A little over a year ago, Kaci Monroe was punching the clock as a staff physical therapist in a small outpatient clinic in northwestern Montana. And while there were a lot of great things about the job—the location was incredible, the patients were awesome, and the practice was growing—Kaci couldn’t shake the feeling that she was destined for something more. “As a new graduate, getting my first job, I remember during the interview telling them someday my dream would be to open my own clinic here in [my hometown of] Bigfork,” she said in a recent interview with WebPT.

When she learned that she might have the chance to become a partner in the company, she hoped it would be her ticket to making her dream a reality. That opportunity didn’t pan out—but instead of wallowing in disappointment, Kaci used the experience to strengthen her resolve. “It was kind of a self-push,” she said. “Once I realized I couldn’t go any higher in my other job, I was like, ‘Okay, where next?’”

With the business-planning process set in motion, Kaci left her previous position to focus on getting her clinic up and running—something that would take a lot of patience, perseverance, and paperwork. And while Kaci would argue that nothing can fully prepare a person for the trials and tribulations of opening a private practice, she did offer the following golden drops of advice:

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1. It’s not as bad as you think.

For a long time—too long, she admitted—Kaci let fear hold her back from striking out on her own. Once she got the ball rolling, though, she realized that there were plenty of resources out there to help her through the process. “Everything’s out there that you can imagine,” she said. “It’s much easier starting a business nowadays than even 10 years ago...Everything is online. You can get everything that you need to start. You just have to do the work.”

2. It’s not a linear process.

Kaci’s first step to getting her clinic off the ground: purchasing a PT business book on Amazon. That book helped her put together a basic checklist of to-dos, but she stressed that it definitely was not an all-encompassing guide. And as she started tackling the items on her list, she often discovered sub-items that she had to knock out before she could move forward. “One of the first things was that you have to establish your business,” she said. That meant selecting and registering a business name, meeting with business lawyers, setting up an LLC, and getting a bank account, NPI number, and Tax ID. “[There are] all these things that you don’t find out until you start going through the paperwork and go, ‘Oh, I don’t have that. Okay, where do I go from here?’ And you kind of have to backstep a lot, which is frustrating, but there is no manual.”

3. You don’t have to do it all.

Kaci is quick to admit that she loves being in control of all things related to her business—but that doesn’t necessarily mean she has to fulfill every single function. In addition to hiring great people—she said her front-desk person is “worth her weight in gold”—Kaci has vetted and enlisted a host of vendors to help with things like billing, payroll, website creation and maintenance, marketing, and printing. “There is so much help out there,” she said, adding that really, all you have to do is ask. “All of these companies network and know people.”

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4. It’s okay to learn as you go.

Many would-be entrepreneurs—especially in the physical therapy space—shy away from business ownership because it’s unfamiliar. They know they aren’t up-to-snuff on all of the facets of running a successful private practice, and they see that lack of knowledge as a barrier to hanging out a shingle. But Kaci knows she is far from achieving business guru status—and she’s okay with that. Instead of worrying about doing everything right all the time, she’s embracing each moment as a learning opportunity: “Everyone’s new to this. I have a new grad physical therapist, and a new lady that I’m bringing in as a receptionist...so there’s a lot of training,” she said. And for her part, Kaci still hasn’t quite gotten a handle on the whole work-life balance thing. After all, it’s not like she sheds her business owner status when she’s treating a patient—or when she locks up for the night. “There’s still a lot of stress with making the clinic run smoothly,” she said. “It’s just learning how to balance my time—between a clinician, an owner, and a regular person.” One thing she has found to be crucial: good communication. That starts at the beginning of each day, when she gives each staff member a printed schedule of the day’s appointments.

5. You have to find ways to differentiate yourself and your practice.

Even in a community as small as Bigfork, Montana, people have a lot of options when it comes to physical therapy care. For that reason, Kaci was determined to bring something different to the market, starting with the location. She had been friends with the owner of a local athletic club for years, and she felt that establishing a PT clinic on the premises would be valuable to both businesses. So, she approached the gym owner with her proposal, and he accepted. She then enlisted her father, a contractor, to handle the construction of the addition that would house her office. Being involved in the building-planning process meant she could create the exact clinic environment she was envisioning—complete with a warm-water therapy pool, which has proven to be one of the clinic’s biggest draws.

And even though building a clinic from scratch is a huge undertaking—she never could have imagined the degree of careful consideration that goes into picking paint swatches—partnering with the gym has paid off, big time. “Being part of the athletic club has brought so many clients,” she said. “I mean, I’m surviving right now on word-of-mouth alone. I haven’t even marketed to MDs yet because I haven’t had a need to. I’m full every week.” Another differentiator: the number of specialized certifications she’s racked up in the years since she graduated from PT school. For example, she’s certified in dry-needling and spinal manipulations, both of which are popular among her patients. “There’s a lot of certifications out there,” she said. “I still take tons of continuing education courses, and I take the courses that are going to put me apart from someone else. Don’t go to the cut-and-dried classes; go to something that’s going to give you a certification in something, because people want to see that you’re certified in something.”

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6. Business opportunities can arise anywhere, anytime.

A few months ago, Kaci—a former high school and college track standout—bumped into her high school coach at a booster club fundraiser. When the coach started telling her about an injured runner, Kaci immediately recognized the opportunity in front of her. She offered a free consultation for the athlete, and that snowballed into providing taping for the track kids before each practice. “I want to work with [athletes], so I’m willing to put in the time and the effort to work with the high schoolers,” she said. And if they or their families ever find themselves in need of rehabilitation therapy, she’s confident they’ll come to her. Plus, having been an athlete herself, Kaci feels compelled to provide Bigfork’s high school athletes with the type of care she wishes she had received at their age. “I remember receiving physical therapy when I was in high school, and I remember doing exercises; I remember doing stretches; I remember getting ultrasound—but I don’t really remember any good, hands-on treatment,” she said. “I think my empathy and my realization as an athlete of what’s bad care and what’s good care has really shaped me to be the PT that I am. I know what I would want...as a patient.”

7. If you’re thinking about starting a clinic, now is the time to do it.

Every day Kaci walks through the door at River Bend Physical Therapy and Preventative Care, she’s met with a deep-seated feeling of achievement, satisfaction, and—most importantly—happiness. “Every morning when I unlock the doors...I don’t know, I can’t explain it.” she said. “It’s definitely a different level, being an owner [and practitioner] versus just being a PT. You just care so much more.” And to anyone with aspirations of private practice ownership, Kaci offers this short-but-sweet piece of advice: “Do it. Don’t wait.” Although it can be tough to leave a solid job behind in favor of venturing into the great unknown, Kaci said her only regret about the whole endeavor was that she didn’t do it sooner. “I think I started being unhappy after two years [as a staff PT], and I think if I would have started then, it would have [made] all the difference, because I just knew that I wanted something more, deep down, and being a staff PT just wasn’t going to do it,” she said.


Are you a PT with private practice ambitions? What’s holding you back? What questions do you have? Share your thoughts in the comment section below.  

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