E614 | The State of Cash-Based Practices 2023

In this episode, Doc Danny discusses the current state of cash-based practices in the US in 2023. He shares the trends that he has observed and encourages listeners to check out the results page on physicaltherapybiz.com to understand the value of working with them.

Danny is optimistic about the growth of cash-based practices and explains how they are becoming more popular as people recognize the need for an overeducated personal trainer to help quarterback their health and wellness. He discusses how even small towns have seen success with cash-based practices, with some breaking the seven-figure mark.

Doc Danny also emphasizes the importance of customer experience and outcomes when it comes to getting referrals for a business, and notes that clinicians are increasingly looking for cash-based practice jobs for the work-life balance.

He suggests that cash-based practice owners need to match the compensation models of higher volume in-network settings in order to attract high-quality employees. Additionally, he discusses the potential benefits of using artificial intelligence for content creation, clerical work, and research.

The podcast episode also touches on the challenges that cash-based practice owners face, including increased competition from larger hospitals. Danny notes that in order to compete, cash-based practice owners need to be good at marketing, dominating a niche, providing great customer experiences, delivering consistent outcomes, developing relationships, and maintaining a good reputation.

Finally, he recommends that physical therapists take advantage of the market opportunity while it is still available, and emphasizes the unique opportunity they have to help others with their health and wellness.

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Podcast Transcript

Danny: Hey, real quick before we get started, head over to Facebook and join the PT Entrepreneurs Facebook group. If you haven't done so yet, we have monthly live trainings going on there. There's an opportunity for you to join in the conversation instead of just listening to what I have to say on this podcast, as well as the people that I bring on, and it's a really cool place to join about 6,000 other clinicians that are.

Honestly trying to change the landscape of our profession through these cash and hybrid practices. One other thing that's really cool is we have a guide in there that's a quick start guide. When you join, you can go and check this out. There's about seven videos that we've curated that are the most common questions we get, and the best case studies that we've found to really help you start, grow, and scale your practice up to seven figures.

So if you haven't done so yet, head to Facebook request to join the PT Entrepreneurs Facebook group. You have to be a clinician. We're gonna check you out. We don't just let anybody in. But if you are head there, go ahead and get signed up. We'd love to have the conversation with you in that group.

So here's the question. How do physical therapists like us who don't wanna see 30 patients a day, who don't wanna work home health and have real student loans create a career and life for ourselves that we've always dreamed about? This is the question and this podcast is the answer. My name's Danny Mate and welcome to the PT Entrepreneur Podcast.

What's going on guys? Doc Danny here with the PT Entrepreneur Podcast, and today we're talking about the current state of cash based practices and. In the US in 2023, and what I'm gonna do is I'm gonna share with you some of the things that I'm seeing on a 30,000 foot view. This what this is a common air force term.

When you're flying 30,000 feet things a lot differently than when you're boots are on the ground and you're you're in it, right? It's it's hard to see the forest through the tree sometimes, but what. I get a chance to do with PT Biz. One of the cool things that, that I guess I get a chance to see is the momentum, the trends, the things that are changing within the cash based world in particular.

In particular, the performance based. Niche within the cash based world. That's our bread and butter. That's what we crush it with. That's what I built my practice on, is really helping people get outta pain, but then getting back to some sort of physical activity some sort of physical goal that they have.

And and that's, primarily who we work with and have now for years and currently. We're working with close to 300 businesses that we get a chance to be a part of that business, communicate with on a very frequent cadence, and as well as see a lot of the data.

That is coming from these practices in terms of patient volume, demographic areas that are working well, marketing that's working well, sales is working well. Hiring trends, like all kinds of things because we track a lot of that to help these businesses be able to more effectively run their business.

So what I wanna do is be able to share with you some of the trends that I'm seeing in 2023 and some of the things that I'm seeing as we go forward that are probably going to happen. At least my best assumption of what's gonna happen based on the data that I'm seeing now. If you're thinking about starting a practice, this will be, applicable to you.

If you have a practice, this probably is gonna be even, more helpful just to here are some of the things that we're seeing, what's working and make sure that you're doing those things. And if you're trying to figure this out all by yourself, by the way, you don't have to you can head to physical therapy biz.com, check out what we do.

Pick a time to talk to one of our advisors, because let me tell you something, it's, it is, So much harder to try to figure out all this stuff on your own versus the shared information and what's working with 300 other clinicians that are so similar in terms of how we work with people. It's the benefit of being a part of a franchise with.

Without actually like being in a franchise, it's your business. We don't own any of it. But we get this shared information across channels that is so helpful and so valuable. And there's a reason why most people that we work with stick around for years and years within the Mastermind. It's because they see so much value from actually being able to interact with these other individuals, for us to be able to work with them on their business and to.

To see this ever evolving world that we're in especially within the business world to where we can really make more of the right decisions and be ahead of the curve versus trying to play catch up. So if you're interested, head of physical therapy biz.com, check out what we're doing, just check out, go to the results page and they'll speak for itself.

If you're on the fence about working with us we actually like truly help people. There's a lot of people that have not done what they're teaching other people how to do. We've done it, we've done it now with hundreds of clinics all over the US and Canada and even other countries. But anyway, let's get to this.

So I'm about as optimistic on cast BA based practices as I've ever been. And and I'm pretty, I would say I'm a big fan of 'em obviously, but, What I'm seeing now is more and more people independently being aware that these types of practices in per in particular, they're performance based niche, where they're looking for this sort of, it's almost like they're looking for an overeducated personal trainer to be their like to help quarterback their health and wellness.

They don't know what they're doing. I see this in my neighborhood. All the time I see this in networking groups that I'm a part of and, some of these groups I'm around a lot of very successful smart people. And legitimately the most valuable thing I can talk to them about is why their knee hurts.

The most valuable thing I can talk to them about is how they can change their eating habits or improve their sleep, or how they can, pick up their kids without their back hurting. It's the most valuable thing that I know, and I don't even treat patients right now. Think about that for a second.

It's the most valuable thing to the world to, to the people around us and yet we undervalue it so much. I could sit down and I could show these guys how to build out, a. A business consulting company and a remote sales team and, overhaul their marketing and they don't care.

All they wanna know is why their wife's wrist hurts. It is so valuable and we undervalue it continually, but I'm telling you, the market is catching up to us. They're looking for people like us, and a lot of this has to do with content that's being put out there. People that are, have been leading the way for a long time.

Like Kelly and Juliette stt, the new book they've had, they came out built to Move. It's stuff like that's getting people to realize, oh, I do need to be a little bit better, with these things. And you have a unique opportunity to build a business around being able to help those people who are actually looking for you as, especially, like I said, those performance based niches where you can say, man, I help.

I help runners get outta pain and get back to running, half marathons or whatever, pr their 10 K or just do their first 5k, whatever, like whatever it is that you want to do, dominate a niche that's movement based. People are looking for you. Deductibles continue to increase. And HSA plans continue to be at an all time high.

As far as companies offering those and people taking those, in many cases, companies only offering one option, which would be an hsa. They don't have many of these other healthcare plans they used to have as options anymore because, The cost of healthcare continues to rise ridiculously so I don't understand it.

I don't understand how this stupid ass healthcare system works and is so inefficient that we spend so much money on basic health standards and there's so much more skin in the game for people, even if you're in a bigger company, like if you're in a giant. Like consulting company, like a pwc or a Deloitte or these big four firms, or you work for like a Google or Facebook or something like that.

Okay. Maybe you have an awesome healthcare plan. The rest of the people that work for most other companies, they are gonna have typically higher deductibles. A lot of 'em are gonna be HSAs. And a lot of people are self-employed. More people are self-employed now than they were even two, three years ago.

Many people left their jobs or they were furloughed, during covid and they just never went back. They got jobs doing, 10 99 contractor work and they. They like it more. They have more flexibility. Maybe they make it make more money, but they have more on their own in terms of benefits.

So a lot of these people have high deductible plans. They have HSAs potentially that are connected to those, and they are informed consumers, and it's, there's more and more of these people every single year. Now, why is that a benefit to you? Because they got skin in the game. It's their dollars.

They are looking for where they can get the most value if they go to a hospital physical therapy clinic. They're gonna pay just the same amount, if not more, as if they go to a niche based performance clinic that works with people like themself within whatever the sport is that they want to actually function it.

So the playing field has become far more level, and in many ways it's in our favor. If you're comparing somebody where they get to spend an hour one-on-one with a. High level clinician that knows and understands the ins and outs of that person's niche so well that they can literally articulate it and understand every problem, versus they go to a generalist that has no idea besides basic, get you outta pain, get you back to a baseline.

What do I do you after that? I have no idea. Discharge. Who are you gonna pick? Oh, also that other clinician's probably seen a couple other people at the same time, it is an unfair advantage that we have. We just have to be able to tell people that. They have to understand that there's a difference, and that's marketing.

That's getting out there with your content and meeting people, and that is where we're seeing a lot of traction be made because the playing field is very level now. So we have now seen over the last couple years that the seven figure mark has been broken in completely, cash based practices in cities as small as about 200,000 people in the population.

This is something that I definitely, I would say 10, roughly 10 years ago when we started our practice, no way in hell I was like, 200,000 people, there's no way you're gonna build to build even like a six figure practice. And that's like good town. It's too small. You gotta be in a big city, you gotta be in a big metropolitan area.

And that is just not true because people are looking for these types of services everywhere and in small to mid-size cities. I actually think it's a bit of a sweet spot right now because there's less competition. There's less great clinicians than if, if I go to Manhattan in New York City, I can throw a rock and probably hit three great clinicians.

If you take that same high level skillset and you drop yourself into a smaller town of a hundred to 200,000 people, now all of a sudden you're the best game in town. Like you're light years better than everybody else, and. You can have more of an advanced approach. It's different. Like people will see that and it's, you're gonna have a lot more business than we probably know what to do with for now until other people realize that they can do the same thing.

So we've seen the seven figure mark be broken in towns as small as about 200,000. We've seen the six figure mark be broken in towns as small as 10,000 people in population. Now keep that in mind. These are businesses that are. We thought, okay, maybe you can have a lifestyle business in a really small town like that.

But for sure you can grow a six, multiple, six figure practice and be able to bring on other staff in a small demographic size town. Again, it's because people, it's the playing field is getting leveled. They are having to put more money into it themself. They have more skin in the game, so they want to go to the best providers that they can, and now they're becoming informed about that.

And the more that we get out and we, be part, become part of the niches that we wanna work with in the community that we want to be a part of, the more people realize who you are. And then it's like a no-brainer. It's like, why would I go see this person when I could see this ninja over here that knows exactly what I'm talking about?

And the price is the same, like it's an unfair advantage. We're seeing this. In small towns, midsize towns, obviously cash-based practices and cash based practices out narrow practices, they do really well in bigger cities as well. But we're seeing this mid-size where it's a bit of a sweet spot. Right now there's just less competition, but still a lot of people to to work with new patient efforts that are working.

Okay. And these haven't really changed too much, but I will say that there's a few things that, that I'm seeing. That are definitely trending in certain directions. So one of the things that we're seeing is cost to acquire with paid ads continues to rise. So here's what I mean by that. You might have been able to get somebody in the door with an ad, and I did this for years with Facebook ads for our practice.

I could get somebody in the door for like a hundred dollars offer for probably 20 bucks, right? And. I look back on that and I'm like, why didn't I spend so much more money on ads back in the day? It's because I didn't know that it was that great of an ROI in comparison to where it is today. So today you might be spending, 50 to $70, to get somebody in the door for maybe a 90 to a hundred dollars offer.

Maybe even break even. Maybe you're spending, a hundred bucks and it's because cost of acquisition is going up. There's more and more people that are advertising. On digital platforms, and you gotta think of it like a newspaper, right? It's, there's not an unlimited amount of space in a newspaper for ads.

They have to have some content in there, otherwise no one would read it. Same thing with magazines, whatever. Digital platforms are the same way. They can't take up all their real estate with ads otherwise nobody would get on those platforms, right? So if you just saw nothing but ads on Facebook, you just wouldn't be on that platform or on Instagram or whatever it is.

So they only can allocate a certain amount. It's starting to become, it seems like more and more advertising space, if you've probably noticed the same thing. But there's not an unlimited amount. So with the space that's available, they're gonna increase the cost to advertise there. And especially as bigger companies start to do more and more of that, they just buy up more of the real estate across the board.

It's like Coca-Cola branding, right? They used to do this with billboards and with commercials Radio, all kinds of stuff like that. And now digital advertising is a really big part of their marketing, which means there's less real estate for small businesses like ours. And the cost to advertise continues to go up.

So that means you gotta do one of two things. A either be really good. At ads and be a ninja when it comes to that stuff. Get a really good agency that's gonna help you with that, which is probably even harder to find. And then be really good on the sales side, right? So you gotta be really good at being able to get people to commit to working with you and solve a problem and commit to a plan of care.

Otherwise your ads are gonna eat you up and you're not gonna get much of a return on investment from that and maybe potentially negative return on investment. So the other areas that are working really well, content still is king. Whether that's content on your website with blog posts and really ranking for search engine optimization and driving people via you being a subject matter expert in a certain niche in your area, that's still very popular.

Local relationships, they are not going anywhere. And if anything, are becoming more and more important. So those of you that are really doing a good job of being a part of your community, being a part of the niche that you wanna, really help and serve and being a part of an ecosystem of other providers that can really refer in between each other and have this sort of ecosystem of health and wellness.

That's gonna be a really key thing for you to maintain and really solidify those long-term relationships, not just for you, but for the people that you're working with as well. Because to be a, a good referral partner, you have to refer to those people as well, right? So we gotta keep that in mind and be a part of the relationship, not just one, one-sided referrals, primarily driven by customer experience and results Now.

Most clinicians think I'm gonna get these amazing results. They'll speak for themself and people will just send all their family and friends to me. I wish it was that simple. That's part of the equation for sure. So getting great outcomes is half of the battle when it comes to getting somebody to refer somebody your way.

The other part of that is how you made them feel. And the experience they had when they came into your building, when they came into your facility and they worked with your staff and your team. That could be how your, your front desk, office manager is engaging with people on how they're using their first name and being, timely with your providers, being always seeing people on time every time with them being very diligent about sending.

Thorough follow up guidance and making sure people understand what's going on, checking in on them. That could be like relevant gifts at different times with milestones that they hit, or something like that. It could be somebody's, family member dies and you send them flowers. Like it's the experience people have when they're at your facility or when they think of your company.

What kind of experience do they think about? And then that plus great outcomes increases the likelihood that somebody is gonna send somebody your way dramatically. And the customer experience side outweighs the outcomes in a lot of ways. Isn't that strange? Don't you think it would just literally be like, oh, they solved my back pain.

Yeah, that's helpful. But they solved my back pain and oh my God, I love their office manager. I just go stop in just to talk to her like that is what drives viral. Referrals, wic, word of mouth, referrals that are predictable and then will drive a lot of business your way. And we all know that those are the best clients, easiest clients to work with.

Your people are doing the selling for you in many cases. Now, you can't just build a business just off of that. In most cases it can be a big chunk of what you're doing, but it needs to be predictable and consistent so you could hire based off of that. So these are the areas that we're seeing. Really a lot of new volume be generated if you need to be getting to that point where you're at, 40 to 70, 80 new patients a month, somewhere in that range, depending on how many providers you have, you gotta be doing really all of these things to drive that kind of that kind of volume for the revenue you need for that staff size.

So staffing, this is another big area that we see a lot. We've had a lot of people hire, like literally in the last year, we've had over a hundred hires that have happened within our just within our Mastermind. And what we've seen with that is, is. Quite interesting in terms of lessons learned from people structuring compensation packages certain ways looking for new grads versus really seasoned providers, in between people that maybe have a couple years under their belt.

And what we've seen is the trend is really clinicians that are looking for cash-based practice jobs in particular for one primary reason. And that is work-life balance. We all know that burnout in our profession is a really a massive problem. We know that. But so do our peers, so do our colleagues.

They know that they feel that, especially in high volume settings or settings where they just have so much additional documentation and questionnaires and all this stuff. And if, their nighttime routine is finishing their notes and their Saturday morning routine is finishing, catching up on stuff from the prior week, that's a real shit.

Routine that's not cool. You should do something way better than that. We all know that. So clinicians that are in network are actively looking at out of network and cash based practices for a potential place to work because they know the work life balance is better. Now, here's the challenge. For cash-based owners like yourself, you have to be able to match compensation models.

With what they're seeing in the out of network or the outpatient world that are higher volume which is tough because they're gonna make more money per provider. The business is in an. Outpatient in-network setting. So think of like your big sort of corporate clinics. They're gonna make more money per provider than you can make with a clinician that comes into your practice typically by anywhere between 60 to maybe $150,000 per year.

Just because you don't have the same volume. And sometimes these hospital contract payments, which are just like crazy when they get these high volume clinics plus hospital contract affiliation payments, they can make a ton of money per provider. So you gotta compete with that, but you can't have the same net revenue spread that they would have with a provider at an in, in-network clinic because they're not.

Seeing as much volume at your clinic. So you've got to be able to at least get very close to matching the compensation model that they see and increasing their guaranteed payments, I guess is a good way to put it. So one thing that we saw really early on was cash-based practices. You could get away with like super low base salary and then base everything based on bonus comp.

So it's 50 50 almost In terms of their compensation, 50% was salary, 50% was bonuses. It takes a lot of sort of pressure off the business owner puts it on. The employee challenge with that is, that's a sketchy model for the employee and that drives a lot of them to leave and just go do their own thing because they're are already taking a lot of risk.

So why would I, why would I stay here if I'm already taking all this risk? In order to combat that, what we see is owners are having to increase base compensation salaries to really be very close to what people are seeing in these in-network settings, and they're having to take a bit more risk upfront on themself knowing that they can help fill those schedules up.

But in order to get a really high quality person, that's not gonna be risk tolerant. They're gonna jump ship as soon as they possibly can. You've gotta be able to take that risk on yourself, and that means you have to have solid financials. You have to have really good cash flow management and understand how to run your practice the right way.

From the financial side, which, hey, guess what? None of us went to school for that because we only went to school to learn how to treat somebody's ankle sprain and we didn't go to school to understand how to read a profit and loss sheet, a balance sheet, and understand cash flow in our business and how much cash reserves we need to hire somebody based on their compensation structure.

How many months do we need with that, with taxes and all the benefits associated with that and understand. You know how to effectively do that without crippling your business, while also getting a really high quality person that can help grow the business. As complex as that sounds, that's what you have to understand how to do to be able to actually be able to grow past yourself and your business.

And we see so many people be able to do that and understand the basics of it. And then all of a sudden, a lot of the challenge associated with risk of the unknown, of the monetary side of things, of them not knowing, like what they need to look at on the financial side. That really goes away when they start to get a clean, clear grasp of their own financials and their business.

And that's a skill that you just have to learn to understand how to hire. But the key selling factors that you have the number one selling factor that you have is work life balance. You can be more flexible with people, you can give them a more flexible schedule. And they can see fewer people, which means fewer notes, less time on the phone trying to request more visits.

None of that crap is happening. So the amount of time that they're working, Is it could be equivalent in terms of patient a available hours, but the rest of the time that they're putting in this additional work just to do the job that is very minimal in comparison. So they're saving a lot of time.

So the cost per hour, like the amount that they're making per hour is actually higher in most cases in a cash based practice than it is in an in network practice because they're seeing a lower patient volume, but also, Their notes are far fewer because there's less people, they're easier to write because they don't have to justify treatment to, to whatever the insurance company is.

And, or maybe you're working with all these personal injury cases that have to be super detailed and like you need to have justifiable, defensible documentation. Obviously you need that but you don't have to fill all these other questionnaires or try to justify things and that That time comes back to you and it's just always this, Hey, just this one more questionnaire.

It'll only take you a minute or two, right? It's death by a thousand paper cuts. Man. You gave me, this is a third damn questionnaire that's new this year. Now this patient, every patient I have is an additional three minutes, but I got 20 people in a day. That's an extra hour of stuff that I have to do every single day that you don't have to do in a practice.

So this is what's appealing to people that are looking to actually work in these environments. So keep that in mind, like when you're selling people on the idea of working in these clinics. You're selling them on the fact that their life is gonna be a lot better, they're gonna have more energy for their family, they're gonna have more time for their own personal health and wellness, and they're gonna have a better work-life balance.

Plus to get to work with really cool people, one-on-one and in, really build long, lasting positive relationships with them and help them with their health and wellness. That's an amazing, personally rewarding thing to do, that they actually get to have, as their income, as their actual salary for their job.

The other big thing that we're seeing right now, And this is just the beginning, I think of all this is the utilization of artificial intelligence within different career fields. Artificial intelligence isn't like some robot that is whatever, like cleaning your house for you or some sort of self-aware technology that's taken over the world.

What it is at this point is basically advanced software. It's very advanced software that can help with certain key tasks, right? So it can learn habits, it can learn skills, and it can facilitate helping make things easier, especially when it comes to clerical things and research. Now, I think that where people can effectively use this right now, Is in the areas of content clerical work, and then, researching different things that you might want for your content and or for the business.

You can look at things like note taking things that are research based. There's a, there's a. AI tool called Notion that really helps with organization of this. It's very similar from what I've seen to something called Evernote. But Evernote is a little more manual notion, is a little bit more actual like automated and will kinda learn certain things you do and it helps you just do things faster.

There's things that you can use that are tools that will help take content and repurpose them faster. So instead of you having to sit there and edit everything, maybe 50% of that time can be taken away. By these AI tools that can basically do part of that for you and then you can do the rest. So I don't see this as replacing anything in anytime soon.

Within the the physical therapy world in particular, I think other professions are I would be a bit more concerned about my job if I was like in a very clerical position. Let's say I was like a paralegal or something like that where I'm, helping research things and draft different documents.

In that case, like you could probably have one person that's leveraging some of these tools and they can do the output of two people. So all of a sudden, like you need half as many paralegals within your law practice. That's a real thing. That's something that's happening right now. The ability to like, dry needle somebody or, teach somebody how to move better.

I just, that's not going anywhere anytime soon to develop relations and trust with people. That's not going anywhere anytime soon. I do think there's ways you can leverage this to help with some of the marketing and the actual like content side of things and clerical things to make them make your front desk staff more efficient.

And these are just, like I said, very new. They're developing quickly and it's just a matter of seeing where these things trend. And then applying those to the problems you have within your business because it will make you more efficient. And I do think that it's something to keep an eye on, even though I don't think our industry is gonna be very fast to adopt a lot of these things.

But I do think they could help in a lot of different ways in terms of, some of it could be like really advanced biomechanical assessments and being able to really see different joints, how things are moving, and then you layer that into your understanding of movement and your assessment as well.

And something like that could be a very useful tool. To help drive a lot of test, retest a lot of predictability in terms of moving patterns, a lot of consistency with people, doing their homework exercises and actually like making progress and sh showing that objectively. Like I think there's some really cool ways in which this is gonna be used right now.

It's mainly, like I said, content, clerical work and and research is where I'm seeing the vast majority of it. The last thing that I would say, and this is something that. I was just having a conversation the other day with our advisors that talked to a lot of potential clients that, that we might work with.

And one of the things that, that I'm seeing more and more of, and it's something that I'm not surprised by this is just more competition, more options for cash based, niche based providers, not just from individual. Clinic owners, not from small practices, even big hospitals. I'm seeing this now, even the in Atlanta, I've seen this now.

One of the major hospitals in Atlanta started their own basically out of network or cash-based practice that focuses specifically on performance. So if that ist a telltale sign that there is an opportunity there, I don't know what is. This is a, one of the big three hospitals in the city and they dumped a bunch of money into a really, High-end facility and they outfitted it with providers that look very legit.

Now, that's the competition that you're gonna have to deal with as some of these bigger hospitals realize this so you have to understand I. You can't just rely on clinical expertise alone, you're gonna get your ass whooped. When these big clinics start dumping a bunch of money into it and they start propping up these facilities that you don't have the capital to build, how are you gonna compete with that?

You're gonna have to be really good at marketing to the people that you work with. You're gonna have to dominate a niche. You're gonna have to have a great customer experience where they come in your door. You're gonna have to be super consistent. You're gonna have to get great outcomes. You're have to develop great relationships.

You're gonna have to maintain your reputation in your area and local marketing that you have. All the things that you have to do to have success in the business anyway. It's just, five, six years ago it was easier. You could be bad at the business side of things, but be a great clinician.

There weren't a lot of other people that were options. Now there's more and more people, not just other cash providers, which I do see obviously a lot more of that. And I'm also seeing this from bigger hospital organizations, like I said. So something to think about for many of you, and this really comes down to, there's two things that I'm seeing.

Some of you wanna slow play growth in your business, which is fine. You might have real reasons why you're like, man, I just want to chill with the business the size that it is. I just wanna leave it like this. I like the way things are. I don't wanna change anything. And, and I would call those sort of Sweet spot.

Businesses. Businesses that are usually, it's like between, two and three providers. You have small footprint you're very net positive as far as profitability is concerned. Pretty easy to run. It's a good culture to have. It's great. You can have that business I think for a really long period of time.

But what I think you have to look at is what are you leaving on the table in terms of. Growth potential over, especially like probably the next five years and security when it comes to that. So when you have a team of, two people, if somebody leaves. Or if something happens in the business where you know you can't justify keeping another person, you gotta let that person go that's half your workforce is gone.

Versus let's say you have six people and somebody leaves, all of a sudden you can absorb the difference in work so much easier. So there is some safety in numbers within a certain scope and size. I think if you get really big, then you're having to, there's a lot of leverage associated with that.

And it can be a. Bit more stressful to, to run and challenging. But it's, it, the opportunity's there and it's not gonna be as easy to make progress to gain market share over the next few years as it is now. It's not easy by any means right now, but it is easier than it's gonna be cuz you're gonna have less competition now than you will in a few years if you are.

New to this, and you're you're thinking to yourself, man, should I start a practice? I don't know. It seems like a lot of work and it is, there's no doubt. Like it's not the easiest thing to do by any means. But it's also what keeps a lot of people out. If you look at the opportunity for you to have success with your practice five years from now versus right now, I'm telling you, you're gonna have an easier time of it.

You're gonna have higher likelihood of success now versus five years from now. And it has a lot to do with. The landscape becoming more crowded and more competition that is is gonna be there. And listen, I'm all for, this abundance mindset. I think there's so many people that don't even know we exist.

That's where the real benefit is. That's where the real, in increase in in business size and revenue. And there's just so many people that have no idea that we exist. It's probably like the, 95% of the city that I'm in has no idea what we. Do or who we are, and it's up to us to educate them on that.

And that's marketing, but. At the same time, as you get more and more people that are vying for the attention and the business of the same sort of core people, it becomes harder to have that sort of recurring easy business that would come in no matter what. If you know you're starting later to the game, so something to think about if you think things are gonna be hard now, things are gonna be harder in five years than they are now.

For sure. And it just means you're gonna have to be a better business owner. You're gonna have to be a better clinician. You just have to be better. And I actually look at it as a very positive thing. The best clinics, the best clinicians are gonna thrive. They're going to absorb other clinicians that are mediocre business owners that are.

Pretty good clinicians that just didn't wanna work for somebody else, but do not actually wanna be business owners. And some of you might be listening to this, and guess what, if you don't, there's nothing wrong with that. Don't feel ashamed if it's man, I didn't think I was getting myself into this.

This is way different than I thought. I just wanted to treat people the way I wanted to work with them. In the next couple years, there's probably gonna be an opportunity where you can get absorbed into a clinic that makes a lot more sense for you. Or if you're on the other side as a great business owner that's ambitious and wants to actually capitalize on that.

I would start looking for these great clinicians that have, have great clinical expertise but suck at business. And I would try to basically, incorporate them into what I'm doing, and give them an opportunity to really thrive within a company that can manage the business side for them, which is really probably what they wanted anyway.

They just didn't have a choice, so they thought, all right, I'm gonna go start my own business and. I'm seeing that more and more right now than ever. I don't expect that's gonna change. I think we're gonna see that, ongoing over the next few years and it's probably not far off from there being some sort of national based group that's really gonna try to go after.

Almost potentially a franchise model on a large scale, around the us I don't think that's too far off either. So again, you have to decide what you want your business to look like. What's your, you want your future to look like. The type of jobs you're wanting to provide for people, the type of culture you want your business to have.

All that is up to you. And, you can stay small and just be amazing at whatever niche you want it to be, and you'll be totally fine. But if you want to grow, now is a better time to do it than waiting a few years. Just so you know, I think that's something to be aware of. You might have other lifestyle activities or family things going on, and it's not the right time and that's fine.

It's totally normal to have these sort of like growth cycles and then you flatten out and you chill for a while. Growth cycles. You flatten out and chill for a while. Just growth. For, years and years. It's very hard on you. It's very hard on your family. It's just very hard on the business and your employees.

And it's nice to give these like sprints and then break sprints and then break. But just don't take a break for too long as I do think you have a lot of market opportunity and if you don't take it, somebody else will keep that in mind. So guys, that's the state of the cash based world for right now in 2023.

I hope that you find this Helpful. I know this is a lot of information. And again, this is something that, this isn't necessarily theory. This is based off of what we're seeing in real time. So I wanted to share this with the profession. I just think that this is something that can be helpful for those of you that are trying to do your own thing and In the physical therapy or clinical world, I'm obviously a huge fan.

It's, I'm not I'm not doing this just because I think it's a great business opportunity. Like I'm a clinician first. I, that's what I tell people. People ask me what I do. I tell 'em Im a physical therapist. Then it gets a little weird when they ask me where I treat patients. Cause I don't treat patients anymore.

Dinner parties are a little strange. But even still, that's what I am, that's what I went to school for. That's like what I nerded out on for so long. That's what I taught other clinicians how to do. It's very important for me, for our profession to, to move forward and and not, be left behind as other professions see more and more opportunities to help people long term, especially with their health and wellness.

Where I think we have such a sweet spot, especially if you really gravitate more towards this performance based approach, like I did and I still very much believe in I think we are. Uniquely positioned to help people with problems that they're gonna have that are not gonna go away.

Everyone's health is getting worse. Everyone is getting busier, everyone is doing less physically. Everyone is trying to augment everything with all this technology and what supplement should I take? And it's Doesn't have to be that hard. They just need someone that can help them that's knowledgeable, that they can build trust with.

They can be their coach as far as health and wellness goes. Get them outta pain, get them back to things that they like to do. Be an accountability partner and have these long-term relationships that I think are just so good for your business, but also so good for these people that we get a chance to work with.

So as always, I really appreciate you listening. If you're interested in getting some help from us on the business side, Head to physical therapy biz.com. Check out what we're doing for the right fit. We'd love to have a conversation. If not, hope this podcast helps you either way. So as always, thanks for listening.

Catch you next week.

Peach entrepreneurs. We have big exciting news, a new program that we just came out with that is our PT Biz part-time to full-time five day challenge. Over the course of five days, we get you crystal clear on exactly how much money you need to replace by getting you ultra clear on how much you're actually spending.

We get you crystal clear on the number of people you're getting to see, and the average visit rate you're going to need to have in order to replace your income to be able to go. Full-time. We go through three different strategies that you can take to go from part-time to full-time, and you can pick the one that's the best for you based on your current situation.

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