The Biggest Challenge In Launching Your Cash-Based PT Practice

Show Notes

Today, I'm diving into the single biggest challenge holding many physical therapists back from launching their cash-based PT practice. In this episode of the Dr. JJ Thomas Podcast, I discuss how decision paralysis is holding you back and how these simple yet effective mindset shifts can help you break free. So that you can align your core values with your business skills and take the first step toward a fulfilling PT career.

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Creators and Guests

Host

Dr. JJ Thomas

Master of Movement With over 20 years of experience, Dr. JJ Thomas has established herself as a highly successful clinician and educator. Her unique experiences and training have shaped her into a passionate advocate for movement and patient care. Graduated from the renowned University of Delaware, the #1 ranked physical therapy school in the nation. Holds multiple certifications in advanced specialty techniques, including dry needling, SFMA, FRC, and more. Instructs and trains clinicians nationwide in physical therapy, chiropractic, and sports medicine, both through Evidence in Motion (EIM) and independently. Expertise in movement analysis and dry needling has made her a sought-after professional in the field of sports medicine. Worked with notable organizations and athletes, including the US Field Hockey Team and professional athletes from NFL, MLB, NBA, USATF, PGA, US Squash, USPA (polo), and more. Recognized as an expert and consultant in dry needling, contributing to national legislative advancements and education standards in the field. Lives an active lifestyle, engaging in various activities like running, weight lifting, Jiu Jitsu, hiking, skiing, and more.

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

Every single decision has to match your vision, mission, and goals. And when you are true to that, you are gonna see bounding results in your patients, in your practice, in your shelf. It's so rewarding. Welcome to the doctor JJ Thomas podcast. I'm doctor JJ Thomas.

Dr. JJ Thomas: 00:19

Today, we're gonna talk about the single most important question you can ask yourself when you're struggling to make a business decision, or really any decision for that matter. Let's put this in the realm of cash based practice though, since that's what we are. Most PTs want to open a cash based practice. We did a little study. We did a poll with our viewers on, social media.

Dr. JJ Thomas: 00:42

And what we found was that 93% of the people that we asked, 93% of the physical therapists that we asked, said they would prefer to be in a Caspase practice. There's definitely not 93 percent of the people of the PTs out there in cash based practice. So what's the limitation? Why aren't people jumping to do this? I would say it's because of decision paralysis.

Dr. JJ Thomas: 01:04

Yes. I made that up. I've never heard it before. But I was thinking about it, and I'm like, why don't people do this? I think the main reason people don't do it is that it's overwhelming.

Dr. JJ Thomas: 01:14

You think about opening a cash based practice, there are all these things to consider. And it's like a deer in headlights. All of a sudden, they're like, oh my god. It's too much. I don't know.

Dr. JJ Thomas: 01:22

I can't do anything. I'm just gonna keep here grinding, and I'm not gonna get any better, and I'm gonna be unfulfilled. And what you need to do is start making some decisions. So one of the best ways we can arm you with an ability to make a decision is ask yourself this question anytime you have a decision. Again, business or personal related.

Dr. JJ Thomas: 01:41

The question is, is this action or is this decision going to move the needle towards my personal vision, mission, and goals? So now you say, well, shit, JJ. I don't have a vision, mission, and goals. Well, you gotta get one. So how do you get one?

Dr. JJ Thomas: 01:56

It's not that hard. What you need to do is you need to come to terms, spend some time with yourself, asking yourself what's important to you? What are your core values in life? What is your purpose in life? These things will all relate to your vision, mission and goals for yourself, for your company, for your cash based practice.

Dr. JJ Thomas: 02:15

That's what you need to do is spend the time getting to know yourself and getting to know what's going to drive you to create a successful environment for yourself and your patients. If you're still not sure, you're like, JJ, you're talking, you're very confident, that's great, but I still don't know what the heck my core values are. Then I ask you this, what keeps you up at night? You're working all day. You're working your butt off.

Dr. JJ Thomas: 02:39

You come home. Your kids are tired. You're tired. Your husband wants to hang out. You're you don't have anything left.

Dr. JJ Thomas: 02:44

You're, like, putty. And then you go to bed, and all of a sudden you can't sleep. Why can't you sleep? What is what is keeping you up at night? That often relates to what your core values are.

Dr. JJ Thomas: 02:55

So when I talk to my friends that are still in insurance based worlds and and I ask them about these things, I think it's that decision paralysis. When they come to me and they say, JJ, I wanna open a Caspase practice. It looks great, and it is great. And they're like, how did you do it? You know what?

Dr. JJ Thomas: 03:11

I just had some guts, and I slowed down, and I made some decisions. But every single decision was based on my vision, mission, and goals for myself. Let's think about this. How many of you have been to a diner before? And you go to the diner, and you're all excited, and you get there, and you get the menu, and, like, crap.

Dr. JJ Thomas: 03:28

I don't know what I want to eat. And there's pages and pages. It's not like there's a lack of things to get. But you don't know what you want to eat. And I would say that's for two reasons.

Dr. JJ Thomas: 03:36

Number 1, you didn't come hungry. Number 2, you don't have a purpose for that meal. You didn't go to that meal with a purpose. Life is the same way. If you don't come hungry, number 1, you're not gonna want to eat.

Dr. JJ Thomas: 03:47

Number 2, if you don't have a purpose, you're not gonna know what to eat. So let's take the diner example again. You go there, and your purpose, your current goal, vision, mission for yourself is, you know what? Summer's coming. I wanna trim my waistline.

Dr. JJ Thomas: 04:01

I wanna get 6 pack back. I'm gonna have egg whites, and I'm gonna have some veggies on the side. That decision perfectly aligned with your goals, vision, and mission for yourself. But maybe your goal isn't that. Maybe your goal is, you know what?

Dr. JJ Thomas: 04:14

I don't see these friends that often. Once a month, I want to go with these friends. I want to let loose. I want to have some pancakes. That's that's your decision.

Dr. JJ Thomas: 04:22

And as long as that decision meets with your vision, mission, and goals for yourself, then it's the right one. So when you go to open your own cash based practice and you feel like you have this diner menu of options because you do, and that's part of the great thing in the world. Right? It's like a catch 22. We're in this world now where there's so much available to us.

Dr. JJ Thomas: 04:40

There's so much accessibility. There's people you can hire for this. There's accessibility to this. There's all these things, which is wonderful until you go to make a decision and you have decision paralysis. And you're like, well, crap.

Dr. JJ Thomas: 04:52

I'm stuck. I don't know what to do. Think about the diner example. You gotta be hungry for it. So you gotta get over that.

Dr. JJ Thomas: 04:58

You gotta be hungry to make these decisions, and go ahead and do it. And the way you're gonna do it is you're gonna ask yourself every time, every decision, whether it's what cup should I buy or what table should I buy or what space should I rent. You're gonna ask yourself, does this decision is it going to impact or move the needle in the way that I want to match my vision, mission, and goals? It's that simple. So if I could use myself as an example, if I think about when I hit my tipping point for wanting to open my own cash based practice, my burnout period, my kind of pivotal moment in my life where I was like, I'm done with this.

Dr. JJ Thomas: 05:36

I can't do this anymore. My sleep at night was interrupted. My core values were being challenged. And I didn't like the way I felt. And so in 2013, one of the pivotal moments that I remember distinctly to this day is coming home from a late night of work.

Dr. JJ Thomas: 05:52

My kids are already in bed, and I had so much paperwork still to do. And I was already so behind on the paperwork that if I put it off another day, it was gonna be just too overwhelming the next day. And I remember grabbing you know, going up, kissing my kids, even though they're already in bed. My husband put them to bed for me. Coming back down, pulling out my laptop, very, like, you know, unmotivated ish.

Dr. JJ Thomas: 06:17

And I hop in the recliner, and I'm sitting there. And my poor husband's trying to talk to me, and I'm like, oh, I gotta do these nuts, babe. You know? I'm trying to remember what I did with the 30 patients I saw that day. And I just remember thinking like, this is not what this is about.

Dr. JJ Thomas: 06:30

This is not why I got into PT school. This is not gonna work. So that's when I had my first heart to heart with myself of like, alright, we got to do something about this. Like, you can either shit or get off the pot, and let's get something going, and how am I gonna do this? So I gotta start making some decisions.

Dr. JJ Thomas: 06:45

What I realized is that my decisions were going to have to relate perfectly to what my core values, my vision, mission, and goals were. And so I had to come, you know, I had to come to a realization with myself and really ask myself the hard questions. What really is important to me? Why am I being kept up at night? Well, what I found with some discovery and some some searching, some soul searching, is that what was really important to me was number 1 and number 2, I'll put these equal, is I wanted time with my patients.

Dr. JJ Thomas: 07:14

I've realized that time with my patients, with time with my patients, I could get them better. So time with my patients was going to give me meet that vision, mission, or goal of getting people better and feeling fulfilled. So that was number 1. Number 2 was I wanted time with my family. I wanted to be able to come home and maybe put my kids to bed on my own, maybe have a conversation with my husband instead of being, like, I'm too burnt out to have any conversation.

Dr. JJ Thomas: 07:38

And those were the top two priorities for me. And then when I started actualizing this Caspase practice in my mind, I thought, okay. If I'm really gonna do this, I'm not, like I'm a very creative, successful, I'd say, talented physical therapist, but a business person was not really in my nature initially. And so I another thing that was important to me is that if I was gonna make this work, this business plan had to be pretty simple. I had to keep light on the business plan, and I had to keep heavy on the patient care.

Dr. JJ Thomas: 08:09

Because patient care is what makes me happy and patient care is what helps me sleep at night. So when it came time to actually make decisions on steps that were going to move me forward to the cash based practice, everything went back to that vision, mission, and goal. I chose a very low rent, low risk place to space to work. I had part time 2 different spaces because I had relationships with people who said, you know what? You can actually, one was amazing.

Dr. JJ Thomas: 08:37

I had I could for $200 a month, I could do this, this golf center. I worked in this golf center, and I brought my own table, and I had my best tools with me. And it was simple and easy. And then another day, I rented space from a gym, and I just paid these people per patient. So it was a very simple plan, and the space was very simple and it had very low risk because I wasn't tied into a formal lease that had me locked in for years.

Dr. JJ Thomas: 09:01

So the business plan was simple. I kept the equipment simple, obviously. Like I said, I had my best tools with me, my brain in my hands. That was all I really needed at the time I did have a table. But that was it.

Dr. JJ Thomas: 09:10

I was like, you know what? We can do mostly bodyweight exercise where we need to. In the gym, I had some equipment available I could show people, but very simple. And the last thing I did was I focused on my strengths. I went to these patients or these patients came to me, and I did the things that I was best at.

Dr. JJ Thomas: 09:26

That's what was going to match with my vision, mission, and goals. Those are the decisions that was going to help me raise the bar with patient care, but more importantly, raise the bar with my practice and my business. I'm going to sidebar for a minute and just talk about that strengths issue because I think it's important. When you're considering making these decisions to open a cash based practice, focus on your strengths. Don't if you have weaknesses, great.

Dr. JJ Thomas: 09:49

That's fine. We all have them. But no amount of marketing is going to make your weaknesses look any better. Patients are much smarter than that. So don't go into a practice where you think you can just market everything under the sun and have the type of patience and, following that you want.

Dr. JJ Thomas: 10:06

Focus on your strengths. Do what you're good at. What you're not good at, move on or get better at. But be honest with yourself on that little point. Sidebar, but I think it's worth it.

Dr. JJ Thomas: 10:16

The other thing I did when I was opening the Cashiers practice is I really focused on relationships and referrals. Not I want to say referral relationships, but also relationships with my patients. The relationships are one of the biggest pieces that will is a game changer for working with patients in a cash based practice. I'm gonna tell a little story about when I was probably 5 to 7 years into my cash based practice. You know, I had some good income coming in.

Dr. JJ Thomas: 10:43

I was cruising, and I was like, what am I gonna do with this income? What should I do? I was like, well, you know, I'm I'm so busy now. I'm having a hard time connecting with some of my referral sources. Like, when I wasn't so busy, when my when I didn't have a wait list all the time and my book wasn't slammed all the time, I would you know, when I had downtime, I would, like, grab cookies and go to my favorite doc down the road and just check-in.

Dr. JJ Thomas: 11:04

Hey. How are you doing? Good to see you. Whatever. I ran out of time for that, which is a good thing.

Dr. JJ Thomas: 11:08

Right? But I thought maybe I'll hire a guy that can help me keep these relationships going. He can just show up with some cookies. JJ wanted me to drop these by. Be a representative for me.

Dr. JJ Thomas: 11:18

Great. This guy, I know him. He's a great guy. But what happened is his vision, mission, and goals didn't align with my vision, mission, and goals. His way of attracting, referrals was very different.

Dr. JJ Thomas: 11:32

He didn't have the same value that I did in terms of our relationship had to be collaborative, and I had to respect every doctor that I worked with. He didn't get that. I remember sitting in a meeting with him, and he was like, alright. I got these 5 docs. I want you to text them.

Dr. JJ Thomas: 11:46

And and I'm like, who are they? I don't even know them. And he was like, well, this one does shoulder elbow. And I'm like, but I have my shoulder elbow guy. And he's like, yeah.

Dr. JJ Thomas: 11:52

But it's good to have 2. Well, I don't need 2. I love my shoulder elbow guy. And he was looking at me like, what is wrong with you? But the point was, I'm not gonna just I'm not just I'm having to meet these people.

Dr. JJ Thomas: 12:05

But if I meet these people and they don't align with my values, my vision, mission, and goals for my patients, I don't want them. I don't want them at all. Every single decision has to match your vision, mission, and goals. And when you are true to that, you are gonna see bounding results in your patients, in your practice, in yourself. It's so rewarding.

Dr. JJ Thomas: 12:24

So I would encourage you to stay true on that. When people first start to open their cash based practices, I think it's very easy to fall into the pattern of, I'm gonna call it lack of confidence, where they feel like and it might even be desperation, where they feel like kind of like that marketer was saying to me, like, well, why wouldn't you want more? Well, it's fine to have more, but I have to first test them out and make sure that they're gonna be in line with my vision, mission, and goals. So that's the story time on that. As far as relationships with patients go, it's the same thing.

Dr. JJ Thomas: 12:58

I will say that I've actually parted ways with 4 patients. 2 of which were because they didn't align with my vision, mission and goals. They didn't really respect the work that I was doing. And again, no hard feelings to them, but even the patients you treat need to understand what what your vision, mission, and goals are for them. And if they're not in alignment with that, there's someone out there that's right for them, and you need to let them go.

Dr. JJ Thomas: 13:23

Because everything you do, every decision you make, every patient you're with, every person you hire, every table you buy, every piece of equipment you buy should fall under that vision, mission, and goal. So for another example, so my first two years, I rented the spaces, the gym and the and the golf place. And then after 2 years, my book was booming. And, I really it was becoming very inefficient for me to trek my table around from place to place. And so I realized that if I really want to be true to my vision, mission, and goals, which is to help as many people as possible, then I'm gonna have to buckle down and get a space.

Dr. JJ Thomas: 14:01

So again, what did I do? I went back to my question to myself, what type of space do I want to move the needle towards my vision, mission, and goals? And so the space that I chose at the time, was, you know, a decent sized space, but it was affordable. It was very simple, and I could put myself in a 3 year lease. And I felt like I could do that comfortably and be able to survive and thrive with the with the patient book that I had grown, essentially.

Dr. JJ Thomas: 14:29

When it came to buying now I had the space. Right? Now I had to choose what equipment to buy for it. Again, it was simple. I had to go back to my business plan must be simple.

Dr. JJ Thomas: 14:37

Light on business, heavy on patient care. One of the the 2 most important pieces of equipment I bought, 1 was a wrestling mat. Because in our practice, we do a lot of movement. We do a lot of getting on the floor, moving around. Movement is one of the biggest requirements that we do.

Dr. JJ Thomas: 14:53

So I looked at those flint things, and I was like, I don't need a big flint. I can't even move on that thing. That's not gonna match what I wanna do with my patients, my boys wrestle. So I was like, well, that's perfect. And then little did I know that I ended up doing jujitsu later on, so maybe it was foreshadowing.

Dr. JJ Thomas: 15:08

I don't know. But, but I had the wrestling mat before I did jujitsu, and that's because it met my goals of what I wanted to be able to do with my patients. So wrestling, Matt, that was a big splurge. I wasn't afraid to spend money on the things that were going to match my vision, mission, and goals, but they had to be the right decision. The second piece was the high low table, and that goes back to my goals for myself, which is I'm a manual therapist.

Dr. JJ Thomas: 15:30

I'm 5 foot 1 3 quarters, or at least I was a long time ago. I'm probably 5 foot 1 and a half now. But I needed a high low table that I could get on top of patients to mobilize the glenohumeral joint at times, or I could, you know, raise a table up and and use it as an exercise as a table for a certain exercise. But I needed that accessibility for my patients. And, again, that was the second piece that was gonna match my vision, mission, and goals.

Dr. JJ Thomas: 15:53

And then slowly and surely, as I was in the space, I realized there were other things I needed. But every time, I asked myself, is this going to support what we're working on here? Is this going to support the core values that I'm trying to always bring it back to? And then at some point, I had to hire help. So I have my space.

Dr. JJ Thomas: 16:13

I have my equipment. Wow. This shit's really working. My patient book is growing more and more. I have less and less time.

Dr. JJ Thomas: 16:19

This is all a good thing. But now I've realized, am I most efficiently going to meet my goals on this trend? And what I realized at that point years years ago is that I needed to hire help. I've told you guys in previous podcasts, our rates are by the minute. So, essentially, at the time at the time, my rate was broken down.

Dr. JJ Thomas: 16:37

It was a 100 and an hour, so it was $2.83 a minute. And so I realized started realizing I was checking my patients out at the end of the session, and I started realizing, man, I love my time with my patients, but I'm spending 5 minutes checking them out, and that's $14. And if I spend another 5 minutes treating somebody versus checking them out, I can hire someone, and that's more efficient. That's gonna help me get to my goal, which is ultimately patient care. So the more patients I could help, the better for the practice, the better for people.

Dr. JJ Thomas: 17:09

And I had to go back to that again. But that decision to hire help, again, also went back to what are we trying to accomplish here? While we're on the decision topic, one thing I want to say is you're going to make some bad decisions. You're going to make some decisions that are not ideal for your situation. You might even, even after this rant that I'm on, you might even make some decisions that really don't match with your vision, mission, and goals.

Dr. JJ Thomas: 17:34

It's okay. It's gonna happen. It has to happen, actually. A lot of things in life are just cycles that we, you know, we tread on and we adapt to, and that's what makes life so interesting. But when they happen, buckle up, move on, make another decision, and change it.

Dr. JJ Thomas: 17:50

And that's it. Stay the course. Just if you can bring yourself back every now and then and ask yourself that resounding question is, is this decision going to move the needle towards my vision, mission, and goals? I say this all the time, but it's simple but not easy. Right?

Dr. JJ Thomas: 18:04

So again, it's a simple concept. Just ask yourself this question and the problem is solved. And it's true. Not easy all the time because you have to frequently check-in with yourself, and sometimes you have to make decisions that might hurt other people. And that's that's hard in a in a in a profession where we really care about people.

Dr. JJ Thomas: 18:19

But it's important. I'm gonna give another analogy because when it comes to decision making, I think still, I've given you this simple tract. Right? The simple, like, just ask yourself this question. But I know many of you are still out there, like, yeah.

Dr. JJ Thomas: 18:34

But there's all these questions. So what I'd like to do, and I've done with other therapists that I've talked with just on the phone in the past, is think of this venture. Think of this adventure as a marathon. Right? Patients come in.

Dr. JJ Thomas: 18:50

Hey. I want to run a marathon in 4 months. There's a lot of things that have to be done for that. Right? That's the end goal.

Dr. JJ Thomas: 18:58

That patient is now on a task though. They have a goal for themselves. You're going to help them make decisions that will get them to that goal. There's a lot to be considered. They're going to have to consider what shoe where they're going to wear.

Dr. JJ Thomas: 19:10

They're gonna have to consider a training plan. They're gonna have to consider what they're eating on certain days and at certain times. They're gonna have to consider their sleep cycle. They're gonna have to consider their recovery cycle. These are all things that we're comfortable with.

Dr. JJ Thomas: 19:22

You know, patients a patient who's not an avid runner might come in and feel very overwhelmed by that. That's you sitting in the chair thinking about your cash based practice. Right? But here we are, the experts in in writing a plan that relates to the musculoskeletal system, and we're like, it's simple. You take the goal, you work it backwards, you figure it out, blah, blah, blah, blah, blah, and then you're there.

Dr. JJ Thomas: 19:40

It's the same thing with the Caspase practice. You have this big goal. Right? And you have to just start thinking, okay, what do I have to consider? Let me look at a timeline.

Dr. JJ Thomas: 19:48

What's a reasonable timeline for me to meet these goals? And then you just start banging it out, and every decision has to meet that goal. And you're going to do it. So when you're opening your cash based practice, remember the marathon example. You're going to hit some road bumps along the way.

Dr. JJ Thomas: 20:04

You're going to adapt to every situation. You may have to re course every now and then. You may have to change your shirt. You're going to make some changes. Whatever you decide to do, get back on the horse, refocus, and recenter your goals, and everything's gonna work out just fine.

Dr. JJ Thomas: 20:19

Thank you for listening. Leave a comment or review wherever you listen to podcasts. Look forward to hearing from you.