Ann Wendel of PranaPT Shares How to Start a PT Clinic
Today we're excited to release Part I of our interview with Ann Wendel from PranaPT. Thanks to Ann for being candid and sharing her story of opening physical therapy clinics with us.
Tell us a little bit about you and your practice.
I graduated from University of Delaware in 1992 with a BS in P.E. Studies, concentration in Athletic Training. My goal was to work in sports medicine. I worked as an ATC in a sports medicine clinic for 3 years while taking more pre-requisites, then applied and was accepted to University of Maryland’s Physical Therapy Program. I graduated with with my Masters in 1998. I started working in a hospital right after graduation. They rarely hired new graduates to work PRN; but, I had more experience because of my years as an Athletic Trainer, so I got the job. I worked in acute care, neuro, and outpatient ortho. From 2003 to 2006 I went out on my own and ran my private practice in space I sublet from a Pilates studio. My next step was to work for a larger Orthopedic practice. I worked there for 4 years until October 2011, when I went back to my own business, Prana Physical Therapy. I now work as an independent contractor for Core Wellness and Physical Therapy in a co-op building. We end up co-treating patients and being more collaborative. We do different but complimentary techniques.
Tell us something we wouldn’t know. This can be an interesting fact, a fun anecdote or even a more formal piece of information about starting a PT clinic.
For my current business, we don’t take insurance. We’re a cash-based clinic, and out of network providers. As I left to start my new business, I had some Medicare patients that wanted to follow me. What I learned through research is that if you don’t accept Medicare, you can’t treat Medicare patients. It’s illegal to accept cash payments from Medicare patients for physical therapy (see Section 40 of the Medicare Benefit Policy Manual from CMS). Medicare patients can only pay out of pocket when they see a P.T. for “Wellness” (i.e. general conditioning and not treatment). This is a little known fact that is devastating for a small practice (read Ann's blog post on the topic for more info). These are the folks that typically need care beyond what Medicare can pay, and they are not able to come see you. If you didn’t know about this and you got audited by Medicare you’d be in trouble. The way the code is written, the only practitioners who cannot opt-out of Medicare are P.T. and Chiropractic.
What is the number one thing you think PT’s need to know before starting their own clinic?
New clinic owners need to understand that they will work about 18 hours a day to start out. People think having your own business is great, and it is; but, you’re never done. When you work for someone else, you see your patients and go home. If you go out on your own, you do it all yourself. You’re responsible for answering all of the questions from your patients. You do all the marketing. And of course you treat all the patients. Part of that is exciting, part of it surprises people. A lot of physical therapists who have always worked as salaried employees are used to a full case-load appearing every week. So, when you go out on your own, it is surprising to see a blank calendar the first few weeks you’re open. You have to work really, really hard until you have sizeable number of patients.
What is something that you wish someone had told you before starting your clinic?
My first time around I thought everyone would be really excited and happy for me. What I learned is that you can’t expect people in your industry to be happy for you. I’m always really happy for others and supportive. I was shocked to find that people were not so supportive. You have to be sure of what you’re doing and don’t listen to anyone else. It’s a big risk. You just have to surround yourself with big supporters who are happy in their own lives. Don’t be shocked by negative responses.
Click here for Part II of our interview with Ann Wendel!
Reader Comments
Awesome start to the reality of starting a private practice! However, I would like to contribute my experiences, if possible:
1) Get a lot of advice from varying sources, especially business owners who are NOT in healthcare. Some of the best advice we received was from people who owned small businesses that were not healthcare-related. There was a lot of valuable BUSINESS advice that was priceless, and this advice made us MORE successful than the average new private practice because we thought "out of the box" compared to traditional healthcare business models.
2) Get advice from colleagues, but take their suggestions with caution. Colleagues start to think of you as a competitor once you start asking them advice about setting up and running your own practice. I was very surprised how tight-lipped people became when I told them my plans to start my own practice despite the fact that my specialty area was different from theirs. As Ann stated, don't expect a lot of supportive, happy, and encouraging people giving you advice. It's almost like they want you to learn the "hard way", or fail, which is the scarcity mentality. Under the scarcity mentality, there are only so many patients in the community, and we all compete for the same patients. If you have the abundance mentality, which is that is there's enough business for everyone to be successful, your intellectual prospects improve and people don't see you as such a threat. A lot of this mentality depends on the competitive nature of the person you're seeking advice from. Choose your sources of advice VERY well.
3) My BEST advice: Limit overhead and carry no debt. Start your business with personal resources and DON'T get a loan. YOU ARE 100% INVESTED AND CANNOT ACCEPT FAILURE! That is very hard for many people, but my wife and I planned our practice 20 years in advance. We saved prodigiously in preparation for the start-up costs. We analyzed what we truly NEEDED, and did NOT base our equipment needs on prior experiences. We identified our NICHE, and equipped based on the specific needs for that specialty. We used our prior employers to get the necessary continuing education and training to become experts in our chosen field, obtained valuable OTJ experience in management and business that expanded our knowledge base of what we needed to know for our personal success, and completed advanced academic degrees based on continuing education allowances. Before I left corporate medicine, I had over 10 years of clinic management experience, received advanced quality improvement skills and certification training, received my academic MSRS and DPT degrees with minimal personal expense, obtained all required board certifications for my chosen specialty area. We were well positioned to offer a competing service that the larger healthcare organization that I previously worked for did NOT offer. We filled the market niche before the hospital knew there was a need.
Remember, large hospitals / healthcare systems move very slowly. There are a lot of regulatory and management decisions that need to occur before decisions are made. As an entrepreneur, you can move more swiftly to identify a niche market and fill the need far quicker than the large organizations. Often, when the large organizations finally enter the market and do offer a similar service, it is substandard because the people providing the service don't have the passion and commitment that an entrepreneur does. The organization simply offers the service because they "should" to be competitive in the market place. The organization often doesn't fully plan for the product development of the service or the program. They simply just "offer it". That's why small businesses continue to survive in the current healthcare market.
For those contemplating private practice: Don't be discouraged by the challenges of entrepreneurship or afraid of pursuing your dream of self-employment. Just understand the competitive field and take advantage of your opportunities to move quickly and fill a market need. If you have fully prepared, it is likely that you will succeed. Often, most of the competition enters the market as a secondary presence and NOT really a competitor. As long as you continue to outshine the "competition", you will do well. Just stay grounded and remember why you chose that niche to begin with.
Best of luck!
As a new grad that's planning to open a private practice later in my career, its awesome to read of a colleague who's made a cash-based business model successful for private practice! Looking forward to part II.
-Ryan
www.ryanbalmes.com
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