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Reflections on Starting a Cash-Based PT business



For at least 18 of my 21 years of being a physical therapist, I vehemently said I would never start my own PT business. Now, one year and a few months in, I am elated.


Admittedly, I’ve written this post partly for me, because reflection is integral for growth.

I’ve also written it for those of you who might be considering this same transition, as well as, my tribe of small business comrades. But truly it's for anyone thinking about doing something new and perhaps a little scary.


Looking back, here are my insights.





Sounds crazy, right? After reading eight Seth Godin books (and a handful of other self-help books with cuss words in their titles), I decided to stop merely nodding in agreement and start doing.


While it is prudent to spend time deliberating on starting your own business, imagining that one day you’ll simply wake up ready is pure myth. As in, Big Foot caliber myth.

On a personal front, here were some of my “excuses”: aka, the stories I told myself about why I wasn’t ready:


- "I don’t know enough yet": Maybe I’d be ready after I took those two additional continuing education classes or read those 3 additional books about what was needed to start a business. This list can be truly endless and can hamper your ability to fire the starting gun.


- Fear of failure: This presented itself in multiple forms. Will people be willing to pay for rehab services out of pocket when they have them covered by insurance benefits? Do I have what it takes to market myself if patients don’t just drop in my lap? How long would it be ok for me to be in the red? Fear of failure is a truly normal part of taking the plunge. Accept it.

- “I just like treating patients”: I’ve never been a big fan of the other stuff: the paperwork, the business management, etc. Truthfully, I’m still not.


- "It’s not the right time, just yet": The right time? I’m not sure there is one. Why wait?

Don’t get me wrong, being prepared is an admirable goal but when are you prepared enough? I know a few recent grad PTs that have started cash-based PT businesses and been successful, not long after graduating.


The day I quit my job was not the day I’d planned to, but it happened. So, in more ways than one I started before I was ready.


As Seth Godin says, “Starting something is not an event, it’s a series of events.” So if you are mulling about going down this path…. you’ve actually already begun.





“Success is doing what you want to do, when you want, where you want, with whom you want, as much as you want.” – Tony Robbins



To most people the definition of success is biased toward financial success. While I appreciate Tony Robbins’ quote, it behooves each of us to formulate our individual definition. My success metrics have been multifactorial and are still evolving.


Here are some of them:

  • Control of my schedule

  • The ability to deliver the quality of care I want, that people deserve.

  • The feeling that I am adding value to other people’s lives

  • Being part of a movement that is raising standards in our industry


While we're on the topic of success, have you ever thought to plan for it? I didn't...





One thing that helped me take the leap was being asked “Can you get another job if this doesn’t work out?” Without hesitation I could answer “yes” and I assume that most who are considering this could as well.


It’s judicious to have a back up plan. It's normal to wonder what you’ll do if your venture doesn’t work out. I had that possibility covered: I’d get another clinic job.


What I didn’t consider was what would happen if this business grew faster than expected.


One of my patients shared an analogy that really resonated with me this past year. He said “You’ll only ever hit the ball if you swing the bat.” With that analogy in mind, consider this. A baseball player doesn’t walk up to the plate with a plan of what he’ll do if he strikes out. He's got a plan for how he’ll run the bases for whatever kind of hit he gets.


Have a plan for success. Contemplate how your life will change if you become busy quickly. I had a plan for how I’d fill the time waiting for my business to grow but no plan for what I’d do when my free time became suddenly limited.





I call my business - Level Up Rehab - because I want people to think of me as more than traditional physical therapy.


Being different can entail many things. Your practice can specialize: in a sport population (eg: golf), an age population (eg: teenagers) or a patient need (eg: concussion).


Do you have to specialize to attract business? Definitely not, but I thought this might be the case for years so I hesitated.


How do people know that you’re different? You need to tell them and show them.


As of yet I haven’t had to do any formal marketing, but in truth every time you talk about your business or see a patient you are, in fact, marketing yourself.





Undoubtedly my biggest challenge has probably been my largest area of growth. Putting myself out there. It’s not my comfort zone.


‘Branding’ felt like a dirty word to me before I started doing it. I now realize it is a part of every business: big or small.


My biggest lessons here have been that you can do it authentically, that it doesn’t have to consume your life (better if it doesn’t) and depending on your definition of success, it might not be needed at all.


These days, putting yourself out there involves a dip into social media. There will be many opinions out there on the best way, but my views on this are quite simple.


Figure out why you are using social media and aim to fulfill those goals with integrity and authenticity. Simply put, make it YOU.


I’ve given myself some personal guidelines for posting content. It needs to feel genuine; it needs to be relevant to my business and me and hopefully helpful to folks.


There are a ton of great Instagram accounts out there. I knew I would not be happy trying to mimic what others have done, so I just do what I want to do, what feels like me.






Simple but important.


Caring more will not necessarily make you the best practitioner, but if you can show people your sincere investment in them, this will accelerate value in what you do.





How can you improve if you don’t listen to feedback? How will you get feedback unless you ask for it?


I’ve learned that is important to seek feedback and be receptive to it. I’ve also learned that you don’t have to take all advice.


Starting a business is pretty exciting. Many people want to help; to share their experiences or compare notes. Listen to what they have to say and then decide what you want to apply to your business.





Because you are.


I mean this primarily in regards to how you manage yourself.


Have you ever wished you had a boss that looked out for your best interests? One that pushed you when you needed to be pushed, praised and awarded you when it was appropriate, etc?


When you are your own boss you need to do that without falling into the trap of just pushing yourself to work harder.


I remember reading about how intensely entrepreneurs work their first year: it’s the truth, one hundredfold. When you run your own business there’s always something to do.


I’ve learned that I must put on my boss pants and set boundaries: with myself! My business-personal management skills are a perpetual work in progress, and at the top of my list for “areas of improvement”






A cash-based PT business can be done without a lot of overhead costs or investments.


I’ve accrued my equipment, rehab "stuff" etc over the past couple years. Not gouging my bank account has helped ease the anxiety of financial risk, but it’s also made the “building” more fun. I’ve got a wish list of things I tick away at.


I also minimize costs by using Google Calendar to schedule my patients in lieu of online scheduling. I realize there are benefits to the online schedulers but I appreciate the control of scheduling myself. Yes, this takes time but it also has some potential benefits to adding value to your business. Several of my patients have told me that they appreciated being able to talk directly to me on the phone instead of a front desk person.





If you had told me 10 years ago that I would start my own practice, join Facebook and try to write a blog, I’d have laughed and thought to myself “you don’t really know me!


Apparently I didn’t really know myself! And that’s been one of the greatest gifts of starting a business. I’ve learned more about myself this past year than any other year.


And I will keep learning. Once you’ve started doing things that are “uncomfortable” and pushing yourself to Level Up you realize you have more to give and more room to grow.





Starting a business, big or small, is quite the experience. It’s so incredibly personal. Reflecting as you go is a must. Looking back is just part of the process of moving forward and onward we go. Happy New Year!

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