4 Reasons Why You Should Not Go Into Cash-Based PT

Show Notes

In today's episode, we dive deep into the realities of running a cash-based physical therapy practice. From handling conflicts to ensuring you're not settling for average, I share my personal experiences and insights. If you're considering this path, it's essential to be confident, solution-oriented, and always strive for excellence.

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What is The Dr. JJ Thomas Podcast?

Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.

Dr. JJ Thomas: 00:00

In this cash based practice world, if you think that average is gonna cut it, you're really going to be mistaken. You're in for a rude awakening. Welcome to the doctor JJ Thomas podcast. Hi. I'm doctor JJ Thomas.

Dr. JJ Thomas: 00:19

Thanks so much for coming today. I'm getting more and more excited about these about these shows, because I do feel like I have a lot to share with my experiences, and I'm just happy to be here with you. Today's episode, we're going to talk about the four reasons you should not go into cash based practice. So we've done quite a few sessions, quite a few episodes on things you should do that will give you confidence to build your cash based practice. And I'm, you know, hooting and hollering you on about, yes.

Dr. JJ Thomas: 00:48

Let's do this. You can do this. And I realized, you know what? I should come up with some I should identify the reasons you shouldn't go in a cash based practice. Because let's be honest, it really isn't for everyone.

Dr. JJ Thomas: 00:59

It's a lot of hard work. There are some definite identifiable factors that you should have if you plan on doing this and doing it well. So the first reason you shouldn't go in a cash based practice is if you are risk or conflict averse. If you've listened to any of our other episodes, then you've you've heard us talk about the importance of leadership in everything we're doing. I really feel strongly that leadership is one of the most important qualities you can have in life in general.

Dr. JJ Thomas: 01:27

But especially in a Caspase practice, you must lead from the front. You must lead by example, and you must have those great leadership abilities. And with that, you're going to have to be dealing with conflict, and you can't be conflict averse. You can't be risk averse. You're going to have to deal with each situation.

Dr. JJ Thomas: 01:49

Boom. Forward it, put it out, deal with it in whatever way possible so that, number 1, you gain people's trust around you. Number 2, you come up with solutions. And number 3, you succeed in the end. I'm gonna talk about one of the examples that I thought of when we're when I was preparing for this episode of really a time in my life where, my own leadership abilities was revealed.

Dr. JJ Thomas: 02:13

And this was way before I opened my Cash Paid practice. This was, this time that I'm thinking of, I was, in an insurance based world. You've heard me talk before. I did a lot of pool therapy. And and in pool therapy, we had quite a number of patients in there at once, and and it it worked out pretty well.

Dr. JJ Thomas: 02:30

This is actually a little bit of a tough, a tough memory because it was not only a time where my leadership was challenged, but also a time where, I wanna say, like, my belief in, people was challenged. And so let me explain. So I was in the pool. There were about 4 or 5 other people in the pool with me. And our the way our pool was set, people would come in to the front desk area, obviously, out of the pool.

Dr. JJ Thomas: 02:58

They'd check-in. They'd say, okay. You can go back and see JJ now. They'd come through the locker room, and then I would I was literally in the pool with patients. So they'd come through the locker room ready to get in and get started with me, and they'd bring their file and etcetera.

Dr. JJ Thomas: 03:11

So anyway, this one day, I'm in the pool. I have, like, 4 to 5 patients in there. And this woman, very old woman, I mean, gosh, she walked like she was 90. She could have been a little younger, but she was pretty old. She had a walker, very hunched over, kind of meek looking, actually.

Dr. JJ Thomas: 03:29

Very meek looking, I'll say. And then she looked up, and she saw the people in the pool, and there was a black man in the pool with me. And her meekness completely disappeared, and all I saw was hate on her face. And she she used a word that I don't agree with, and she said, I'm not getting in the pool with that man. And and the word that she used, which you can just imagine.

Dr. JJ Thomas: 03:53

I just refused to say it. So, anyway, a very it was a very pivotal moment where I couldn't hesitate. I had to deal with this right away, and I had to do what was right. And when she came in and said that, number 1, like I said, my my faith in the world was was damaged, because that was the first time I think I'd seen, like, racism or bigotry really so obvious in my face before. I wanna tear up just saying it just now.

Dr. JJ Thomas: 04:20

And, but number 2, I had to deal with this. Right? Like, this woman was coming in. She was a patient. I was supposed to see her, And I had to have a very quick conflict resolution within my head of how am I gonna deal with this?

Dr. JJ Thomas: 04:32

This woman is being so hateful, and how do I deal with this with these other patients? And what should I do? And I and right away, thank God, I was like, I just gotta do what's right. So I got out of the pool. I walked over to her.

Dr. JJ Thomas: 04:45

I said, ma'am, I don't know you. I'm JJ. I'm in charge here. We don't tolerate that here. We don't see color in this pool.

Dr. JJ Thomas: 04:54

We don't see color in this building. If you're not comfortable getting in with anyone else in this pool, then then we may not be able to treat you here. Or we may have to see you another another time, but we can't tolerate that in this environment. And it it was a little hard to get those words out because I had to be you know, it was very conflicting. Right?

Dr. JJ Thomas: 05:15

Like, it was a very, kind of an aggressive situation. She had pure hatred that I don't even understand or begin to understand. But thankfully, I didn't hesitate. I got out of the pool, and I was like, we're not gonna tolerate this. And thankfully too, my leadership at that time, because I wasn't in char I wasn't I was in charge of the pool, but I wasn't the owner.

Dr. JJ Thomas: 05:37

Later, when I told up my owner about it, he was like, thank you, JJ. Thank you for representing us well. Thank you for dealing with that conflict so quickly. You're right. We don't tolerate that.

Dr. JJ Thomas: 05:49

And and I was really relieved that I had that support from my leadership. One step further, I want you to know I went into that patient and I said, I'm so sorry. Like, I didn't have that hatred, but I was so sorry that my patient had to experience that. Again, another awkward conversation. Someone who is risk averse or conflict averse may not handle that so gracefully, and that's okay.

Dr. JJ Thomas: 06:12

I'm sure if you're that person, you have other strengths, but you really do wanna think twice about opening a cash based practice if you're that person, because those situations, unfortunately, are gonna happen. It may not be that situation, but it's gonna be another uncomfortable situation. And you can't just wish your wish things away. You can't not deal with them. You have to deal with them head on.

Dr. JJ Thomas: 06:34

Otherwise, you're not setting a good, example or leading in the front for any of your people, for your patients, for your employees, for yourself. So that's one example. I'll give you a cash based practice example, that I thought of in this in this episode. And this is more directly related to the cash based model, really. I had another patient.

Dr. JJ Thomas: 06:58

This is maybe 9 years ago, 10 years ago when I first opened my cash based practice. And if you've been listening to previous episodes, you know the way we the way we charge our patients is, by the minute, essentially. So they're 15 they're scheduled in 15 minute blocks. But if I only see someone if they're scheduled for 45 minutes and I see them for 40 minutes, then I only charge them for the 40 minutes. Because I want them to know that I value their time and that I'm not gonna just stall and do another 5 minutes just to charge them another 5 minutes.

Dr. JJ Thomas: 07:28

They don't need that extra 5 minutes. I don't charge them for it, and I just let them go. So I had a patient who was coming to me, and she was doing really well. She was very happy with the the progress she was making. But when we would finish our sessions at the time, I hadn't hired a, administrator yet, so I was still ringing my patients out at the end.

Dr. JJ Thomas: 07:49

And they knew how the rates worked. And every single time I went to check her out, she would actually try to haggle with me on on the time we spent. So I am very, I'm very habitual. I wanna make sure that I'm honoring my patient's time, and I'm only charging them for their time. So the minute I start with a patient, I look at the clock.

Dr. JJ Thomas: 08:09

The minute I finish with them, I look at the clock, and I I take that and I subtract whatever they need, and I go with that. So anyway, I was very sure of myself. And every single time, she's like, I don't think we spent 35 minutes. I think we spent more like 25. And the first couple times I argued with her, you know, I said, no.

Dr. JJ Thomas: 08:28

We did. And she let it go. By the 3rd or 4th time, I said to her, listen. I'm not gonna haggle with you every time. I am certain that I look at the clock when we start, and I look at the clock when we finish.

Dr. JJ Thomas: 08:41

And when I tell you it's the time, trust me, it's the time. And I actually went another step to her and I said, listen, if you don't value my time, please don't schedule with me. But I refuse to haggle with you every time. That was awkward. Right?

Dr. JJ Thomas: 08:56

That was kind of an awkward conversation. But I have enough respect for myself and my work. I'm not gonna sit there and let her beat me up and make me feel guilty for the for the minutes that I'm spending with her every time. There are plenty of people who wanna come in and value my time, and I'm gonna choose to spend my time with those people. So I just nip that right in the bud.

Dr. JJ Thomas: 09:16

I'm really thankful for it because then she stopped haggling. I still treated her. She still got better. She was very happy, but we just nipped that conflict right in the bud. If you don't have the capacity to do that as an owner, as a cash based practice owner, you are going to struggle.

Dr. JJ Thomas: 09:32

People are going to run over you, and you're not gonna feel very good about it, and you're not gonna be very success successful. So do yourself a favor. If you're one of those people that are risk averse, think twice about opening your cash based practice. That leads us to our second topic, second reason you shouldn't open your cash based practice. And, really, what it comes down to is if you're not if you're not a problem solver.

Dr. JJ Thomas: 09:57

And what I mean by that is you need to be solution oriented. As I said earlier, you're gonna have conflicts in everything. You're gonna have conflicts with patients. You're gonna have conflicts with employees. Those conflicts are essentially problems.

Dr. JJ Thomas: 10:10

Not only do you need to not be avoiding those problems, but you also need to be a person that is willing to, actively look for solutions to those problems. I learned so my kids are 18, 16, and 12. And throughout my cash based practice, I would say that I've learned a lot over even even as a PT, even over the last 23 years. This next topic, part of where I got this learning from is actually from a dad that I met on the typical American parent that I am, I sat on the sidelines typical American parent that I am, I sat on the sidelines for all the practices to watch and drool over every move that he made. And, and I got really close with a couple of the parents.

Dr. JJ Thomas: 10:57

And this one dad, I found really fascinating, and and, we're still friends today. But he his I gotta tell you about his job because this is part of how I respect him so much. What he did is he actually he's a person that created, detonating containment or containment of bombs that were detonating underwater. Like, talk about solution oriented. He had to he created a model that allowed the military to contain, an explosive device and then transport it so it didn't explode while those people are transporting it.

Dr. JJ Thomas: 11:33

I mean, I'm worried about minutes of payment. This guy's worrying about bomb detonating. Anyway, what he said to me that hit home with this solution, mindset personality is he said he said, you know what I tell my kids? I say, don't come to me with a problem. Come to me with a problem and a solution.

Dr. JJ Thomas: 11:52

And when he said that, I mean, that was, you know, my son's 16 now. That was at least 7, 8 years ago, maybe 9. And I'm like, yes. That is right. Don't come to me with a problem.

Dr. JJ Thomas: 12:04

Come with a problem and a solution. If you're just the person that's focusing on problem, problem, problem, not thinking, here's the problem. What solutions do we have? Then you are gonna be stuck in a very sad cycle. You're going to be in this cash based practice, and all you're gonna see are the problems.

Dr. JJ Thomas: 12:21

You're not gonna see solutions. So if you're the person that's stuck in that problem mindset and you're not a solution oriented person, I wouldn't suggest you take this route. I would say you either need to figure out someone who can help you become more solution oriented or maybe just go back to working somewhere else. I'll give you an example of a time where, in practice, I had to, be solution oriented. And, what it was so I've started teaching, you know, in 2012.

Dr. JJ Thomas: 12:53

And through my teaching, I've been so lucky I've been able to meet, brilliant therapists. And it's also allowed me to stay really on the cusp of of cutting edge technology and cutting edge techniques for physical therapy. And I remember when blood flow restriction training was first coming out, and I was hearing about it from my colleagues, my teaching colleagues. They were like, this is amazing. The results are incredible.

Dr. JJ Thomas: 13:20

I'm seeing so many great things for so many different, injuries and rehab protocols. And so I started becoming interested in it. And finally, about couple years of them talking about this, blood flow restriction training, I went and got trained. And, the company that I was trained with was one of the original, developers in the US. Amazing people.

Dr. JJ Thomas: 13:44

And the device that they the particular device that they have, that they promote, is, accurately measures real time, But it's the only device that accurately measures real time limb occlusion and maintains that pressure while our patients are exercising. So it's kind of a critical piece of the research. Right? It also has other things that make it very different. Like, the the cuffs are wider than most of the, other cuffs on the market.

Dr. JJ Thomas: 14:12

You know, the little things matter. But the point is that I wanted to have this device, And it was 4 times more expensive. And here I am, a small business owner. But I had to come up with a solution. Because, really, it's not it wasn't okay for me to offer my patients mediocre.

Dr. JJ Thomas: 14:30

We're gonna get to that in a second. I had to offer them the best, and I had to offer them what the research was gonna show is valuable and is actually applicable. So I was like, I gotta figure out a solution for this. So what I figured out is, I could buy that unit. I can use that unit.

Dr. JJ Thomas: 14:48

I can teach patients how to use that unit 1 on 1, and they pay me for my 1 on 1 time. And then once I have witnessed that they're able to use that device safely on their own with the exercises that I've given them, they can use it next to me. And I can see them, and it's very safe, and they can just rent the unit. So I came up with a solution. Wow.

Dr. JJ Thomas: 15:11

We can have it all. I can have this awesome device. My patients can utilize this awesome device, and it'll end up paying for itself because it can be used at a time when I don't have to be there 1 on 1 with them. If they need me, they can stop. I can stop, of course, and just not charge the patient I'm with for that time.

Dr. JJ Thomas: 15:29

Anyway, it was a solution. So if I were not a solution oriented person, I might not have come up with that solution, and then our patients wouldn't have access to this amazing device. So solution oriented. I mentioned something in that last topic that is gonna lead us to our third reason you should not open your CACHE based practice. And the third reason is if you're okay with average, if you're okay with mediocre.

Dr. JJ Thomas: 15:54

You can't be okay with average in this in this world. In this cash based practice world, if you think that average is gonna cut it, you're really going to be mistaken. You're in for a rude awakening. Patients are coming with an expectation that you're gonna give them something different than what they would get in the insurance based world, and they're valid to think that. So if you find yourself thinking that you can open a cash based practice and just because you're 1 on 1, that that's enough to make you different, you're going to be sadly mistaken.

Dr. JJ Thomas: 16:29

You guys have heard me talk about the company Fuqua Hump before. They're they've become friends of mine. This is one of their shirts, actually. A lot of their mottos are amazing. But, one of the things they say that I that rings true to me every day is, average is the enemy.

Dr. JJ Thomas: 16:46

Average is the enemy. That's right where average is the enemy. I don't if I want an average if I wanna feel average, I'm not gonna pay out of pocket for that. No no freaking way am I gonna do that. Average is what creates complacency in life.

Dr. JJ Thomas: 17:00

Average is only average is c. Average is b minus, maybe. I don't want that. I want a plus every day and everything for my patients, for me, for everyone. So if you think you're okay with average, this isn't the place for you.

Dr. JJ Thomas: 17:14

And with that, consider, like so ask your I guess what I want you to do with that topic is ask yourself, if I think I'm not average or if I think I'm not okay with average, what is gonna set me apart? What is gonna make me above average? What is gonna make me that elite cream of the crop person? And I'm here to tell you, it's really continuing education and learning. It is making sure that you're addicted to learning.

Dr. JJ Thomas: 17:45

Part of the reason I started teaching back in 20 2012 was because I knew that if I were if I wanted to know it better than anyone, I needed to teach it. In addition to that, what I found as a bonus is that I was now teaching with all the other cream of the crop people. So they were gonna rub off on me, and I was gonna learn from them. I was addicted to learning. Quite honestly, I was addicted to learning at, like, 5.

Dr. JJ Thomas: 18:08

I used to try to hop on the school bus with my sisters, and the bus driver would walk me off politely every day. But, anyway, regardless of that, what if you don't wanna be average, I would suggest sign up for every course that interests you. Read every book that interests you. Even read books that don't interest you. If you read it and you're like, I don't agree with that, that's still knowledge that's going to empower you to be up here rather than here.

Dr. JJ Thomas: 18:35

So that's the third thing. Average is the enemy. If you're okay with mediocre, it's a third reason you would not wanna open your cash based practice. The last reason I would suggest you don't open a cash based practice is if you're not confident in your own abilities. If you don't believe in yourself, no one's ever gonna believe in you.

Dr. JJ Thomas: 18:56

And everybody I will say that you probably all agree, that for a patient to get better, they have to believe that you're willing you're able to get them better. So if you're coming into work every day, or you're thinking about opening a cash based practice, and you're not really sure of yourself, I wouldn't do it. It's gonna be a it's not gonna work out for you. Patients can read through that. They're we're all animals.

Dr. JJ Thomas: 19:18

Right? They can feel that. And so you're not gonna fake it. If you're not confident in your abilities, don't do it. In our practice here, we have a standard.

Dr. JJ Thomas: 19:28

We tell patients, we expect you to be very confident that you're going that you're on the right track with our therapy in 4 to 6 sessions. And we tell them a step further. If you're if in 4 to 6 sessions, you don't feel like you're on the right track, we're either gonna completely switch our approach, or we're gonna find someone else to work with you. Because we own we have ownership over getting our patients better, whether that means we're doing it or someone else is doing it. And we're also so confident that we're going to be able to do it.

Dr. JJ Thomas: 20:01

We can give them that timeline. Now, if somebody has, like, really bad chronic pain, or they've had, you know, this injury for years, and nobody's been able to get them better, obviously, I'm I'm gonna say to them, look it I'm not gonna get you a 100% better in 4 to 6 sessions, but I'm gonna know if we're on the right tracks in 4 to 6 sessions. That makes them feel better. And it and I stand by it. Because I'm not gonna waste anyone's time or money.

Dr. JJ Thomas: 20:26

That's not gonna be good for my brand. If I'm not making a difference, then I'm gonna find someone who can. That's the 4th thing. So if you can't be confident in your own ability, and you can't say to a patient, I'm so confident that if you don't feel better in 4 to 6 sessions, your standard doesn't have to be the same. Create whatever your standard is, but find a standard for yourself and stick to it.

Dr. JJ Thomas: 20:49

And when you do that, it'll only breed your own confidence. You're like, you know what? I lived by my own code. I was confident in what I was doing, but I wasn't moving that patient's dial, so I I had the, self respect to refer them out. And and then patients respect you for that.

Dr. JJ Thomas: 21:06

So even if you didn't get them better, they're gonna respect that you moved them in the right direction and that you honored their time and money investment into your practice. So that's really it. It's those 4 things. I mean, it's not a ton of things. Four things.

Dr. JJ Thomas: 21:20

If you have any one of these 4 things, really think twice about opening a cash based practice. If you have one of those things, some of them are trainable. Right? Like like the confidence thing, I mean, depending on where your lack of confidence is coming from. If your lack of confidence is coming from less continuing education or just not having the right group of of educators teaching you, there's things you can do.

Dr. JJ Thomas: 21:42

Right? We have a ton of educational content out there. We have our free ebook. We have, continuing education courses. We have dry needling master classes.

Dr. JJ Thomas: 21:51

You can find all of those on the website. There's also a ton of other really talented educators out there. I'm happy to make recommendations for you. But the point is, some of these things, you can improve. But if innately any 4 of these things ring true to you, please think twice about opening a cash based practice.

Dr. JJ Thomas: 22:10

It may not work out so well for you. If you found yourself listening to this podcast and you don't have any of these four things, then you're probably gonna be really great in a cash based practice. And I think what you should do is continue to pursue that, get the information you need. Please feel free to use us as a resource. You can like and subscribe to our YouTube channel.

Dr. JJ Thomas: 22:29

Find us on Spotify. Check out our ebook and our website. And please, by all means, send comments to our podcast because I'm always looking for material. I'm getting direct messages from people about what they wanna hear about, but really, it'd be better on the comments, below because then, I'll know if more people are thinking it. Looking forward to hearing from you, and talk soon.