Physical therapists and chiropractors are sort of like the oil and water of the musculoskeletal community. They have differing perspectives on a lot of things, and they haven’t always gotten along. So, before I dive into this discussion, let me set up some guardrails. Despite how it may appear, I’m not writing this article to purposefully ruffle feathers. I’m not aiming to stir the pot, rake in clicks, or be contentious—though I recognize that dedicating any space to chiropractors on a PT, OT, and SLP blog might be a little divisive. I’m writing this article because I genuinely think that chiros have managed to succeed in one area that many PTs have not: marketing and business savvy.
Take a second to think about it. Chiropractors, as they’re recognized today:
And yet, despite chiros’ fraught history with physicians and their slow adoption of evidence-based treatments, that doesn’t deter patients from seeking their care—at all. In fact, many patients flock to their local chiro whenever they experience musculoskeletal pain. So, what’s happening here? Well, chiropractic marketing strategies are strong, and—using these strategies—chiros have successfully shaped the public’s perception of their care, convincing patients in pain to seek them out first.
Patients have bought into wellness services—but not physical therapy.
In recent years, “alternative health care” (e.g., chiropractic care and massage therapy) has boomed into a multi-billion dollar industry. Patients are still going to their doctors, but they’re also seeking relief through spinal adjustments and acupuncture. What’s great about this is that, while PTs fall under the umbrella of traditional medicine, conservative and holistic healthcare is totally up PTs’ alley.
And yet, despite this public shift toward holistic medical care, PTs are still struggling to get patients in their clinics and retain them through a complete course of care. Some PTs believe that’s mostly due to climbing copays—or because these alternative healthcare options are encroaching on the PT market. And while that may be true, I believe the biggest roadblock PTs must overcome is their ever-present branding problem. In other words, this is a marketing thing. There’s a lot of proof that patients will pay their weight in gold to get rid of their back, neck, joint, and overall body pain. They just won’t pay a physical therapist.
The numbers don’t lie.
In 2016, Gallup and the Palmer College of Chiropractic conducted a joint study about Americans’ perception of chiropractic care. Researchers asked respondents which healthcare provider they would choose to see if they:
- experienced neck or back pain, and
- knew the cost of treatment would not vary.
“Respondents were given five specific healthcare providers—a medical doctor, a chiropractor, a physical therapist, a massage therapist or an acupuncturist,” the study reads. “About half (53%) say they would most like to see a medical doctor about their neck or back pain, and 28% say they would most like to see a chiropractor — on par with results from 2015. Far fewer would most like to see a massage therapist (7%), a physical therapist (6%) or an acupuncturist (1%) for neck or back pain.”
When you remove the object of cost, patients still don’t choose PT over other treatment options—even though PTs are the best-equipped providers to assess and treat musculoskeletal issues. Further proving the point that high copays aren’t PTs’ main problem: Even when you pop money back into the equation, patients don’t shy away from high costs.
According to CostHelper (and a few other sources), a “general vertebrae adjustment” at a chiropractor’s office costs, on average, $65. That’s comparable to the price patients have to pay for PT under a high deductible health plan (for reference, I personally paid $75 copays to see a PT last year). So, that means patients are totally cool with paying a good chunk of money to get their mobility back.
But what, exactly, are PTs supposed to do about this problem?
PTs can (and probably should) take a leaf out of the chiro marketing book.
If PTs really want to revamp their image, capture the public eye, and convince patients to choose PT, then the first order of business is doubling down on marketing efforts. The wider public does not know what PTs are capable of (seriously, check out those links), and yet they’re well-acquainted with chiropractors’ scope of practice. That’s because chiros have some killer PR and marketing—which PTs could totally co-opt.
1. The most important marketing objective for PTs is getting new patients in the door.
First and foremost, your mission—should you choose to accept it—is to get people to walk into your clinic. That’s it! You don’t have to give them an initial eval or even get them locked into a plan of care—at least, not yet. You just want to get them in your doors so you can gently educate them about your capabilities and the treatments you offer. So, how can you do that? Here are a couple of strategies to consider:
Offer services that require a smaller time commitment.
One of chiropractors’ biggest strengths is that they can (and do) offer services that don’t require a big time commitment. This chiropractic clinic, for example, claims that initial visits only last up to 30 minutes—while a followup can occur in as few as 5–10 minutes. Now, this approach absolutely will not work with a standard patient (there’s a reason PTs bill CPT codes in 15-minute increments!). But, that doesn’t mean it won’t work at all.
PTs can provide a host of wellness services on a cash-pay basis—services that offer the kind of easy, breezy, abridged time commitments that appeal to patients. That said, it’s up to individual PTs and clinics to pick and provide the ancillary wellness services that best serve their patient population. You could start by offering orthotics fittings—or gait analyses, or (cash-pay) cupping and dry needling services. You could even allow walk-ins to use therapy tech—like NormaTec massagers. As long as the wellness services fall within your scope of practice, you can go absolutely hog wild when selecting the quick-delivery services you want to offer.
Offer some instant feel-good services—even if they’re non-traditional.
If you’d rather not encourage patients to swing by your clinic for short bursts, you can still encourage them to come in and enjoy other feel-good services. In other words, you may want to consider offering wellness services that show immediate (if temporary) results. This is another area where chiros excel. Many patients leave a chiropractor’s office feeling immediate relief, because they received instant feel-good care—whether that was some combination of spinal adjustments, massage, hot rocks, ultrasound, etc.
PTs, on the other hand, offer mostly long-term evidence-based care—which means patients often must attend multiple appointments before they start to notice big, positive changes. PT patients are in it for the long haul, so to speak. That’s exactly why PTs could benefit from offering some complementary short-term services that will bring patients a similar degree of immediate relief that chiropractors provide.
You could offer massages or assisted stretching sessions—or maybe even “provide yoga, Pilates, or strength training classes.” You could also potentially overlap with the fast-paced treatments I mentioned above (e.g., dry needling, cupping, and various therapy tech). The goal with this strategy is simply to give patients the ability to experience some kind of immediate result.
Once you hook patients on your wellness services, pitch the whole kit and caboodle.
When you offer patients these quick, easy, instantly-gratifying services, you’re actually giving yourself an opportunity to secure their trust and educate them on the value of traditional physical therapy. Chiros are really good at this. They get patients in the door for a single adjustment, and then—after the patient feels a modicum of relief—they’ll suggest followup appointments and services. Some chiros may go so far as to pitch a subscription package, so patients can get immediate relief whenever pain occurs.
This tactic could totally work in a PT clinic. Say, for example, a patient comes in for a massage to help alleviate shoulder pain. You help the patient get immediate relief by providing that wellness service, and then sell him or her on the idea that, with regular PT treatments, you could help reduce or eliminate that pain—for good. Just remember that in order to successfully sell your PT services to patients, you can’t be afraid to tout your expertise. Patients need to know why they should trust you—and more importantly, pay you. So, it’s your job to reinforce your position as the ultimate musculoskeletal expert.
2. PTs must dedicate time to developing their marketing and business acumen.
Chiropractic care originated as an independent service—and chiros, for a very long time, practiced separately from other healthcare providers (i.e., they didn’t rely on referrals to stay afloat). As such, they were directly responsible for their own business success from the beginning—and the earlier names in chiropractic history “emphasized salesmanship, advertising, and practice building.” This focus on business and marketing know-how has carried forward to this day: many post-graduate chiropractic programs offer (or require) business management and marketing classes.
Devote time to furthering your own business and marketing education.
PTs are altruistic. They’re empathetic, people-oriented team players who are passionate about functional well-being. All of those skills are incredibly useful when treating patients—but they don’t help PTs run or market a business. And while some people may have a knack for marketing or management, innate talent can only take you so far. At a certain point, you need some kind of education or training to develop these skills.
The problem is that, unlike chiropractic school, PT school doesn’t devote a lot of time (read: any time) to developing students’ business and marketing skills. In fact, after skimming the coursework of a dozen different accredited PT programs, I found only one (at the University of Iowa) that even briefly mentioned marketing or business coursework. This could be a holdover from pre-direct access days, but in today’s environment, there’s no reason not to learn these skills!
The takeaway is that if PTs want to assert a more prominent role in health care—or even become a widely accepted first line of care—then they must devote time to learning these skills. The proof is in the pudding. Chiropractors have a long history of emphasizing marketing and business savvy, and it’s no coincidence that their specialty is more widely known, understood, and frequented by patient-consumers.
Luckily, there are myriad ways for PTs to sharpen these skills. You can attend a conference, find a marketing mentor, or even read some books—and the sooner, the better.
3. Cash-pay models are more than just viable—they’re downright lucrative.
Although several payers cover chiropractic care (Medicare included), many chiropractic clinics are still heavily rooted in cash pay. According to this 2019 chiropractic industry survey, 16% of practices are cash-only facilities, and a whopping 84% offer at least some cash-based services. For comparison, our 2019 State of Rehab Therapy industry report found that 3.7% of rehab therapy clinics are cash-only facilities, and only 22.3% offer at least some cash-based services.
Reevaluate the role cash-based services play in your clinic.
PTs definitely have some room for growth in the cash-pay arena. Patients are willing to shoulder high out-of-pocket costs for musculoskeletal health and wellness services—and it’s time for PTs to capitalize on that. The physical therapy industry is perfectly poised to stake a strong claim on the health and wellness market. Now, that’s not to say that PTs should immediately transition to a fully cash-based model (it’s not feasible for every clinic out there), but they should absolutely consider offering more cash-pay services.
Plus—getting back to the marketing discussion—cash-based wellness services are a little bit easier to market than traditional medical services. You can provide firmer pricing—and freely run specials and discounts—when you’re not totally beholden to payer constraints, and you can let patients pick and choose the services that they want (sayonara, medical necessity requirements!).
PTs may be at a slight disadvantage when it comes to marketing and business prowess, but that doesn’t mean you can’t even out the odds—especially if you take some of these lessons to heart. Marketing and managing a PT practice is a learned skill, and it never hurts to learn from the people who are doing it well.