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How to Make a Successful Cash Based Physical Therapy Practice

Updated: Mar 22, 2023

5 Key Factors

I wanted to talk about some of the factors of success that I've seen over the past couple of years with myself as a cash practice owner and with my business coaching clients and students. I will be sharing some objective data I've seen that have lead to more success, faster. Of course success is objective. However, I wanted to share some of the numbers because I put a bunch of my data together from my clients over the past two years and did a whole bunch of data analysis on it with my my brother who is a PhD student in Minnesota. He's going into Physics and has done tons and tons of statistics. He has really helped me take some different observations from the data that we looked at, and now I get to share it with you!

If you are considering a coaching program, (like my DPT to CEO program), you probably want to make sure that whatever you're investing your money and more importantly, your time, in is going to be worth it. Not every coaching program is a good fit for everybody and that's totally okay. That's why it's important to find one that resonates with you and offers what it is you feel like you need.

Number One Factor of Success For PT Practices

What do you feel like the number one factor of success might be for a new practice owner? This is a common question that I know people want to know about, so that's why I've been putting all this data together. The number one factor of success intangibly, I would say, is your ability to be relentless. I feel like I have a really hard time putting into words what I mean by that and a lot of it has to do with just never giving up... ever. If it's something that you want to make work and you want it to be successful, you have to get to a place where even if you are shaking in your boots, nervous beyond belief about failing, you are going to keep going anyway. That's been my experience. You can never tell yourself:

You can't open up shop every single day and have those negative thought patterns drive how you are going to show up for yourself and everybody else every day. You might be nervous, you might be worried, but so are the rest of us! We're still pushing ahead. You owe it to yourself as a clinician who is very passionate about what you do and how you can help people. You owe it to yourself to see that through and figure out a way to provide care and help to people who really need it in a way that feels authentic and ethical to you. You also owe it to your patients to do this. You have to have a mindset of "I'm going to get my way no matter what it's going to take!" You have to be relentless in pursuit of your dreams, but also relentless in the pursuit of better health care options for people

That's a really big thing and the number one factor that I'm looking for in potential practice owners. Even if you aren't sure what to do next, you're going to figure it out because that's the only option. You won't settle.

Let's talk data points. I could just talk for days about this stuff! These are the different data points that I looked for in my clients over the past two years:

Are you in a special category? Find your cash pay niche.

Are you in a particular niche OR are you somebody who says that they can treat all the things and you market to all the things? (<-- Please don't do that).

I really want to talk about this one because it's really important. I know everybody here and their mother has heard "pick a niche" to work with and to market to. Lots of people get stuck here. I think it's a really common thing to get stuck on this because you want to help everybody. Just like I tell all of my clients, your niche is who you market to, it's NOT what your caseload is. You can treat whoever you want, whoever comes up to you and you can help them. If they're a nice person and they want to pay you, then go for it! Take them on your caseload! It's completely up to you, but you have to pick a specific niche in order to drive your marketing message home.

Any time in my life when I have tried to expand and broaden things out, it just ends up getting a lot more complicated. My marketing and messaging is not as strong when I do that. It's confusing and not a good time. You have to pick something to go after, In the past couple of years some of the different categories have been: ortho, pelvic health, sports, pediatrics, chronic pain, neuro, (if we count my husband Kyle targeting working with people who have had a stroke).

I would say the majority of the people that I've spoken with and who have joined the program, tend to be ortho, sports, or pelvic health related. I feel like it doesn't matter what you pick that's going to make you successful. What matters is that you pick something specific enough that you can have a unique marketing message and people can understand exactly who to refer to you. If you were telling people that you own a practice and you're saying, "I can help CrossFitters. I do pelvic health. I work with kids, people who are bed bound, patients who have had a stroke, but I also work with college athletes", it would be confusing to people.

Keep in mind that the only people who I feel like really understand what therapy is are in this group and other therapy groups. It's us as therapists. If the only thing that you are leaning on with your marketing message is "I'm a physical therapist or occupational therapist", nobody really knows what that is, or they have a misconception about what it is. Then, the referrals that you'll get will not be the people that you want to treat or can treat.

By identifying your practice in your business and creating a marketing message around a problem that you solve, you're going have a much easier time marketing yourself. People will know exactly what problem you help with and who to refer to you. It's important to be able to put a specific problem into easy to understand language so patients will know what you can help them with that you're passionate about.

Another example would be in this program here: helping therapists grow a practice. If I marketed myself as somebody who can help any entrepreneur build a small business, that gets lost. I don't stand out in any way.

Can you continue your full time job as a private practice owner?

In my coaching program, (it's a six month program), I look at where my clients were in relation to how many of their own patients they had, and the revenue that they were making. That is really interesting to see because I know that is a big question that people have when it comes to doing their own practice. People often worry about if they are going to be able to do this in conjunction with having a full-time job. I will say that I think it takes a very special person who does not need a lot of sleep in order to make that happen to a point where you could leave your job and make your practice a full-time thing. I've heard about people who do this and it comes with a lot of sacrifices that I'm not really sure if I would be willing to make. Everybody has different priorities and that's totally fine too.

I am a big fan of having at least a PRN job when you are first getting started if you are responsible for your finances. Everybody has different situations obviously, so this is just a generalization.

I found when I was not doing as much PRN work and I was meeting with new patients, evaluating them, selling plans of care that there was a higher level of anxiety and almost desperation when I would talk to people and prescribe them a plan of care. I was trying to make the sale and I knew that it really mattered if I made that money that week. It comes across in your sales conversations and this is something that one of my business coaches would always talk about. Having a little bit of that safety net when you are first getting started is so important so that when you talk to people it doesn't matter as much to you as to whether or not they're going to work with you. It becomes easier to care more about whether you're truly the right person to help them or not. It takes a lot of pressure off of the sales conversations and evaluations.

I wish that I had stayed doing a little bit more home health for a little while, but I was so miserable that when it came to "do I want to make money or do I want to have better mental health?" The mental health ended up winning out in the end, which is probably good. All that to say, I'm a huge fan of keeping a PRN job until you reach a certain goal in your practice, but it's going to be different for everybody.

What I will say is the number one thing that can kill your progress in this coaching program, and in general, is maintaining a full-time, 40-plus hour a week job, (or doing extra shifts). What I think has really helped the students in my program is having anything less than full time job. You are going to end up being more successful, faster than if you maintain that full-time job for the entire six months. About 1/3 of the people in my program started with a full-time job. I know there are a lot of factors, but unfortunately students who maintained a full-time/plus job during our work together had a very slow and difficult time in order to get their practice off the ground.

People who are more successful, between months three and four in the program, tend to make a decision to drop the full-time job and either do part-time, PRN, or just their business altogether.

I think that is a really big factor that plays into things and at some point if you're really wanting this to be successful you have to give up the full-time job before you're ready. I know it's really scary, but that job will always be there for you. You can always go back to your full-time therapy job or do something else (work at Starbucks if you want!). You will always be able to find another job, but if you learn how to market yourself, sell whatever it is, and maintain a business, you'll also never need to worry about being able to make an income because you'll have the skills to do it.

Mode of treatment delivery

I have worked with people who have a bunch of different methods of treatment delivery: mobile, online, brick and mortar, etc. My observation has been that the rate of gaining clients is much quicker if you have a strong presence in your community and if you have consistent relationships locally if you're wanting to do in-person stuff. That's not to say that you won't be successful if you are totally brand new to a location. You just have to put in the work to build the connections.

What I've seen in the two places where I have gone to do CrossFit, it took about six months of me continuously going before people started to ask for my physical therapy help. If that's one of your strategies, that's been my experience. I think if you have a really strong foothold in your community locally, you're probably going to be more successful, faster. It doesn't mean that you're unable to do it if you're new though. My friend Tyler and I talked about this when I interviewed him about his business in How to Deal With Failure Even When You've Prepared: An Interview With Tyler Burke.

If you want to do Telehealth or are offering different services or products online, you have to show up! You have to hustle, show up, and do things. You have to make relationships online, and it takes a lot of time and effort, similar to in person. However, I feel sometimes there's a misconception that if you just get a website and maybe post once on your social media about your business, all of a sudden you'll get a bunch of clients. That's just not how it works. You have to show up, tell your story, provide value to people, and be willing to reach out to them and talk to them, make offers, test things. This is common mistake made by new practice owner's, (read more about that and other common mistakes in Top 3 Mistakes New Practice Owners Make [And How To Avoid Them]). You have to do this very consistently in order to make an online business work. Again, it goes back to what I said earlier about relentlessness. It has to be a "never give up" attitude. If you let the negativity come in, it's it's going to make it really difficult to grow and even find your first client. You have to be really cautious about that.

If you already have your business entity set up

This is something that I feel like I didn't really look too much into in the first year of the coaching program: Do you already have everything set up? In my program DPT to CEO, the very first phase of it is Therapy Business Basics. It is a four-part, mini course available on my website, that will take you from having nothing set up to having everything in place that you need in order to legally see a patient, (at least according to my own research and the different people that I've learned from).

I've gotten really good feedback on that four part mini course just because of the fact that it gives you a checklist and tells you step by step what you need to do in order to set up a business entity. The reason that I made that course was because it was something that I never learned about and it was really helpful for me to have something visual that I could see, a checklist in order to create a business.

That is the first phase of DPT to CEO, the coaching program. However, clients who already have that set up, they are going to end up having an entire extra month in the program, (which we can always use to explore other options for marketing, other service designs, other things we can do to add a layer to your practice). What I've seen though with my clients, it's about 50/50 of the people who enter this program as to whether they are all set up or not. 50% of people already have their entity set up, and 50% don't. That's the main thing about it, logistically you'll go a lot faster if you already have your business entity set up: LLC, forms, scheduling, email, domain documentation system, etc. If you already have that set up, you'll have extra time in the program. It can be valuable, but it doesn't necessarily correlate with success.

Final Thoughts

That was some different data points that I've gathered. If you want me to share more information, (more numbers about what I've seen in the past couple of years doing this coaching program, length of time in the program, how much profit my clients made after investing in the program... hint: most people made a profit!), contact me at You can also learn more about my programs and what I offer if you are looking to start your business within the next year!

I can speak for my own program, and I'm really proud of it. I would bet that you would get your investment in the program back within the six months. Obviously there's a range. Some people don't, some people triple their investment in the program... or more. The median profit though for my clients from 2020 - 2021 was around $3,000 and that's after paying for the program. Then, from 2021 - 2022, the median profit currently is around $6,000. That's awesome!

I understand if you're not a numbers nerd like me, but I know plenty of people want to know if their business is going to be successful. There are a lot of factors that go into it, but I think the biggest thing is you have to be willing to figure it out. If you're wishy-washy about it, it's only going to float farther away.

Listen to this episode on my podcast!

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