Part 2: How Long Do You Have to Work Until You Start Your Own PT Practice? Why Wait . . . Go for It!
How Long Do You Have to Work Until You Start Your Own PT Practice? Why Wait . . . Go for It!
If you want to find out how a young physical therapist is progressing in his new business, take some time over lunch at the clinic or in school – read about it and talk it over with your friends. Hopefully it will inspire you to do the same.
Part 2 of An Interview with Ryan Michael Smith, DPT, Owner of UMove Physio.
This is the second part of our interview with Ryan Smith, DPT, as he shares his UMove Physio story with us. In case you missed Part 1 of our interview where Ryan explained what he did to get UMove Physio up and running, here is a link .
In the second part of our interview Ryan tells us how things have been going since he opened his practice 4 months ago.
Let’s get back to Ryan …
Hoyme: Welcome back, Ryan. I hope since we last talked, you have seen some growth in your business as you keep pushing upward & onward! It was fun to hear what you did leading up to opening the doors to your new practice. We had great interest from our readers in your first interview. A number of students tweeted me and said they follow you on Twitter and have listened to your podcasts. I’m honored to be associated with a young celebrity like you!
All of us are really interested to hear how things are going with UMove now that you are 4-5 months into it. Let’s start with the basics . . . How do you get paid for what you do? Fundamental to any business model is getting money in the door. In health care there are essentially two ways to get paid – direct payment from your customer – or patient – and payment from a third party – usually a health insurance company. In the health care industry, when a provider attains a contract with a health plan and receives payments from them, we call this an “In Network” arrangement. When a provider chooses to by-pass contractual relationships with third party payors, we refer to this as an “Out of Network” model. Of course you can have a combination of the two. In Network and Out of Network business models both have advantages and disadvantages.
So did you choose to be an “In Network”, “Out of Network”, or “Combination” model for UMove?
Smith: I do not take insurance of any kind… I am completely Out of Network. Yes, there are pros and cons for this decision, but for right now in my career it makes the most sense.
Hoyme: What were the main reasons you decided to go out of network.
Smith: The main reason I decided to go out of network was, again, simplicity. Starting out I knew I had to keep my overhead costs low and create a workflow that I could manage myself. When I looked at the costs and work involved with working with commercial insurances and Medicare, I realized it was not in my best time or financial interest to seek in-network status. That may change in the future, but for now, I feel it is best to stay out of network as a provider. I always look at the big picture strategically. I know I must always deliver value to each patient so they are willing to reach into their billfold to take a different ‘cash out of pocket’ route with me rather than falling back on their health insurance with another provider.
Hoyme: Very cool, Ryan. I am really fascinated by how you Go-Right-to-the-Consumer-PTs make it in a health care market dominated by third party payor relationships. Sarah Haag and Sandy Hilton (@EntropyPhysio, @SarahHaagPT, @SandyHiltonPT) in Chicago, Julie Eibensteiner (@laurusrehab) and Eva Norman (@LiveYourLife_PT) in the Twin Cities, Karen Litzy (@karenlitzyNYC) in New York, and now you are carving out a real niche, and all of you have created different ways to strategically distinguish your practices in highly competitive markets. I’m an In-Network-Solution-Finder, however, there is a definite place in the world for both us.
While many people are willing to dig into their back pocket to pay their physical therapist, I still believe a majority of people prefer to have their health plan pay for as much of their care as possible. Do you ever run into prospective patients who choose an In-Network physical therapist over you because of cost considerations?
Smith: I know losing people to In-Network providers is a real risk in this business, but I am always very upfront with everyone about my business model. Honesty is the best policy. I try to sell each person on the value I deliver that is much different than what they will receive from anyone else. I continue to be successful in helping a number of people see the value in choosing me as their personal physical therapist, but, unfortunately, yes . . . I have had some people choose to go in-network rather than with me. In most of those cases, they chose in network because they wanted their insurance to cover as much of the cost as possible. But I always let those people know I respect their decision and am readily available to them if they have questions or concerns about their plan of care with another physical therapist. Physical therapists in any setting must be good at selling value. Being an out of network physical therapist changes the conversation you must have with your prospective patients, and I must always be ready to talk about the outcomes they will achieve with me. That is my REAL value.
Hoyme: I am really glad you so strongly emphasize value, Ryan, and that you have to sell it!. Most PTs, unfortunately, don’t think of themselves as a sales person, but like author Daniel Pink says, “To sell is human.”
Let’s switch gears from sales to marketing . . . how do your clients find out about you? Do you have a base of referral sources?
Smith: Most of my clients find me by three main avenues – word of mouth from my clients, from the visibility I have in the two gyms where I’m located, or through my social media accounts. Regarding the latter, Instagram has been a surprisingly big way in which people find value in what I do and then follow up on it. Being in gym settings is especially helpful as it gives me an opportunity to reach out to people where they are living out their healthy lifestyle . . . trying to get ‘bigger-faster-stronger’ or simply just working out for fun. Those connections with healthy-minded people have been the best thing I have done to bring business into my clinic. My philosophy is – “make it simple for people” . . . take the work out of people trying to find you. Go directly to them.
Hoyme: Reaching out to potential clients takes a lot of work, but it’s worth it. This approach works because it patient-centered – you can discover what is really important to your clients and potential clients AND you can start to build relationships with them. I always say . . . “Relationships are the meaning of life.” On that note, I have to get a plug in for our friend Jerry Durham and his 8 Step Customer Life Cycle. I highly recommend following each of those relationship-centered approaches to attract and maintain client relationships for years.
You work closely with personal trainers and staff at the gyms where your clinics are located. Collaboration with other providers is one of the most important ways to deliver patient-centered care in our demanding health care market.
How is your relationship with your gym partners? Do you work closely with the personal trainers? If so, tell us how that works in your care model.
Smith: I get the chance to interact and work with the coaches at the Crossfit gyms (not personal trainers per se). They are certified Level 1 Crossfit coaches. As of right now we work well in tandem if I’m seeing one of the members as a client, but they are still participating in the workouts of the day. We talk about scaling and modifications for those individuals. Most importantly, those coaches challenge me to see exercise from a multitude of perspectives. As physical therapists, we are spoiled in our one-on-one interactions with patients. But in all honesty, the movement experts out there are the group fitness coaches who are helping groups of 20 or so people at a time move more efficiently and safely! I give them props every day for the amount of art and skill it takes to do that. I’m there just to help in any way I can.
Hoyme: Marketing and sales are two different efforts and require two different skill sets. And both involve relationships in our business.
Even though you are out of network, you still must schedule patients and document each visit.
What scheduling and EMR system did you choose to use? Why did you pick that one?
Smith: I use google docs for EMR, scheduling is done online through Calendly but I also schedule on my own on the side on an old fashioned planner. I don’t have nearly enough clients for scheduling to be a massive issue, but I do have the systems in waiting to make it more automated. Intake Q is what I use for initial intake forms and that also has a potential scheduling component that I have not dived into yet. Erson Religioso and Aaron Lebauer both got me onto using google docs for my EMR and I believe they offer an online intro course to it in case anyone would like further details on how that works.
Hoyme: How do you bill for your services? I know your patients pay up front for their package of services, but do you ever have to send out invoices or do any type of accounts payable management?
Smith: If someone is unable to pay at time of service – for any reason – I send them an invoice online through my accounting software, Xero. This is rare, but if needed, it can be done. Otherwise all billing is done through my Square app and device. If a patient would like a superbill for them to submit to their insurance company I will supply them with that at the end of our plan of care. But I want to emphasize, if they choose to submit to their insurance, they must do that themselves.
Hoyme: Every business must grow . . . New Patients, Visits, Charges, and Revenue.
How has your growth been thus far? Are you seeing more new patients and visits each month since you started? Have you been happy with your growth thus far?
Smith: I’ve been fairly steady since month one. I typically see 2-3 new evaluations a month, which to all new graduates must seem like a crazy low statistic, but to me, it is what I thought I would experience initially. Yes I would like more new patients, (who wouldn’t?), but establishing trust and value in a community takes time. I want to be the go-to person at the Crossfit gym before I ever try to branch out more.
Hoyme: When do you think you will be able to quit your other jobs and focus solely on UMove Physio?
Smith: I would have to be seeing at minimum 5-6 new evaluations a month to be able to focus solely on uMove Physio. That would cover my living and business expenses. I don’t quite have a time table for that, but I’d rather keep it that way. Currently I am doing fine with how things are. I’d rather let the quality of my evaluations and word of mouth determine that rather than forcing it along a defined time frame.
Hoyme: You don’t have any employees at this time. Do you foresee hiring people in the near future?
Smith: I do foresee hiring people, the first hire would be front office staff person if I got to that amount of volume. I went through Paul Gough’s course and first hiring a qualified front office staff person was paramount in his course. As the first touchpoint for all customers, the most important hire a business owner can make is the person at the ‘front desk’ . . . the person who makes a positive first impression.
Hoyme: You are so right on that point, Ryan. Your ‘Director of First Impressions’ can make or break you. You know what . . . I actually left my previous primary care physician because his practice had such disengaged, uncaring front desk staff. The physician I go to now has very friendly, helpful people who greet and check in the patients, and I feel so much better about the care and caring I receive. People don’t care how much you know until they know how much you care.
Business is always a challenge. It seems like it is never completely smooth sailing.
What have been the biggest challenges since you opened your clinics, Ryan?
Smith: Structure, cash flow and my sanity. Let’s start with Structure. I’m very sporadic and time tends to get away from me. Thankfully I sat down with my mentor two months in and he gave me some great perspective. There are 168 hours in a week. Sleep for 56 because sleep is king. You are left with 112. What are you doing with those hours? So every night I write down an hour-by-hour schedule on my whiteboard to combat that. Rarely do I stick to it to the tee but it keeps my mind focused with the tasks on hand and reassures me that I can get to other things later.
Now the scary Cash Flow thing. When you don’t have a salaried job, and you have debt to pay and expenses to cover, it’s difficult to see where and how things all fit together. I have three different income sources, and only one is semi-consistent in terms of how much I earn each month. So my money management learning curve was tight, and I quickly had to learn how to manage my income budget for my expenses.
Last but not least is My Sanity. Every day is a roller coaster of emotions. I joke around that if I don’t go bankrupt, get sued, or burn down a building . . . well, it’s a good day! You know, Jim, the reality is, I do sort of believe that. It keeps me positive. But being on your own for so many hours a day when you are trying to create content and run a business can run amok on your own thinking. I’ve found ways to combat this, but every day is difficult, much more than I thought it would be.
Hoyme: Hey Ryan . . . You are a man after my own heart (and Jerry Durham’s). You use a whiteboard! An invaluable tool for every businessperson. However, I suggest as you gain more experience, you make the big step to a wipe WALL. You can get wipe board paint from your favorite hardware store, and it only takes 5-6 coats. Also – insightful perspective on your ‘sleep is king’ mantra. I recently read an HBR study that showed a strong correlation between consistently getting 7-8 hours of sleep per night and being able to provide effective leadership.
The sanity thing . . . I can relate to that. It never really goes away as long as you are a business owner.
OK … Let’s free flow here. Share with us anything you want the readers to know about your business
Smith: I’ve really enjoyed being able to share UMove’s story thus far with you and the podcast episodes I have done. As I have gotten further into this journey I want everyone, especially DPT students, to understand that this is not a glamorous way to start off a career. I am a manager at a wine bar/Italian restaurant, I do website design, and I happen to also own my own physical therapy practice. I often feel lost, uncertain, and frightened of an unknown future. That being said, I still feel I made the right decision to open my own business. I am able to practice in a way that aligns with my values, from the very first patient interaction all the way through their plan of care. I don’t regret my decision at all.
Ultimately this may not be a successful business, and I’m okay with that. I’ve given myself a year to see how it all pans out. I will see if I happen to be fortunate enough to be part of the less than 20% of businesses that make it out of the first year. If so . . . I will be ecstatic! If not, then I’ll have acquired a year’s worth of skills that I deem valuable to any business. Maybe the best thing to come out of this is that DPT students should know it is possible to start your own business out of graduate school, and it can be vastly different than the typical brick and mortar practices they are used to. I hope I have been able to provide a realistic viewpoint to what I’m doing. It may or may not work, but it’s possible. In the end, mine is only one possible model in the vast healthcare system, others will follow, things will change, and eventually we will find something that works even better. I’m glad to be a contributor to physical therapy innovation!
Hoyme: Successful business future, Ryan? I believe in you and your long term success. As young JP said about the Angels’ chances of winning the World Series in the movie Angels in the Outfield . . . “It could happen”.
I am confident you are going to make it, my friend. As you look to the future . . . what is your long-term vision for your practice?
Smith: Ultimately my vision for my practice is for it to be fully integrated with a Crossfit gym. I want to oversee Crossfit programming and physical therapy services within the same building / area. I see myself helping a lot more people by providing group exercise, nutrition education, and lifestyle changes in that realm than in a more conventional one-on-one physical therapist role. Crossfit and physical therapy meld together nicely and will help create a movement culture in the communities we serve.
Hoyme: UMove’s movement culture! I love it! Great vision, Ryan. I may have to move to Columbus to take advantage of it. Can I get a UMove sweatshirt?
One last question. If you were to offer ONE WORD – yes ONE word – to your peers who want to open their own practice but are still hesitant, what would that word be?
Hoyme: Awesome stuff from a Badger-Buckeye movement guru! Thanks so much for your interview, Dr. Smith. I know you have sparked a lot of interest in your model, and you will no doubt inspire other millennial PTs to follow an entrepreneurial career path. We need more business role models like you in our profession!
Readers . . . If you have questions or comments for Ryan or want to set up an appointment with him at UMove Physio . . . contact him at
and follow him on Twitter
If you are interested in the In Network model and want to organize with other talented private practice peers in your market, give me a shout
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Upward & Onward!
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