'm not saying your first few patients are going to be a complete show anyway. You're on your own. You're going to have to apologize 30 times over for a new setup. Practicing with the EMR though, my EMR company I told them I was going to need at least five dummy patients because half of the EMRs you're building yourself and that's stressful. The experience of building it yourself and knowing that you can modify it if you need to was awesome because you're not doing unnecessary paperwork for no reason.
I have a mobile practice. I found an amazing table that weighs 10 pounds less than my smallest child, 27 pounds. Nothing but great feedback from my clients. It's soft, comfortable, easy, it's on wheels.
Morgan: That's so cool. All these little things that you figure out to make your life a lot easier and not as much physical load on your body.
Dara: I have a professional makeup artist case. I have all of my things and it has drawers. I've got my therabands, my hot packs, my e-stem, I've got all my linens in there, and it is on wheels and goes four different directions. That was not how I started.
Morgan: I think I started with a tote bag.
Dara: I had a big ass bag on my shoulder that was probably going to throw my back out in under six weeks.
Morgan: Pro tips with Dara, get you some wheels.
If anybody is on the on the fence about starting their own business, what advice do you have for them?
Dara: Just do it. In our profession, if you're a therapist out in the world, you can get a job somewhere else, you're employable, we're all very very employable. If you're thinking about starting your own business, you're probably coming from one of two places. Place number one is, "I can do this better and I can be happier than what I'm doing". Place number two is, "This place is not where my soul is happy". Either you're not working a fulfilling job or you think you can genuinely improve your lot. Neither one of those are good enough reasons to not do it, so just do it.
Morgan: I mean the worst thing that'll happen I think is you might be out $1,000 on all the things that you spend money on and you find out you don't like it.
Dara: Or you do it for a year and it's hard and you're like, "Meh this is not for me", and then you just go get a job.
Morgan: Yeah, you don't have any regrets.
Dara: Or you can create a successful business and sell it.
Morgan: There you go too. That is definitely an option.
Dara: I mean I know a lot of practitioners who have been practice owners who've done it for 10 years and sold their practice and are practicing in a totally different setting. Something that doesn't require the mental and physical load of running a practice, but they still enjoy being therapists. Just like all of these other things, none of these decisions are for forever. Barely any of them are for the next six weeks. If you see it, if you see a genuine need and you feel very passionate about it, do it. That's all I got.
Find somebody like Morgan. Have her tell you all of the things, tell her that she's wrong a lot, and then watch her tutorials, have her tell you again, write down all the notes, and then realize she's right. Then you'll be fine.
Morgan: Sometimes you just have to learn by your own mistakes
Dara: And telling Morgan she's wrong, and then eating your words.
Morgan: Ultimately here you are doing so great and you're so happy with what you're doing.
Dara: It's awesome. I get to do things like laundry on a Tuesday. I get to take every day that my kids have off this year. Because the reality is there are four years, maybe six years more that they're going to want me home on their days off. I get to do that. I get to do that. I get to take days off randomly throughout the year and hang out with my kids. Nobody's going to tell me no and I can just work my schedule around it. To be honest, my demographic of people do not want me at their houses when their kids are home either. When I come that's their time, that's self-care time.
Morgan: I'm so happy for you that things have worked out the way. You've also you worked really hard. You kept up with it too despite all the highs and lows.
How to contact Dara:
Website: seacoastmobilept.com
Seacoast's Facebook: Seacoast mobile PT
Dara's Facebook: Dara Storch
Instagram: seacoastmobilept
Listen to this episode on my podcast!
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