Ask Mike Reinold Podcast

How to Prepare to Transition to a Cash-Based Physical Therapy Practice


On this episode of the #AskMikeReinold show we talk about some of the things you should be prepared for if you’re thinking about starting a cash-based physical therapy practice. Transitioning to cash-based PT isn’t easy, but it’s rewarding if you’re prepared. Find out what you can do on this episode. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 191: How to Prepare to Transition to a Cash-Based Physical Therapy Practice

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Show Notes


Mike Reinold: On this episode of the Ask Mike Reinold show, we talk about some strategies for you to best prepare to transition to a cash-based PT practice.


Mike Reinold: All right, what do we got? Andrew? We got the King?

Andrew King: So, we have Lindsey from Indianapolis: “As a newer grad looking to open a cash-based practice in the next few years, what would be the most valuable certification to pursue? Manual therapy, OCS, SCS, CSCS, or other strength and conditioning certifications, et cetera?”

Mike Reinold: Lindsey. Oh, Lindsey. All right, so all right. Let’s dissect the question. So, Lindsay is a new grad, wants to start a cash-based practice, wants to know what certifications, like a OCS, SCS, CSCS, all those acronyms, right? That will be best to help her get a cash practice. And, we can have a whole episode, Lindsey, on whether or not you should be opening up a cash-based practice. I think that’s a whole other question for a new grad on, do you want to immediately get into your own cash-based practice by yourself? Which, kind of sounds like you’re doing. But, let’s talk specifically about what is the best thing Lindsey can do to prepare herself for this?

Mike Reinold: So, I’m going to rephrase your question a little bit Lindsey, because rather than just say which certification for you to get, I want to know, do we think any of those certifications matter? Did I sway that a little bit? Does it matter for what you want to do? And, maybe what you should do instead. So Mike, you just graduated college, right? I’m kidding. Old joke, sorry. Old joke.

Mike Scaduto: Fresh wounds though, fresh wounds.

Mike Reinold: So, Mike was a new grad three years ago, plus? Over three years now.

Mike Scaduto: Yeah.

Mike Reinold: So, three years ago that immediately went into cash-based practice, so I think has a different perspective. But, maybe Mike comment on starting cash-based practice versus insurance, and maybe the difference of what you did here with the group versus just going by yourself.

Mike Scaduto: Yeah. Well, I guess I’ve never worked in insurance based clinic, so I don’t really know how insurance based clinics work to be honest. So-

Mike Reinold: Well, I mean, you did in a clinical sense, right?

Mike Scaduto: I did, yeah. I did for clinical, and I worked as a co-op rehab aid and stuff like that. Never full time as PT, right? So, my first job was that Champion cash based clinic. It was a little bit intimidating at first, but I think the big thing for me was having the guidance of all the people sitting here, which kind of, I used them as my mentors. They were there to help me work with patients, and we see pretty specific patient population here. So, they were able to get me up to speed, and I’m still learning from them. Still making mistakes and still learning, but I definitely made a ton of mistakes early on. But, it was nice to have a solid crew of people that I could ask questions to when needed. I think that was the big thing.

Mike Reinold: So, I think that’s a great point for you, Lindsey here, is that Mike had a good group of people that are in a similar situation. All of us came from an insurance model prior, and then came into this model. So, we know a little bit about the difference. But, he had people he could talk to, and that’s one thing I get nervous about with new grads entering cash based businesses, because most cash based businesses that new grads want to start is, I’m just going to go to the gym down the street and put a massage table in the corner, right? And that’s great, but do you have enough clinical experience? Do you have enough people to talk to, to help you continue to grow? That’s a big challenge for a new grad, right? So-

Dave Tilley: And, my point too, I think that the reason that I was able to be successful in a setting transferring away from a busy insurance place is because I personally am not the guy for the finances. The back end, the billing, understanding, that kind of stuff, I-

Mike Reinold: The organization. I did it not rushing and keeping it… Oh no, sorry.

Dave Tilley: I did things to superficially obviously to understand my billing and coding, my involvement as a PT, but I definitely was not running the back end. So, for me personally, having you guys do that stuff or be good at it, and me being able to just focus on treating and getting better as a clinician, it was helpful for me. So, if you are considering doing that, maybe consult with someone or pay with someone to help you understand, because running a business and then being a good PT in a cash-based business to me are just two completely different things.

Mike Reinold: I would agree with that. So, so far, I’m going to start collecting responses. So essentially, what’s the best thing to prepare is make sure you surround yourself with people that that can still help you, right? Don’t work in isolation, I think that’s a big thing. Two is that probably instead of a OCS certification, I have no idea what that’s going to do for you by the way, Lindsey, you need to understand a business, right? And, how to get the most out of a business. So, what else? Anything?

Lenny Macrina: I mean, there’s a lot. And, when I heard that question, it’s just there’s so much as a new grad to learn, that I think learning to run a business is just going to make it that much more difficult. The first year to three years as a new grad, you need good mentorship, because you just need a lot of people to help you learn how to talk to people and address all these different pathologies that are going to come through the door. Whether it’s a post-op ACL when you progress them to this and that with rotator cuff repair, versus, I don’t know, some kind of random pathology comes in and you don’t know what to do with it. So, you need to learn all that stuff, and I’m still learning too 15 plus years into my career. So, having these guys helps me.

Lenny Macrina: So, you definitely need more experience just as a clinician. And then, hopefully as you’re doing that, maybe the clinic you’re working at, which is probably going to be an insurance based clinic, allows you to see the business side, and you start talking to managers, you start helping them with that stuff. I think that would be a good way to hack their system is to just learn the financials. What does a PNL mean, and all these different reports, and how to read it, and what it means to the business, and there’s so many different things to do.

Lenny Macrina: I think being a good clinician first is going to be priority, and that’s going to give you a little foot in the doorway in the community that when someday you want to start a clinic, which I would recommend probably three to five years at least into your work as a clinician, then you would consider it and hopefully have connections in the community that you’ve been working in that they would then trust you to want to come to you.

Lenny Macrina: So, it’s not just, I graduated PT school, I want to start a clinic, a cash-based clinic. That’s going to struggle, trust me. You need people around you, not just clinicians, but people in the community that trust you, because they’re going to come to you for PT, not the facility for PT. They want to see you, the clinician, and that’s going to be huge if you can develop that rapport with people in the community to be able to come and find you when you open up your facility, whenever that’s going to happen. You know what I mean? And then, hopefully you’ve understood the business aspect, and what you need to buy, and how to pay people, and taxes, and human resources aspect. It’s so much stuff you wouldn’t even understand. Trust me.

Dave Tilley: It’s a venting session for Lenny.

Mike Reinold: So, it sounds like Lenny agrees with Dave, learn business, right? But, I think one other thing I picked up from Lenny here was that you got to be able to communicate and connect with people, which is a big deal. And, my guess is Lindsey, that’s what you excel at, right? Because, that’s probably why you’re considering doing this, is you’re good at connecting with people, you’re helping some people. It’s pretty neat.

Mike Reinold: Now, Lisa, you are jumping in and making the transition as we speak from insurance-based to cash-based kind of model a little bit with your stuff. There’s one thing you have that we all have, right? That makes you unique, right? It’s being a niche with a specific subset of people that not only you like to work with, but that you could say you’re an expert at, right? And, I think that’s a big deal right there.

Mike Reinold: So, Lisa’s a former rower, and former lots of things, right? But, a former rower… No one’s ever a former rower, right? You’re a rower. A former collegiate rower?

Lisa Russell: Sure.

Mike Reinold: That’s what I meant to say, right? So, right? But, Lisa understands rowing, and rowing injuries, and working with rowers, the mindset of rowers. So, she has this big niche. So Lisa, why don’t you explain how that niche has helped you be more confident making this transition?

Lisa Russell: Yeah, so I mean, I spent a good amount of time in the traditional insurance model, because I didn’t feel confident in just telling people, “Hey, I’m a PT. Come and work with me. I’ll help you out.” Even though I’ve been treating rowers essentially all through PT school, because all my teammates and everyone as I was learning my skills were like, “Hey, you want to help me out?” So, rowing has sort of been at the foundation of me developing my skills, but at the same time I never felt fully confident to just say, “Okay, this is the niche I want and this is where I want to be.” It’s more, as my skills have gotten stronger as a whole clinician, I felt more confident that I can say, “Okay, these are the people I enjoy treating and the people that I am as enthusiastic about it as I can be. So, let me kind of put myself into a little bit more of a specialized corner I guess.” But, if I hadn’t taken the time to do the broad, I don’t think I would feel the same way.

Mike Reinold: Right. It’s like you need two things, right? You need to be confident in yourself as a physical therapist, and then confident in yourself and an expert in something, right? So, is Lisa an expert physical therapist? No, but she’s an expert physical therapist for rowers. Am I an expert physical therapist? No, but I’m an expert physical therapist in the small world that I work in. I don’t know how to treat pediatrics. I don’t know how to treat neurology stuff. I don’t get that stuff, right? So, it’s about like being really good at one specific niche where you’re an expert, and I think that’s a big deal. And, I think that’s the one thing that a new grad is going to struggle with, too.

Mike Reinold: So, I think that was a bunch of good advice. Let’s not inundate Lindsey, because I think you’re doing good things and you’re obviously kind of thinking in the right direction. But, I think an OCS, an SCS, a CSCS, none of that matters. Those are just letters that only you understand and your peers understand, the person doesn’t understand any of that, right? What they do understand is somebody that is cutting edge, somebody that’s keeping growing by being surrounded by mentors, somebody that understands the nature of making a business so that way this is a good environment for everybody, and they’re an expert at a special niche. And, I think you kind of put all that together, I think that’s the direction you should probably start focusing on. Don’t worry about taking a test, worry about becoming an expert at a special niche, and understanding what goes into running this type of business. Make sense?

Mike Reinold: So, great question Lindsey, and hopefully that helps a lot of people. I know tons of people have that question. I don’t know, maybe a third at least of our students here at Champion say that that’s their goal, they want to open up a cash based practice next week, right? That’s their big goal. So, I think a lot of people kind of share that. So, great goal, and I hope we all get there one day, but I think if you take those steps, you’re going to get there even more successfully. So, if you have a question like that, the more the better, keep them coming. Anything related to PT, fitness, sports performance, business-related stuff, and career advice like this would be great. But, head to mikereinold.com, click on that podcast link, and you can fill out the form to ask us questions, and we will see you on the next…

Dave Tilley: Next episode?

Dan Pope: Episode. Yes.

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