Writing and speaking to people in the physical therapy and wellness fields is a real honor. After a while, you begin to hear some questions over and over. Some are extremelyPhysical Therapist at SPARK Physiotherapy in Alexandria VA Working With Patient thought-provoking exchanges about leadership as a physical therapy and wellness entrepreneur. Other questions are just pleas for advice so a new therapist or owner can avoid a few pitfalls.

Here is a short list of some of the most FAQs and my best answers to them:

Is It Possible to Charge People for Physical Therapy Out-of-Pocket Where I Live?

This is a question I’ve heard many times, and most of the time, it is from professionals who already have established in-network physical therapy practices. There is a fear that moving toward a fee-for-service environment will decrease their bottom line and destroy the business they’ve spent years building. This makes perfect sense, but most of the time, the pro interested in moving toward an out-of-network practice is doing so because they feel handcuffed in some way by a third-party payer system. Then why the question about whether or not it’s possible? They see the loss of client visits but overlook the loss of hundreds of person-hours working to collect reimbursement and paying administrative staff to handle such matters. In many cases, this risk/benefit completely washes itself out. More often than not, given a professional’s solid reputation in the community, it winds up moving a practice well into the black.

What Should I Charge as an Out-of-Network Provider of Physical Therapy Services?

This is obvious to professionals like us who have years of experience working as strength coaches and personal trainers. The value system has almost always already been established. Go to your local gym, fitness center, YMCA, yoga parlor, or massage therapist’s office and see what they charge. If you feel overwhelmed about your new mission to provide physical therapy services out-of-network, charge what they charge. As a licensed doctor of physical therapy, you are probably confident in your skills. As an entrepreneur, you must build your business on a solid platform with a well-thought-out P&L (profit and loss) system. Once you fully understand your costs (rent, equipment, maintenance, etc.), find a comfortable position on a fee schedule relative to the providers we just listed. In this way, you can be confident in the basic income and expenditures you will maintain and the established value of your services relative to those of providers in your community. After all, hasn’t all of that post-grad education, license, and thousands of hours of free work for your CIs made you more ‘valuable’ than the neighborhood yoga instructor? The personal trainer?

What Should I Spend to Begin a Manual Therapy Practice?

Table. Stool. Shingle. That’s pretty much it! As manual therapists, we operate with a distinct advantage over others who claim to provide rehab or pain management services. We don’t need a single piece of equipment if we have our hands and the constant, which is gravity! Now, more is sometimes nice. We have a fitness center complete with kettlebells, Olympic weights, racks and bars, several cable apparatus, and lots of other cool toys. But this wasn’t built overnight. I started with a table, a stool, and a shingle. You can, too.

Once you’ve established yourself, you may realize that you could augment your work with a few small pieces of gear. So do your homework. Understand your current costs and add new costs one at a time. When purchasing equipment, understand that all vendors compete with each other, and they ALL want your business. Use this to your advantage.

There Are Several Options for Marketing My Services. I Can Connect With Fitness Centers and Offer Regular Inservices Free of Charge. Of Course, There Is the Normal Courting of Physician Practices. Which Is Most Effective for Getting Your Practice Going?

Monthly inservice is too often. This is another thing that you'll need to look at with caution. Do NOT give this away for free. If the gym values your time and increased expertise over the staff on-site, they will pay for it and wait several months for the next one. You can use the knowledge of the staff and member base to guide the info you deliver.

This is a fine idea, of course. The more people that understand the added value of your service vs anyone else’s work, the better. One word of caution: be mindful of the time and expense you use to market yourself to surgeons or MDs. I’m not sure how the physician-physio relationship is in other countries. Still, in the US, physicians have an ivory tower or gatekeeper mindset toward physio and are almost always hesitant to have new relationships with physio. Many see it as an infringement on their bottom line.

Your best referral source is always going to be your current client base. That doesn’t include the 4,000 members that the gym is trying to sell you as a benefit for being there. Remember: the gym will use you, an on-site physio, to sell gym memberships. They will not work to sell YOU.

What Is the Best Way to Generate Business?

See above: separate yourself and your skill set from that offered by on-site gym staff AND surrounding professionals. Treat each client as if they are the only client you have. Create a client experience that has no rival. Easy to write down on paper but hard to create. This will be the basis for your core values as a professional.

What Errors Have You Made Previously That I Should Avoid?

There are too many to recount here. Don’t spend too much money or time on anything you cannot recoup in 3 months. Form deep and active relationships with a select FEW. Market yourself toward ONE audience. If your messaging speaks to everyone, then you are aiming your messaging at no one.

Should I Pay a Monthly Fee or a Percentage of My Income?

Pay a monthly fee based on a percentage of gross revenues that the gym SPECIFICALLY provides you. Do not pay a percentage of the revenues you generate outside the gym. The terms/percentage paid to the house should be negotiated regularly, at least annually.

How Do I Ensure Longevity With Existing Members?

See above RE: client experience and highest value service. If there were one answer for this, the average lifespan of a small business wouldn’t be only three years.

The last pearl I invariably leave colleagues who ask for my advice is that ‘if we want to advance the perceived value of physical therapy, we MUST all work with a more entrepreneurial spirit. Always treat people as if their return is NOT guaranteed; no one ever owns a client, and they will go where they feel they are receiving the best value for their health care dollars.

Many physical therapists and staff in PT Mills can safely assume their schedule will be full, double and triple booked the next day. This luxury is not guaranteed to any cash practitioner. We push value expectations and work feverishly to deliver an experience clients would seek us out for. Those of us who work to maintain the status quo of the PT Mill will be left behind as more educated health consumers search for the real answers to their pain and function questions.’

Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist, and a Certified Myofascial Trigger Point Therapist. In addition, he holds a Master’s Degree in Clinical Exercise Physiology. He has treated high school, collegiate, recreational, and professional athletes of various sports, including baseball, softball, football, hockey, tennis, swimming, golf, and martial arts. His experience as a collegiate and semi-professional athlete, as well as a professional baseball coach, make him a sought-after resource among elite-level athletes on the field and in the training room. The concept of ‘all the way well’ in his work as a physical therapist and fitness professional is what continues to drive Dr. Berio to be the best movement specialist there is.

Carlos remains active in several sports and is an avid agility training, powerlifting, and adventure race runner. He is an advocate for his patients, clients, and his fellow PT colleagues. He can be reached at [email protected].