Mindset is Everything!

the old way new way direct access mindset

Starting a cash practice is the easy part. It’s just a bunch of administrative tasks minus the insurance headaches. It is changing your mindset that can prove to be the most difficult concept to master.

Let go of the idea that physicians will refer patients to you.

Even if they do, the patient’s are not typically ready to pay you out of pocket, even if it means they need less treatments and the situation proves better for them financially.

Direct Access is key.

Even if you live in a sate without or with limited physical therapy direct access, the mindset that patients should seek you out 1st for musculoskeletal problems is vital.  If you have a limitation or your state requires a prescription for physical therapy there are many ways you can work with this to position yourself as the primary contact person for patients who have musculoskeletal problems. You should still market yourself, take phone calls, schedule appointments, evaluate them if you can and if a patient must get a referral before you can even evaluate or treat them, you can tell patients they need to see their physician for an “administrative” referral to sign off on your plan of care and you should help them set up the appointment or direct them on what to ask for based on the specific laws in your state.

road sign against sky“Doctors”

If you talk or write about physicians as “Docs,” “Your Doctor” or even “Doctors,” you are placing their care and opinion above yours.  Physical therapists are “Doctors” too.  You may be a DPT, you may not be, but whether you have a bachelors, masters or doctoral degree you want your patients to view YOU as their primary go to person when they hurt, have pain or are injured.  That is the mindset you need to convey.  Changing your mindset and referring to the patient’s primary care physician as “your physician” is just a simple step in this direction.  Think of yourself on an equal level of care as physicians, be visible and available as a primary care musculoskeletal expert and your patients will call you 1st.

What are you worth?

You are no longer worth what you earned for your salary or what the patient paid in co-pays each visit.  You have to decide what you are worth, and then ask people for that much before or after their treatment.  How much did you pay to go to school?  How much do you need each month to live? to operate your practice?  What is the going rate?  Be careful about charging too little, or underselling your services.  Find a price that’s a little above your comfort zone and start there.  Look at yourself in the mirror and say “I am worth X amount of dollars an hour.”  “That will be $X, Thank you.

Your New Way of Being

Once you start to change your mindset from a person who provides a treatment directed by someone else to a primary care provider who decides on the treatment, you will begin to thrive and find patients in your cash based practice.  At this point you may now see that marketing directly to your customer, the potential patient, is where you should spend your efforts.  There is a tremendous amount of marketing that you can do with out spending large sums of money or paying to “advertise.”  This is where Google is #1 and why building an online presence is just as important as your reputation in the community.


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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.


  • eziah

    Reply Reply August 7, 2013

    Thank you so much for this post.

  • Kristen K Glancey PT

    Reply Reply August 15, 2013

    Great tips! Your insight is very helpful. As a PT, what EMR do you use?

    • Aaron LeBauer

      Reply Reply August 15, 2013

      Thanks Kristen. I use old fashioned hand written notes and manilla folders. I have evaluation, daily SOAPs, re-evaluation and intake forms all on paper. I have them made so I can fill in the blank, circle or check the techniques or regions of the body that I treat. It’s simple, efficient and inexpensive. I have not found and EMR that meets all of my needs, the number #1 problem with EMR is that someone still has to sit and scan and upload patient history forms, objective measures and anything else that the patient fills out or brings in with them. The other big issue I’m waiting to be solved is that I have not found an EMR with a dedicated Android app so I can schedule patients when I’m outside my office. I currently used Google Calendar for that purpose and it can’t be any easier.

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