When I was a physical therapy student, I always knew that one day I would open up my own private practice.  My initial perceptions were only about the money, deliriously thinking that in private practice I’d make big bucks while at the same time doing what I love practicing physical therapy.  Selfish, I know.  Well I’ve grown much wiser since then.  I’ve learned that such a reality, while not entirely impossible, is not the way I’d want to live my life.  The focus on only monetary values leads to pretty unsightly results. 

High volume.  Decreased time spent with patients.  Belittling reimbursements and contracts.  Heavy overhead for billing and associated staff.  Bloated operations.

Sad that as a recent graduate I’m already disgusted with how private practices have to operate. 

As a recent graduate with an entrepreneurial spirit, I’m presented with two choices.  I could settle to operate in the status quo, where I could still possibly be  successful or innovate to practice in a better business model, with returns that benefit more than the business itself.  I recently completed a project to create a business plan, which was an excellent lesson in seeing how all the numbers worked out.  I designed the plan exploring the idea of a solely cash-based practice, along with other progressive concepts.  Although I was navigating through unknowns, considering the currently flawed reality as the alternative, I’ll optimistically work in the uncertainty.  The cash-only model would eliminate insurances’ associated heavy overhead of staffing and operations.  One progressive concept is the idea that business must now play a vital role in increasing the wealth of the human experience in the community, instead of the monetary wealth of the business itself.  My business plan sought out to increase the wealth of the community’s health and health knowledge. 

Now I’m still learning and exploring how innovations in technology and business can apply to building a new physical therapy practice.  My to-read list of books seems to constantly grow.  The same applies to reading the blogs that I follow.  I’ll keep reading and increasing my knowledge base, but I do know that I’ll eventually need to put it all into practice.  From my readings, I highly suggest Umair Haque’s publication Betterness:Economics for Humans.  Consider this a primer about the role of business for the future.  This book has motivated me to further my personal/professional development and helped shape my vision of my own private practice for tomorrow’s economy.

So what’s my main motivator now?  Definitely not the money.  Instead I want to go into private practice for one thing - to practice physical therapy, educating my patients and the community, to improve their health.  How would I want to practice?  Smart and sustainable, utilizing technology to better the patient experience.  This is the private practice in the future that I strive to open and grow.

Today's post is contributed by Ryan Balmes DPT. Ryan Balmes graduated in May 2011, currently working as an orthopedic resident at LSU-Shreveport.  You can follow him on Twitter @RyanBalmesPT and read his blog at http://ryanbalmespt.com.

Our contributing blogger today is WebPT Member, Jack Sparacio, MSPT, COMT, CFMT. He is also the Owner and President of Sparacio Physical Therapy P.C. in New York. We're excited to have Jack sharing his expertise. Thanks Jack!

I know what you’re thinking. There is no way you can open an outpatient private practice for less than $8,000. But the truth is, you can.  There are plenty of articles out there that will tell you that opening a private practice requires tens of thousands of dollars and a team of accountants, lawyers and consultants. While that might be the case for some people, it does not have to be the case for you. All it takes is a little creativity and being a cheapskate. Let’s call it being “creatively efficient” (cheap). Of course, you will need patients. We will discuss getting patients later. 

Let’s first take a look at what I mean by being creatively efficient.  Buying equipment for your office does not need to break the bank. And with the Internet, you can quickly compare prices to save significant amounts of money. Why spend $3,500 on a high-end Ultrasound-Electric Stimulation Combo Machine when you can buy separate portable ultrasound and electrical stimulation units for about $100 each?  You will have a lot of choices to make.  Just make the more efficient choice. You can buy a $3,000 automatic high-low treatment table or an economical wooden table (with an adjustable backrest) and a step stool for under $500. Or, watch for other clinics going out of business and you may be able to snag a high-low table at a discount. You can buy electrodes for $10 per pack or for $2.00 per pack (which I just did recently).  You can buy massage cream for $28 a jar, or for $14 a jar. You get my point. Just do a little bit of research and you can save more than 50% on most items. Use your referral and peer resources and networking to find good deals. Most patients don’t care about fancy bells and whistles. They just want to get better.

Furthermore, there is a very practical method to designing your office. Do you need to buy bulky and expensive exercise machines or can you accomplish the same goals with smaller less expensive materials?  A great idea is to utilize different length ballet bars attached to various positions (top, bottom and middle) on a wall. You can then attach various sport-cords and resistance bands for patients to perform hundreds of exercises.  Also, keep in mind that when designing an exercise program for a patient, they are not going to have access to that expensive exercise equipment at home. Giving them exercises in your office utilizing sport-cords and resistance bands are reproducible and practical. Moreover, not having all those large exercise machines will enable you to utilize your space more efficiently. Do you need to rent the 3,000 square foot office and pay rent for space you are hoping to grow into? Or can you get your practice up and running in the 800 to 1,000 square foot office for one-third the rent? Growing out of your office is a better problem to have than paying for space you are not utilizing. Subleasing space from other health professionals or health clubs can also be an affordable alternative. 

When it comes to marketing and acquiring patients there are only a few things you will need. You will need business cards and letterhead.  At this time, you do not need to spend money on any other marketing materials.  You don’t need brochures, “Welcome to the Practice” folders, newsletters or even a website.  There is no magic marketing widget that is going to have your phone ringing off the wall with new patients. The most important thing you need is time. You need to take the time to go out and establish relationships in the local community. Yes, I know your time is valuable, but there is nothing that can take the place of a strong personal relationship with a local referral source (Physician, Physician’s Assistant, Personal Trainer, etc.).  And the good news is you don’t have to lay out any money for your time.

As far as practice management goes, there are methods available to get your practice up and running in a very affordable manner.  Outsourcing your billing to a medical billing company can be one such method. A billing company will take anywhere from 5%-12% of the money they collect from you. However, you will not need to lay out all the money that is associated with billing for your services. For example, you don’t need to purchase a billing software program or hire and train a staff person to manage your offices billing. In the early stages of developing a new business, most of your time should be dedicated to providing exceptional care and acquiring new patients. Without patients, your business will have a challenging time being profitable.

Today we are pleased to present Part II of our interview with Chad Novasic, PT. Chad received his B.S. in Physical Therapy from Marquette University in 1988, and has served the Racine and Kenosha areas for the last 13 years in private practice. He has practiced several years in both a long term care setting and an acute care outpatient clinic setting. Chad is the owner of Alliant Physical Therapy Group. Alliant serves Southeastern Wisconsin with several clinics and is currently planning aggressive growth in the coming year.

If you could go back and do one thing differently what would it be?
When I got out of school, I think I had quite a bit of ego. Everything was driven by what I wanted. If I had learned about other people’s wants and needs, I would have had an easier time. I needed to listen and not talk. The more you listen the more action you get. That was a big lesson, learning to let go and not make it about me. Also in the beginning, I don’t think I had a clear purpose of why I started. I started because I wanted to make money. That was a bad reason. You’re not going to make it. Making money is the benefit of doing quality work, having empathy towards patients and great communication. We go into business to make money, however, making money alone is the least long-term motivator that exists.

What’s been the most rewarding part of owning your own business?
Personally, I have the freedom to control my own life. My family. My work. My faith life. That balance and control is great. I’ve been able to watch great therapists succeed. To be able to watch them take care oftheir families while helping people out, that’s rewarding. Part of my mission is to help young therapists take off in their own lives.

This post was contributed by Ann Wendel, PT.  Ann is the owner of PranaPT, a member of WebPT and active on social media. Thanks to Ann for being a resource!

Today’s post covers a topic that has been on my mind a lot inthe past month. Turf wars. Ugh, I just gave a little shudder eventhinking about it!

The turf wars I’m referring to are the escalating interactions involving bickering among healthcare providers. Anyone who is active in social media knows what I’m talking about. In the age of the Internet, everyone is an expert, everyone has an opinion, and most people are bravely ready to let the world know just how smart they are (and how stupid everyone else is). Turf wars are not a new phenomenon. I have been in this field for 20 years now, and even in 1992 when I started my first job as an ATC, there were turf wars in the clinic. Even then, everyone was fighting for their piece of the pie.

The difference is that back in 1992, when you had an opinion, the only folks who had to hear about it were your friends and family. Maybe if you were really passionate about something, you would write a letter to the editor of a publication and wait a month to see it in print (I have a vivid memory of writing a letter to an editor in 1994 on the very topic of turf wars!)
Today, if you disagree with something, you can fire off your opinion in the comments section of a blog, on Twitter, on Facebook, or on all three simultaneously! Statements made in the heat of the moment, often without full understanding of what is being said, are posted for the world to see. Forever. If you made a nasty comment in the heat of the moment, you have to live with it floating around the web for the rest of your career.