4 Phases Of Entrepreneurship And 4 Ways To Make 6 Figures As A PT: Call With UMass Lowell DPT Club

TCLHP 173 | Six Figures

 

Working as a physical therapist is undoubtedly one of the most under-appreciated professions in the medical field. But by fully embracing what it can deliver in the entrepreneurial sense, one can even start earning as much as six figures! Aaron LeBauer shares his Zoom conference with UMass Lowell DPT Club, where he talked about the complex yet rewarding process of starting to work under a certain employer and eventually evolving into a full-time entrepreneur. He also explains why no customer ever gives a lot of attention to medical titles, emphasizing the importance of always providing immediate care that truly works. Aaron also answers a couple of questions from the participants, discussing his own physical therapy business, as well as some practical and easy-to-apply strategies.

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4 Phases Of Entrepreneurship And 4 Ways To Make 6 Figures As A PT: Call With UMass Lowell DPT Club

This special episode is a training I did with the UMass Lowell DPT students. I believe this was their entrepreneurship club or DPT business club consisting of some 1st, mostly 2nd, and 3rd-year DPT students. In this episode, you’re going to learn the four phases of entrepreneurship. You’re going to learn which phase you are in now, which phase do you want to be in, and how you can move from one phase to the next. We’re also going to talk about how I went from sleeping on the couch in the rain in Berkeley during an El Niño for six weeks to generating 6 and 7 figures in physical therapy businesses.

What you’ll also learn is how to make six figures as a physical therapist, whether you’re a student, you’re working in a job, you’re thinking about cash practice, or you already own a business and you’re not there yet. We’re going to talk about that because that is one of the most important topics, especially for PT students and new grads. You’ve paid six figures for your degree, but when you graduate and you get a job in outpatient orthopedics, there are not very many jobs that are offering six figures. There are very few jobs that are going to offer you six figures in physical therapy treating patients. There are four specific ways that you can do that so you can pay down your loans, go on vacation, and have the life that you want. We’re going to dissect these in this episode. There was too much good in here to keep it and never share it. We’re putting it out here for you. I appreciate you reading and enjoy the episode.

What I am trying to do is keep this from being boring, help you out and share some things with you that I didn’t learn when I was in PT school. Are you different years in school?

We’re all different. A majority of the people here are in the second year. We have a couple of third years and then even some undergrad students in the Exercise Science program are here as well.

About Aaron

If there’s something you’d like to get out of this or a question you’d like to be answered, we will do a Q&A at the end. I’m going to start and tell you a little bit about who I am and what I’ve done, and we’ll go from there. My name is Aaron LeBauer and I went to Duke as an undergrad. I don’t know how I got in. There were thirteen kids from my high school class of ‘52 that got in. I had the lowest grades of anybody. I had a 420 on my verbal SAT. Back in the day, SAT was scored differently. My math score was 620. The highest was 800 at the time. Six hundred twenty was great. I have ADD so my brain goes in twenty different directions. There are a couple of things I’ve done over the years to harness that talent and think outside the box.

If there’s one thing that I do well, it’s think creatively about solving problems. I solve problems for my patients and coaching clients. I try not to solve problems for my wife unless she asks me. I went to Duke undergrad. I was supposed to be a “doctor” like a physician. My dad, my uncle, and my grandfather are physicians. I got an A in regular chemistry and went to organic chemistry. I sat down to do homework for the first night, which was a review of the last two semesters in one night. I couldn’t do it. It is going to take me four hours to reteach myself molarity and whatever else it was. I realized that day I’m not going to be a physician because I don’t want to be a physician so bad that I’m going to put aside my whole social life and not have a life outside of studying. That wasn’t my thing.

Being an entrepreneur is about taking calculated risks and not being afraid to try something. Click To Tweet

I went through school. I went to guidance counseling and they said, “I don’t know what to do with you. Go to this person.” The next person said, “I don’t know what to do with you. Go to this one.” I didn’t go to the third time. Everyone I graduated with was either going to law school, going to do business consulting or med school. There pretty much wasn’t an option for people who didn’t. I lived out of the country in Israel for a year, and then I got back. I moved to the Bay Area and I thought I could get an apartment. It turns out the Bay Area is more crowded and everyone wants to be there. I slept on a friend of a friend’s couch on his porch in the rain because it was El Niño year.

I love racing bikes. I was trying to figure out how I can race bicycles. I couldn’t do that making $14 an hour, flipping burgers and pouring beers for people. I ended up in massage therapy school. I had an epiphany one day and I was like, “I can go to massage school. I can work four hours a day and I can race my bicycle.” I did that and I raced semi-professional in the US for about seven years. I race all over the United States and in Belgium for a summer. I wasn’t Tour of France level but it was darn hard. Those guys were way ahead of me. I wasn’t racing with those guys. They were worlds different. I got to a point in my massage career, studying myofascial release and doing medical therapeutic massage. People were coming to me and saying, “Aaron, I know I need to come to see you. I tweaked my back. “

At the time in California, there was no direct access. They would come and say, “I tweaked my back. I need to see you. Can you get me in now?” I also had patients who were telling me I’m the first person to touch them where they hurt. No one’s ever touched them where they’re hurt. “I’ve been to the orthopedic surgeon, chiropractor, physical therapists, massage therapists, acupuncture, and everything. I’ve had surgery. You’re the first person to help me.” What was I doing? I was touching them with my hands. I was spending an hour with them. After doing that for about seven years, people were asking me, “Aaron, when am I going to get better? When is this going to go away?” I didn’t know how to predict their recovery. I didn’t have that knowledge because that’s not what we learned in massage.

Massage is a wellness service. You’re trained to say, “Let’s get you in. How often would you like to come, once a month or once a week? To get the best results, I recommend come in once a week but once a month is great.” They choose and you say, “What works better, Tuesday or Thursday?” We learned how to sell the next service for people, but I didn’t know how to tell them, “You’re done, healed, and better now,” because I didn’t have the pathophysiology anatomy. I didn’t know how to give people a prognosis.

We moved to North Carolina because I wasn’t going to be able to buy a house in California working as a massage therapist. We had tried a couple of other places where my wife was from. We didn’t want to go to LA. We moved to North Carolina and within six months, I had enrolled in Elon University’s DPT program. My wife re-enrolled in school at Guilford. We bought a house, got married, and the rest is history. I went to the Elon DPT program. I got one question right more than I needed to get in without studying for the GRE so I got in. I go on my first clinical rotation in January, the beginning of our second year. Within a few weeks, I’m treating a bunch of patients and I saw 43 patients one day. I was there until 9:30, 10:00 at night writing notes.

I had a 45-minute drive back across Atlanta to where my mom lived to stay with her. I realized that day I’m not going to be able to treat patients the way I want or see that’s necessary for some people working in a traditional insurance model. I knew that day that I was going to have to do something different. I was going to have to go back and charge cash. I was already making $85 an hour doing massage therapy in Greensboro. I gave myself a raise moving from the more expensive West Coast to East Coast. I was charging $85 an hour, four people on Wednesdays and four on Saturdays while I was in PT school, except when I was on clinical rotations.

TCLHP 173 | Six Figures

Six Figures: If someone says you shouldn’t do something as a new grad, they probably had a bad experience.

 

I had this realization and I’d talked to my CI about it in the next few weeks. He said, “No, one’s going to pay more than their copay for PT.” At the time we had a patient who had a $20 copay. She was supposed to come in three times a week. She showed up once every two weeks. I said, “Why don’t we discharge her?” He said, “That would look bad to the referring physician.” He didn’t say referring physician. He said, “That would look bad to the doctor.” I’m like, “Frank, you’re a doctor. We’re not helping her. We should discharge her.” He was like, “No, that wouldn’t work.” I was like, “That doesn’t make sense. She’s not coming in. We can’t help her. She’s not doing work. She’s not incentivized. She’s got a lot of other things in life going on that’s probably keeping her from coming in, but this patient didn’t see the value of what we were doing. She would come in and do exercises on her own and with $20. She had to get someone to bring her in.” That was a big deal. It was a lot of money for the value we were providing.

When I graduated from Elon, my final clinical rotation was a six-month rotation. Luckily, Allen Ling, who owned the business out in California, was willing to do a clinical experience for me that was around business, not just treating tons of patients. I had met him at PPS, probably at the end of my first year. I was presenting at PPS on adding massage therapy services as a cash-based service. I met Allen there and he’s like, “You should come and do a rotation in our clinic.” I was like, “No way. I live in North Carolina and I’ve got a wife. We’ve got a baby on the way,” but it worked out that I was able to do that. I started my cash practice right out of school. My professors said, “Where are you going to work?” I said, “LeBauer Physical Therapy.” They looked at me cross-eyed and I said, “I’m working for myself.” They said, “Do you have all your insurance contracts and things set up?” I was like, “No, we’re doing it all-cash.” They looked at me like, “That’s not going to work.”

People told me that it wasn’t going to work. It was unethical. No one’s going to pay more than their copay for PT. The North Carolina Medicare adviser for the APTA told me so much as, “Don’t even breathe on a Medicare patient because it’s illegal for you not to be a Medicare provider.” This is not the truth, but this is the lack of information and understanding of people about what I was doing and what cash-based physical therapy was back in 2008, 2009. Fast forward to now, we’ve got a clinic and I’ve got a cash-based practice next door. I’ve got two employees, a physical therapist and a practice manager/patient care specialist. I’ve got a coaching business where I help other physical therapists launch and scale their cash practices.

If there’s anything that you leave here with, the one important thing is if you have a great idea and someone comes to you and says, “That idea is a bad idea, you shouldn’t do it,” or they hate on you or give you some crap, understand that you’ve got a great idea. They’re just scared because they would never take action on it themselves. If it’s a family member, they’re just trying to protect you and that’s okay. Family members who aren’t business owners or entrepreneurs, their job is to protect you because being an entrepreneur is a risk. It’s taking calculated risks but not being afraid to try something because failure doesn’t exist for business owners. You either have wins or you learn. If something doesn’t work out right, you’ve got to extract the learning. Otherwise, all the struggle wasn’t worth it.

I’ve got a couple of other things I want to share with you, but I’d love to know what’s your plan after you graduate? Are you planning on opening a cash practice? Are you planning on working in one, or are you undecided? Let me know in the chat which one you are. I’m going to talk to you about the four phases of entrepreneurship and how to make six figures as a physical therapist, which should help everybody. I see a lot of undecideds. I wonder how many people want to do travel therapy? I can speak about travel a little bit. I work with a woman named Jess Jenney. She’s the Wanderlust PT. She’s awesome. If you want to do travel therapy, I’ll get you connected with her. She’d be great to present on that, but traveling is awesome. It’s one of those things that people say, “You shouldn’t do as a new grad,” which isn’t always true. If someone says, “You shouldn’t do something as a new grad,” they probably had a bad experience or they’re just thinking in closed squares.

Employee

Let me talk to you about the four phases of entrepreneurship. Phase number one is Employee. Being an employee is not a bad thing. It’s great. You clock in at 8:00 AM and you’re out at 5:00 PM or 6:00 PM. When I saw 43 patients, I left at 9:30 PM, but I was a student. They can make us work until whenever. You get the same amount of money every two weeks. What are some of the other benefits of working for someone else? It’s stable. You can clock in and clock out. It’s known if you do well with having consistency and someone else’s like, “You do this. You treat these patients. I pay you this much. Here are your benefits and here’s your thing.”

Mentorship is a good one. You have to be careful about mentorship because everyone’s definition of mentorship is a little different. I’ve had some good friends, one in particular, who’s no longer working as a physical therapist because his first job was supposed to be mentorship but didn’t get any. He put the work and he got to talk to someone every once in a while. You have to deal less with the risk when you’re an employee. There’s no risk in our profession and in starting a business. You don’t have to do the marketing. You don’t have to stress about where the next patient is coming from.

A business owner can always close down their business, but an entrepreneur never stops. Click To Tweet

Self-Employed

The next one is Self-employed. You go out and you say, “I’m going to start seeing people, whether it’s a side hustle or a full-time thing.” A self-employed physical therapist is someone that makes money when you spend time helping people. This is where you trade time for money. I did this for a long time, a lot longer than I probably should have looking back. This is where the benefits are, you don’t have someone micromanaging you. You don’t have someone telling you when to work or when not to work, you can take time off when you want, and you can travel whenever you want. The downfall is you’ve built yourself a job and you’re your own boss. If you want to take a week off to go to PPS, this is the thing I struggled with. How do I go to PPS and pay $1,000 to be there? They stayed at these nice hotels. I can spend $200 a night and it’s all during the middle of the week. If I wasn’t in the clinic, I wasn’t treating patients, there was no money.

Business Owner

When you’re self-employed, you’re still stuck. If you’re going to start a business, you might spend some time as self-employed but I want you to think about how we’re going to get to the next category. Even as a self-employed, a cash practice, or in networth, you’re going to earn anywhere from $100,000 to probably $250,000. How do you earn $250,000, whether you’re charging or collecting? If you’re doing what we’re doing and you have $250 times 22 people a week, times 45 weeks of the year, and you’re charging what we’re charging, it’s $247,500. That’s 22 patients a week one-on-one. That’s dope. Is anyone here do not want to bring in $250,000 a year? There’s a lot that goes into it. There’s the marketing, the admin work, and the setup. If I take time off, I don’t make money. That’s the self-employed trap, which is fine. Some people spend years here.

How do we start getting out of that into the Business Owner category where you own a business? What’s the difference between being self-employed and owning a business? You can have people work for you. That’s the big one. You have the employee. I could be down here and still have an employee. I can still have someone like my administrative assistant and I’m the physical therapist. If I’m out of town, we don’t generate revenue. What I have to do is I have to employ other PTs or technicians. Physical therapist, we are all highly trained and educated technicians. We do a technical service, which is touching people or analyzing their movement and helping them improve their function or whatever the APTA says it is.

Physical therapy is a very highly skilled and educated technical service, which is great. To move from self-employed to the business owner is not just hiring people. It’s leveraging your time. It’s no longer hinged on the money you generate. What’s been helpful for you about this so far? Time does not equal money and that’s your time. “Make money without being there.” Other people make money for you. “Constant flow of cash even if you take the day off, you don’t have to do everything.” If you have an online business, what that looks like is you could still be self-employed, but you start moving into a business owner when you can automate sales. If you’re doing online business only, like in my coaching business when I started selling my courses, I was automating them through webinars. You can do a combination of this. I have clients that do this as a combination in their businesses where they’re treating patients, but they’re automating wellness services, sales courses, and things like that.

The number one thing most business owners get wrong is that they think that they are the most important person in the business. They get stuck. I was on a call with a physical therapy business owner a few years ago. He was like, “Aaron, I need to learn more marketing.” I was like, “Why?” He’s like, “The PTs I employed aren’t busy. They’re only treating half the patients I’m treating. They were responsible for their own caseload, but we need to do more marketing.” I was like, “How many patients were you seeing?” He’s like, “40, 45.” That’s one-on-one for an hour. He’s busy. He’s got these two people he’s paying who were only seeing half as many and he’s resentful. What he wasn’t doing and wasn’t willing to do was move his patients over to their schedule so he had more time, then he could market the business and fill their schedule. It’s about leveraging your time.

Entrepreneurship

That’s where we get to this last one. We start getting into Entrepreneurship where you leverage time to do more income and more impact. Income, impact and time because time is more valuable than money, and impact is more valuable than time. How do I help the most amount of people? It’s not treating them one-on-one. I can help people very deeply or specifically one-on-one and that’s important, but how do I leverage my time to help even more people? Time is more valuable than money because time is always running out. We’re only going to live so long, but we can always get more money. If I can get a job, I can get paid every two weeks. I’m going to get $3,000 to $5,000 every two weeks. That’s always going to replenish, but time is running out. I judge my actions and my choices, I make decisions based on how much time is this going to give me versus how much money am I going to get?

TCLHP 173 | Six Figures

Six Figures: A self-employed physical therapist is someone who makes money by spending time helping people.

 

What are you getting out of this? Daniel says, “Small is great.” No one taught me this in PT school. In our business class in PT school, it was, “Here’s the history of insurance. Here’s what average copays are. UnitedHealthcare only pays $45 no matter what you do. To design a clinic, you have a $250,000 budget. It has to be a 5,000 square-foot clinic, and write out a business plan.” I’m like, “Can we do 1,500 square feet?” “No.” My clinic next door is a little bit bigger than 1,500 square feet. We have room for a free full-time therapist. We don’t utilize it because we don’t want to and COVID kept us from growing in 2020. We’ve had as many as two PTs when I was treating patients and a part-time massage therapist. It’s 1,500 square feet. That’s a great size and we were underutilizing it at that point. What do we do? We maximize our time.

For the clinic, when COVID took all our patients away, there was a point at which we canceled everyone for a week. We moved 95% of our patients over to telehealth. As things started opening up, they weren’t going to tolerate telehealth anymore. We started seeing people in person around July. Everything we did in those three months, April, May, and June, was to make our systems even better and more solid to create more online courses. We worked on our application funnels and lead magnets. The fourth-quarter in 2020 was a better fourth quarter than 2019. October 2020 was one of our top months ever in our clinic, which is crazy. Seeing this after the election in November, we had eight people scheduled that week. On Monday, someone canceled and we had seven. By Wednesday afternoon after the election, we had nine new patients scheduled for Thursday and Friday. Our average number of visits a week pre-COVID is 25 to 28. For me personally, seeing 26 people a week was a little too much.

Entrepreneur is where you want to go to. If you stop at self-employed, what happens when you retire and want to go on vacation? A business owner is great. A lot of people stay here. What entrepreneurs do is they leverage their time to generate more money and a greater impact so you can focus on multiple things. I would even say an entrepreneur is someone who is a creative problem solver and is willing to take risks to help even more people almost to the detriment or expense of themselves, their personal relationships and family if they’re not careful. Not everyone is an entrepreneur. There are some great business owners, but not everyone is an entrepreneur. Entrepreneurship I believe is where you can let your creativity. Once you become an entrepreneur, failure is not possible. A business owner can always close down their business, but an entrepreneur never stops.

Making Six Figures

I wanted to show you four ways to make six figures as a physical therapist. Here’s the problem. You probably paid a lot to go to school. I did but I didn’t probably pay as much as you guys. Our tuition was $25,000 a year. It was three years. When I graduated, I had $68,000 in federal student loans. I took the maximum federal student loan. I didn’t take private student loans. I had a little help from my parents. I was working part-time and my wife was working. I was able to make that work. I didn’t pay off my student loans as fast as possible. I paid them off as slow as possible. My goal was to get out of school. I only consolidated the first year into a lower rate because I could, but then after that, I couldn’t but I kept it as a federal loan. I got on the graduated repayment plan because it was the way for me to pay the least amount as possible.

You probably hear people talking about Dave Ramsey. He’s going to tell you to eat Rice-A-Roni and tuna, and pay off your student loans. My recommendation to you is only do that before you go to PT school and you want to race bikes. When I raced bikes and lived in San Francisco, I’d eat a lot of tofu because I couldn’t afford to buy my own chicken. That was worth it. As a physical therapist, your earning potential is much higher than a temporary employee or a massage therapist. Remember, I only wanted to work four hours a day, four days a week as a bike racer. I put $45,000 on my credit card racing bikes.

Delay paying back so you can invest the money in growing your business, whether it’s a primary business or a side hustle. If you can spend a year or two finding a side hustle that brings you in $2,000 a month. Now, you can start putting that into your loan if you want to pay it off, but spend the time and invest the money to learn what you need to learn. Get the coaching you need to get to the point where you’ve got an easy side hustle or an easy primary business. It was only years ago once my clinic was fully automated and my coaching business started taking off that I said, “I’m going to put some extra money into my student loans in big chunks.” I was able to pay it off, but it took me ten years.

Your ego around how good you are will get in your way of being successful. Click To Tweet

How are we going to make six figures? One, get a home health job and negotiate a salary where you’re making over six figures, which is great, but not a lot of us got into PT to do home health. You could do that and make some money. You’ve got flexibility. You could start a side hustle. It’s a great way to start a side hustle. I’ve worked with people like Alexis Sams who was making $108,000 a year doing home health and Phoenix. It was too good. It was hard for her to move into her cash practice. It took her three years of doing cash practice as a side hustle. When she finally decided to commit and quit her job. Through the coaching program that we did together, she tripled her income. She went from $2,900 a month to $8,900 in three months. She got back to her six-figure level in three months. Taking that leap was one of the hardest things she had to do. She did it because I was able to put together a plan for her, but getting a home health job, you’re going to make six figures.

Let’s say you’re in this for an ortho job. You’re like, “I want to work with orthopedics but it doesn’t pay as well.” Do the job because you love it. Find another problem you can solve and start a side hustle. It can be as a cash practice. It could be doing something online. If you bring in $2,000 a month with a job paying you $76,000 a year, your $2,000 a month side hustle is 24. Now you’ve got $100,000 a year as a PT. A side hustle can be online. It can be through social media if you do it right. If you’re doing social media and you have followers, you should be expecting to make a minimum of $10 per follower or per email address per month. If you start collecting leads, followers are not dollars and followers aren’t leads. They don’t belong to you, they need to be on your email list. A few people do it right and a lot of people are just out there to get followers. All you need is one person to pay you $2,000 a month. You go to their house every morning and make them breakfast. Write their training program once a week, and meet with them at the gym twice a week. That’s all you need. That’s the other way to do it.

Think about, what can I do on Friday night before I watch a movie and eat some popcorn or Saturday morning for four hours? It doesn’t take much time to do it. You just have to figure out what people want you to help them with. The third way to do this is to start your own business. You have to charge what you’re worth. Don’t charge anything less than $150 a visit. It’s more like $200 to $250 is what you should be looking at charging. How do you do that? You don’t charge per hour. You create a plan and care for people, and position the value of what you can do for them versus the cost of the plan and care. Depending on what you charge and how many patients you want to see. As I showed you before, you can bring in $150 working nine patients a week, charging what we charge in my clinic is $108,000 a year. That’s nine one-on-one visits a week. It depends on how many people you want to see. That limits your earning potential until you start hiring other people.

Four, would be to start an online business. You can take your side hustle. All you’ve got to do is generate $8,400. How would you do that? That’s 28 core sales at $297. One of my mastermind members, Marcy Crouch, did this. She’s @TheDownThereDoc on Instagram. She did this in January. You automate that every month, or 4.2 private coaching clients at $2,000 each. That’s one new coaching client a month at $2,000. Think about this, for $2,000, how long would you train someone? I learned a lot of stuff from outside the PT industry. My coach Bedros Keuilian, he’s the CEO of Fit Body Boot Camp. When he was a personal trainer, he would sell 12 and 18-month coaching packages because he’s training people. We can train people too. We’re not doing just personal training. We’re doing almost skilled performance rehab training. What would that 12-month or 18-month program look like? He sold $83,000 in personal training in one day. He was a personal trainer who didn’t graduate from a community college.

The number two lesson I want you to leave here with is that while you are a highly educated physical therapist. If you want to be successful in business, you have to start studying business. You have to understand that you need to work with teachers, professors, clinical instructors, or mentors and coaches. Find groups of people like mastermind groups who are doing what you’re doing. Don’t be the smartest person in the room. Your ego around how good you are at physical therapy and helping people is going to get in your way of being successful in business. You’re going to be afraid to ask a question and look stupid. You’re going to be afraid to ask for help. You’re going to second-guess the advice given to you, especially if it’s free. Even if it’s paid, you’ll be like, “Do you think I should do that? I’m going to sit here and analyze it forever and never move.” The people that I work with who are the most successful are quick to ask for help.

This is where you set your ego aside and go, “If I want to learn something to be good at something, I need to ask for help. It’s not that I can’t go figure it out on my own. Why would I have to figure it out on my own if someone already knows how to do this and I can buy the time from them?” As I said before, I buy my time back. I would rather pay someone $5,000, even $50,000 a year to give me the shortcut to where I want to go to making $3 million a year. I want the shortcut to that. I’m willing to pay $50,000 a year to my coach to get that. The coaching costs the same, but I’m going to shorten that curve. I’m going to pay someone to find it. You’re quick to ask for help and take action. If you seat on the fence and think, “That possibly won’t work for me or what are all the negative consequences of this happening?” It’s going to be much harder to find success. Action beats anxiety. If you have any anxiety or stress about something, just take action on something. Delays kill dreams. The longer you delay, the less likely you are to achieve your goals.

TCLHP 173 | Six Figures

Six Figures: An entrepreneur is a creative problem solver who is willing to take risks to help people, even almost to the detriment or expense of themselves.

 

The most successful people are quick to share their wins and their lessons. How did I get here? I was sharing what worked for me on LinkedIn groups, on PPS like web forums that you probably may or may not remember, before the Facebook groups existed. I was sharing what I knew with other people. People started asking me, “Aaron, can you help me? Can I pay you to help me?” That’s how my coaching business was born because I was sharing what I learned. Those are the big four things. Don’t let anyone stomp on your dreams. The moment you find a hater, it means you’re doing something right. I’d love to know, what was your number one insight or what was the most helpful for you?

Why Behind The Why

Brayden said, “I was a PT charging $11,000 for 200 sessions. Do you recommend the more sessions or less money per session model?” I would say, find out what the result is that people want and charge accordingly. Why do people who want to lose weight come to PT? You’ve got to find out why. What’s the why behind the why? If I can build a big enough reason why, this is called sales, then I can charge $11,000. It doesn’t matter how many sessions I see that person. I can see them once a week, if I’m giving someone a result that’s worth $100,000 to them, then they’ll pay $11,000 for it in a heartbeat. James says, “Can you mention what you recommend to charge per hour per patient?” You have to charge what you’re comfortable with, and then go up into the uncomfortable zone. Maybe 10%, 20% more, but somewhere around like $199 to $250. I know people are charging $350, even $450 per hour because they’re not charging per hour. They’re charging for a plan of care.

Remember, the hospitals are going to bill $600 per unit for your services. I’ve seen $1,000 per unit and patients are getting stuck with these bills and some patients are paying $20, but what’s it worth is it saves someone’s life. You keep them out of unnecessary surgery. You keep them from having a physician tell them that they should never bend forward again because their distal slipped out and flew across the room. Brayden says, “Decreased pain.” Shawn says, “The most helpful to me was the impact is greater than time is greater than money.” I’m glad that landed for you. Thomas says, “That was a great insight.” I’m going to have to do that again. That came out of my head in that way. Abigail says, “I love the action beats anxiety and it helps value yourself.” Is there anyone here that knows they’re going to do a specialty in pelvic PT? This is a very easy analogy. My friends who were pelvic PTs, one of the most transformational things they do is help people have sex comfortably again. If sex is painful and you came to see me and within 6 to 12 weeks, I could help you have sex with your partner again. Is there an amount of money you would put on that? You’d probably mortgage your house to get it.

Why is that important to you? That’s easily worth a $2,000 plan of care. If I can do that in eight visits in the course of 10 to 12 weeks, wouldn’t you be onboard with that program? It’s a little harder when we’re talking about CrossFit athletes. What do we have to do? “What’s wrong?” “My knee hurts.” “What’s keeping you from going to CrossFit and squatting? Why is squatting so important?” “It’s because I go to CrossFit and hang out with my brothers or my community.” “Why go to CrossFit? You could go to yoga.” “CrossFit makes me feel X, Y, and Z.” “Why is feeling strong so important to you?” This is what someone told me. “It’s because I want to feel like I can run across the parking lot and jump over the fence.” “Why is being able to run across the room, jump over the fence so important to you?” “If someone’s chasing me, I know I can defend myself and get away.”

“Mrs. Jones, you told me your knee hurts and in the next ten weeks, our goal is to help you feel strong and confident enough so you can run across a parking lot and jump a fence and defend yourself if you have to. I can do that. It’s going to take about 10 to 12 weeks. It’s $1,998. What we’re going to do is I’m going to show you two exercises a day, do a treatment, and schedule your next visit so that you can go back to CrossFit, lift and squat every day so you can feel strong, confident and healthy. You can run across the room and jump over the fence easily without worrying about doing any more damage to your knees. How does that sound?” She goes, “Yes. Sign me up.” Do you see how that switches things around? We’re no longer trading time for money. We’re not selling physical therapy based on time. We’re selling it based on the result.

“Could you talk all about neuro cash-based PT or other specialties?” Yes, it works. What you’re selling isn’t physical therapy, it’s not the treatment technique, and you’re not selling rehab for a body part. You’re helping solve problems with people and creating a meaningful change in their life. We can do that. If people find value in what you’re doing, they’ll pay cash for it. Neuro PT is covered by insurance, not everything is. Even if things are covered by insurance, people expect a higher level of service. “What’s the largest scaled cash-based clinic you’ve personally seen?” There are a couple of them that come to mind. John Barnes has a clinic. He teaches myofascial release. He’s got a clinic in Sedona and Paoli with 5 or 6 therapists in each. Ian Kornbluth owns Activcore and he’s got a clinic in Denver, New Jersey, Maryland, Pennsylvania, Georgia and somewhere else. He’s got about twenty employees.

One of my coaching clients, Ben Bagge has a clinic in Oakland with three PTs that generate $65,000 a month. He started a second clinic in LA when he was down there for two months. At the end of 2020, he’s already got his third clinic up in Iowa when he moved back home in December. I have no doubt that he’ll build that up. I’ve worked with Yohei Takada in New York City who’s got five other PTs working for him in Manhattan with a clinic location, somewhere North of Harlem. It’s not a question of, will it work? It’s the question of, is that what you want to do? Do you want to make it work? Abigail asks a great question, “What do you do if people aren’t able to afford to pay for that? Do you ever run into people not coming back because they can’t afford sessions?” Yes. Price isn’t the objection. It’s a lack of perceived value. There are some people that can’t afford it, but they can’t afford a $20 copay either.

There's no reason to wait to start a business. It will just delay everything. Click To Tweet

In North Carolina, we didn’t have a Medicaid expansion. Medicaid covers 1 to 3 visits for people with Medicaid. You can only get to the hospital. You only get three visits if you had an amputation or cancer. Generally, if someone has back pain, they get one visit. In Medicaid, recipients don’t have expendable cash, but we see farmers and teachers. We see blue-collar workers, factory workers, people that work in retail, and we see people that drive BMWs and Mercedes, and whatever. The most difficult thing is that I cannot guarantee results. I can’t say, “Mrs. Jones, in three weeks, I’m going to make you $10,000. When you get started today, for $2,000, I’m going to show you how to make $10,000 out of it.” There’s no math. I can’t put a number on their change. I can’t say, “This is worth $10,000.” This is life-changing and there’s no amount of money. We have to build value in a different way.

The problem is people can afford it but there are a couple of confounding factors. They feel like because they spend a lot of money on insurance, they are owed something by their insurance. Sometimes out of principle, they won’t pay even though they know they should pay. Out of principle, they’ll go somewhere and admit to us, they’ve got crappy care, but that was their priority. Others will come in and they’ll realize, “I didn’t get healed in one session. It’s not worth it.” What they’re looking for is a quick fix. They think physical therapy is going to be this quick miracle fix. I was telling Dr. Herzog, who works for me, about this one instance I had with a lacrosse player who said it was a miracle. I said that only works one in twenty times. Maybe not even that much. We have to mitigate their expectations. There are so many factors. There are plenty of people that don’t.

How do we make it more affordable to people that can’t afford it? That would be called group programs. There’s a group program I can do. I’m not trying to do one-on-one physical therapy with four people in an hour. How could I charge ten people $20 to come work with me for an hour? I’m a physical doctor, a physical therapy. They pay me $35 for this one-hour class. When twenty people come, what am I making? $700 for that hour. Most people could afford that. With a group of twenty people, I can go around and find out what’s wrong with you. I’m a certified yoga teacher and a physical therapist. I can go around and find out where’s the problem. I can modify it for everybody. I can give them something to learn and that’s new. I’ve made thousands of dollars doing that for marketing. I make money doing the marketing and we get new patients out of it.

“Would you recommend having a side hustle up and running before having graduated? Would you say focus on being a new grad and then try to form the second form of cashflow?” It depends on what you want. If you know ultimately you’re going to own a business, get started. There’s no reason to wait. Waiting is going to delay everything. If you’re a little unsure, you try it, see if you like it. You can always fall back on getting a job. If you know it’s what you want to do, there’s no reason to wait for a specific thing to happen because I’ve worked with people who are PT school dropouts, have businesses, people who never treated another patient, and have successful physical therapy businesses.

“How much did it cost to start your business?” This is Jeffrey, “Can you talk about your biggest mistake? How many sessions do you see patients? How long until you began turning a profit?” How much did it cost to start my business? I started with $5,000 in the bank. I’ve put other money into it over time, but I’ve gotten a lot of money out of it. Can you talk about your biggest mistake? The number one thing would be not moving from self-employed to a business owner soon enough. It took me five years. I didn’t have other physical therapists around me who believed in what I was doing. It took me meeting someone else to see what he was doing. This is my friend, Paul Gough. We chatted and he came up here to Greensboro. We speak the same language, not just English, but our brains work very similarly. I was like, “This is how I can do it. I saw it.” Generally, I get that from my coaches and mentors, but I also get that from my success partners where I can see someone else like me doing it.

This is why I said you have to be in a room full of people that are more successful than you in certain areas so that you can see what success looks like because success leaves clues. How many sessions do I typically see patients? It depends, I would say on average 5 to 8, but I’ve seen people for twenty. I’ve even seen some people over the course of years for 60, 80 visits, multiple things going on. That’s rare, just like the one visit wonder is rare in someone’s clinic. How long until I began turning a profit? My wife had our first baby on the way. She was eight months pregnant when I started, so probably our second month. My expenses and overhead were extremely low.

TCLHP 173 | Six Figures

Six Figures: What you’re selling isn’t physical therapy or rehab for a body part. You’re helping people solve problems and create a meaningful change in their lives.

 

“Can you talk about how to find the right mentors or even how to find one? Can you also speak on the topic of investing in yourself and spending money to make you a better clinician?” Great question, Justin. How do you find the right mentors? You find someone who’s doing what you’re doing, who has the knowledge that you want and experience that you want. Find out how to work with them or absorb everything they’ve done. If you want to get there faster, pay to work with them. They’ll get you there faster. It’s like paying to go to Con Ed. I’m going to learn manipulations faster going to a Con Ed course than I would be watching manipulations on YouTube. I can study it. I can read about it in a textbook, but if I can have someone hovering over me helping me place my hands and doing it, it’s going to go much faster.

On the topic of investing yourself, you’re your own best asset. You’ve spent three years getting clinically proficient. If you want to own a business, clinical proficiency doesn’t matter. You have to go to give people a good result. You have to be one step ahead of where they are. You’re already one step ahead of where all your patients are going to be. It’s rare that you’re going to have a patient who’s been a physical therapist for twenty years. If they’re a good patient, they’re going to listen to you because you’ve got outside eyes. It’s not just about being more experienced with someone, it’s about having outside eyes and an outside perspective. As a coach, it’s like you’re in the forest, running or doing orienteering. You’re going down and I’m in the helicopter. I can see down through the trees and tell you to turn left or right. If you turn right, you’re going to run over the cliff. I can say, “Turn left in 100 meters and you’re going to hit the highway.” That’s what a good coach can do. He’s not telling you exactly how to do everything, but help you navigate so you get there quicker rather than just running straight and being in the forest forever.

Rachel says, “Is it worth considering going insurance and doing cash-based PT to offer a variety if you’re an owner or if your business allows it?” Yes, if you could do insurance. One of my coaching clients, Ja’nae Brown. She’s out in San Pedro, California. She has one insurance like the local 509 Dockworkers Association. They pay $185 a visit no matter what they do. There’s no reason for her not to do it. It’s easy. They then do cash for everyone else. They are in a network or contractor with two insurance companies. If insurance is going to pay you enough to feed the family, keep the lights on and leverage your time, utilize it, but it’s just going down. It’s so much harder to get the money, but a combination is perfectly great. Some people start with Medicare plus cash and eventually, without Medicare or Blue Cross plus cash.

“What’s your take on residency programs? It seems that they’re getting more popular by the year if you’re considering cash PT?” This is a great one to end on. If you want to own a business, don’t go through a residency program. An OCS or WCS, a certified specialty designation is not going to get your patients to pay you more. The learning process can help you as a clinician, but the initials behind your name, your patients don’t give a crap about them. They don’t care. Your professors and other people in our industry care because it makes them look good. They feel confident about it like, “I’ve spent a lot of money doing this.” If you want to own a business and you want to help a massive amount of people, don’t waste your time. There are plenty of places to go and learn how to be a great manual therapist or a women’s health specialist or whatever else. You can do it 2 or 3 weekends a year. You can study and practice on your patients, but knowing the nomenclature of joint movements isn’t going to get people to pay you more or grow your business. You should spend that time and money and effort studying business. If you want to be a great clinician and teach other people at the university level, you should do a residency.

Thanks for reading. If you’re a PT student or someone who works at a DPT program and you’d like me to speak to your student group of some sort, send us a DM over on Instagram, @AaronLeBauer. We’d be happy to set up a call to do a Q&A or a little presentation as we did with the UMass Lowell folks. Thank you so much. We’ll see you on the next episode.

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About The Author

Aaron LeBauer

Aaron LeBauer PT, DPT, LMBT started a 100% cash based physical therapy practice right after graduation. He's on a mission to save 100 million people from unnecessary surgery & enjoys helping passionate therapists build successful businesses without relying on insurance.

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