Blog Post

How to Upgrade Your Physical Therapy Business from the ’90s Model

People are not products. They are your practice's most important asset.

Brian Gallagher
5 min read
April 6, 2021
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The 1990s were a wild ride for many businesses. This decade had a lot to offer in terms of growth, innovation, and basic business development. 

It seemed at the time that the only direction the future held was up! Things continually moved forward at a faster and faster pace, galvanizing owners to do more of the same in order to increase the volume of output—and thus, revenue.

The Decade of the Patient Mill

This trend certainly held true in private practice physical therapy. I specifically recall a company staff meeting on the topic of managed care that I attended as an employee in 1994. The speaker was proposing solutions to capitation and fixed-rate payer insurance plans, which at the time took a significant bite out of per-visit reimbursements.

We were told to limit visits and increase weekly patient volume, respectively. This was expected—until the presentation took a turn, and the speaker began instructing us to treat each patient according to a set diagnosis protocol. In other words, for each diagnosis, there was a prescribed treatment regimen—complete with the number of visits we were allowed to provide and what, exactly, we were to do during each session.

Well, I broke rank right then and there. I refused to be a part of that logic, because patients are not products: they are humans who have emotional influences that affect their behaviors. Therefore, no two people are going to respond to the same treatment in the same way.  

The “Evidence-Based” Fallacy

I realize now that this speaker was trying to sell us the bill of goods that if a treatment hasn’t been researched and deemed “evidence-based,” then it should not be included in our care plans. Unfortunately, this theory completely negates the therapist’s influence on the patient’s spirit, motivations, collaboration, and compliance—all of which are necessary to bring about effective change both physiologically and emotionally.

If a patient feels persistently poor with their therapy—regardless of the “evidence-based” approach—then they will not stay on your schedule for very long.

I always said my purpose in becoming a therapist was:

  1. to make a difference in the lives of my patients so they could live with optimal health, and
  2. to have an impact on the well-being of society through my local medical community.

Patients will go where they feel they are best cared for and listened to not only as clients, but also as people. 

When you treat with a strict “evidence-based only” approach, your clinical scope of practice narrows as your philosophy of physical therapy moves away from its roots as a combination of art and science.

Robotic physical therapy sessions may soon again become the norm, and we will be right back to that protocol model of the ’90s. Our patients will feel the difference, and they will ultimately seek out other providers with whom they can truly connect—providers who break these rigid protocols to collaborate with each patient as they present individually.

In many ways, this 1990s paradigm still exists in PT practices today.

These practices have been running on cruise control, pleading, “But this is the way we have always done it!”

Prioritizing the volume of patient treatments per week is the treadmill approach of starting them, treating them, discharging them—repeat. In other words: Get a new patient, treat the patient, discharge the patient, get another new patient—ad infinitum.

We need to embrace newer practice models that have better, more inclusive treatment philosophies primed for greater patient care outcomes.

The hamster wheel treatment approach does nothing to fuel the purpose-driven desires of today’s workforce. 

If you are the owner and/or clinical manager, and you solely focus on hiring the employees who can most efficiently perform the functional tasks that will generate the most net revenue, then you are living in the ’90s. In today’s world, net revenue is a byproduct of your staff, your patients, and your community all winning together.

One of the main focuses of my company’s practice management training is to align owners and staff by purposes, not issues. Remember: You can never be an effective leader while trying to manage over disagreements.

Leading your team is often similar to leading your family household. For example, as a husband and father, I want nothing but the best for my wife and children, and I strive to promote the exchange-in-abundance mentality. Life is a two-way street, and the better we can all play our part in giving more value than we ever expect to receive in return, the more we all thrive.

The Practice Model of the 2020s

With that in mind, here are some ways to break out of the ’90s mold and into the ideal company culture of the modern world:

  1. Create a consistent onboarding process for each position in your practice, and make sure you always onboard new hires on what it takes to be a great overall employee before they begin training for their specific role.
  2. Set aside weekly one-on-one time with each new hire for the first 90 days to hear and acknowledge them as a person. Try to listen carefully and be more interested than interesting.
  3. Discuss what it takes to be a rock star in your practice—and what you will do from your side to help the new hire achieve this status. Gain agreement on what their goals are and how they will be measured (remember the two-way street of exchange).
  4. Successful people—in life and in business—set goals for themselves. You must realize that each employee you bring on is either a facilitator or a barrier to these goals. Find out how you can build a common vision of success by aligning through agreement and understanding.
  5. Go beyond merely keeping an open door for communication: build a steady stream of communication into the monthly schedule for each employee from the top down.
  6. Create an after-care program with the intent of helping each patient reach optimum health beyond their premorbidity level. This often manifests in your business model as cash-based services.

The 1990s were, in many ways, a selfish period of time in business. People were seen as products—not unique and skilled humans who could bring about individual value.

Don’t run your practice with the intention of profiting off your human capital (i.e., your personnel, who collectively form the greatest asset of your business). Value each person, and look for ways to enhance them both personally and professionally—not only for your benefit, but also for theirs. Make their decision to join your team the best decision they ever made. In doing so, you will have an opportunity to create a team that achieves group goals that also fuel individual goals.

The right business model starts with the right mindset.

Leaving the ’90s behind means shifting your focus from profit margins to personnel growth margins.

With an efficient environment and proper company structure, you can leverage technology to offer post-development training with Learning Management Systems that will broaden your staff’s personal and professional skills with minimal effort on your end.

For most, it’s an empowering feeling to know you are making a difference through the products that you have rolling off the lines. Remember, your profits will come as a byproduct of your staff winning and doing well, while also taking pride in their accomplishments.


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