The following Article was published in the September 2024 issue of Impact, a publication of APTA Private Practice.

BEING A SMALL BUSINESS OWNER IS A VULNERABLE thing. Sometimes it can feel like you’re the sixth-grader with a solo at the school concert. The lights are on, the stage is set, everyone’s watching, and you’re not really sure if that voice of yours will hold up when you open your mouth and let it rip. It takes a special kind of person to step out there in the first place. But if you do, there’s the possibility that something great could happen. There’s a beauty to this kind of boldness because whether you hit all the right notes or not, having the courage to step out and sing makes your classmates want to join in the chorus. And if they do, there’s a chance that the audience won’t be able to keep themselves from singing right with you.

This is what starting and growing our practices can feel like. Growth for a small business happens when you can get your team to sing the same song as you; explosion is when the clients sing along, too. There have been moments as a private-practice physical therapist when I have felt the music rising, a booming and boisterous and beautiful noise coming out of the few faltering notes I did my best to sing at the start. What a joy those moments are!

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A SIREN’S SONG

But there’s a siren’s song that the members of our teams are hearing when they walk out our doors. No matter how much they love the team or business, people have bills to pay and mouths to feed. The reality is that for many staff outpatient physical therapists, there is a costly barrier to entry, a weak financial growth trajectory, and a relatively low earnings ceiling. Some individuals interested in our profession may ultimately be lured by areas of the medical field that pay more for a similar education and entry cost.

I saw this happen firsthand in my own practice. Right in the thick of the Covid-19 pandemic, I overheard two of our physical therapists commenting on how they wished they would have been physician’s assistants instead. And I’m not sure I blame them! Physician’s Assistant programs

are roughly equal in cost and duration to physical therapy programs, yet a recent report showed physicians assistants usually net a minimum of $20,000 more than physical therapists in their first year and have a ceiling far above that of a staff outpatient physical therapist.^[1]

COURAGE AND VULNERABILITY

At some point, we can’t keep singing the same tune and expecting people to join in if someone down the street will pay them more to sing a similar melody. We must demonstrate the same courage and vulnerability it took to get started if we want to be around long enough to sing a second verse.

We know the insurance model has significant challenges, yet our practices still rely on it. Why? Because change is hard! We get stubborn in our ways, plug our ears and just keep singing louder and louder, even when everyone else can plainly see the music has stopped. Do you know what this sounds like? Most Americans, when it comes to their exercise habits! Physical therapists know the notes people can play to make something beautiful with their lives, but our guidance stops way too soon and, often, abruptly. What a wasted opportunity.

At Freedom PTTC, we decided to seize the opportunity instead. Since 2022, our superpower has been our ability to progress our physical therapy patients into a cash-based fitness entity that is membership based. This program already generates 25% of our total revenue, with a goal of increasing that to 50%.

We have found this approach can provide margin for practice owners, improve pay and purpose for staff, motivate patients, and create community. Perhaps most importantly, it generates opportunities for aspiring physical therapists and those already practicing, increasing both their earnings and impact.

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Expect it to take at least 12 months to get momentum. No matter what, do not give up!

Eighty percent of Americans do not exercise, yet 100% have a strong desire to be independent and functional in their later years.^[2] They know they need to do something, but they have no idea what to do. When they try, they often end up in our clinics, dejected, confused, and hopeless. Reframing physical therapy as part of the fitness industry can break this cycle. It can be the way we turn our single voice into a choir of people who can’t wait to hear what song we’ll sing next.

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Don (Donny) Dequine, PT, DPT, CSCS, is an APTA Private Practice member and owner of Freedom Physical Therapy and Training Center in Shawnee, Kansas. He is a strong proponent of private practices having fitness options following physical therapy. He can be reached at don.dequine@freedompttc.com and @freedompttc.

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REFERENCES

1. Elgaddal N, Kramarow EA, Reuben C. Physical Activity Among Adults Aged 18 and Over: United States, 2020. NCHS Data Brief. 2022 Aug;(443). Available from: [PDF Version]

2. U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Physician Assistants. Accessed May 2023. Available from: [https://www.bls.gov/ooh/healthcare/physician-assistants.htm]

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