Business Matters: How the PT Profession Must Evolve to Succeed

On September 20, WebPT held its inaugural Ascend conference, an educational event focused on helping rehab therapists grow their practices. Featuring an all-star lineup of expert speakers and CEU credits, the conference had a great turnout, and we received plenty of positive feedback. I opened the event with a “fireside chat” with Mike Manheimer, WebPT’s marketing director. We talked about everything from the PT brand to direct access—certainly a lot of hot topics. That’s why I thought I’d boil down the main points our discussion into a blog post for EIM. I want to continue this important dialogue about the vision and future of private practice PT and get more people involved in the conversation. With that, here’s a blog-ified version of my Ascend chat.

I find myself frequently pondering, what is our vision for PT? A while back, the APTA released its Vision 2020 statement—which, I am sad to say, was changed last year. The statement read:

By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, activity limitations, participation restrictions, and environmental barriers related to movement, function, and health.

Personally, I think this is a great vision—one that can and should be embraced by our profession. Our lack of unity in pursuing a common goal is something that has held us back for a long time. Over the years, we’ve formed too many silos of competing visions—and that has made us slow, docile, and vulnerable to the changing environment around us. In the words of my colleague, Jen Gamboa—who is leading disruptive change with her clinic BodyDynamics in Virginia—we must be willing to recognize and give up our sacred cows.

What does she mean by sacred cows? As most of you know, the therapy industry has changed a lot in the last couple of decades. Back when I first started practicing—more than 15 years ago—it was a very corporate environment. Therapy giants like HealthSouth and NovaCare dominated the landscape after gobbling up many of the small, independent private practices.

But when the economy tanked in the early 2000s, so did many of the tops dogs. It wasn’t pretty, and it led to one of the lowest points in the history of our profession—fraud, audits, breaches; does the name Scrushy bring back any memories for you?

But we’re PTs—we bounced back as small-business-focused, entrepreneur-minded individuals. This time around, though, we tried to do things differently. The corporate backlash led to the pendulum swinging back toward an emphasis on providing exemplary patient care—and that gave independent private practices an opportunity to shine. The push toward autonomy gave way to the direct access movement. It was an amazing shift—for us and for our patients. But not one that we’ve capitalized on.

Business education is something that physical therapy students get very little of—if any—in PT school, despite the fact that they are completing highly intensive, doctorate-level programs. As a matter of fact, thinking back to my own PT education (we won’t say how many years ago that was), I recall completing a four-week group assignment that involved researching how to set up a clinic and then giving a short presentation on what we learned. It was a simple pass/fail project that my classmates and I did with very little guidance from our instructors. By contrast, student chiropractors go through three quarters—that’s 27 weeks!—of courses with titles like “Development of the Chiropractic Practice” and “Management of the Chiropractic Practice.”

So, it’s no wonder that, while chiropractors seem to have the business game figured out, hundreds of PT private practices will close their doors this year. Yes, hundreds. In fact, at WebPT, our number-one reason for Member cancellation is clinic closure. These clinics fall through the cracks not because their businesses lacked viability from the start, but because the owners got in over their heads—merely reacting to the market conditions around them rather than pro-actively preparing to deal with the challenges of running a rehab therapy business in the modern world. Then there are those who are simply unwilling to change. How many of you have ever thought something to the effect of, “Well, this is the way that we’ve always done things”? Unfortunately, today—with the combined pressures of strict documentation and compliance regulations and decreasing reimbursements—those words just aren’t going to cut it.

In a time when we have the potential to truly thrive, private therapy practice owners are struggling—struggling to communicate the value of their services, struggling to educate themselves on changing regulations, struggling to stay in business. And, with no cohesive vision or unified leadership, they’re considering giving up. As proven by the numerous clinic closures, many already have. But it doesn’t have to be this way. In fact, I believe when the stakes are high, the rewards are greater.

Direct access to therapy has shifted from being the exception to being the rule. There are a lot of misconceptions out there, but the truth is that all 50 states have some form of direct access. In some states, it’s limited—but still, in every single state, we now have the ability to at the very least perform an initial evaluation for anyone who walks into our clinics. We’ve fought long and hard for this right, so why aren’t more clinicians taking advantage of it? Are we afraid of insurance companies? Are we afraid of the liability? Or is it simply that we don’t know how to market ourselves effectively—don’t know how to make prospective patients understand what we do and the value we provide so that they’ll want to come to us, and more importantly, be willing to pay out-of-pocket for our services?

Direct access eliminates the middleman—and having no middleman changes the marketing game, big time. We’ve relied too heavily on physician referrals and too little on our own abilities to generate business. We still put too much stock into physicians and insurance companies selling our strengths on our behalf, which means the general public has a very narrow perspective on what we actually do. Sure, referrals are important—and will continue to be for the foreseeable future—but we are moving into a new age of healthcare, one that gives the consumer far more decision-making power. Our co-dependency on insurance companies has brain-washed us into thinking that they are our partners. But if they value us so much, why are they continuing to cut our payments? Why are some of you out there still signing contracts for less than what it takes for you to run your business? With direct access, we must learn to serve a different audience, and that’s the consumer.

To do that, we need to take a step back and look at what we do from a consumer perspective. Essentially, it’s time for a new version of our marketing strategy. We all have to re-examine our brand—both at the individual clinic level and as an overall profession. Do general consumers really understand the meaning of descriptors like “doctorate-level musculoskeletal expert” or “neuromuscular expert”? Do they know what we mean when we say we “enhance function” or “transform society”? Terms like these have left physical therapy somewhat shrouded in mystery. And if potential patients don’t even understand what we do, how could they possibly understand why they’d benefit from our services?

We stick up our noses at the business tactics of some other professionals. But dentists, chiropractors, massage therapists, and personal trainers have all done a better job marketing themselves to consumers than we have. And as I mentioned before, I didn’t really learn much about business and marketing in PT school—and I’m betting a lot of you didn’t, either. But here you are doing something about it.

We’re at a formative time in our profession—a time when we must assert ourselves and the value we provide. We are being underused and underestimated. We have let others define us over the years, but now it’s time to take control of our own destinies. We are doctorate-level medical professionals; there’s absolutely no reason why people—ourselves included—shouldn’t consider us primary care providers. Changing that perception—and creating a new iteration of our role in the healthcare community—means we have to change the way we, as therapists, think of ourselves. Yes, we are the compassionate, empathetic, patient-focused care providers that we got into this business to be. But the key word there is business—and to hold our own in the increasingly competitive medical space, we’ve got to start thinking of ourselves not just as healers, but as business people, too.

We’ve all heard the hope-raising statistics about the PT industry:

  • how PT is consistently ranked as one of the top professions in the country, year in and year out
  • how the demand for PT will jump 30% in the next decade
  • how 10,000 baby boomers a day turn 65
    • and how the majority of them will at some point seek care for the things we’re really good at treating

But remember, many other professions are competing for those same consumers. If there’s one thing I have learned since making the jump from PT to software business owner, it’s that the long-term success of your business depends on your ability to differentiate yourself from the competition. You have to get customer buy-in, which means you have to prove to the consumer why he or she should choose you—and your services—over someone else’s. As PTs, we have a unique advantage in this area because so much of what we do is rooted in evidence-based practice. We’re constantly striving for better patient outcomes—and achieving them. And from a business standpoint, that’s perfect because it’s the exact reason why patients seek out our services in the first place: to achieve the outcomes they want. You can probably see where I’m going with this: tracking outcomes is crucial.

But using objective methods to track outcomes isn’t only necessary on the clinical side of things; it’s equally important on the business front. I’m talking about metrics. Clinically, you wouldn’t—and couldn’t—develop or progress through a patient’s therapy program without completing any objective measures. Well, that same principle applies to your business. There are numbers that correlate to every part of your clinic’s daily, weekly, monthly, and annual business cycle—numbers that can tell you how you’re doing and where you should focus your plans for improvement. And they go beyond the stereotypical business side of things. There’s data to track throughout every area of your practice—from the front and back offices to inside the treatment room—and all of it affects (or should affect) how your practice grows and evolves.

With that, it’s time for all of us to intelligently attack and navigate the many business challenges before us. More than learning how to overcome obstacles, though, we must learn how to identify—and capitalize on—the abundance of opportunities in front of us. After all, we as PTs are in the business of helping people, but we can help more people if we commit to seriously focusing on our businesses.

Using a collaborative, forward-thinking approach, we have the ability to raise the status of private practice PT in the healthcare world—to gain the autonomy and respect we deserve and grab the attention (and business) of all the people out there who truly need our help. There are millions—literally millions—of people in need of therapy services. They just don’t know it yet, and it’s our job to show them. This is our mission, and I hope you’ll join me in accepting it. Let’s get to work.

About the Author

Heidi Jannenga, PT, MPT, ATC/L, Founder and COO of WebPT

As Chief Operating Officer, Heidi leads the product strategy and oversees the WebPT brand vision. She co-founded WebPT after recognizing the need for a more sophisticated industry-specific EMR platform and has guided the company through exponential growth, while garnering national recognition. Heidi brings with her more than 15 years of experience as a physical therapist and multi-clinic site director as well as a passion for healthcare innovation, entrepreneurship, and leadership.

An active member of the sports and private practice sections of the APTA, Heidi advocates for independent small businesses, speaks as a subject matter expert at industry conferences and events, and participates in local and national technology, entrepreneurship, and women-in-leadership seminars. Heidi is a mentor to physical therapy students and local entrepreneurs and leverages her platform to promote the importance of diversity, company culture, and overall business acumen for private practice physical therapy clinics.

Heidi was a collegiate basketball player at the University of California, Davis, and remains a life-long fan of the Aggies. She graduated with a BS in Biological Sciences and Exercise Physiology, went on to earn her MPT at the Institute of Physical Therapy in St. Augustine, Florida, and recently obtained her DPT through EIM. When she’s not enjoying time with her daughter Ava, Heidi is perfecting her Spanish, practicing yoga, or hiking one of her favorite Phoenix trails.

10 responses to “Business Matters: How the PT Profession Must Evolve to Succeed

  1. Nicholas Rutigliano says:

    Thank you Heidi for sharing your thoughts and experiences. Do you have any recommendations on entrepreneurship seminars for PT’s?

    1. Hi Nicholas
      I’m not sure if you are a member of the APTA, but if so, I would start by becoming a member of the private practice section http://www.ppsapta.org/. They offer quite a bit of good info on starting your own practice and their conference in November each year provides great content. You are also on a site right now with EIM that promotes out of the box thinking. I would also be remiss not to share the WebPT resources page ( http://www.webpt.com/blog) in which we have blogs and webinars promoting lots of entrepeurship like this: http://www.webpt.com/resources/webinars/entrepreneurship-and-physical-therapy

      Good luck!

  2. Scott Gaustad says:

    Well written and you’re right on! Even though the DPT educational level as been in place for nearly 10 years, students still and I’m afraid experience clinicians have no clue how to establish a business let alone writing a business plan. We are failing our profession.

    1. I would definitely agree Scott – there is certainly a lot of work to be done with respect to PT education. I know that EIM agrees and is precisely why they are starting their own DPT program https://www.evidenceinmotion.com/about/blog/2014/09/greetings-from-the-south-college-eim-dpt-program-information-session-how-to-apply/

      Look forward to seeing the progress.

  3. Sorry for a late response. As a PT who will re-enter practice Jan 1,2014 as a 70 year old PT and former member of PPS-APTA, I agree with everything Heidi mentioned.

    I am stunned,however, by the failure rate she mentions. During the “Fall of the Corporate” period that she mentions, I presented dozens of marketing and business positioning courses to those new and emerging private practitioners at PPS and Combined Sections Conferences. I have the following perspective:

    Given current patient demographics,along with the new and improved education, no PT should fail in private practice unless they believe that clinical skills alone are all that is necessary for success.Even PTs with poor business skills can make it if their patient-therapist relationship skills are adequate.

    A private PT practice has 3 major components:business, clinical and marketing. I separate the business from the marketing, because the most important marketing is internal and in my opinion,inseparable from clinical. The key is to develop relationship building skills, and that sure does not seem to be a strong suit of today’s PT graduates.

    Jim Glinn SR. PT Geezer Guy

    1. I whole-heartedly agree with the 3 major components needed for a private practice PT, however, I don’t believe that they are getting adequate education in those areas. Relationship building is a 2 way street – give and take – we have just been on the receiving end too long and have become passive in the relationship. Value must be shared for the relationship to be perceived as important on both sides.

  4. Paul Potter says:

    Hey Heidi,

    Great content as usual. Thanks for casting the vision for the “PT Renaissance” that needs to occur in our profession. You clarified many of the challenges that need to be addressed and overcome.

    Now the discussion shifts to how do we do this?

    I see online, on demand learning as a great opportunity to equip therapists with the business and marketing skills they need to compete. There are many online learning sites such as CreativeLive.com that could be emulated for cutting edge PT business education.

    The courses could be seen by therapists all over the world creating a world wide movement. I’m all in. Let’s Do This!

  5. Liza Tan says:

    “There are millions—literally millions—of people in need of therapy services. They just don’t know it yet, and it’s our job to show them. This is our mission, and I hope you’ll join me in accepting it. Let’s get to work.”
    Totally agree to this. It’s our job to show them. Mission accepted, let’s move forward.

    1. Thank you everyone for the great and kind comments. I have faith that we CAN do this – just need to continue to spread the message and put action behind the words.

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