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Revolutionizing Physical Therapy: A Patient-Centered Approach Through Cash-Based Practice

Ross Childs, Owner of Fit for Life PTNH

We are back with another interview! I have been loving interviewing all of these different guests and learning about each of their individual journeys! Today we have the famous amazing Dr. Ross Childs. Ross and I have been working together since late 2020. Like so many therapists that I have spoken and worked with, Ross was frustrated with what he was seeing while working in a typical clinic (the toll it took on him as a therapist, his patients, and even the effect it had for his work/home life balance). Today Ross is the founder and owner of Fit for Life PTNH. Since starting his cash-based practice, he has been able to bring PT treatment focus back to being patient-centered and also found freedom in his own life.

What we will be covering:

How many patients do you see a week?

Ross: So currently I'm averaging 27 a week,

Morgan: And it feels like it has been at that average for the past two years almost.

Ross: As we talked about when I first did my numbers, I was hoping to average 16, so the fact that I've been averaging 27, is a great problem to have.

Can you tell us a little bit more about you your background and what led you here?

Ross: Absolutely, my name is Ross. I'm currently a physical therapist in New Hampshire. I went to Franklin Pierce University and obtained my DPT about 11 years ago now. It's hard to believe that much time has flown by. I'm a core faculty member at Franklin Pierce where I went to school teaching all of their MSK courses for the first year students. I also have a six-year-old son, so it keeps me busy when I'm not in the clinic or teaching classes.

Tell us a little bit more about what led you to start your practice?

Ross: Oh geez how much time do we have? To keep it short, like a lot of people that I've heard their stories, I really wasn't happy. I wasn't happy with the current system that we were treating in. I didn't like seeing tons of patients each day. I was getting bogged down with paperwork each day and it just got worse and worse. I actually wanted to start my own business three years prior and I just didn't know where to begin. I hadn't found you yet, so I figured I'd give it one more shot in-network. It just didn't get any better and I wasn't enjoying what I was doing. It wasn't what I set out to do.

I finally got to the point where it was either 1) I have to leave the field. I'm that unhappy or 2) I have to do it my own way. I got to the point where I honestly thought about getting a job, like rotating produce sounded better than having to deal with insurance day in and day out. That's how close I was. Then I realized I have so much time and effort spent and debt from going to PT school that I can't just throw it all away, so I'm going to have to find a better way of doing it.

That's kind of what led me down the path and there were other little things. The pandemic hit, I got furloughed from work. I was spending all this extra time with my family. I was able to have breakfast with my son. I was going for walks, riding our bikes together midday. I was having dinner with them every night and it was like, "Why am I spending so much time in the clinic? Why am I giving the clinic the best of me and my family's not getting the best of me?" I also knew I needed to make a change personally. That's, as we'll get into "my why", one of the reasons why I wanted to make the jump.

Morgan: I remember when I first left school and went into the clinic where I lasted all of four months because I was miserable. There's almost a feeling, at least for me, where I felt totally alone. I was having these feelings of, "What did I just do?" I go into this field where I thought it was going to be something that it's obviously not in a lot of places. I was crying on my lunch break, crying when I got home. Really not great mental health. I feel like that's kind of ironic for the healthcare provider to not be taking care of their health.

It seemed like a lot of the other clinicians around me were just fine with letting things be the way that that they were. I don't mean that to sound judgmental or anything, but it just wasn't for me. I felt really alone and once you start investigating and entering into this world of private practice as a whole, or running a cash-based practice, running a business at all, you're able to find so many people who really align with your own values. Like the things that you're mentioning, putting your family and yourself first. Because you're here to live your life for you. You're not a corporation.

Ross: Those are emotions that we as therapists go through once we jump out of school. Because school leads us to believe, "Hey you graduated and they're going to roll out the red carpet. You're going to fix the world!" That is the farthest thing from the truth because they don't teach you about the real world. They don't teach you about insurance, and the biggest thing of all, they don't teach you about the day-to-day grind. What it's really like when all of a sudden you have to treat 15 - 16 or more patients a day, you have to make sure you get your paperwork done, sometimes you have to actually work through your lunch breaks because they're just double and triple booking people.

Especially in that first year of school, you just don't have any experience, so you're questioning yourself as a therapist to begin with. Now you're getting thrown into this system that's failed over and over again, but we keep doing it. No wonder the burnout rate is so high. It's unfortunately never going to change, so it's really up to us as therapists to change the way we go about doing it. As you and I have talked about many of times, it's all about providing that value so that patients can see that there's a whole other PT world out there and you don't have to get stuck in that that mill type setting.

Morgan: Yeah absolutely, and by no means is it easy. It wasn't easy to quit my job. It wasn't easy to figure out how to even build a business at all, but the biggest thing about it is that you put yourself in a position to create opportunities and you have a choice. You don't have to just show up from seven to seven and every day because that's how you get enough money to pay to live. You have a choice about what you're going to do with your everyday life, who you want to help, how you want to go about living. That's almost really important too. That would have been a cool class to take in college: how do you be an adult and enjoy yourself.

Ross: What do you want out of life. That's the unfortunate part is we go into it, we get out of school and we're going to be these amazing PTs, which I think a lot of us can be. Then we would just get brought down by "the system", and unfortunately we lose our way. For the longest time there was no other way. You just grin and bear it. Then you have those therapists that let things roll off their back or they almost became robots. They just came in clocked in, clocked out, and left. Which if that's what you want to do, hey I'm happy for you if you can do that. However, I always thought there was more to this and I got into PT because I wanted to help people. In no way, shape, or form did that come down to me caring about reimbursement or me caring about productivity, so I quickly knew that the system wasn't going to be the way for me.

Morgan: I think for all of the newer therapists out there, one thing that I really want to impress on them is that it's okay to not like the system, like you're just saying Ross. It's okay if it's not for you and you don't have to keep doing it just because you got that degree. There are so many other intangibles that you gain from pursuing your degree that you can apply to other things besides just the practice too. There's a lot of different ways that you can go out and help people. Don't let anybody make you feel bad about deciding that the traditional route is not the way that you want to go. I just wish that more people had talked to me about it and maybe I should have noticed when two or three of my CIs were constantly stressed out every single day that I was there that maybe it wasn't an ideal situation.

Tell us more about who you are, who your business is and the story of the past year and a half of actually working for yourself.

Ross: Really it all started actually one day where I went through the process of researching cash-based business and was this true. I was like, "I really just wish someone would come around and step one: how do you actually start a business." That's what actually led me to you. You had the Therapy Business Basics workbook and that literally walked me through each step. I thought it was amazing. Here you have these other coaches that are great cheerleaders. They're going to show you how to get packages. They're going to show you how to do marketing and sales and that's great. However, I need step one. Baby step. Not even step one. I haven't even formed my business yet, what am I supposed to do? Then here you are. You have this free PDF that answered all my questions. I was firing off a ton of questions to you and you answered all of them. You were taking your time and answering them. Then we had a consultation and I knew that night that I wanted you to be my coach. That was kind of the next the next step.

Really from there it was trying to identify as a therapist what do I want out of this. As we talked about finding "your why", I had to be able to identify that first. Why am I doing this? It came down to, I wanted to enjoy what I do again. I have to love it. I want to be a PT. I want to be the best PT that I can be. I also want to make sure that I'm providing patients with the care that they deserve. Not because it's based off a reimbursement, not because it fills the bottom line for the hospital. It's whatever the patient wants. Then, I also want to spend more time with my family. That was really for me. If I'm going to have a business work, I need these three things to fit first.

Once we're able to establish that then it was: who am I going to go after. You helped me identify what my niche market was going to be. I was already well known in the community that I was in. I had been there for about a decade and I noticed, just naturally, I was treating middle-aged, Weekend Warriors, a lot of triathletes as well. I really just helped prevent them from having injuries and optimizing their performance. There you go. There's my niche market right there! I think it was a little bit easier than I anticipated, and I've said before, I probably had an unfair advantage being that I was in the market that I've been in for a decade now. It was a lot easier and I had a lot of great support from the community. I think I remember telling you my first week I had 16 people right off the bat. I didn't expect hitting that for six to nine months. Then it really has just been quite amazing since. Then there's been a lot of learning experiences with this process because there are some business coaches that really stress marketing sales, make sure you do your prepaid packages, and things along those lines. Really it's taken me a while to identify that my goal for all of this, other than creating time and knowing my why, it's accessibility over profits. I like making money, don't get me wrong. I've seen enough patients where the money is not the goal. I don't want to limit access to people that I think I can truly help.

That's something that's taken me the longest to really identify. I think deep down I knew that always was, but it was actually you two calls ago, you were listening to me and you said that I was going for accessibility over profits and that should be my slogan now. I do use that all the time now, so I should give you that! It was really from you listening the way that you do when we have our meetings. You were able to pull that out of me because as simple as it is, I probably wouldn't have identified it that simply.

Morgan: That is one huge pro to working with a business coach in whatever capacity. You have somebody that you can just talk at and they can help make sense of the ramblings that you're having, all the different options that you have in front of you, and help you identify which ones line up with the way that you want to live your life and the way that you want to do business. Follow that.

I think another big thing that you might have been alluding to with the pricing of things and the packaging of services, I know when you and I started and even for a little while after that, we were wondering why people aren't buying packages. This is the way that I personally have done stuff in my own practice, but every everybody always recommends that. It's not typical to see marketers or coaches recommend single sessions just because of the way that things can go down, but the opposite ended up being true for you...

How you were able to align your pricing and services with the value of accessibility? Can you elaborate on that and how we worked our way to how you're doing things now?

Ross: Sales and marketing are not my forte. I have no background in business whatsoever. I was starting fresh. Basically anything that I learned was from you and you were basically baby stepping me along and telling me to try this, try that. Again, I wanted to make it very accessible in the beginning and you're starting with $100 an hour or so that we were starting off with as our introductory price . We said we're going to do six months at this price and then we'll go from there. I think I got one package, maybe two packages four packs, and I think maybe one eight pack in the first six months. Then you and I spent countless times meeting together going over my sales pitch. I remember writing it down and saying it to you. You would come back and pretend to be the patient and we would practice it over and over again. I feel I got pretty good at the sales part of it and even closing it if I needed to. However, people just weren't interested. I'd say, "You can buy these packages. I think it's going to take six to eight visits. We do have the package and if you buy that there is a certain percentage off." People were saying no and that they would just pay single visits. It just never registered. In the end you're paying more money.

I know that it's always the fear that if you have them buy individual visits that they may not finish their plan of care, so I'm taking that risk. Also not knowing what to expect. People were finishing out their plan of care. They were coming in for four, six, eight visits. Then what I noticed is they started saying, "I know we're done, but can I keep coming to you?" So then you and I came up with a maintenance plan and people would start coming in and paying their same fee for that. It was at that time I realized, these people are coming in for 12, 14, 16 visits now. That's already more than what my packages are. They they're basically doing what a package would be, but they'd rather just do it session by session. After about a solid year with the packages, you and I both agreed that the packages just weren't working because the single sessions were going great.

Even after that six month time frame, you told me I need to raise your prices and to do a dry run. I bumped it up to $125 for June, and July I did $135. Then I bumped it up to $150 in August or September and you said that no one's going to say a word, and no one did! I felt comfortable because you told me in the beginning to pick a price that you feel comfortable. It had to be between what you're comfortable saying and a price that you want to vomit. That always resonated and I thought $150 sounded like something that makes it more accessible to someone, but also at the same time it felt like it was more my worth.

It also came down to I don't like traditional Physical Therapy the way that it's run. Because typically you have a lot of therapists say to someone, "You need to come in two to three days a week for X number of weeks, and then we're going to do a re-eval... blah, blah, blah." I figured that there's got to be a better way. We have all these tools. We promote patient education. I'm not going to see people once a week. I may not even see people once every other week! I do the evaluation, I'm going to prioritize who needs to be here and who doesn't. Through that, I started seeing people every other week, and then every third week. Now I've gotten to the point where I may see people every two to four weeks. I just felt that I've done my evaluation, we've identified the impairments, I'm giving you the tools, all you have to do is use them. What that does is it saves you time and money. The only thing that I ask is that my patients communicate between sessions, and people have really done well with it.

I know a lot of therapists that are in network are like, "Your plan of care sucks. It's wrong. I don't agree with your plan of care." They're in-network. They're so used to doing it that way. You can't prove to me that seeing these people two to three times a week is going to get them any better. What really matters is their compliance. If they want to come see me more often that's fine. I'm not against it, but here are the tools. Just use them and then check back in with me. Then we'll start all over again. In the beginning it took a lot for people to change their mindset because they're so trained from traditional Physical Therapy. They're like, "Wait a minute you don't want to see me this week?" I could but I don't need to. I give them their tools and tell them to use them. It's caught on now by word of mouth about how I don't want to see patients every week or every other week, I identify what's going on, develop a plan that best suits their needs.

I really feel cash-based PT captures patient-centered care. Even though in-networks says it's patient-centered care, it's not. I don't even feel bad for saying that. There may be some in-network therapists reading this right now that disagree. At the heart of it though, patient-centered care, if we look at the insurance, and then the institution you're making money for, and then the actual patient, the patient is lower on that list than we're led to believe.

Morgan: I think that that's one of the saddest realities of what physical therapy is really in the traditional sense, outside of school. You are not just responsible for evaluating and treating a patient and making them better and that being the primary goal. You're also responsible for making sure that in whatever capacity you see the patient it's also the most profitable. That's a lot to put on one person, let alone have the profit aspect come in and trump the patient experience and the results that they get. Also, how bold of another therapist to tell you that your plan of care sucks!

Ross: Yeah, it's just one of those things. An in-network therapist has been so trained. If they want to see someone multiple times a week I'm fine with it. It's nothing that I want to do. Not only am I saving someone time, but I'm saving them money. Again, a lot of people appreciate that not having come multiple times a week.

Morgan: Another thing that I think is kind of interesting to think about here is, is there one right way to do things? You and I very much are on the same page: cash pay/private pay is king. It's the best way to do things because of the ways that we practice and what we believe in. The reason that I want to bring this up is because I feel a lot of people who are newer to this or even a couple years in, fear judgment from other providers or other businesses. First of all, if anybody passes judgment on the way that you do things, we have to figure out a way to not let it get to us because it doesn't matter. There's no one right way to do things.

One thing that I really want to point out for myself and my experience as being a cash-based provider, I feel it has made me a much better therapist than working in a clinic. Because I do have more time so I can dedicate more time to researching for my patients and prepping for their sessions and contacting them to give them their HEPs. It's also that this person is paying me a couple hundred bucks, so I better step it up and make it worth their time. I had one insurance based provider message me last year at some point and got all huffy about how I think I'm a better therapist than them. I honestly don't care what you do as long as we're all trying to do things that's the best for the patient. That's what really matters. Also making sure that clinician is not going to have a mental health crisis ideally.

Ross: Which most of us are probably going to get to that point which is the sad reality. We have all been there, but just to go back to your point. I have patients that come in that I'll give them a consultation and they'll say that they want to use their insurance. It's not my job to try to convince them otherwise. It's now my job to direct them to someone who I think can help them the most. I have multiple friends that work in the area in in-network clinics, so I refer them to there. It's always about building your team and building your network. I don't see in-network as being competition. It's another avenue for patients, should they choose to go down that.

Now I will say I've also had therapists and network therapists say no one's going to pay me when they can just pay this for their copay. Maybe but what about when they value what I'm able to do for them? Everyone gets one hour treatment across the board. What if they're coming three times a week? They have a $50 copay. You expect to see them for four weeks. Well now they're paying $600 anyways. I'll probably see them twice in that time frame so they're saving time and money. Then they'll say, "Well it's unethical to take money from them!" No it's not. They're choosing to spend their hard-earned money on me. I've also found that when people have more skin in the game they tend to be a lot more compliant and they have better outcomes.

I think first and foremost that that's really the biggest thing that when someone goes to cash pay or sees a therapist who's cash-based, they are serious about why they're there. Let's get to the root of it and let's fix this. That's not a word that I to use often because I feel that's thrown around a lot in our field, but that's what the patient wants. I'm spending this money because I want something that's greater at this point. That's what we're all providing in this private pay system.

Morgan: Absolutely, and there's a saying that "people who pay, pay attention". Something else that I always like to bring up too, because you can get all kinds of heebie-jeebies trying to tell somebody to pay you. It's not something that we as therapists are super familiar with. We're not really in the money things, even though you still should see every Medicare patient for eight units or whatever, we're not familiar too much with the actual cash value of those units. It matters a lot if you think that you charging somebody is doing them a disservice or you're being shady about it. You're not. You're actually just being really honest and direct about what's happening: here's the price, this is how it works, and if you'd like to do it great, if not let me direct you somewhere else. That honesty and straightforwardness really matters to a lot of people, especially in the U.S Healthcare System where things could be very gray.

I also just want to point out too that there are people who see the amount of effort that you put in to caring for them and they also do appreciate the one-on-one time. They might not always tell you, but they are watching. Patients are paying attention to the way that you treat them. Eventually over time, like you were saying Ross with the word of mouth getting around town, I think that patients across the country too are starting to understand the difference between going to a clinic that accepts insurance and hiring a private provider, whatever specialty it might be. Because more and more people don't want to be treated poorly or only be seen for eight minutes and that's it.

Ross: I agree. There's a lot more awareness now and there's a lot more awareness now than previously, especially in the last decade. I think social media plays a lot into that. In a time where I'm not that techy, and I've learned a lot of my tech stuff from you, but a lot of people are and social media has really drawn attention to the fact that there's more than one way to do this. Especially for PT, this is what we can provide and this is what we can help you with. It's never been about we do manual therapy. It's that we can transform your life to get you back to playing with your grandkids. We can get you back to the high level sport that you need to play or whatever. Even though in-network therapists say that, and maybe they even market it that way, insurance just doesn't allow for it. You have eight visits, you have a cap, whatever it may be. It only gets you so far. Nothing against the therapists that are in that world or the business owners that are in that world, but they've had to respond to the limitations set forth by the insurance companies. It's just a game which was unfortunate because the people that lose out are the therapists that really want to make change and the patient. Cash-based is perfect because you eliminate the greedy business owners. You eliminate the greedy insurance companies. Then you have a patient who wants to get better, you have a therapist who really wants to help you get better, and it's a perfect marriage.

Morgan: Yeah and the thing for me too is it's just so transparent. It's very clear what is happening at any given time. Creating that much of a stable healthcare experience and even trustworthy. Being able to create that environment for somebody as they're healing. On some level that's got to be worth quite a bit as well instead of sending somebody into a clinic where they get a ton of anxiety and then don't really end up getting what they need out of it.

Ross: I think you just described it perfectly. By creating that environment, patients really want to make sure that they feel heard. They want to feel they have a say in their care. Again, I know that PT as a profession says that we're patient-centered, but that's usually not the case in in-network. You have so little time that it's basically a dictatorship: this is what we found, these are the questions I'm going to ask, these are the impairments, these are the exercises, we'll see you in three days. It's as simple as that. When you're outside of that and the shackles are off, it really opens it up. You get to know the person that's sitting in front of you. There's a body part, you get to learn them, they're family members, their friends and like you said that's how word of mouth happens. 80% of my patients are word of mouth. Eight out of 10 people coming through the door are from other people who at least I think are satisfied customers.

Morgan: It's amazing what can happen when you allow yourself to make those connections and relationships too. As scary as it can be to talk to a bunch of new people and everything. One thing I wanted to go back to before I forget, going back to the discussion about doing single sessions. There are all these factors that we just talked about that really help to shape the experience that a patient has. However, for people who are dead set on doing package stuff or just a little bit worried about the single session because of what can happen...

What do you feel has led to creating the, what sounds like, 90 to 100% compliance in return visits over the past year and a half in your practice?

Ross: I think a lot of it has to do with the education that I provide to them really helping them. Because I go into every evaluation and I start with my introduction and I say, "I'm really laying this out for you because by the end of today I want to be able to..."

  1. Give you a better idea of what's going on

  2. Tell you what you can do about this

  3. Tell you how I can assist in this process

  4. Tell you how long it's going to take.

I really try to bring them into the examination. I want them to be a part of it with me. I basically say everything out loud as I'm doing it. Sometimes I try not to, especially with a posture assessment, (I don't want them to think that they're going to die on the spot because of all these manufactured impairments). I just want them to hear my clinical reasoning as I go through. Then it's just setting them up for success: "These are the things that are wrong. However, this is what's still working really well and this is the success that I think we can have. I think it may take this long. I probably don't want to see you for a couple weeks."

Then usually for a lot of people it's, "Why not?" We're getting away from that now, so for people it's, "Alright, you do your end, you come back to me." I think setting them up and just letting them know I'm here for them however they need. Hopefully we've identified those four questions and we've answered them. Now they know what can be done for this. I think once there's a little more clarity on why they're in pain, what's causing it, and what can be done about it, people really want to see that through.

For a lot of people, especially with the economy that we're in now, asking them to drop $1200, $1600, $2400, whatever it may be, that that's a large number! It would be great if people did that, but if they just want to come in and pay single sessions, I'm still going to give them the same care regardless. I think a lot of them saw that. Nothing changes whether you pay for a single session or a package. You're still going to get the same high level care as far as I'm concerned.

Morgan: This is something you and I have talked about a ton, but the process that you just described for your evaluations and throughout treatment too is the process of pre-framing, but also setting expectations. At a very zoomed out level look at it, patients are going to feel the safest, securest, and most comfortable if they understand what's going on. I think sometimes in healthcare that's not always clear. We're all humans and make mistakes of course, but making that a priority of the way that you work with your private pay clients makes such a big difference in the compliance, getting your patients to come back. I will tell them, "In X-number of weeks this is really what I'm looking for based on this hypothesis that we have right now. However, in that time if things change for the worse or there's any big changes let me know and we'll tailor our path to continue forward." That is I think one of the biggest things that will really put you that much higher and make you that much better of a provider. Just tell people what you're doing and what to expect. It sounds simple, but any time that I've worked with somebody and they give that to me, then I can visualize it as the client and really feel like I'm part of a team effort. Rather than, "okay they just moved my body around, gave me some clam shells, and I have to go back on Thursday." That doesn't really lead too much to a sense of patient empowerment.

I wanted to give a specific example too. I've had a couple of wonky situations as far as patients' pain that they're having with a couple of my clients last week. Something that I did before their sessions, I spent 20 - 30 minutes researching and re-familiarizing myself with different anatomy, I took screenshots of the images, wrote out some different things, pointed arrows at it, and took maybe five minutes in our session to show them and explain to them. I don't I feel I've ever really had that experience with any other health care provider where they actually involve you in showing you what could be potentially going on.

Can you tell us more about how you do the education?

Ross: A lot of my education is very similar to the way that you just described it, but I find a piece that is vital is using a dry erase board. I have one right in my clinic and I'm drawing on it all the time and I'm constantly explaining anatomy, tissue healing, the recovery process. People really like the visuals. A lot of people end up actually taking snapshots of it. I think that's really a vital piece to me, but it's constantly just asking, "Do you understand? Do you have any questions about this?" Oftentimes I repeat myself, probably more than I should, and I even I warn them that I talk a lot. The more education that that I can give, again it goes back to that empowerment. You highlighted it perfectly with bringing the patient into the experience. You use the screenshots, I use the dry erase board. It's making sure that they have a full understanding so you're solidifying the relationship at the very end and saying we're together, I'm here whenever you need me.

Morgan: It matters so much. I said it before and I want to reiterate: your patients might not ever tell you that it meant so much to them that you spent that time to go over whatever it is. You might not ever hear that from anybody. You probably will, but you might not. It really does mean more than you think it does to take that extra time and go over those things with somebody. Because at the end of the day too it's a human to human experience and if there's no connection there, (and forget sales, forget finding other clients, etc), it's not going to be a successful clinical experience for the person you're working with if they feel weird or ignored.

Ross: It just ends up creating that giant disconnect and you can never really establish that therapeutic rapport. If that's the case then the patient might as well just be going on Google or WebMD and trying to figure them out on their own, which a lot of them are doing anyways.

Morgan: One of my patients that I'm seeing for a hip replacement had texted me the day after his surgery. He was worried because his foot was numb and he looked it up on Google and found all this stuff. I had to tell him, "Please stop. Please don't look at anything else online." Me just being able to text him back and tell him to relax and explain that he just had surgery and that we would talk about it next week. He was so appreciative that I was able to talk him down. Being able to offer that too I think means something as well.

Ross: It just provides that little extra piece that I think is missing in health healthcare in general, not even just physical therapy. Someone's putting their trust in you. For me it's, if someone's e-mailing me on the weekend, I can take the five seconds to email them back to let them know that the pain they're feeling is perfectly normal at this time or if something is a little more concerning I can get them in earlier. I don't want to say they're relying on me, but they're putting their trust in me and I want to make sure I'm as available as I can be for them.

Morgan: Right. Then on the flip side there's setting boundaries and staying true to who you are, but also your vision for the business and the way that you want to interact with the world.

Looking back since you first started, how have you stayed true to your values, philosophy, and vision even when things were unsteady?

Ross: We've talked about before, there's a number of times where you'd say, "How are things going?" and I would just spew it all out at you. You'd have me calm down and we'd break it down. You've always been very good at helping me slow things down and looking at what's important today, what we can then line up for a month from now, where my vision was in 6 to 12 months, etc. You helped a lot with that.

My values have not changed at all. The values really come as part of "my why" as well: being able to provide care and hopefully get people back. Then my mission is to really help as many people as I can to perform as optimal as I can to live a relatively pain and injury-free life. That really has solidified itself, but also still allowing me to give away free treatments when I need to or telling someone not to worry about today because it's a consultation. Having that wiggle room has changed a little bit too because that's really helped identify that, "We are really causing a change in someone's life". We are transforming them. We're doing something great for them. We do a lot of good for people and that that's only been highlighted the longer and longer that I've been in business. Really with the word of mouth that's what people are coming to expect as well which that's a great expectation that they should be having. They should hold all of us to the highest of standard. They don't know what that standard should be because other systems don't really allow the therapist to excel the way that they should.

I will say, over the last year my philosophy of being there for the patient sometimes has gotten in the way of my boundaries. As we've talked about, I have a pretty busy schedule between the clinic because it's been a lot busier than I have ever anticipated, (again a good problem to have), between teaching, going through my orthopedic fellowship, and then also being a dad. I'm busier than I've ever been, but I feel everything's getting equal attention. Some weeks teaching is going to take a little bit more priority, some week patients are going to take a little bit more priority. Oftentimes this stuff really doesn't get done until my son goes to bed. Once he goes to bed then I'll finally do everything else. I've had to learn to prioritize where everything fits in. Dad first, business second, teaching third, my fellowship is going to be fourth. It's got to go in that order. These are non-negotiables, at least number one is the non-negotiable for me. That's been highlighted and solidified over the past year as well and it's really made me a better therapist, a better teacher, it's made me a better father, a better student. It's having me stop and smell the roses whereas before I'm lucky if I had time to stop in a network day and do anything. Take a drink, go to the bathroom, anything along those lines. It has been a great experience all around.

Morgan: That's something that I will always say is that starting and running a business is by far the best decision I ever made. I tell everybody too, even if you get into this and decide that you don't want to have a practice, you could decide that you want to go into business doing something else or just take the skills you've learned and apply them in a different way. So much of this obviously is really hard work, dedication, commitment, motivating yourself when you're not motivated, and sticking with something. That combination of discipline and creativity and confidence even if you don't know the results of whatever you're doing, it's going to take you really far in life, no matter what you do.

For somebody who's on the fence about starting their own practice or business, what advice do you have for them?

Ross: The biggest thing is never doubt yourself. It's all about mindset. You have the skills to be able to go and do this. Always remember that the fear of regret will always be greater than the fear of failure. I would much rather see someone fail instead of saying, "I should have tried this." That's where I was for the longest time. I always played it safe. Once I realized the "so what if I fail?" I would fail and then learn from those mistakes and try again. At the very least, I have to go back into an in- network clinic for a while and then I'll try again. Give it a shot. You really have nothing to lose. I mean if nothing else you go back to your old job that you had or something equivalent.

However once you get into this private pay system, cash based, whatever you choose to call it, the freedom that comes with it is intoxicating. It's hard to go backwards. Everything is an opportunity at this point. If you believe in yourself and you believe what you can do for your patients, that's going to resonate in your treatments. Patients will pay to come see you.

Morgan: 100%! I totally agree with you about the mindset. If that's what you want, if that's the result that you want you have to believe that it'll come. Because if you go into it every single day just saying, "Nobody's ever going to want to see me. I'm never going to get patients", that's what's going to happen! You have to lead with the result in mind just knowing that it'll come because you trust yourself. If you made it all the way through therapy school you can do anything.

Ross: Getting in and passing therapy school is the hard part. Like you said just the trust that it's all going to work out, you even said that to me before when I had some months that were a little bit slower, you've got to believe that it's going to pick back up. Then within a couple weeks the next thing I know I got twice the number of visits, my schedule's packed, and I think that I have to take them during admin times. Which of course you say, "No don't do that!" But again it's just being as accessible as I can for patients.

Morgan: Uh huh, also really making sure that you're monitoring your boundaries and you're not stepping too far in one direction.

Ross: I've made sure I've stuck to my guaranteed one admin hour a month like you've asked.

Morgan: Perfect! Thank you Ross so much for being here. Like I said in the beginning, this has been really helpful to just hear everybody's journey. They all look different. There are all kinds of things that could come up on this journey to growing a business and you'll never really reach a destination. It's just all mystery and a path of growth.

How to contact Ross:

*Located: in Concord, New Hampshire

Listen to this episode on my podcast!


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