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In this episode, Dr. JJ shares her experience working with both insurance-based and cash-based practices. Drawing from her years of knowledge as a physical therapist, she highlights the pros and cons of each model. So that you can make an informed decision on which model is right for you based on your unique qualities and needs.
Get A Free Copy Of My Book:5 Things You MUST Do to Build a Successful Cash-Based PT PracticeThis quick, easy-to-read guide is your no-BS steps to what really works in building a Cash-Based Physical Therapy business.👉 https://bit.ly/CashPTebook
In this episode, Dr. JJ shares her experience working with both insurance-based and cash-based practices. Drawing from her years of knowledge as a physical therapist, she highlights the pros and cons of each model. So that you can make an informed decision on which model is right for you based on your unique qualities and needs.
Get A Free Copy Of My Book:
5 Things You MUST Do to Build a Successful Cash-Based PT Practice
This quick, easy-to-read guide is your no-BS steps to what really works in building a Cash-Based Physical Therapy business.
👉 https://bit.ly/CashPTebook
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.
If you're gonna complain about something, you need to do something to change it. Or the other side of that is don't complain about something if you're not willing to do something to change it. Welcome to the doctor JJ Thomas podcast. Welcome to doctor JJ Thomas podcast. I'm doctor JJ Thomas.
Dr. JJ Thomas:Today's episode is gonna be a lot of fun, but first, let me start in case any of you don't know me yet. Let me tell you a little bit about me and where I come from. I'm a physical therapist, and I've been one for 23 years. 10 years ago, I opened my own cash based practice. And I did so out of the sheer need, desire to do right by my patients and my family.
Dr. JJ Thomas:And, it grew exponentially. And to a point where the bonus was that I now have this financial freedom that, has allowed me to have even better time with my family and better time with my patients. And so it's something that's worth sharing. And so that's what these episodes are about. These episodes are about sharing with you my successes and failures through my journey of opening this CASH based practice and and being part of it as it's grown, and just trying to help more people through not just helping our patients the way we do 1 on 1 here, but helping more therapists so they can help more patients 1 on 1.
Dr. JJ Thomas:So that's why we're here. Today's episode's gonna be an awesome one because I always try to answer questions for you guys that I know that I dealt with myself when I was first entertaining the idea idea of opening a cash based practice. And this is one where I remember struggling with the insurance based world and struggling with so many things that I was dealing with when I was working in that environment, both from a patient perspective, from a personal perspective, from a financial perspective, all of these things. And one of the ways that I had to wrap my head around whether or not I was gonna do something to change it was to do a pros and cons list. And so today, we're gonna go through a pros and cons list that's been refined now through my 10 years as a cash based practice owner.
Dr. JJ Thomas:I guarantee when I when I did this pros and cons list, like, 10, 11 years ago, it probably was pretty close to this. But now I can say to you, absolutely, that I can think of both sides here because I've been in both sides. I was in the insurance based world for 13 years, and I've been in cost based practice now for 10 years. So that's it. I'm gonna give you the raw data, the raw examples of what I've been through on both sides and talk about the pros and cons, to try to help you make your, your decision for what's right for you in your journey.
Dr. JJ Thomas:I guess one other thing I wanna start off by saying though is, again, more about my original journey is when I first decided to go into CASH based practice actually, let me back up even further than that. When I started as a physical therapist, when I went to PT school, when I decided this was the profession that I wanted to, dedicate my life to, this was my calling. I never ever envisioned if you asked me 23 years ago if I was gonna open my own practice, I would have said, hells no. No interest. No way, no how.
Dr. JJ Thomas:Even further, I wouldn't have even said that I would be in a managerial position because everything for me was always about the patients. It was always about getting people better, helping them do what they love, which I think is what a lot of us PTs get into. Right? We get into this profession because we wanna help people. So I never I really never wanted to have a business role, in this.
Dr. JJ Thomas:And then what I realized over time is as I was in that insurance based world and I was hammering away at seeing so many patients and not being able to give them the care that I wanted to do, a 100% because of the sheer volume that I was seeing, I came to this pivotal point where, you know, my kids were young at the time. My oldest is 18 now. My youngest is 12. But, you know, 10 years ago, they were 8 ranging from 8 to 2. And, I was always I'm always harping on them with, like, motivational things and, you know, life skills.
Dr. JJ Thomas:And and one of the things that I say often because I want my voice to be in their head is that if you're gonna complain about something, you need to do something to change it. Or the other side of that is don't complain about something if you're not willing to do something to change it. And so for this, I remember making this list when I hit a point where I was kinda coming home dragged out, drained, complaining like, this sucks. I saw 35 patients today. So tired.
Dr. JJ Thomas:It drained me. Like, I felt like I didn't have what I needed for my family. And all of a sudden, I heard my own head. And I'm like, if you're gonna complain about something, you gotta do something to change it. And so that's where this pros and cons list came from years years ago.
Dr. JJ Thomas:And it dawned on me when I was thinking about episodes that might be helpful to you guys as you're considering cash based practice. And, that's where we are today. So here it is. We're gonna break it out. We're gonna start with first, we're gonna start with the pros of the insurance based world.
Dr. JJ Thomas:And we're gonna start there, honestly, frankly, because there's not a ton. And like I've said in previous episodes, I have no judgment on people in the insurance based world. I think it serves it has its place. There are people that it's right for. It's just wasn't right for me and my model and this is kinda kinda explain why.
Dr. JJ Thomas:But the pros of the insurance based world are, number 1, stability. Right? In an insurance based environment, you're going to have more stability in your schedule in the sense that, you'll have very planned expected timelines of when you're going to be at work and when you're not going to be at work. Right? Your directors, your managers that you work with are gonna have outlined for you hours that they expect you to be there.
Dr. JJ Thomas:It's also gonna be very systematic, stable in terms of how many patients you're gonna see when you do that, how full your schedule is gonna be. But it's gonna be a very standardized schedule. Right? Maybe it's going to be 8 to 7. Maybe it's going to be 8 to 5.
Dr. JJ Thomas:Whatever it is, you have it. It's consistent. You can count on it. You know it's always going to be there. There's some comfort to people in that.
Dr. JJ Thomas:Having a stable schedule can be comforting. Along those same lines, you have the stability of a standardized paycheck. You when you sign on with a company for an insurance based practice, you sign on for a salary. You get a set amount of benefits. You know that you're gonna get that regardless of how hard you work or how hard you don't work, how many patients you see, which we'll talk later, could be a con.
Dr. JJ Thomas:But regardless of that, the actual check that you're getting at the end of every 2 week period is going to be something that you can expect and anticipate and count on. And so for some people, that offers a lot of comfort. And the last piece of this is the last stability piece, the last pro to the insurance based world is that you're essentially clocking in and out. I'm gonna give a disclaimer. We all know who all of us that have been in the insurance based world know that's not a 100% true in the sense that when you're seeing double the volume of patients, when you're seeing double, maybe even triple the volume of patients in an insurance based world than you are in the cash based world, your notes are pretty hard to keep up with.
Dr. JJ Thomas:And so, in fact, when I made that pro and con list originally 10 years ago, I made it because I was sitting there late at night after I put the kids to bed trying to do notes and feeling so overwhelmed. I caught myself complaining and I was like, I gotta do something about this. I gotta change this. And so, while that clock in and out thing isn't entirely true because there is overflow with the notes, The point is that you don't really have the same relationship with your patients that you do in the cash based world because you're kind of clocking in and out. It's not set up the same for that very personal relationship that you might develop in the cash based practice world.
Dr. JJ Thomas:So in that sense, your schedule is stable, your paycheck is stable, and your clocking in and out is pretty stable. They're all very, very, reasonable pros to consider in the in the insurance based world. Now let's get to the cons because that's the easier part of this for me, honestly, and probably for you too if you're listening to this podcast. The cons, honestly, number 1 on my on my list is the schedule for cons because well, actually lots of them have equal value. But the cons one of the one of the cons is the schedule.
Dr. JJ Thomas:While there's some comfort to having a very stable schedule, if you have a family, if you have other priorities that you're trying to put at the top of your list, it doesn't leave much room for you to be able to move those priorities around so that you can meet your own, schedule goals for yourself. What I mean by that is, like I said, when I was 10 years ago, my kids were small. I was running into situations again and again and again where I would find out, you know, 1, 2 weeks before a school event. Oh, there's a Halloween parade at 10 AM. Crap.
Dr. JJ Thomas:I already have I already have 4 people from 10 to 10:45 on there. And how am I ever gonna leave work? That means 12 people, essentially, to leave myself an hour ahead and an hour behind to get there, see the parade, and come back. Rescheduling that many people in order to go make that happen was almost impossible. Whereas in the cash based world, that's actually something you can manage because you're seeing so much less volume that if you need to move people around to go see your child do a parade or go to be mystery reader one day, or go to, you know, the, what do you call it?
Dr. JJ Thomas:The, gingerbread house making at the school. All of them are like in in the younger years of your kids. They're in the middle of the day. And oftentimes, they're not scheduled out as far as our patients are. So you don't have any flexibility over that.
Dr. JJ Thomas:If if I'm asking my boss every time I wanna at an insurance based practice, if I'm asking him or her every time I wanna go to some kid event, it's such an inconvenience for them. It becomes draining for everyone. So that's a big con. On top of that, you're stuck in terms of how you can take off for holidays and vacation. So if, you know, what I remember is I'm in a practice with a bunch of colleagues who I respect and only a few of us can take off on certain days for holidays.
Dr. JJ Thomas:Well, that's a problem because, you know, every year we host Thanksgiving and it's really nice to be able to take off a couple days to prepare for that. But every year, it became a problem. So in terms of yearly planning of your schedule, when you're in an insurance based world, you can't exactly prioritize your own personal needs because you're trying to manage the burden with everybody else in the team. And, and so that's another con of the insurance based world. And then the last piece, in terms of schedule, I already mentioned.
Dr. JJ Thomas:That's the paperwork piece. So while I said that there's stability in the schedule, there is. But we all know how inefficient we can be when we're trying to juggle multiple patients at once in the insurance based practice. And so, when we're trying to juggle that, you're you're bound to have to do patient notes later on in the day. And so now it's interrupting your personal life once again.
Dr. JJ Thomas:Because instead of spending time with your husband or wife, instead of spending time with your kids, instead of going to bed on time so you can get up and kick ass at the workout the next morning, you are staying up late. You're draining yourself even further. And all the while, this brings me to my next point, all the while, you don't even feel like you're honoring what you got into the practice to begin with for. And this is one of the big, big cons that I see in the insurance based world is that all of us, I would say almost all of us, got into physical therapy because we have a passion, we have a calling to help people move better and live their life in a physical, fulfilled way. And in that world, in that insurance based world, when we're overloaded with many, many patients, we simply cannot do what we set out to do when we originally went to PT school.
Dr. JJ Thomas:So now we're drained because our schedule's over overloaded. We're drained because we're not able to make our personal events because the schedule is so structured. We're drained now also because we're not fulfilling our original calling. I remember busting my ass so hard. Like, I still I every day, I was like, patients deserve a 110%.
Dr. JJ Thomas:Every patient needs to get it. I mean, I would try so hard to give everybody exactly what they needed. And in doing so, I would I you know, I think I did a pretty good job. But in doing so, I really took a lot out of it was draining, soul searching because you're just exhausted. You're just trying so hard to keep up with it.
Dr. JJ Thomas:And, ultimately, what happens is when you look at yourself in the mirror the next day, you're kind of like, I'm gonna do this all over again, and I'm gonna try so hard to go and be a 100% for my patients. But meanwhile, I know that I'm nicked. Like, I know that my fire, my passion is getting thwarted because of all the uphill battle that I'm working against in this insurance based practice. Those are all big, big cons. And then the last piece of that is that not only are you drained from the schedule, from the paperwork, from the lack of being able to fulfill your abilities as a as an excellent clinician.
Dr. JJ Thomas:But on top of that, the pay structure that you're given in a lot of these insurance based practices is just not gonna cut it. It doesn't here's the biggest problem in my mind. The pay doesn't reflect 2 important things. It doesn't reflect your work ethic, your work effort. They're kinda the same.
Dr. JJ Thomas:And it doesn't reflect your results. It's not results driven. So there's not a positive relationship. There's not a direct correlation between whether or not you're getting your patients better, which is the whole intention of us doing this practice to begin with, and what you're getting paid for it. So that old that never sat right with me either.
Dr. JJ Thomas:Right? Like, I love hard work, actually. I I love that feeling, whether I'm working out or whether I'm treating a patient, I love that feeling of of working hard. It's not that I mind uphill battles, but what I need at the end, which I think is very common in human nature, what we need at the end to feel good about that battle is a reward. And in the insurance based practices, you're not getting that reward.
Dr. JJ Thomas:I remember, you know, I don't know how they do it nowadays, but 10 years ago when I was still in cash based sorry. 10 years ago when I was still in insurance based practice, every morning, we woke up to our dash we woke up. We signed in to our dashboard that had our productivity numbers on it. And the productivity numbers are what, decided whether, whether our bonus structure, whether we would receive a bonus or an incentive for not for that or not. There was nothing in there related to our success with our patients, to our patient outcomes.
Dr. JJ Thomas:There was nothing in there related to how happy our patients were or how productive we were as therapists in terms of, success in rehabilitating an injury. The only things in there were the numbers. Right? How many patients did you see? How many cancellations did you have?
Dr. JJ Thomas:And those target numbers, I am telling you, they were, like, almost unattainable. So again and again and again, therapists were missing their ability to progress financially because they refused to sacrifice. I'm I was one of them. Refused to sacrifice their standards as clinicians in order to do so. I remember having a conversation with 1 of my, managers, one of my actually directors at the place where I used to work, and we were friendly.
Dr. JJ Thomas:I liked him a lot. He was, you know, he was doing his job, but we were actually at a Christmas party. And, you know, I never I never met my my numbers. I never met target numbers. And most people, they would sort of harass every week.
Dr. JJ Thomas:Like, you're not hitting your numbers. You gotta hit your numbers. And they kinda left me alone because I did get people better consistently. So what he said to me at this Christmas party was, he's like, JJ, he's like, you know, I don't need you to be the numbers person. And I was like, what do you mean?
Dr. JJ Thomas:He's like, I don't need you to be I don't need you to meet the targets. I need you to just keep getting people better. And I looked at him like, that's nice. But what he meant what he said so he he must have seen my face. Like, where are you going with this?
Dr. JJ Thomas:And he said to me he's like, you know, people send to us because you get people better. And he's like, so I don't really I'm not gonna harp you about getting your numbers, hitting your target numbers. And I'm looking at them and I'm like, okay. But no. You know, not to be rude here, but I'm still not getting any more money for actually getting people better.
Dr. JJ Thomas:So you may not need me to hit my target, but it's physically impossible for me to get the people better the way I'm doing it and meet my target. So financially, I was basically being penalized, as I'm sure you've all been there, for spending the time with my patients that it took to actually get them better. So the there's no correlation there. So I'd say that's one of the other huge, huge cons in the insurance based world. If you're listening to this, like I said, guarantee you're already aware of it.
Dr. JJ Thomas:So let's get to the cash based practice world. So here, I just harped and harped and harped about, the things in the insurance based world that frustrated me, and and actually, ultimately led me to open the cash based practice. And so what I wanna do now let's actually go to the cash based practice cons. Let's let's take that same approach of I just really went after insurance based world, and let's talk about what the cons for that, cash based practice are. We'll start off with and the stability of the schedule and the spill stability of the paycheck.
Dr. JJ Thomas:In the cash based world, there's no vacation included in your salary. Right? If you wanna take a vacation, you just have to recognize you're not gonna get paid for your time during that week because you're not gonna take any patience then. We're gonna talk later. The pro to that is that your work is actually now equivalent to your, payment.
Dr. JJ Thomas:Right? So now there's a correlation between how hard you work and the results you're getting and what you're being paid for. But I don't wanna get ahead of myself. So one of the big cons that people might say in cash based practice is, JJ, you're doing this. You don't have any paid vacation.
Dr. JJ Thomas:Well, what you'll see later is that you do have paid vacation. It all works out in the end. Another huge cash based practice con that I think, is probably one of the number one reasons people fear opening their own cash based practice is what I'm gonna call the business scaries. So this was a big one for me. I, as I said earlier, like earlier in the episode, I was saying how really when I became a physical therapist, I had absolutely no intention of a managerial role, a business owner role.
Dr. JJ Thomas:It just was not where my, passion was. And so when I decided I had to listen to my own voice and make a change so that I could, deal with those complaints that I had, I had to get I had to face the business scaries. I had to, all of a sudden, take the time to learn about the business side of things. Now, I will say this is I'm gonna add this in now because I think it's important for you to see how you can approach addressing these business scaries, in a way that is manageable. And essentially, what the way I worked it is, when I first opened my practice 10 years ago, I was building a schedule.
Dr. JJ Thomas:Right? I was building a business. I was building a brand. And with that, I had some time openings in my schedule so that I could start to deal with these business scaries. Right?
Dr. JJ Thomas:I could spend time on the web site. I could spend time on, working with the Web Designer to make sure that we had the best, SEO, SEM available for that market. So the business scaries, while they are scary for those of us that are clinically based, clinically minded, and we don't see ourselves as business minded people. It just takes a little research. Some later episodes, we talk about some real numbers with business, and stay tuned to those because like I said, I didn't come into this with a strong business intention for myself.
Dr. JJ Thomas:Really, it was all driven for patient care and for my family time. So the business scaries, while they can be overwhelming, you figure it out. And if you can't figure it out, you hire people. You consult with people who can help you figure it out. But that's another con.
Dr. JJ Thomas:I'd say that's a big one that keep people keep people off. That that can be scary, so you have to overcome it if you wanna if you wanna move into the cash based realm. Another con is the schedule. Again, schedule's almost on every pro and con list. But the con to the cash based schedule is that, again, it can go both ways, the con to the cash based schedule is that, you know, you do get paid by seeing patients.
Dr. JJ Thomas:So again, I see that as a pro But it's a con in the sense that, look, you gotta get out there. You gotta see your patients. You gotta put the work in. When I was first opening my practice, there were times I saw patients at 5 AM. Sometimes even before 5 AM.
Dr. JJ Thomas:I like that. But everyone might not like that. They may not like the hours that are a little crazy. We'll talk later, when I go to the pros, on how you can flip that schedule con into a pro for you. And then the last piece of this, what con what cons there are to cash based practice is you're the owner now.
Dr. JJ Thomas:You have responsibilities. Right? With great power comes great responsibility. And, that's a whole another level. So outside, now you're moving out of the realm of just a patient, clinician, just a patient advocate, and now you're an advocate for your entire business.
Dr. JJ Thomas:So with that, there's gonna be some bumps that you'll have to deal with. Think of a snow day. Right? If you have to know if you have to get someone to shovel outside, something as simple as that. You have to have patience, have a way to understand if they're gonna come in or not.
Dr. JJ Thomas:You have to directly communicate all those things and and that's on you. In my next episode, we actually talk about the breakdown, the monetary the financial breakdown of what to expect in terms of overhead for cash based practices. And those are things that are maybe unexpected, and you just have to deal with them. And so, but that's a responsibility that could be considered a con. Another example like that, a big one is think about COVID.
Dr. JJ Thomas:Right? I was in my cash based practice in COVID. Honestly, we came through it pretty nicely, but I will say it wasn't without stress. Right? We didn't have that same stability.
Dr. JJ Thomas:At that point, luckily enough, our practice was very, very stable. So it was actually fairly easy to deal with. But what I want to say is, it was work. It was simple but not easy, I guess I should say. But we had to deal with not only patient comfort with COVID, but also legislative issues with COVID and legal issues with COVID.
Dr. JJ Thomas:And just figuring it out. And that was all on me, which again, there can be a pro side to that too, which we can talk about later. And then the last piece of that responsibility part of a con of the cash based practice is there's gonna be patient issues, and you're gonna have to deal with them. You have to be a leader, as an owner, and you have to deal with patient issues. After I'd been in practice a few years already, I I have a class 4 laser.
Dr. JJ Thomas:It's actually a great laser. It's, anyway, cutting edge. But it had The reason you need to know the type of laser is because it's not like the traditional LightForce laser. The cutting edge laser has 2 pieces. It has a hand piece and it also has a robotic head.
Dr. JJ Thomas:Long story short, because I had that type of laser, I have a laser tech, who runs the laser for me. There was a patient issue I had where a patient who I never had a problem with. Honestly, he was very nice to me, kind to me, very appropriate in our interactions as as a patient therapist. However, this patient, when he was dealing with the laser technician who was female, he made her very uncomfortable multiple times. Kept asking her out.
Dr. JJ Thomas:She kept saying, no. She's actually she was married. She actually was like, no. By the way, I'm married. And then he even got a little no.
Dr. JJ Thomas:A lot inappropriate. I had to deal with that. That was one of the first times I remember being like, oh, God. I gotta go. I gotta I gotta call this guy out on this.
Dr. JJ Thomas:Yes. I did have to call this guy out on this. I flat out said to him, listen. You can't talk to my my clinic my, technicians that way. If you can if you can't refrain from having those conversations with my technician, you cannot come here.
Dr. JJ Thomas:I had to draw a line in the sand as an owner, as a leader. It's an issue. Right? In the insurance based world, you have other people to do that. You don't necessarily have to deal with that.
Dr. JJ Thomas:You go to your manager. You go to director. You say this guy is making so and so uncomfortable. They deal with it. Right?
Dr. JJ Thomas:In your own cash based practice, you deal with it. Again, that's a con on one hand. On the other hand, I am comforted in knowing that it's gonna be handled right because I'm gonna I'm gonna handle it the way it should be handled. So I could probably flip a lot of the cash based cons also to pros, but clearly, I'm biased. Let's go to the pros because that's the easiest part.
Dr. JJ Thomas:So for me, the pros of the cash based world. Number 1, the schedule. So we talked about the cons of the schedule. Right? But for me, all those schedule cons are exonerated because of the pros to the schedule.
Dr. JJ Thomas:So I told you my kids were very young when, when I first opened my practice, and that was, in fact, part of what drew me to open my practice was that I was tired of missing my kids' events. Now they're older. Right? And now I'm able to get to their lacrosse games and their football games and their wrestling matches. And because I have complete autonomy over my schedule.
Dr. JJ Thomas:If I wanna work at 5 AM, I work at 5 AM. If I don't wanna work at 5 AM, I don't work at 5 AM. When they were a little younger, what I would do is I would split up my day. So I would, my husband would take them to school. I would see early patients.
Dr. JJ Thomas:Then I would work till, like, 3. Then I would get to go pick them up from school because they come out of school, that's, like, the best time. When I was in the insurance based world, I used to miss all those stories from when you pick them up. But you pick them up and they're like, ah, mom. I made this clay hand today at art.
Dr. JJ Thomas:It broke. Whatever. Just the little stories that really are what it's all about, they they're dying to tell us those things. And when we're not there to pick them up, we miss them. So when they were a little younger and I needed to pick them up after school, that's what I did.
Dr. JJ Thomas:I'd come, go pick them up, bring them home. As soon as my husband got home around 5, 5:30, I would shoot back here when I needed to and I'd see more patients. And I'd work till 8, 8:30 and then I'd go home. That was like also by choice. I didn't do that every night.
Dr. JJ Thomas:I did that maybe 1 or 2 nights a week, but I had the capacity to do it and the availability to do it because it was it was my space, my time, my decision. On that same token, I could do the same thing on weekends. Like, actually, a good example is when the kids were sick. So multiple times when my kids were sick, I only, you know, in a caspase world, remember, we're only seeing 1 on 1. So our range of volume is anywhere from, you know, 9 patients to 15 patients on any given day.
Dr. JJ Thomas:Some of my patients I see for most patients I see for anywhere for 30 to 45 minutes. Some I see for an hour. Some I even see for 15 minutes. But the point is, if a child is sick, if one of your kids is sick or you're sick and you have to reschedule 9 to 15 patients, that's very different than leaving your team members in the insurance based world with 30 patients that they're trying to scramble with. So the guilt that I had associated with having to take off for someone being sick was really lessened when I opened my cash based practice because now, it was pretty simple.
Dr. JJ Thomas:When I was all by myself in my cash based practice, now I could just move them to 2 days from now or move them to the weekend, and everybody got what they needed. So, the schedule for me is really, really a pro. Same thing with vacation. You know, I can schedule out to go see my mom now, a couple times a month. I can schedule out Thanksgiving, Christmas, whatever.
Dr. JJ Thomas:Yes. I have to keep in in mind that when I'm not there, I'm not gonna get paid for that time. But it's all worth it and it's all on my it's my decision. So I think that in when you're in the cash based practice, you'll realize that that's a huge benefit. Another pro to cash based practice is the pay structure.
Dr. JJ Thomas:So I said earlier when I was talking about, a con of insurance based practice being that the pay that you receive as a therapist doesn't make sense. Like, it doesn't equate to your value and it doesn't equate to patient results. So in the cash based world, what's really cool is the equation is much simpler. Your work ethic, your work effort is going to produce results and you're gonna get paid for those results. Whereas in the insurance based world, you could be working your ass off treating lots and lots of patients, trying to give them a 110%, and you're not going to get paid equivalently for that.
Dr. JJ Thomas:So now all of a sudden, we change the math equation. In the CAST based practice, the math equation is you work hard, you get people better, you get paid for it. It's really like, to me, that has been one of the most freeing concepts is that if I wanna if I wanna bring more money home, I work more. If I wanna, you know, if I want to spend more time with my patients, I check with them because they're paying essentially by the minute. Hey, listen.
Dr. JJ Thomas:In fact, I had someone a couple weeks ago. They were scheduled for 30 minutes. The person that was originally scheduled after them made a mistake so I had a little opening on my schedule. So after 30 minutes, I said to them, listen, I was planning on doing this next time but I had a cancellation. I actually could continue.
Dr. JJ Thomas:Do you want to continue your treatment and get this now versus next week? They said, absolutely. So they get it too. They get that relationship that time equals results. And for us, time and results equals income.
Dr. JJ Thomas:So now the equation is much more simpler to deal with, and we're in control of it. Whereas in the insurance based world, we have no control over it really. It's like this snowballing effect where in the insurance based world, we're, you know, unhappy, unfulfilled, not getting paid what we're worth, not being able to get patients better. And in the cash based world, we're flipping the script. And then one of my favorite pieces of the cash based world that's a pro is that ownership piece.
Dr. JJ Thomas:So I mentioned that the ownership you have in your cash based practice as a con, right, in terms of the responsibility that you have as an owner. However, the pros to the ownership you have in your cash based practice far outweigh the cons. And what I mean by that is, you know, that I don't know if you guys have ever had this, but, like, I still have this. When I come in my office, and I'm the first one here, and I walk in that door, and I turn on the lights, more comes on than the lights. Like, my heart comes on.
Dr. JJ Thomas:My pride is turned on. You know? I'm so proud of what we've built here, and I'm so proud of the work we do. And that is something that is worth so much more than any payment we could ever receive, in fact. Being able to say that now I practice in a way that honors my patients' needs, gets them better, fulfills my dream of helping people, just makes the world a better place.
Dr. JJ Thomas:That pride that fills me when I turn on those lights and I look at the space, that is priceless. And so I'd say that's my final pro to the cash based practice world is that you are fulfilled in a way that you originally may have dreamed of when you went to PT school. And then somewhere along the line in that insurance based world, that dream was dampened, and that passion was dampened and that fire was maybe put out a little bit. And when you can get the gusto to go for it and go for that cash based practice, you're reminded of it, and you're living it, and you'll you'll wake it up. And there's nothing better than that.
Dr. JJ Thomas:So in summary, if you're listening to this episode and trying to soul search and figure out if cash based practice is for you or if you should stay in the insurance based world, Here's what I want you to ask yourself. Here's what I want you to think about. Cash based practices are for people that are hard workers, and they want their hard work to be to be reflective of their result. They want that reward to be based on their hard work and efforts. If you're someone who's a leader and a good problem solver, that's a great person for a cash based practice because of what I talked about before with the business scaries.
Dr. JJ Thomas:You know, like I said, for most of us in the PT world, we may not be born a business mind. I know I don't consider myself born a business mind. But if you're a leader and a problem solver, you're gonna figure that out because it's worth it. If you're a damn good therapist, that's like absolutely. If you're a therapist that believes in what you're doing and is is really into the mission of helping people, then CASH based practice is a 100% way to go because you're going to be given the time and opportunity to actually give that to your patients.
Dr. JJ Thomas:It's so rewarding. If you have a family or if you have personal activities that you feel like you're limited from in the insurance based world, Cask based practice is a 100% gonna give you the schedule that's gonna allow you to foster those family needs, foster those personal needs. And so you can't do that as easily in the insurance based world. So if you're that person, if you have a family, or if you have personal goals that you'd like to do outside of spending your time in the clinic, cash based practice is something you should consider. And lastly, if you're a therapist who wants the financial freedom to, again, be able to live your life outside of physical therapy, but still be proud of what you're doing in physical therapy, that's you're someone who should do the cash based practice model.
Dr. JJ Thomas:So if you listen to all these things and you're like, yes. That's me. Yes. That's me. Yes.
Dr. JJ Thomas:That's me. And you're ready to go and you wanna do this. Right? You wanna actually go for this cash based practice. I'm gonna suggest a couple things.
Dr. JJ Thomas:Number 1, listen to each episode. I am literally going through every episode is going through all the things I've learned in the 10 years to build the successful cash based practice. It's grown from just me to now 3 full time therapists, 2 part time therapists, and 2 admins. And it just continues to grow. So if that's you, please listen and subscribe to the channel.
Dr. JJ Thomas:Continue to reach out to me with questions and feedback. I'm loving all the feedback I've been receiving so far. So thank you for that. And lastly, if you really think you wanna take action, if you really think that you're ready to do this, click on the link in the description. There's a free ebook where I outline the 5 most important things you must do if you're going to build a successful cash based practice.
Dr. JJ Thomas:I literally spell it out for you guys. So if you think you really wanna do this, go ahead and click that link. Looking forward to hearing from you and see you next time.