Thanks to countless hours of hard work and dedication, physical therapists now enjoy some form of direct access in every state. The battle for direct access has not been an easy one, but we’ve made a lot of headway. Today, patients have the ability to seek—at minimum—a physical therapy evaluation in every state. This opens many doors for growing your private practice—if you understand how to operate and market your business with direct access in mind.

Unfortunately, many physical therapy programs spend very little time teaching students how to build and market a practice. Most private practice owners have taken additional coursework or learned the business ropes through trial and error. This lack of preparation stands in stark contrast with the education other healthcare professionals, such as chiropractors, receive. From day one, student chiropractors learn about business and marketing business because they—and their instructors—fully expect that all graduates will go on to own and operate a private practice.

Through my experience of owning and operating a cash-based physical therapy practice, I’ve gained a lot of insight into direct access and what it means for the physical therapy profession. At least 80% of my patients come to me through direct access, and I would like to share some ways that I have harnessed the power of direct access to grow my practice.

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Tip #1: Direct access is a mindset, not a permission slip.

To make direct access work for your practice, you must have the mindset of an independent services provider. That is, you must accept that marketing and building your practice is your responsibility. Direct access cuts out the need for the middleman (traditionally, the physician or the insurance company) and allows physical therapists to market directly to the consumer. This is a new skill for most therapists, who are often uncomfortable with the idea of marketing themselves.

As a profession, we need to get comfortable with educating the public about the benefits of physical therapy and the importance of early access to care. We need to connect with consumers wherever they are—whether it’s online or in-person. This entails everything from having a search-optimized website that allows potential customers to easily find you to writing PT-themed articles for your local news publications. Additionally, I have asked my clients to leave Yelp reviews when they are satisfied with my services as this helps me grow my online presence. At the end of the day, you can have the greatest practice ever—but if consumers don’t know you’re there, you will fail

Furthermore, practice owners need to shift their thinking to be more in line with the cash-based model. Basically, that means that regardless of who is paying the bill, you must treat the patient as a highly valued customer—and hopefully, a lifetime client—of your business. These patients become our “brand ambassadors,” sharing our value with their own networks and thus, driving even more business to our practices.

Tip #2: Physicians are colleagues, not gatekeepers.

With direct access, we as PTs have become a source of referrals for physicians. In Virginia, where I practice, my direct access certification allows me to perform an initial evaluation and 14 business days of treatment before I need a physician-signed plan of care. Because most of my patients come to me through direct access—before they’ve seen a physician for the issue—I am in a position to refer the patient to the physician who I believe is the best resource for that patient. This has allowed me to build relationships with physicians who are advocates of physical therapy and who provide excellent care for my patients. These physicians appreciate the referrals I give them, and in turn, they refer additional patients to me. By building relationships and sharing your unique value with the physicians in your area, you can develop a strong network of like-minded care providers. I even market to physicians who own physical therapy clinics (POPTS) by explaining that 90% of their patients will probably do just fine with a referral to the physician’s in-house clinic; I just want to be the provider of choice for the 10% who need something different. Using this approach, I have built up my reputation as a therapist who takes on difficult cases—and gets results.

Tip #3: Other professionals who have direct access are a vital part of your network.

I have built lasting referral relationships with personal trainers, strength and conditioning coaches, massage therapists, hairstylists, and boutique owners. These business owners have always had direct access to their customers, and they know how to convert potential customers into valued clients. And they’ll be happy to refer to you when they understand the value of your services. To that end, I have offered to do service trades with other business owners to give them an idea of what I offer in my practice. This strategy has proven very successful for me, and it can for you, too. Trust me; once these people experience the level of care you offer, they will become your biggest cheerleaders.

To boost your marketing efforts even more, you could try joining a local business group—such as your community’s chamber of commerce—or even a more informal social networking group. By connecting with others in the business community, you can learn about business, marketing, and customer service from professionals outside of the physical therapy profession. Plus, you’ll have one more platform for educating people about direct access to physical therapy.


By fulfilling your role as an independent provider of care with confidence—and putting effort into building your professional network and your online footprint—you have the ability to inspire the public to take advantage of their right to direct access to physical therapy services. Research has shown us the benefits of early access to physical therapy for common issues such as low back pain—and now it’s time for us to spread the word.

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