CMS has revealed a plan to make significant cuts to Medicare reimbursement for PTs on the physician schedule for 2021.
This will be the fourth proposed cut to PT and conservative care in the past 24 months and many practices are struggling financially with a national average profit margin of 4%.
There are practices that will be forced to close their doors if this fourth cut passes like the three before it. And in addition to hurting our industry, this will lead to a significant decrease in access to care.
What Happens Next:
The deadline for comments is September 27th at 5pm Eastern time. The final rule is scheduled to be issued by the first of November.
What You Can Do:
Submit your comments to CMS before the deadline. Review the video above to see what we’ve prepared at Madden PT and how you can respond before the deadline.
All links mentioned in the video are in the downloadable cheat sheet below.
Do you know the difference between investments and expenses in private practice physical therapy? It’s not always intuitive.
We recently worked with a client who was thinking about adding a PT to their team and viewed the move as an expense rather than an investment. It costs money to hire and retain personnel, which is why many practice owners are quick to say that hiring is an expense. For new practices that are struggling to get off the ground, this may be true.
But a seasoned PT practice owner who has grown and scaled their practice will be the first to say that your personnel is one of four major investment categories that will help you take your practice in the direction you want to go.
The difference between expenses and investments lies in a simple question: Can you reasonably expect to see a return on what you paid?
Let’s explore further.
4 Key Investments for Private Practice Physical Therapy
In a private practice, investments are viewed as assets, while expenses are liabilities. If you’re a PT practice owner wondering where to best allocate your budget, there are four key categories that should give you a return on what you spend. They are:
When you put money into any of these four buckets, you have a reasonable expectation that you will get more in return. A bigger space and more personnel both mean more customers to serve. Information and marketing help increase your visibility and attract patients to your practice, which means more patients to serve. Each of these categories should be considered essential assets in helping you get closer to your goals.
Crafting Your Strategy with a Pro Forma
If you’ve ever written or learned about business plans, you know that most of them include abstract ideas, like how you’ll differentiate yourself in the marketplace, what your USP is, and your company’s mission statement is.
But a successful business plan comes down to being able to keep your doors open. No bank or lender is going to hand over a check if you don’t have a tangible plan to stay in business.
Part of your business plan should include a pro forma (example below) that places your current expenses side by side with a guess of how healthy your finances will look in the future when you invest in your practice.
Let’s focus on the Today column:
To calculate the income, we based that number on a reimbursement of $80 per visit. Some PT practices or areas may be higher or lower, so try to be as accurate as possible here.
For payroll, we calculated the entire payroll cost of a PT and receptionist, including the employer share of payroll taxes, benefits, and IRA contributions. The example also includes billing as an external function.
For internal and external marketing, your cost should be about 10% of total revenue coming through. In the example, 10% of $26,000 is $2,600, which is the combined total for marketing activities.
For reserves, Greg Crabtree’s book, Simple Numbers, Straight Talk, Big Profits, recommends keeping about 10% of your revenue in reserve for expansion. This is one of the four major investments for private practice physical therapy owners.
The pro forma example uses conservative figures, totaling $19,600 in expenses and a net profit of $6,900 per month. In this example, the PT owner takes a $60,000 salary. They have a reserve account, and they are more than 10% profitable, so the practice is generally healthy.
Avoiding the “I Can’t Afford It” Mistake
The pro forma tool can be valuable in helping you see where to increase your investments, but if you want it to be effective, you must also consider the impact of that investment on your income.
Here’s a real example from one of our clients:
If you’re thinking about hiring a new PT, and you deduct the extra payroll cost from your profit without also increasing your number of visits and monthly income, you’ll have a skewed vision of the real impact on your financials.
But think about what adding another therapist will buy you. Hiring a PT, even part-time, could mean more time freedom for you (something truly invaluable), more business stability, and the ability to see more patients in the same amount of time. If the PT is only working part-time, as was the case with our client, then the number of patients you can see each week goes up—and so does your income.
Using the Future column in the pro forma example, hiring another PT might bring another 35-40 visits a week, or about 160 per month. At $80 per visit, that’s an extra $12,800 in revenue, but the practice owner would be spending about $5,000 per month for a part-time PT, 25 hours a week.
You’ll also need to go back through your pro forma to make additional tweaks. The payroll line obviously changes. Billing will also change because you’re seeing more patients each month. Marketing and reserves will change because you now have more revenue, and marketing should be roughly 10%.
Now, do you think you could afford it?
Which One Do You Want?
Once you have a side-by-side comparison of now versus the future, you can start to get a feel for which one you’d be more comfortable with. Whichever one you pick becomes the plan, and from there, you can start working backward and asking yourself better business questions to get to where you’re going.
This is exactly what we did when opening up a second location, and we were quickly able to become profitable, start hiring, and expand into a new space, all from doing these same calculations.
Look at your numbers today and make a calculated estimate of where you’re going to be once you make an investment in personnel, direct access marketing, space, or information. It’s growth with some sense of control rather than rolling the dice and seeing what you end up with.
As a Physical Therapist, you focus on delivering the highest quality of care to your PT patients. And delivering the best outcomes possible.
This is great when you work for someone else, but as a PT owner you’re not just responsible for outcomes.
You also have to have marketing strategies and plans in place to get new Physical Therapy patients into your PT clinic.
That’s what Mike talks about in his case study video.
Before working with Breakthrough, his Physical Therapy practice relied heavily on physician referrals. As a result, he never felt like he was in control of his new patients numbers.
Check out the video to see what worked for Mike and how he’s been able to accelerate the growth of his PT practice by taking control and marketing directly to the public.
[expand title="Full Transcript"]
Mike Strakal: I'm Mike Strakal. I'm a physical therapist from Tulsa, Oklahoma. I have two clinics, one in Tulsa and Owasso, Oklahoma. The name of my practice is Physical Therapy and Balance Centers.
Mike Strakal: I have been in private practice physical therapy since 1974, and I started out as a young young guy who was working with a company that contracted physical therapy when physical therapy, especially out ... There was really no outpatient physical therapy, and so we contracted hospitals. And you actually had to be in the hospital for your insurance to pay for your physical therapy.
Mike Strakal: So I did that for about 10 years, decided that I wanted to get into the outpatient market, started to do some consulting with hospitals who were developing regional rehab hospitals, and I did that for about five years. And then I opened up multiple outpatient clinics just because I really do like outpatient PT.
Mike Strakal: The main reason that I joined Product X was to be in control of my referrals. In 2015, Oklahoma got direct access, and so we were able to see patients for 30 days without having a physician's referral. I didn't have the expertise. I didn't know how to go about getting those referrals, and Product X just spoke to me because it gave me a script, it gave me a method, it gave me a plan that allows me now to start controlling not only the numbers of patients that I want to see in the clinics, but the types of patients that I want to see.
Mike Strakal: My biggest problem has been always being dependent on physicians to refer to me. I really want the ability to control not only the kind of referral patient that I want to see, but also the numbers. And Product X gave me that opportunity.
Mike Strakal: Product X helped me achieve my goals of increasing my number of referrals and the kinds of patients that I wanted because it gave me a plan. It was a structure. It gave me the ability to not only understand how best to get my message across, it gave me a strategy, a tactical strategy on how to get my message across through Facebook. And then, it also gave me a strategy on how to deal with the patients once I got them.
Mike Strakal: Not being able to have a strategy to get new patients into the door. And then, we always knew how to evaluate them and give them excellent care. And so that wasn't a problem. But what was the problem was our inability to be able to find them in the first place, which we were able to do through the Product X modules. It was the fact that we didn't have a structured program that was succinct, and the scripts were very good at putting that together. And then finally, the ability to have, multiple months, after month, after month, of getting the workshops repeated so that if they missed one workshop, they could always come to another.
Mike Strakal: Originally, we weren't really paying attention to the tenets of the Breakthrough PT marketing program as well as Product X. Our first time that we did a <a href="https://breakthroughptmarketing.com/resources/">PT workshop</a> worked out very well for us. But what we learned from the failures and the mistakes that we made was that we could get our people into our office sooner, and so we were able to, on the phone, generate interest from the patient to come in for a free screen. And then, once we saw them, we could give them exactly what was wrong with them. We were able to bring them into the clinic for a full plan of care. It's resulted in the fact that we don't see a lot of people at our workshops anymore because they've come in two, three weeks earlier for a plan of care, and being treated.
Mike Strakal: My biggest Product X win is the ability to manage my practice, and it has given me the opportunity to not only see that we can control our own destiny, we can control the numbers that are coming into our clinic, and it's also given me the opportunity to teach my staff the tenets that I learned through the Product X. The successful ability to bring patients into our clinic without having to rely on physician referrals has been my biggest win.
Mike Strakal: My practice now runs a lot more effectively and efficiently if I'm not there. My staff has been trained now, has an idea of what to do, is empowered to make the decisions to do it. And so, I can go with my wife, we can take time off. In fact, we're going to be taking off quite a bit of time this summer, and we're going to have the practice continue to improve and grow even though we're not part of the group that's doing the actual treatment.
Mike Strakal: You know, many physical therapists and support staff aren't as enamored with an idea as I might be and my wife might've been when we came back from the first boot camp. And so, even though they're good people and even though they want to do a good job, they haven't been introduced to those concepts. And so, what we did when we came back was we spent probably close to five hours a week introducing them to not only the concepts of Killer Marketing again, but also the concepts of the tactical strategies for boot camp. Some people just don't want to do what you want them to do. And so, we had to have frank discussions of where we were going, and if they wanted to get there with us, they would have to get on the bus.
Mike Strakal: And I would say that, without exception, every single one of my staff has been able to not only learn all of the tenets of the Product X, but they're very willing to learn more, because now what they're seeing is that we've come up with solutions to our problems, as opposed to kind of gnashing our teeth and washing our hands because we don't know what to do.
Mike Strakal: The fact that physical therapists are really clinical people, don't really have a lot of business acumen. And even though the billing people, or the front office people, are comfortable answering the telephone, going through the process of the revenue cycle, they really didn't understand the structure of Product X and how it would make their job easier.
Mike Strakal: And so, we were able to ... Basically, through role playing and seeing the successful outcomes of just having perfect strangers call us up and say they want to come to our workshop, and then getting them in, really gave them much more confidence in how to deal with, "I can't afford that insurance. I don't feel like I should be trying to sell them something they don't want." We were able to talk all that through. And so, having the library that Product X has was very helpful in getting me to be able to do that with my staff.
Mike Strakal: So now that we are starting to be able to control our referrals a lot more, and we're seeing more business, we're now expanding our operations into our other clinic up in a Owasso, and we're taking some of those same people, taking them up to Owasso, and teaching the Owasso staff how the tenets of Product X can benefit that facility. And my hope is that we'll be able to do that three more times in the next two years.
Mike Strakal: Because we bought Product X, we didn't really expect it to be much more than just a method that we could use to improve the kinds of referrals and the numbers of referrals that we would get into our clinics. But what we found was there was a lot of side effects as a result of the tenets of the Product X concepts, such as being able to pick up the phone and talk to just about any stranger with the idea that they want to come in and be helped by our treatment programs.
Mike Strakal: It helped my people to understand the revenue cycle because they didn't have to go through, a lot of times, the insurance products, because we were doing cash pay. It helps my physical therapists and my physical therapist assistants in understanding that it is not their place to decide if a person should get treatment or not. It's really up to the person to get treatment. It's their job to lead that person to get that done. So it doesn't matter if it's a Product X patient or even the typical patient from a referral, they now are much better at being able to articulate why the patient needs physical therapy and how physical therapy is going to benefit them.
Mike Strakal: Successful outcome for these programs has been pretty good in my opinion. We had 26 registrants for our workshop. We were able to provide patient care to 14 of those before the workshop ever occurred. So the numbers that are showing up at our workshop are less, but it's because we're getting them into the clinic faster.
Mike Strakal: Well, I've been a physical therapist for about 45 years, and physical therapist is a very serious profession. We're here to help people who are in pain. But what I found is the fact that I have realized how much fun I'm having as an old guy as I am providing these workshops, as I get a chance to work with my staff, as I get a chance to interact with different therapists around the country. And I used to think about retiring, I used to think about taking all kinds of time off. But really, I'm enjoying myself so much because of what I've been able to accomplish. I don't know if I'll ever retire.
Mike Strakal: Well, my big, audacious, hairy goal was to see 100 patients a day between my two clinics and to see six to eight new patients per week. Now that I see how powerful this concept is, I'm looking at, in the next two years, either acquiring or developing new programs outside my other two clinics. And I want to have at least five clinics. And so, I am going to continue to use the tenets of the Product X, as well as Killer Marketing and the other outstanding programs that Chad has developed, and I'm going to for sure see an increase in not only the number of visits, but my big, hairy, audacious goal will be 400 patients a day with 22 to 25 new evaluations per week.
Mike Strakal: You have to understand what you're trying to accomplish with it. My personal feeling is I wanted to accomplish increased referrals of the kind of referrals that I wanted. In trying to get that point across to my staff, I may not have been the best leader or manager to be able to explain that to them appropriately. But because I was able to use some of the tenets and some of the research and some of the true leadership of the Product X BTPM programs, I was able to get them to understand at least what I was trying to accomplish. That gave me a new journey. And that journey was to understand how they learned best. And it also gave me an opportunity to know if they were on board or not.
Mike Strakal: And so, the truth of the matter is, is that this is a management program no different than any other management program. What is important is that the manager, myself, or you, is going to have to understand how best to implement something like that. And I think that Product X is really an outstanding way to do that.
If you want to learn more about the systems discussed in the video, make sure you sign up for my new training webinar.
If you look at how Private Practice Physical Therapy has changed over the last 2 decades, it’s easy to see why so many owners feel frustrated about their business.
The rules for growing a successful PT practice are very different than they were 20 years ago.
It’s important to get a look at how our industry is evolving
so that you can stay ahead of the trends and put an end to needless frustration
over how to move forward.
Below are the top trends owners need to be aware of.
Physician Referrals are Dying a Slow Death
There may be a few owners in the US who can comfortably rely
on physician referrals, but that number is on the decline.
Even those who are hanging on and surviving with such a limited marketing arsenal (physician only) now recognize they must diversify their new patient sources into their past Physical Therapy patient list and the general public.
PT Practices and companies who have not embraced the “direct-to-consumer” model will struggle to survive in today’s healthcare economy.
The good news is that “direct-to-consumer” marketing not
only gives owners more control of their numbers, it also brings in a better
You walk in Exam Room A. You ask the patient, “What brings you in today?”
She responds, “I’m having trouble with my back. My doctor sent me here.”
Next you walk into Exam Room B. New patient. Same question.
She responds, “I’m having trouble with my back. I read your book. Came to your workshop. I know you can help me.”
Who would you rather treat? Yes, nearly 100% of owners agree it’s the patient in B.
We know she is significantly more likely to meet her goals, complete her plan of care, graduate, return to Physical Therapy for additional care in the future if she needs it, AND refer her friends and family to us.
The problem? Going direct to the consumer is relatively
simple…but not necessarily easy.
What I mean by that is, anyone can make a Facebook page for
free and spend a few dollars on ads. The advertising platform on Facebook makes
it very quick to get started (especially compared to something like advertising
But…what happens after that? For most business
owners…nothing. They run their ads and maybe a couple of hundred people see it.
Maybe a few of them even “like” it.
But how many new Physical Therapy patients are generated? Zero.
And so, in this example we are technically advertising
directly to the public.
A few decades ago, a Practice Owner may have been able to
run their business off of word-of-mouth alone.
Usually because they were the only PT in town.
However, those days are gone. Most markets are competitive now –
The Self-Employed Mentality of providing high quality of
care and growing through word-of-mouth, managing finances via checking account
balance, and hiring PTs and staff by posting a simple ad?
This does not work today.
It is NOT a problem
should you want to remain a small practice with a handful of staff. However, if you’re choosing to grow and build
a true Private Practice Business, then you’re going to have to learn
operations – the creation of processes and systems – for your marketing,
finances, personnel, billing, etc.
Working More for Less Money
When I look at the amount of documentation our PTs are
putting in for one visit…it’s unreal to me.
In general, we are doing way more documentation as
clinicians. Frequently, we’re doing this
for less or capped money. It’s alarming
how fast the healthcare GDP is growing…$3.3 Trillion per year. That’s
$10,300 per person per year in the US.
However, we are not getting healthier for those
dollars. We’re actually getting less
So, the answer is to make it more cumbersome on the
conservative care clinician…and ultimately have decreased access to care.
Rising Cost of PT Degree and the Scarcity Mindset
When I graduated PT school, the maximum student loan I was
allowed to borrow was $24,000.
Today, for many graduates, it’s that figure PER YEAR.
A quick survey of recent grads revealed student loan amounts
of $160,000-$240,000. Never mind the exorbitant costs of education.
So, the student debt plays out to be a $1,000/month payment
for the next 30 years. That’s a mortgage payment.
There are a limited number of PT graduates each year. Many, pressured by financial stress, will be
forced to work in higher paying environments, such as the hospital systems
(where reimbursement is 3x what we receive in outpatient PT for the same
Because of the reliance on physician referrals in the past
within the PT industry…that scarcity mindset is still present. Scarcity mindset = I win, you lose. However, a handful of forward thinking,
outside-the-box owners are paving the way with Out of Network and Cash Pay
This is BIG and worthy of your attention. In the end, those companies have adopted an Abundance Mentality. This sets them up to hire the best new PT grads accordingly. Letting owners stuck in the old mentality to fight over the remaining students.
Theresa from Ohio has a truly unique story about opening her practice after getting laid off from what she considered her “retirement job.”
Not only was she was able to accelerate the growth of her practice by using proven business systems and marketing automation.
She’s also witnessed the positive impact that running a successful business has had on her family.
[expand title="Full Transcript"]
Chad: Hey, everybody. Chad Madden here, and here with a very special guest. I should've asked you how to pronounce your last name before I did this, but I think I got it right. It's Theresa Pavlovic? Is that right?
Theresa: No, Palkovic.
Chad: Palkovic. Okay.
Theresa: There you go.
Chad: Great. So, we won't even edit it. We'll keep that in, Theresa. But the reason that I wanted to do this call with you, Theresa, is because you're a practice owner with a unique story. You definitely had some challenges, and I love what you have shared with our owners in the past, so thank you for doing this and being here.
Theresa: Thanks for asking me.
Chad: Great, so can you fill in the gaps there in the intro? Where's your practice at? When did you start? How man years have you been in business, etc.?
Theresa: Okay. I started my practice in 2013. It's Valley Rehab Center. It's in Bellaire, Ohio, which is a small town along the Ohio River in the tri-state area. West Virginia, Pennsylvania, are all within like 20 miles of us. I originally was never planning to be in private practice. I got laid off at age 55 from what I thought was my retirement job, but because of the cuts that were being made with the Affordable Care Act, I was in a home health position as an area specialty director, and they laid a lot of us off.
Theresa: So, I needed a job. In the area that we live, jobs were very scarce, especially any kind of management job. I was at the top of my pay scale. I had already had 33 years of experience in physical therapy. They were looking for younger, less expensive therapists. My husband had a business established here so we really couldn't pick up and move, still had children in college, and so I had to do something.
Theresa: So, I ended up setting up an arrangement with a chiropractor friend of mine to rent his space and his equipment when he wasn't using his office. I started my clinic basically two days a week, Tuesday and Thursday from seven to three, Friday afternoons from one to five, and then we grew from there in 2013. For 2013 to 2017, we actually operated our business out of an old Victorian home that had two stories and 13 steps, and half my treatment rooms were upstairs in bedrooms.
Theresa: So, that's how we started, and we just grew from there. I think I took on a part-time therapist in 2015, and then went to ... I had a part-time and a full-time therapist in 2016, 2017, and we've grown consistently from that point.
Chad: Great. So, when did you come into the fold here at Breakthrough and we started working together?
Theresa: I started Killer Marketing in November of 2017, anticipating that we were moving into new space. So, by the end of 2017 we were kind of rim-locked. We couldn't grow anymore than we had already grown where we were. So, we decided to go into an actual [inaudible 00:03:31] clinic atmosphere. So, I had rented space, and they were finishing that space out for me for a clinic that was going to be about 2600 square feet.
Theresa: So, I was anticipating growth, so I got the call, or got on one of those things with practice promotions, and Chad, you were a guest, and heard about Breakthrough and kind of got in touch with you. So, I started Killer Marketing in November of 2017, went to my first bootcamp in Atlanta in 2018. So, I've been to the Atlanta Bootcamp, the New Jersey Bootcamp, and then I took myself and two staff members to the Orlando Bootcamp, and then I have all my staff coming with me to Chicago Bootcamp.
Chad: Sweet. So, just to fill in the gap there, you started Killer Marketing. You were growing. You wanted to fill space. It was about 2600 square feet, so you were leaving the Victorian home.
Chad: Right? With the treatment rooms upstairs. Can you talk a little bit about what practice life was like before you started going direct to the consumer, before you started putting the marketing systems in, whether it be Killer Marketing or Product X? Can you talk a little bit about what life was like then?
Theresa: Well, it was very stressful, for one thing, because where we are is a small town, and there's one major hospital player, and they have probably five outpatient clinics. In fact, one is directly across the street from my clinic that I have now, so it was a very competitive market in that, because they pretty much owned the physicians and the referral sources.
Theresa: So, there were people that, fortunately, knew me as a therapist, so that's what had started ... my original referrals came from them, and we had started doing, tried to do some workshops ourselves right before I started with Breakthrough, but they were kind of local advertising and through my newsletters. So, we would get two or three people, maybe, and we were doing those, but we weren't really getting a steady flow of referrals. Our referrals were running around 20 to 25 a month.
Theresa: Now, last month, I just finished May stats, we had 56 referrals.
Chad: Nice. So, you've doubled.
Theresa: Mm-hmm (affirmative).
Chad: Great. So, what I heard there is life was a little bit stressful. You weren't exactly sure where your new patients were coming from.
Chad: Like many of us, you had physicians that were networking for the hospital system. They were likely not allowed to refer to you, or at least not the extent that they did five years ago, and you wanted to replace those referrals, and you've actually doubled the number of new patients coming through. So, great work to you and your team.
Chad: Can you talk a little bit about what life is like now? Like, what that did for you and your business, having that certainty of being able to control the new patients, and then also once you do that, what it means for you as a person as well? Because I know you're a mother and a wife, and lots of other things.
Theresa: Well, before Breakthrough, I was a practice owner, but I was really a clinician working in my business. I was more a clinician than an owner. I didn't really understand a lot about managing my business. I didn't understand, because Breakthrough's been more than just marketing. It's been an education for me. It's taken me through the whole process of becoming a business owner.
Theresa: So, life before was treat patients for 10 to 12 hours a day, and then I just was talking to my office manager here a few minutes ago about the fact that we used to just ... money came in and money went out. Money came in, money went out. We didn't manage anything. I didn't know what my cost per visit was. I didn't know any of that stuff. I was just a rookie, but yet I'd been a therapist for 38 years. So, I was a rookie at being a practice owner. I could be a really good clinician, but I wasn't really good at the management part.
Theresa: So, being with Breakthrough has helped me to make that transition from a clinician to a business owner, so it's changed my perspective on how I look at things. It's also given me some more freedom. Probably the first four or five years of my business, I only took maybe two weeks of vacation ever.
Chad: That's not two weeks a year.
Theresa: Right. To leave my business meant to leave money on the table because I'd be closing my business, because I didn't have any strategy in place to cover. I was also afraid that if I was gone, then I wouldn't be able to ... something would happen. We wouldn't get referrals, or there would be something. Actually, last year I took three vacations, so I had about three weeks of vacation in 2018.
Theresa: This year, actually, I had a daughter who had a baby, and she was born premature in February, so I took five weeks off and left my business for five weeks, and went and stayed with my daughter and helped her. I'm actually planning now through the rest of the summer, plan to go at least one weekend a month for a long weekend to spend time with her, because she's just starting to get back to work and that kind of thing. So, I wouldn't have had that freedom before. I didn't have that freedom before.
Theresa: So, at least I know now that I can leave my business and it's going to still run, and we're not going to take a big dip. I'm not going to come back and have no referrals for three or four weeks because Theresa's been out of town, and so I haven't been in contact with anybody. All the patients are getting taken care of. We are learning. We're working on our systems and getting our systems down better, and the workshops definitely help.
Theresa: The workshops have, with the Facebook marketing and everything, that has really put us out there. People didn't know that we existed before, and I make it a habit of every new patient, asking them, "How did you hear about us?" A lot of them will say, "Well, a friend of mine had told me about you, but when I saw the Facebook marketing, I thought, you know, maybe I'll give them a try."
Theresa: So, we had a good reputation word of mouth, but we have an even better recognition now that we're doing the Product X marketing. I think, too, when people come ... having the workshops in the clinic, when they come into the clinic, they get a feel for what they can anticipate when they come here for therapy, and I think that that's helpful for people. I really do. I think it makes them feel comfortable coming, and because the workshop kind of gives them a preview of what we're going to do for them, what our knowledge base is, for one thing, and then how we will proceed, because we talk a lot about what are their options for treatment and that kind of thing.
Theresa: We're fortunate. We have the LightForce laser. We do dry needling. I've been to Dan's course on ... and want to get my staff. So, we do a lot of manual therapy, so we have a lot of good stuff going on here. When people come to the workshops and they hear about that, then they come here. I've had people come into the workshop and say, "I'm getting therapy down the street, but what do I have to do so I can get transferred over to you?"
Theresa: Just to go back to your question about referrals and that situation, actually, last October, in October of 2018, I got a phone call from my main referral source whose office is in the hospital building that's our competitor. She told me that she had gotten a visit from the hospital administrator and the director of physical therapy wanting to know why she was referring people to Valley Rehab Center and not to their clinic, to the hospital clinic.
Theresa: She said to them, of course, ethically, she has to refer people where they request to go, and that people had been requesting. So, obviously, they were data mining and figuring out that people were not coming to Wheeling Hospital Physical Therapy, and they were choosing Valley Rehab Center. Then, after that, found out from a couple of my patients who were referred after that point that they got a phone call from the local hospital wanting to know why they chose Valley Rehab Center instead of Wheeling Hospital.
Theresa: So, definitely the exposure, the opportunity to let people get in the door and know a little bit about us before they even have treatment makes a big impression, I think, on people. They know what to expect, and they're also learning that they have a choice, too.
Chad: That's awesome. I'm going to read into this a little bit, but basically, if we take your full story at 55, 2013, being laid off, to where you're at today, how does it make you feel knowing that the intentions of the hospital, or, we'll blame it on the hospital administrator, but probably the hospital, was to take your retirement, basically take it away from you and make it their own, but yet, in the end, patients are speaking up and saying, "We want to go to Valley Rehab. We want to see Theresa and her team instead." What does that do for you?
Theresa: Well, I mean, it's very rewarding for me to know that, but I think it's more so I love what I do, and I think that as therapists we have a lot to offer. I think that we've watered down our profession in some of these big box type facilities, and if we want to flip the pyramid, people need to know what we really can do as physical therapists.
Theresa: And, also, people need to be educated that they do have a choice. I think all too often people just take the word of what their doctor says, "Do this, do that, do that." I think we as physical therapists can offer a lot of education to people and help them to see that there's a different way.
Theresa: As far as, for me, another thing that I've shared with you guys in the past is that before Breakthrough, and before owning my own practice, I guess, for sure, but before Breakthrough, as a working mom who put in a lot of hours to her profession because I love what I do, and my kids always understood that, but still, I was a mom going to a job. And now, I'm a business owner that my children are proud of. So, they view me differently. I'm not just a mom going to a job. I'm actually somebody who's built something and who is changing the environment in this area with regards to physical therapy.
Chad: That's great. How many children do you have?
Chad: Four, all right. I know you had a crucial conversation with your son, and I promised not to get too emotional here, but can you share some of that crucial conversation that you had with him, and just what that meant for you?
Theresa: All my children are grown now. They're all adults, and my youngest son in particular has a very entrepreneurial spirit. So, being involved in business now, we've connected in a different way. He'll call me, "Hey, mom, you need to read this book." Or, "You need to listen to this." Or, "Hey, I'm sending you this link for this." So, we've connected on a different level, and it's really opened up, or changed our relationship for him and I in sharing those things.
Theresa: Also, it was very rewarding for him to say to me ... it was right before I came, while I was in Harrisburg, actually, the night before I was going to film for the shoulder workshop, and we were talking on the phone, and he said to me, mom, how proud he was of me, and everything that I had accomplished. Again, as a working mom, you think you just go through the routine. You work, and you work, and you work, and you keep running through the cycle, but you always want to be proud of your children. So, to have one of your children say they're proud of you certainly makes an impact on your life.
Chad: I love that. Thank you for sharing. I'll try to compose myself here, but I really admire what you're doing, not only in your area with Valley Rehab, but also what you're doing in terms of helping other private practice owners. So, thank you for doing this, Theresa.
Theresa: Thank you. Hey, I just want to share one more thing.
Theresa: Our goal was to be at 600 visits. Not 600 visits scheduled, 600 visits seen, and we only missed it by six visits in May.
Theresa: So, it's 594 seen with a 93% arrival rate.
Chad: That's great. Congratulations.
Theresa: So, if we could've been at 95% arrival rate, we would've had those other six patients.
Chad: That's great. Thank you, Theresa.
Here’s an issue that’s come up with many of the Physical Therapy private practice owners I’ve worked with:
“I want to grow and scale my PT practice. We’re doing everything just like you laid out. We had some growth initially. But now, we’ve kind of plateaued…I’m telling my staff what to do, they’re just not doing it.”
If you have staff, this may sound familiar to
It’s tempting to put the bulk of the blame on your employees. And it’s true that every organization occasionally makes a bad hire.
But most the problem comes down to vision.
At your practice, you’re the Chief Executive
And likely the Chief Operations Officer.
That in itself is two MAJOR roles in your
Frankly, when we’re wearing too many hats, we
tend fall short in some of our responsibilities. We simply don’t have the
time and bandwidth to be all things to all people.
But we can prioritize and focus on the work that’s going to have the greatest positive impact. Here’s what that means for you and your PT practice.
What It Means to be a
CEO (And Where Many Owners Fall Short)
Where many owners fall short is confusing what
being a CEO means…and ultimately what a CEO does.
A competent CEO paints a vision – a picture of
the destination – and coordinates the entire team (whether PT, billing,
reception, finance, PTA, marketing, legal, compliance, or PT tech) working in
harmony toward the realization of that vision.
Being a CEO is NOT about
getting to tell people what to do.
A Big Takeaway from an Exclusive Breakthrough PT Marketing Members Only Session at Bootcamp
Transitioning from an “I-told-you-so” entitled
leader to a competent CEO involves a transformation.
And to give you a glimpse of that
transformation, I want to share a behind the scenes look at a one of our
Bootcamp sessions from a past event.
The subject was “How to Get Your Physical Therapy Staff on the Same Page.”
The audience was advanced Breakthrough PT owners and their staff who are presently growing and scaling their practices.
The reason we started covering topics like this is because as Physical Therapy business owners solve the marketing problem – their schedules become full – and other problems rise to the top.
Or as Dan Kennedy puts it: “For every one
problem you solve, two others will come up.”
For example, once schedules are full, most
owners now focus on hiring PTs and other staff.
Not the easiest thing to do in today’s market
with so much competition.
After that, it’s revenue cycle – getting paid quickly
for what we do.
After that, it’s typically motivating staff –
getting everyone on the same page.
So, to start this session, I asked, “What are
you struggling with right now in getting your team on the same page?”
Here were a few of the responses:
I can’t get my staff to buy in to weekly meetings. We only meet once every other month right now.
How do we roll out financials for our staff? How do we start sharing that information?
How do we get our team to keep doing Green Ink Letters? 7 Step Killer Exams? Killer PT Testimonials Machine?
Take a step back and look at the above list.
What stands out for you?
What jumped out at me was delivering the change – the new process or idea – with the “WHY” – the reason we’re not making the change.
That’s not happening in the list above…
If we deliver the WHY in a compelling way, one
that appeals to our teams, then those problems go away.
That list is not the REAL problem.
The real problem is the ability of the CEO to paint the vision then explaining the chess moves to get there – including the reasons why we’re making the chess moves.
What the Best, Most
Effective CEOs Do
Just to recap, the best CEOs paint the reason
“why” when introducing changes.
Typically it follows this format:
we’re going.” Paint the Vision.
(You’ll get bored doing this. Persist. Don’t quit.
Repeat it until your team can tell this story).
“Here’s what we need to
do.” Most of us nail this part.
It’s really directives and/or delegation.
“Here’s why we need to
do this.” Connect the directive with why it’s important to taking a step
towards the vision.
Sounds simple, right?
The next time you feel frustrated as a CEO, go back to this formula and adapt it to the area where you are trying to make progress in your Physical Therapy practice.Now, if you’re still dealing with marketing problems and want to work on filling your schedule, check out my newest training – How To Double Your New PT Patient Visits In Less Than 12 Months
When they started their practice, Kristie and Frank did everything right.
And these goodwill efforts combined with superior patient outcomes helped them grow their practice for many years.
But when local competition in their area increased – national companies started moving in, hospitals started buying up POPTs etc. – it became clear that delivering better quality care wasn’t going to be enough if they wanted to scale.
Watch the full case study to see how these private practice owners used marketing automation to produce a 51% increase in their new patient numbers.
[expand title="Full Transcript"]
Kristie: My name is Kristie Kava, I'm from Oakland Physical Therapy in Novi, Michigan. We started in private practice about eight years into our profession. We'd been working eight years and between the two of us, my partner, Frank Kava, who is my husband, we had between us worked in about four different hospitals, and we'd also gone back to school to receive a master's in education. So when we came back from the master's degree work, we decided to do the things the way we wanted to do them, we needed to work for ourselves, to be in private practice.
Kristie: We started in private practice and physical therapy because we had both worked in four different hospitals between the two of us, and we really wanted to provide patient care the way we wanted to do it, the way we thought it should be done. We both were trained orthopedic manual physical therapist and wanted to use the skill in providing better patient outcomes.
Kristie: When we started the private practice, we received referrals from physicians because they liked the patient outcomes that they were seeing, but we also kept a lot of communication going about the patients with the physicians. We would send plan of care reviews so that they knew what we were doing, and there was a continual reminder that we were there and who we are. We also did newsletters, and at that point we were doing them probably quarterly and they were pretty much goodwill type newsletters, but they also put the name out there. We also did community education classes, where we offered classes on different points of our expertise and how that would benefit the patient.
Kristie: When we first started in private practice, there was little competition. There was just Oakland Physical Therapy as a private practice and the hospital in the area, the outpatient physical therapy from the hospital, and that competition was really easy to work with. We provided a more intimate patient care to our clients, to our patients, and also the outcomes were better than what the hospital was able to create. But as time went on, many more private practices came into the area, a lot of national companies, a lot of companies that were being supported with private equity, and the hospital itself was being very demanding of keeping the business within their structure. So we had a lot of competition in our small area that didn't exist when we started.
Kristie: We bought Product X to increase our numbers of new referrals. And we needed to do that because it became apparent to us that it wasn't enough just to advertise and promote, talking about our quality of care.
Kristie: Product X helped us see, along with killer marketing, what we didn't know. The piece of marketing and advertising where you really wanted to ask the patient to perform a call to action, was really new to us. We were primarily delivering goodwill, good information, letting the patient know what they would receive when they came to PT with us, but we really didn't take that closing action where we're asking the patient to do something.
Kristie: We started Product X in September of last year, and I looked at the whole year, and looking at the entire year compared to the previous year, with only four months of Product X, we were up 10% in new patient referrals. Then going on into this year, I looked at the first three months of this year compared to the first three months of last year, and I was up over 40% in new patient referrals this year as compared to last.
Kristie: We've never had problems obtaining physician or physical therapy referrals. We're in a medical office building, and orthopedic surgeons who are even right next door who have their own PT services refer their patients to us. A lot of private practice physicians in the building who are affiliated with the hospital refer their patients to us, and there's a PT department within my building as well, which is hospital based. From Product X, what I really needed help with was to reach direct access people or patients. From the last three months, from January to March of this year, I've had 28 new patients from direct access from Product X, and 14 of those patients I've turned into physician referral networks, and that absolutely is my biggest win with Product X.
Kristie: In general terms, quality of care for my practice, I think has three important components. One is a very effective and thorough evaluation so that the therapist really knows what's wrong with the patient. Once they know that, then the second important and necessary piece is that they provide the most effective treatment for that diagnosis. In addition to that is they have to be able to train and educate the patient as to what they need to do to overcome this difficulty, this problem they're coming to me to solve today, and also how to prevent it from happening again, and improve their quality of life.
Kristie: When I start a new patient, I'm also thinking about how I may turn this patient into a physician referral source. To do that, I'm really looking to do two different things. First of all, within the context of building my relationship with the patient, I educate them along the way, right from the evaluation as to what the problem is, what I see needs to happen, and how we're going to achieve their best outcomes. For example, in orthopedics, usually people come in because they're having pain, and they can't do something that they want to do in their daily activities. So we really look at those things and bring it down to a level where the patient can join in with me and understand why they can't do the things they want to do.
Kristie: So when I'm working with them, say with manual therapy and mobilizing a joint, which is a somewhat passive movement, I explain to them why I need to do this, why this will improve their range of motion and help them as they begin to progress. Then when we move on, hopefully right away into more active treatment and I'm supporting that passive movement that I was doing with the manual therapy with active movement training and exercise, I also am teaching and explaining and educating them as to why this will help them do the thing that they can't do, say get up off the floor. Also within that context, I'm educating them as to how they need to make changes in their body, in how they perform activities, to help prevent this from occurring again and improve their quality of life.
Kristie: The other thing that is really important in this whole scenario is that I communicate with the physician directly as well. So I've done all this with the patient, provided the treatment and achieved positive outcomes, but the relationship with the patient is intentional because that helps the outcome. But I know that relationship I'm establishing with the patient then goes on to the physician, and does turn into a physician referral source. And I will actually say as we're getting close to the next return visit from the patient, "You need to go in and tell your physician this, tell them how much better you're doing, that the pain is now much less. I can do the functional things that I need to do in my daily life, I'm stronger, my movement is better." So I really prep the patient to go in and say that, I don't just assume they will, I tell them to tell the physician.
Kristie: Finally, a third thing that we do with a new patient coming from a new physician that we don't have a relationship with, is we make an effort to reach out to them, introduce ourselves, explain what we do in terms of our patient care, and we send them materials that they can refer back to, referral pads to make it as convenient as we can for them.
Kristie: My biggest personal win since beginning Product X is feeling really positive about learning something new. This is not an area that I had looked into before, I mostly worked within education within the clinical realm, and I've been really excited about this, I've learned a lot, I feel like I've done a really good job with it, and I find it very rewarding.
Kristie: I see my future with Product X as being continuous as long as I practice. We have continued to refine this whole process, so I see myself continuing with using Product X as a really important, large component in the workings of my office, and continuing to bring appropriate, great new patients in. And we've had some really wonderful patients that have come in through this avenue, direct access because of Product X.
If you’ve been following Breakthrough for a
while, you’ve probably heard me mention the PT Story.
You start out wanting to help people. You
see PT can do that, so you decide to become a PT.
Then you buy the story the universities and
colleges sell you, which is ‘Learn from us. When you do…you’ll graduate
being able to practice at a high level – and will deliver a high quality of
care. Delivering a high quality of care is the most valuable skill in the
And you buy it – hook, line and sinker.
You then graduate…and go to work for someone
Chances are you have a jaded experience…you
don’t like the way the place is run. You have an upset with a process and
Then you come to the realization that the
solution is to be your own boss.
So you do…you go into Private Practice for
But you’re still telling yourself the story the
university sold you on, which is that “high quality of care”
is all you need to worry about. Focus on that, and the patients will come.
But you’re NOT in the high quality of care
You realize you’re in the Marketing Business…and
then the Personnel Business…and then the Finance Business.
And after you have this
realization, you become resentful.
Choose Your Own Ending
Now, to be clear, the basics of this story play out for many
different people in many different aspects of life.
A lot of millennials right now are dealing with a version of
this story that replaces “high-quality of care” with “expensive college degree.”
My point being that you as a person and as a PT are not “defective”
because you have this frustration. It happens.
Now you have to decide how to overcome it.
Because one day you will exit your practice…
You could close your doors and walk away.
You could dissolve your business.
Or you could sell your practice and realize the full value
of the asset you’ve built.
Which option do you want? The typical PT story will lead you
towards the first two options.
The rest of this article is for those owners who are looking
for the third option…selling your practice and realizing the full value of the
asset you’ve built.
In order for that to happen, your business must be valuable
in the marketplace. Someone, another company or another PT must be willing to
give you money for your business.
For that to happen, you need a successful private
practice…complete with metrics demonstrating the value of your business: Profit
(or EBITDA), Income, Expenses, New Patients, Referral Mix, Staff, etc.
Anyhow, in general for your practice to be valuable,
you must have a diversity of New Patient Sources…
And this is where we tie back into Dan and the
Competing with HOPTs and POPTs
I’m guessing most of us dislike POPTS and HOPTS
for one primary reason: the PTs working in those settings have an endless
supply of new patients regardless of how well the POPTS or HOPTS is run.
We, on the other hand as private practice owners,
feel like we have to be perfect…walking on egg shells while we deliver amazing
world class care with pressure to get patients better in less and less time.
All the while struggling not just for new
patients but to get paid by insurance companies for the people we’ve already
It’s an uphill battle, and the only way to win is with our willingness to do things that the POPTS and HOPTS PTs aren’t doing (instead of resenting these things).
Hosting workshops is one example.
POPTS and HOPTS PTs primarily get their new patients
via physician referral (at least from my personal and professional experience).
They’re usually not eager to go directly to the general public, which is
what workshops do.
In order for us to succeed as private practice owners
– we have to be different.
Or as Dan Kennedy puts it, “Be #1 in a category
And to be certain, workshops still require time and effort. But I think the payoff is well worth it.
In the process of running workshops, you’re
going to become more of an authority in your area.
With the right pt marketing strategy in place, these workshops will net you new patients and also give you a lift with all of your other marketing efforts.
And workshops are just one of several direct
access marketing techniques that can help differentiate your practice from the competition
and increase your new patient numbers.
Remember, this is the stuff HOPTs and POPTs don’t
have to do. But if you’re truly looking to be a business owner of a PT or
Physio practice and build a valuable asset…for yourself, for your family and
for your community…then you’re going to have to do the work others are
unwilling to do.
I’ve had the opportunity to speak with a lot of private
practice owners over the years.
Owners who are working hard to grow their business and get
more patients into their practice.
And one topic that comes up a lot in these conversations is
the frustration many owners experience when they try to get “everything” done
and end up feeling overwhelmed.
We’ve all been there.
But how do you get out?
In this article, I want to want to cover in how you can handle overwhelm…think of it as your go to guide whenever you’re feeling stuck and alone.
What’s Your Vision?
Owning your own Physical Therapy practice is no joke.
You’ve got fires to put out, patients to treat, employees to manage, and a to-do list that seems to multiply faster than a pair of rabbits.
Some days everything goes well. You get a lot done, stuff runs
smoothly, and you feel like you’re making some real progress on building the
business and the life you want.
Other days…not so much.
You know, those days where you wish you could call in sick and
spend the day in bed. Where even the simplest task seems too daunting. You feel
In other words, overwhelmed.
So, why do you do it?
That’s not a rhetorical question. What’s your motivation for
owning your own business? What is the vision you have for the future that you’re
working towards each day?
I’d suggest spending some time thinking about these
questions and, more importantly, writing the answers down.
Then, taking 5 minutes each day to review what you’ve
Don’t dismiss this advice. It’s vital not just for
overcoming overwhelm but for helping you actually make your vision a reality.
No, it’s not magic. There’s still work involved.
But what this gives you is a North Star that you can always
rely on for guidance. And when the feelings of overwhelm come, you can take a
moment and remind yourself what all this hard work is for.
Financial Freedom with the ability to open your own PT practice
A new grad DPT reached out to me at the last boot camp in San Diego, he said, “You know, you are not really reaching out (meaning me) to the new grad, people that are coming out of school with their DPT. They want to own their own practice. They want to pay off their student debts. They want to have some time and financial freedom but they don’t know how to do it.”
After our conversation Samir went through the Killer Direct Access Marketing program in which he was able to pay off student debt, open his own practice and hire his mother who he was living with at the time of our San Diego boot camp.
To set a little perspective for you when I went to school my annual costs was around 20k a year. Now education is the bubble that won’t seem to burst. It just keeps going up. I believe the school I went to is over $50,000/year from what I have learned from DPT students. The cost of education is astronomical everywhere.
If you are a DPT student and are coming out of school wanting to pay off your student loans as quickly as possible because you are likely coming out with $160,000 to $250,000.
AVOID the following as a new grad entry-level PT: Don’t try to minimize your lifestyle and just throw all of the money at the student loan.
Let’s say and I will even tell you where the logic comes from… I have done this. I’m not giving you theory. I have paid off my student-debt.
Let’s say you have $200,000 and let’s say it is 8%, so $16,000/year, you are paying just in pure interest. You are not paying against the principal or anything else, so $16,000 a year.
Well the logic is if I can decrease the principal over a few years and get it down really quick, then I’m saving all of that interest money.
Ok, that is fine.
That philosophy actually comes from the Great Depression. If you had grandparents that lived during that time, like I did, there was this idea that you don’t want to have debt. The reason that we didn’t want to have debt is because the bank at any given time could come and take whatever you had debt on. So back in the 1930s, in the beginning of the Great Depression, 1929 and early 1930s, if you had a mortgage on your house and for some odd reason, the bank wanted to claim your house, they could just come and claim your house if you still owed money on it. That is not the way that it is today. It is a different economic environment and there is a smarter way to do things.
Non-Traditional Way of Paying Off Your PT Student Loan DEBT
I’m going to show you exactly what I did because it is very non-traditional. It is now taught. I will give you 3 references. At the end of this video, I will give you 3 books that you can go and start investing in yourself and improving your financial education. But I find that 95 % of PTs don’t want anything to do with learning how money works.
Now they just traded, just think about this for a second, minimum wage which you could have done without your college degree. You could go out and earn…what is minimum wage? Eight dollars or $8.25/hour? So you could earn about $17,000/year. You went, and I did the same thing, we went and bought a college education. My college education was about $100,000.
If you are graduating today, it is about $200,000, $250,000 or $300,000 in exchange for not only helping people and working in a profession that we want to work in but also the idea that we are going to earn more money.
So now instead of $17,000/year, let’s say we come out of school and we are earning $70,000/year. So, we have improved our financial situation by $53,000 in income. However, there is a little error in judgement there and logic. What happens is that $53,000 that we improved upon, we are actually…we have to pay about $20,000 of that in taxes. So, we only get to keep about $33,000. So therefore, if we had a $300,000 education, it is going to take about 10 years, without including the interest payments, for us to break even. Something to think about. Plus we could have been earning about $17,000/year in college during our 5 to 7 years. We are really behind the eight ball here. Again, I want to share with you how you can do this especially if you are coming out of school with a $1,000 to $2,000/month student loan payment.
How can you pay off your Physical Therapy student debt in record time?
This is called an income statement. So it is income and expense. If you are making…let’s say it is $6,000/month or $72,000/year and your expenses are $3,000/month, you have some sort of leftover. That is the whole name of the game with life is that your expenses are less than your income.
Hopefully you did not go out and buy a brand new car the second that you graduated. Or go get a new apartment and have to furnish it with $5,000 to $10,000 worth of furniture or anything like that. Anyhow, that is game number one.
Income must be greater than your expenses. Really, really simple.
A balance sheet is your assets and your liabilities.
So let’s define an asset. An asset for you would be your education. So you have a DPT, you have a degree, you have a license or you are going to. An asset increases your income. So it adds to your income. A liability adds to your expenses. Pretty simple. With this definition, and again this is one of the things that put Robert Kiyosaki on the map is he said, “Ok, is your home and asset or a liability?”
Most people, the majority of people, say your home is an asset. There is this thought that you are building equity over time. That is really a game. A marketing scheme or ploy, a marketing position by most banks who are lending you money. Your house truly is a liability because it adds to expenses.
If you went out and bought a house, even if it is a tiny house, you still have expenses there. You have electricity and plumbing and maintenance to pay for and taxes etc. so, it adds to your expense. If you have an apartment, that is a liability. If you bought a vehicle, that is a liability. I’m not saying don’t buy vehicles. What I’m going to show you here in a second is how you can build out assets and then add expense.
Another type of asset, at least some that I have built over time are real estate. The building that we are in right now, I own 63% of the building. It is a 2.1 million dollar building. We had a 1.8 million dollar mortgage and then that is down to 1.5 million dollars right now. Every month I’m adding $5,000 in income here on my income statement and it is just for paying ourselves rent. Really, really simple. So real estate is a classic asset.
Another one would be my YouTube channel. It is nowhere near the heights of the YouTube days back in 2013 and 2014 when I was making $13,000 a year. But I think I’m making $400 a month right now and it doesn’t cost me anything to do that. So build an asset, just let it run. Really, really simple stuff. That is an asset.
Other businesses that I’m involved with are Madden Physical Therapy here, my partnership with Gilbert Physical Therapy and BPTM. They are businesses that can run partially without me so they are assets. I’m earning money every single month. We have another company called 3 Minute Relief where we are earning money there as well. Anyhow, that is the whole focus, assets increase your income, liabilities increase your expenses.
So what do we want to do? We want to have assets.
So how do you do that? Because very likely you didn’t learn this in physical therapy school. Physical therapy schools do an awesome job at training you to, usually, be a well-rounded PT. You could go into home health. You could go into acute care. You could go into sub-acute care. You could go into long term care or an assisted living facility. You could go into outpatient physical therapy. You could go into peds. You could go into a multitude of settings and succeed.
Cash Flow Quadrant
4 ways that you can earn money:
You can be an employee. That is where you are trading time for money.
You can be self-employed. That is where you are doing that but you are your own boss.
You can be a business owner. That is where you have a system or a series of systems that are working for you.
You can be an investor. That is really just capitalism. You invest money in something.
For example, I am a super minority owner in a fulfillment center in Utah. I think it is 1%. I invested money in. I’m completely passive. I don’t do anything with it at all. There is a return on that investment. It is a completely passive investment. That is an example of I. the main areas that we want to focus on are here (E) and here (B) because there is a chasm.
There is a jump from becoming an employee which is what we learned in school to becoming a business owner. And guess what? You don’t have to be a brick and mortar business owner like this to have an asset that is earning you money that literally will pay for your student loans.
There is a jump here and that jump is going to require you to learn a new language. It is going to require you to put some things into action. Again, this (E) is trading time for money. This (S) is trading time for money for yourself. This is (B) a system, an asset that is earning you income regardless of whether or not you work in it. Again, I will give you an example here, right now Madden Physical Therapy, we have seen 8,000 visits this year and I have seen 6. I invest about 3 hours a week with the staff. We have key people in place. They are awesome people and they run our systems. Really, really simple. I’m no longer trading time for money like I was when I first came out of school and went to work for an orthopedic practice. You can get there too. I’m just showing you what that can look like.
One, you have Physical Therapy student loan payments right now. Maybe you consolidated, hopefully you did and you are either on a 10, 20 or 30 year payment plan. I would leave that as is. Just make whatever payments are required of you. Continue to pay that as simply as you can.
I opened up in private practice September 2, 2003. I was 3 years out of school. On September 2, 2003 and 6 months into private practice, I was making about $100,000/year or roughly $8,000/month. I remember the owner of the building said, “Hey, I’m selling the building. Do you want to buy it?”
We looked at it and it cost me about $5,000/month to buy the building at the time because I didn’t have $100,000 lying around to buy the building. But I knew it was an asset and I knew that it would pay off handsomely over time. And it did. But I remember that I had to sit down with my wife, Stephanie, “Hey, we could be taking this $5,000/month and paying off our student loans. We could go buy a new house. We could go buy new cars.”
I had this junky old Saturn at the time and she did not have a nice car. We were living in basically a 2 bedroom condo/apartment. We really wanted to have a nice house for our family and everything else. I said, “But we really need to do this asset.” It was really not a popular decision but thank God we did that.
That original $5,000/month for 10 months which was the $50,000 that I had to put in to buy the building. That has returned to us as of to date over 1.5 million dollars. So I put 50 in and got 1.5 back and every single month, I’m building $5,000 in equity. By the way, the 1.5 million, we have already received as a return. Anyhow, that is an example of an asset. Not a popular decision. The popular decision, the majority, most people would take that $5,000/month and pay down a PT student loan or go buy a liability like a new car or house.
We chose not to do that. We eventually got the new house. Now we have bought our dream house. We eventually got new vehicles but we did the asset first. Very non-traditional, against the grain but it is the way that you want to think if you are serious about getting out of debt as quick as possible. Payments, the other thing is we didn’t take on any liabilities. No new house, no cars, no new furniture anything like that. We avoided that as much as possible. Obviously, she had a Suzuki Sidekick that did breakdown. We had a newborn so we went and bought a used Toyota 4Runner that was really inexpensive. Don’t take on any liabilities. What are liabilities? They are things that add to the expenses. We want to avoid that as much as possible.
Invest in assets So, you have been educated on how to be an employee. There is an idea that you just want to go out and open up your own business. When I opened in 2003, I had been studying business in one way or another for 10 years. Again, I will give you some books here that you can go to right away but how can you start investing in yourself? I would minimize your living expenses today if you just came out of school.
As much as possible, don’t take on any liabilities and invest as much as possible in assets. Where can you do that? One, you can find mentors. Guess what? They are free. This video that I’m sharing with you right now, I’m just sharing with you how and what has happened for me. By the way, we do have luxuries right now which are amazing. I just took my wife for a 5 day trip in Palafitos, Mexico with a glass bottom bungalow over the water. We are able to go out and buy nice vehicles. She has a Yukon.
We are trading that up for a Model X, the Tesla, SUV. I’m driving a nice vehicle, a Model S. We are able to fully fund our children’s 529 plans which is $28,000/year. We have 5 kids. We are able to pay off our house. Not have debt, not have a mortgage, do everything the right way. But it is because of the foundation that we laid years ago. I share my time with a lot of people specifically young PTs like Samir who are hungry to learn, like you. I did the same exact thing.
When I came out of school, I found 3 mentors really quick. One is in the roofing industry. He is 69 or 70 years old and has flowed a ton of knowledge to me. I was able to learn from what he had done. Anytime I had an important decision, I would just go out to lunch, text him, whatever. I have another one in insurance who is 84 years old now who I have lunch with once a month. Again, Ernie just teaches me awesome stuff about life and how to handle success and failure at the same time. Really good relationship there. Then I have a real estate mentor as well who is in his mid 50s. In his experience, he went 0 to 180 million dollar real estate portfolio with regards to assets.
I learned from him.
I learned wealth management.
I never paid for that advice.
I just asked them to lunch or dinner. I always offer to treat. They always pay. But I just have that sounding board to go to of people who are aware of where I want to be in respective areas within life. You can find those same things. Here is a really quick lesson even though I have done a blog post or a vlog on this in the past. You want to learn and respect their time. So usually what I will do when I get back to my office after we have our meeting, I will just write notes of everything that was discussed and just say,
“Hey, am I on the right track here with my thinking? Is this what you meant to say? Is this what the intention was? Did I really duplicate that principle the way that you meant it to be, your experience?”
And they appreciate that. They are looking for people to flow to. They are usually not looking for money. They are looking to be respected. If you do that, you are going to find some really, really good mentors.
The next thing is books. If you don’t have anybody in your area, if you live in a rural area of the country and there is nobody successful in your area or at least you don’t know how to put forth the effort to find those people, I’m going to give you 3 books to get started with today.
Go to Amazon to pick these up for probably less than $30 for all three.
George S. Clason, The Richest Man in Babylon. Awesome book on money. It is written in Old English. It is a really old but you will get the idea. There is some really good stuff in there that has crossed over into even modern day financial vernacular and talk. That is the classic book. You have to check it out.
Next one…again, I have read 18 Robert Kiyosaki books. This is by far the best one in terms of summary. I hear very few people talk about this but I think it gives the best principles and it expands on this income statement and the balance sheet and also the cash flow quadrant, ESBI.
What most of us perceive as a wealthy person, that person usually doesn’t have money. And people that slide under the radar a little bit, people that wear old shirts…this is a pretty worn out shirt.
We see that and we think that those people have money and they usually don’t. They are usually just somebody who consumes a lot of liabilities and has tremendous expenses. But they are usually behind the eight ball with regards to wealth accumulation.
They usually have very few assets. They are usually just high income earners. So most people who are high income earners here even if they are making 500 thousand or a million bucks a year, like a lot of professional athletes. They don’t understand money management and they get themselves in trouble specifically if that faucet ever shuts off. Because they don’t have a business in place that keeps running. They don’t have any assets.
Physical Therapy Courses
So early on, I can remember being in school and going and taking financial and business courses. It is insane to me when I see DPT students particularly near the end, or entry-level PTs and they will knee jerk with a $500 or $1,000 course. I got to the point where I was investing, I think $43,000 a year was my highest, in my own education.
You can go to the public library and get this for free. Courses, again, I will see therapists who knee jerk at investing $1,000 in themselves but they just invested $250,000 a year to become a higher earner right here. But it is that extra learning how to build asset investment that will take them from $70,000 a year to $150,000 a year or $500,000 a year or a million dollars a year.
Again, I want to wrap this up for you with paying off your student debt. When I paid off my student debt, in the end, I wrote one check to wipe out…I think I had like $15,000 or $20,000 left. But it was because we had assets.
I’m saving more money per month today than what my student loans were. And it is because I did this plan right here.
I focused on building assets. I did not take on liabilities in the beginning and I learned from mentors.
I read a ton of books and I took some really good courses.
Jeff Walker’s company, PLF, they do an awesome event.
Tony Robbins Business Mastery. I believe he has a pretty popular course. There is a lot of places that you can learn from taking both online and live courses. Get out there and do that. Talk with other entrepreneurs, other business owners even if they are not private practice owners and find some really good courses that your peers and friends and acquaintances recommend. I would go to your mentors if you have one or two and ask them where they learned from. And go invest in those courses. It is worth your while.
If you can double your income, your PT student loans are going to be nothing.
If you have right now a $1,000/month PT student loan in your expenses, we are right here, what we are trying to do as fast as possible is find an asset, build an asset that is earning us $12,000 a year or $1,000 a month. Pretty simple to do.