E780 | The 3 Scale Stage Pitfalls

Scaling a cash-based or hybrid clinic is an exciting step, but it comes with unique challenges that many business owners underestimate. In this blog, we’ll cover three major pitfalls that clinic owners face when growing their businesses and how you can navigate these hurdles effectively.

1. Misunderstanding Growth Cycles

Scaling a clinic requires more than just treating more patients or adding new services—it’s a complete reinvestment in your business. This growth stage demands significant financial and mental commitment.

As you grow past yourself—hiring staff, expanding your space, or building systems—you may feel "cash poor" as your profits are reinvested into the business. This can feel frustrating, especially when your business initially provided a comfortable income. However, this reinvestment is crucial to creating a sustainable, scalable model.

Pro Tip: View your business like an investment portfolio. Instead of pouring money into stocks or ETFs, you’re reinvesting in your own company for long-term rewards.

2. Ineffective Use of Debt

Many clinic owners try to bootstrap their growth, relying solely on savings and avoiding debt at all costs. While this strategy minimizes risk, it can also lead to cash flow issues during unexpected delays or slow periods.

For example, taking on a reasonable, fixed-term loan can provide the financial cushion needed to navigate delays (e.g., opening a new space) and avoid the stress of running out of cash. Without strategic use of debt, you may find yourself in a "cash crunch," forcing you to rely on high-interest credit cards or risky financial decisions to keep your business afloat.

Pro Tip: Leverage debt strategically. A manageable loan with a fixed repayment plan can allow you to expand without draining your cash reserves, helping you stay financially stable during growth.

3. Underestimating the Stress of Providing for Others

Hiring staff is a major milestone for any business, but it also brings a new level of responsibility. Your employees rely on you not just for a paycheck, but for their livelihoods. The weight of this responsibility can be overwhelming, especially if your business faces unexpected financial challenges.

Balancing the stress of running a business while providing stability for your team requires careful planning, transparency, and confidence in your ability to grow sustainably.

Pro Tip: Focus on creating a supportive, engaging work culture. A motivated and well-supported team can help drive your business forward, even during tough times.

Is Scaling Right for You?

Scaling isn’t for everyone. Some clinic owners prefer to maintain a lifestyle business, where they have full control and minimal overhead. But for those who want to impact more people, build a team, and create a scalable business, understanding these pitfalls is key to success.

If you’re considering scaling your practice and want guidance on how to navigate growth cycles, manage debt, and lead a team effectively, check out PhysicalTherapyBiz.com. Our experienced team has helped hundreds of clinicians build thriving, cash-based practices, and we’re here to help you do the same.

Do you enjoy the podcast?  If so, leave us a 5-star review on iTunes and tell a friend to do the same!

Are you a member of our free PT Entrepreneur Facebook Group? Join today!

Ready to elevate your practice? Book a call at the link below with one of our expert consultants today and start your journey to delivering unparalleled physical therapy.

Podcast Transcript

Danny:  Hey, real quick, if you're serious about starting or growing your cash based practice, I want to formally invite you to go to Facebook and join our PT entrepreneurs Facebook group. This is a group of over 6, 000 providers all over the country. And it's a pretty amazing place to start to get involved in the conversation.

Hope to see you there soon. Hey, are you a physical therapist looking to leverage your skillset in a way that helps you create time and financial freedom for yourself and your family? If so, you're in the right spot. My name is Danny Matta. And over the last 15 years, I've done pretty much everything you can in the profession.

I've been a staff PT. I've been an active duty military officer, physical therapist. I've started my own cash practice. I've sold that cash practice. And today my company physical therapy business helped over a thousand clinicians start growing scale their own cash practices So if this sounds like something you want to do listen up because i'm here to help you Dr.

Danny here with the pt entrepreneur podcast and today I want to talk to you a little bit about scaling and not necessarily all of the tactical components of scaling but Really the biggest pitfalls that I see that people have issues with when they go to scale their clinic Now when we look at scale, what is that?

When I think about these clinics, There's really three buckets that I lumped them into one is a lifestyle business. It's just you maybe you and a very small team You know, under 500, 000 in gross revenue. But you're very active in the business. And for a lot of people, it's just them, right?

It may just be them. They may be generating, 200, 250, 000 a year in top line revenue very low overhead. And they're essentially just trying to replace their income and probably increase their income working for somebody else, but they've created a job for themselves. That's not really.

A business that has been scaled up. This, the second portion of that would be something that I consider more of a midsize clinic for a cash or hybrid clinic which is really going to be somewhere between half a million and maybe 3 million in top line revenue. And this is an area in which you will have to scale your business.

And the reason that you have to scale is because in order to get. Past, that sort of half a million mark, did you have to grow a decent sized team? And you have to build systems and you have to have a lot of repeatability that doesn't necessarily involve involve you. The last thing would be to replicate that business in multiple places and really to scale it over 3 million in top line revenue to for many people, somewhere between three and 10 and have something that's very sellable and have a big sort of home run exit with those businesses, but.

In regards to what we're going to talk about today, the things that I'm going to talk about are the pitfalls that I see with people when they decide they want to scale a business and sometimes they realize that they don't want to after they have gone down this path. And that's okay because the thing about a lifestyle business is it'll always be there.

Um, some people realize that's all they really want it. Like they really like to treat patients. They have a hard time giving up trust and managing other people. They don't want to really do that. They don't really enjoy having a staff on. They want to keep things really small and simple but be able to still work with patients in a very kind of one to one manner.

And also, be able to control their schedule, right? They have time flexibility and that's a huge advantage of a business like that. But you can always fall back to that. You can always scale back down to a lifestyle business. If that's what you choose to do, right?

For a lot of folks though, they do want to grow a business past themselves. Personally, one of the most rewarding things that I've ever done is grow our Clinic, with my wife past ourself when we started to hire staff, when we started to be able to create great jobs for people that, we felt a lot of pride around having created a company that was able to provide.

and a living for people that we really respected and enjoyed working with. And, that's a really cool thing. It's a very special thing that I, um, I think a lot of people would enjoy honestly, but there's also downsides to it. And I'll talk about some of the things that, maybe you don't ask you underestimate the challenges of, dealing with other people.

But when we talk about pitfalls of scaling. There's really three big ones. And I've talked a bit about growth cycles in the past few months, but the first major pitfall is not understanding growth cycles. So number one, a a growth cycle is where you are intentionally, working to grow your business and, and to grow it to a stage that is significantly different than where you're at.

So one growth cycle is when you first start. That's technically a growth cycle. It's generally far more mentally challenging than it is anything else. There's just a lot of fear around whether you're going to be able to get patients and getting turned down by other people.

Like these are things that by the time that you go through, through that and you get to your, this first growth cycle where you're going to grow past yourself and you're going to take on additional overhead and staff and all that stuff. You've already dealt with a lot of that stuff.

And and you have to, in order to get to this stage anyway. But what you have to realize is as you go through a growth cycle and you're growing your business to scale it past yourself, you're essentially reinvesting in your business as if it is a. Publicly traded company. So imagine you start your lifestyle, you start your business.

It's a lifestyle business. And let's say you're making 10, 000 a month in income from that. And you're like, Holy crap, this is pretty good. Like I'm, I have pretty good income, probably better than wherever you were working before. And then as you go through a growth cycle and you decide, okay I'm going to reinvest in my business and I'm going to grow this past myself.

Instead of you taking that income home, and then maybe you take that income and you invest it in, let's call it a, ETF of the S and P 500 or something like that in a, in the stock market. Instead of that, you say, okay I'm not going to do any of that. I'm just going to reinvest in my own business.

So you take out money and you put it towards growing your business past yourself so that you can have an increased income stream. You can have less active revenue. You can have something that has far more enterprise value. You can potentially sell one day, right? The challenge is you feel very broke while you're going through this.

And it has a lot to do with the fact that you're used to a certain level of income. And now all of a sudden it goes down. So you see your top line revenue go up. So your gross revenue goes up. Let's say maybe you go from making 200, 000 in top line revenue to 350, 000 in top line revenue as you bring somebody else on another staff member, but you've increased your, You've added administrative support.

You've increased your tech stack as you bring, additional tools on to help manage the clinic. You've increased your marketing budget. You're now paying a whole nother salary to somebody plus benefits. And this increased revenue. On the top line doesn't really equate to net profit because you are intentionally investing in your own business.

So imagine you were taking those dollars that you would put somewhere else and you're reinvesting in your business. And that is actually an incredibly important distinction that you need to make is that when you decide to grow a business past yourself. Is that you are investing in your own business instead of taking money out of the business and investing it somewhere else, which is what you have to do with a lifestyle business.

And eventually you get to that point as you grow your net profit in whatever size clinic, you're going to grow your business too. You have to have that mindset of instead of me taking this money and then allocating it somewhere else as an investment, this is now my primary investment.

And that is a mindset shift you have to make as you go through a scale stage. So that is the pitfall, the first pitfall that I see, which is not understanding growth cycles and the mindset difference of a growth cycle. The second thing is not understanding how to use debt. And this is something that many cash based clinics.

Don't really ever have to deal with they, you can start one of these businesses for very little money, a couple thousand dollars low barrier to entry, right? You can keep your overhead really low. You don't have to see that many patients in order to offset your income working somewhere else to be able to go all in on your own business.

If you're just going to make it a lifestyle business. So there's very little risk as well as there's very little. Financial complexity to these businesses. And I'll give you a good example as far as, I guess a adjacent healthcare field, I have a friend that's a veterinarian and he grew his veterinary practice to a couple locations, sold it.

And now he does JV partnerships with other veterinarians in the country, around the country and helps them on the business side. And one of the things that he told me was when a veterinary practice starts, it typically costs between 700, 000 and a million dollars. For most veterinary practices to just get started.

And many banks have specific loan programs just for veterinarians. And that's shockingly high, that's a lot of money. Even though the default percentage on that, the amount of loans that don't get paid back or defaulted on is like very small, it's one to 2%. So it's very low failure rate, but it's still a lot of money.

And especially. Like any post graduate education provider might have, we have a lot of debt coming out of school. So you already are risk averse to that. When you go to grow your business past yourself, you, many people, they try to bootstrap everything. And I did the exact same thing.

The only thing we took a loan out for was was equipment that we had. So we had. Equipment that we had purchased via equipment loan for the business as we expanded it. And that was even that was hard for me to do, take on a loan like that. But for many people, they bootstrap the whole thing, right?

So what they do is they save cash up as much as they can before they go and they grow into, um, they're into the new business that they're going to build. So you go from this little subleased office in a gym or in another clinic or something like that, to then all of a sudden you bring on the overhead of your own space, plus all the equipment and potentially maybe there's some build out loans associated with that.

And there's usually. No debt whatsoever that anybody takes on. They don't take on a loan. They just try to pay for everything themself. And this is where we can hit what's called a cashflow crunch, right? Or have cashflow issues where if you spend all the cash reserves you have, I think on the expansion of your business and you hit a, Slow period as you're growing, you're going to have this period of time where you are very cash poor and it's going to feel very sketchy.

So you can definitely do this. And I said, we did this aside from equipment financing. But I remember, sitting on the couch of, with with Ashley and looking at our business account. And, we had gone from a little over a hundred thousand dollars in business reserves that we had saved up over the first, I guess it was like roughly 18 months that we were in business.

And then we went through our expansion built our location out, hired staff got very delayed on the, Opening of our location and by the time that we were able to open it was about six months later and we had Less than ten thousand dollars of cash reserves and we were like, holy shit. This is not good.

So we needed to have you know a fast start which thankfully for us we did, you know The first month that we were actually open in our standalone space. We essentially had a pr month by Almost two X of what our previous best month had been. And that really helped put us better into a better cash position, but it took us a long time to build back up to where we were at before, which is normal, right?

Because you're reinvesting in the business. But when you think of other ways to go about this, there are, intelligent ways to leverage debt and to get fixed debt that allows you to then use somebody else's money to expand your business and do so in a way where you have a very reasonable.

Monthly payment and you don't have to have the stress of literally all your cash reserves going away because the game is basically to stay in the game. That's business, right? Stay in the game, grow to wherever you want to grow to. But the way that you get kicked out of the game is when you don't have any money left.

And and then from there you have a tough decision to make. It's do you go into the hole with at that point, very sketchy debt. Cause if you go to a bank. And you want to get a loan to expand. You're in a very different position than if you go to a bank and you want to get a loan to stay in business.

You're not very lendable at that point and you're considered a much higher risk versus you're doing really well. You have cash reserves. You are expanding. So things are obviously going well. That's a very different place to be. You do not want to necessarily be on the other side of that. So to go there and try to get money at that point is tough.

And really you're looking at most cases is very high interest rate debt, potentially just credit card debt. And that. Again, put you in a very sketchy spot where we see people, if they go that direction and they can't dig themselves out of that hole, then that's when bankruptcy occurs and business shuts down and businesses close all the time.

By the way, I see it happen constantly around me. And I think a lot of this is number one, sometimes it's just a bad business idea. Hey, sorry to interrupt the podcast, but I have a huge favor to ask of you. If you are a longtime listener or a new listener and you're finding value in this podcast, Please head over to iTunes wherever you listen to the podcast and please leave a rating and review This is actually very helpful for us to get this podcast in front of more clinicians And really help them develop time and financial freedom.

So if you do that, I'll greatly appreciate it now back to the podcast But these are not bad businesses. People are constantly hurt. People are constantly looking for somebody that can help them get out of pain and back to things they like to do. There's a massive need for this. I see some businesses and I'm like, is there a need for that?

No wonder that closed and, or they're really bad at running a business. And one of the biggest things that I see is that they don't understand how to manage their finances. This just happened recently in my neighborhood, there's this great pizza place that is on the other side of the park from where we live.

And it's probably my favorite pizza in the area. They're always busy. And from my understanding, a friend of mine is in the restaurant world. And he was telling me that they're not doing so well. And I was shocked because they're always busy. And he said they had opened a second location and the second location was doing really poorly.

They opened it in a spot that was unproven. They had a new sort of like manager in that, that second restaurant and it wasn't doing well. And the first restaurant, like the pizza place that I would go to was essentially floating the other business. And it got to the point where they couldn't do it anymore.

And now they've had to close both. And this is a casualty of scale, right? And this happens all the time. And I can only imagine that it wasn't managed very well. They didn't manage finances very well. They didn't have a clear plan of how they're going to expand. It goes, expand to a second space of anything is really hard because the owners can no longer control everything.

On a day to day basis. That means you have to have really solid training and systems. And it's very hard to have a second location for a service business like that, like a restaurant, a clinic, something like that. So when you look at the second pitfall, it is not understanding how to use and manage debt.

So if you can get a loan that allows you to have a fixed duration of time in which you can pay that back and it's manageable based on the net profit that you have in the business that puts you in a far less sketchy place than if you're trying to just bankroll everything yourself and and pay for everything in your own cash reserves, because what if.

What if something delays you like us? What if you go from thinking you're going to be open in eight weeks to then six months later, you're finally open. That's exactly what happened with us because of a lot of, it was just certificate of occupancy things that needed to happen that were slowed down.

They really had nothing to do with us. It had to do with the building. It had to do with the contractor. Nothing you could foresee with that that we knew. And I tell you what, if we had some sort of cash reserves that we could pull from and had managed debt much better, had managed finances better, we would have been far less stressed out, which was very stressful.

It was very hard thing to do. And we learned a lot from it in a, in essentially a negative way, but this is one of the bigger areas that I see is just not understanding how to actually manage your debt as you go through this. And it can feel very sketchy for people, especially people that are.

But it's very similar to buying a house, right? Like you can take every dollar that you possibly have. Let's say you have every dollar to your name is everything you need to be able to buy a house, right? A hundred percent. You buy the house in cash, but then you have no emergency fund.

You have no savings. You have no investment anywhere else. And you're completely. Cash poor, but what if, something happened, what did you have to fix something in the house? What if somebody gets sick? What if, your car breaks down? Like you don't have any money to pay for anything else.

It's not a financially prudent thing to do, but yet this is what happens with people with their businesses because they already have a lot of student loans. They don't want to take any more debt out, which I get, but it's not the same thing. You're essentially leveraging someone else's money in order to grow your business to a different place.

So using a managing debt is the the third big pitfall that I see. Or the second big pitfall that I see. The third one is not not understanding the stress that comes along with providing for other people. So this it's hard for you, for someone to understand what I'm going to say, unless they have actually done this, but when you, Assuming you care about that person, which I hope you do if they're, you're hiring them to work for you.

You don't want to put them and their family in a terrible position, which would be, not being able to provide the income. You're telling them you're going to be able to pay them. And this is something that I very much underestimated. And I definitely had quite a few street sleepless nights stressing over it.

Paying my staff salaries as we were growing their schedules. And, if you are convincing other people that have jobs, that they need to come and work for you and you're unable to fulfill on that, it sucks. And having to let people go sucks because to me, I always thought this is how my people pay for their house.

It's how they feed their kids. It's how they. Are able to save for the future tell it by Christmas presents, right? It's things like that and The stress of providing for other people is real like it is no joke It's like having kids right once you have kids You realize holy crap. I gotta buy all this stuff It's expensive diapers are expensive and food is expensive and child care is expensive and all the all these things that are just you know Part of being responsible for another human being.

When you hire people in your businesses, the same thing happens. And there's this like really huge burden that it feels like this sort of sense of responsibility to do the right thing and to help support your folks. If, if you have the right intentions with them, I think if you don't, then you have even other problems, right?

If people think that you don't care what happens to them, like they're probably not going to want to stay and work for you very long. It's almost a catch 22. If you actually really do care about your folks, then you're going to have a sense of responsibility around them. And that creates a lot of stress.

And I vividly remember, I remember thinking I was going to have to let go all of my staff for a period of time when we were going through our growth cycle, even because we'd hired staff and it took way longer to open our space. And I just felt so bad about it because they hadn't done anything wrong.

Uh, we made mistakes in terms of how we grew the business and we ended up not having to let any of our staff go, but man, it got really close because we didn't really have much money left by the time that we were able to open our space. And I don't know if they could tell, they probably could how stressed we were.

I hope that maybe they couldn't and we hit it pretty well, but. Sometimes it's hard to hide that. And and you almost have to though, you don't want your staff to think Oh, is my job safe to start looking for other things that they can do and other opportunities. And that's, that is the challenge and as well as frankly, the best part of the business, the people that you get a chance to hire and work with the culture, get to build the tone you get to set as the owner of the business is just honestly, I think it's the best part of all of it time, financial freedom, all these, but.

Byproducts of a successful business. I think the people are the best part, in the culture and being able to do cool things with a group of people that you're able to curate. You pick these people to work with, right? You're like, all right, I want you on my team. And sometimes it takes a lot of convincing.

You have to sell people on why they want to be a part of your little business as it's growing. Cause they viewed as sketchy and a risk. And you view it as this awesome thing they get to be a part of, but it's not necessarily the case. Like for them, it versus the stability of working for a larger organization.

It's far different. Underestimating the stress that it provides or that provides you when you have to actually provide for other people, the stress that comes with that is a massive thing that people underestimate. That is another big pitfall when it comes to scaling. So if you're looking at growing your business past yourself, and this is really what I think of is like the first growth stage where you're growing.

Yourself into a standalone space. And hiring staff. Now, if you're growing into a bigger space, then you've already gone through some of this stuff and there's other challenges that come from that. But this is the stage where you're growing past yourself. These are the three big things that I see.

And hopefully you're aware of them. Then it can be less of a problem for you. You can avoid some of these. So number one is just not understanding what you're getting yourself into. Not understanding growth cycles, not understanding that you can't grow without some growing pains and you're going to have the pain is going to be felt in terms of time.

Okay. You're gonna feel very time poor and you're going to feel very cash strapped, right? Very just like cash poor as you reinvest in the business. Number two is not really feeling comfortable using debt or knowing how to use debt effectively. And by doing so, again, being very cash poor.

Because you're essentially bootstrapping everything which can be fine, but there's definitely better ways to go about it more effective ways to go about it in, in, in order to be able to like, honestly grow the business even faster, but but be able to do so in a way that is just safer for you to not, Run out of cash and run out of, and not be able to run your business.

So number two is is not understanding how to use debt. And then number three is understanding the stress of providing for others, not understanding the stress of having another person that depends on your business, being successful for them to buy groceries for their family, for them to be able to pay their student loans, for them to be able to pay their mortgage, for them to be able to do the things they want to do in life.

That is a massive responsibility. It's actually a reason why I think a lot of people never hire people. They either are afraid to be able to provide for them to feel confident they can grow the business at that point, or they're scared that person's going to take their intellectual property and their secret, whatever they think they have, and they're going to go take it and they're going to go do something on their own and take all their clients.

Like these are the two big reasons that I see people not really ever want to grow past themselves is they're just scared somebody's going to steal everything they have, or they're scared that they're not able to provide for other people and they don't feel confident enough as a business owner in order to do but those are the three big ones. The last one being just the stress of providing for others. But I will say this, at this point, having started multiple businesses and grown multiple businesses past myself These stages are tough. Always. It's not just every time that I've done this in a business, it's been hard to do a couple of things.

Number one, give up control to other people is very hard, especially when, this is your baby. This is this is the thing you've created that is unique to you. You're the one that's done everything. You're the one that's. Sold, marketed, fulfilled everything. That's a very hard thing to do.

So just the mindset of growing past yourself can be tough because you have to give up control to other people. And then understanding these other variables it gets easier, once you've gone through one growth stage but just the challenges of these is what stops a lot of people. But it's for the right person.

If your goal is to. Impact more people. You have to do that with people besides yourself, right? You're going to be limited by. Time at a certain point. So depending on your vision, depending on what you're trying to accomplish, you almost don't have a choice. So you either have to work on this stuff.

You have to improve this stuff. You have to learn how to manage these growth cycles, which are so tough or else you're not going to be able to, I'm going to be able to help more people. And for me, that was always like such a very impactful, rewarding thing. When I went from seeing, let's say, I don't know, a hundred visits a month, in our clinic to 400 visits a month in our clinic, what a difference that made.

In our community, what a difference that made to people that, that lived around us that were in niches that we worked with. I would see it when I couldn't go to a festival in the city of Atlanta without bumping into a handful of people that we've worked with. It still happens to this day. I haven't seen patients in years.

And I still run into old patients constantly. And it's so freaking cool. It's awesome. And they're not always mine either. Ashley and I, we run into people for her running the business, she interacted with a lot of people. And so did I, people that I didn't even work with, and they have such great things to say about our staff and the work that they did with them, the things that helped them do.

And it's just so cool to know that you're making an impact on so many more people. So the pros and cons of this are, yes, there's challenges you have to deal with. There's things you have to learn. There's risks you have to take that you have to learn how to mitigate and be okay with.

But the pros are the ability to really help many more people, the ability to provide jobs to really great people the ability to build a team and culture that you're, there's uniquely you the creativity associated with that is just, fantastic. And. And be able to grow your skillset in a way where you're able to run a business that is far harder to run and to grow through stages that are very difficult.

And that's a challenge that I think for many of you, it's very worth taking and very worth going on that adventure, I guess is a good way to put it because it is challenging, but you will learn a lot about yourself. You'll learn a lot about where you're capable of, and you'll be able to help out a lot more people along the way.

So if. You're looking at trying to scale your business past yourself. And these are things that you feel like you do need to get help with and you want some help on growing past yourself and doing it the right way and not making some of these mistakes that legitimately might take you out of the game of business.

Head to physicaltherapybiz. com. Check it check out what we're, what we're doing with clinicians all over the country. You can read some case studies on people that we're, we've worked with. You can get resources there that are totally free. You can learn about our team. You can learn about who, we work with.

And if it makes sense to you and you want to have a conversation with one of our business advisors, then, there's a big button. Where you can you can pick a time to talk to one of our staff and these are people that have worked with hundreds of people all over the country, and they evaluate these businesses on a daily basis.

So if you want to get another pair of eyes on your business and get an idea of where, You fall as far as benchmarks are concerned for the businesses that we work with. That's exactly what we'll do. And that's what it looks like when somebody decides that they may maybe want to get help from us is that we want to look at your business and we want to see where.

And if so, what areas do we need to help you improve? And if not, then we want to help you just find the right place to get that help, and help make the handoff to the appropriate person. So if it makes sense, head to physicaltherapybiz. com. Check out what we're doing and hopefully get a chance to have a conversation with you and maybe help you in the future.

And if not, hope you enjoy the podcast. I hope that you enjoy learning about what not to do in the scale of phases of the business. And as always, thank you so much for listening to the podcast and I'll talk to you next week.

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