E648 | Indiana State PT Student Q/A

In this episode, Doc Danny engages in a candid conversation with a group of physical therapy students from Indiana State, sharing his personal journey and experiences in starting a cash-based physical therapy practice. Rather than delivering a formal presentation, Danny opts for a casual discussion with the students, allowing for a more intimate and relatable exchange.

Drawing from his background in the US Army Baylor program, where he was mentored by Nate Henry, Danny highlights the importance of seeking mentorship from experienced clinicians as opposed to solely relying on textbook knowledge. He emphasizes the significance of honing one's skills in a specific area of practice to truly excel in the field. Danny also advises the students to establish mentorship connections before embarking on their entrepreneurial ventures.

Throughout the episode, Danny addresses various questions posed by the students, offering invaluable insights and advice tailored to their individual aspirations. For instance, he guides Emily, who expresses her desire to work with runners after graduation, on how to enter a new area and successfully build a reputable practice. Danny explores potential options for Emily, such as working at a clinic or remotely coaching discharged clients in Salt Lake.

Additionally, Danny delves into different types of practices suitable for neurologic populations, identifying Parkinson's patients as particularly suitable for cash-based practices. He also sheds light on the potential success of performance clinics and women's health clinics in cash-based models, while acknowledging the challenges that may arise with other populations, such as pediatrics, due to insurance requirements.

Responding to inquiries about mobile/home health practices and starting in lower-income areas, Danny provides insights into various models and highlights the increasing willingness of individuals to pay out-of-pocket due to high deductibles and inadequate insurance coverage. He also suggests that education level may be a more indicative factor of potential cash success, rather than focusing solely on income.

In conclusion, Danny encourages the students to prioritize and cultivate their clinical excellence while finding their unique niche in the field before embarking on their own practice endeavors.

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Podcast Transcript

Hey, real quick, if you were serious about starting or growing your cash based practice, I want to formally invite you to go to Facebook and join our PT entrepreneurs Facebook group. This is a group of over 6, 000 providers all over the country, and it's a pretty amazing place to start to get involved in the conversation.

Hope to see you there soon. Hey, are you a physical therapist looking to leverage your skillset in a way that helps you create time and financial freedom for yourself and your family? If so, you're in the right spot. My name is Danny Mate and over the last 15 years, I've done pretty much everything you can in the profession.

I've been a staff PT. I've been an active duty military officer physical therapist. I've started my own cash practice. I've sold that cash practice and to date my company physical therapist has helped over a thousand clinicians start growing scale their own Cash practices. So if this sounds like something you want to do listen up because i'm here to help you

Hey, what's going on? Dr. Danny here with the PT entrepreneur podcast and today Uh, i've got a cool, uh a cool Audio clip for you, a little presentation that I gave to Indiana State University, their physical therapy department is actually, I believe the sixth year in a row that I've spoken with, uh, this university's, uh, senior class, I guess their third year, uh, their third year students.

And, uh, I have some friends that are faculty there. The one in particular that's there right now is Nate Henry. And he, uh, invited me to come in and chat with his, with his, uh, students. So I get a chance to get into some, uh, some Q and a on the sort of cash world, talk about kind of what I see going on right now.

Um, and, and have some cool conversations with, uh, with some students. In fact, in particular one in real time, we're kind of break down, uh, what her next few steps could be, uh, who's in the running niche. Um, so kind of a cool opportunity to kind of just see, uh, off the cuff. You know, kind of coaching and, and, uh, you know, consulting lens of, of what somebody in this person's position could do.

So anyway, I hope you hope you like this one. Uh, if you, uh, you know, if, if you are a student, hopefully this resonates with you. Uh, if you are, um, out of school or you just graduated in, you're interested in, um, You know, us having a conversation with students at your school, uh, about, you know, the cash PT world, uh, or the performance based world that we, we function so well in, um, please reach out to us.

Just, uh, send us an email at, uh, admin at physical 30 biz. com, uh, about the school that you, you'd like us to have a conversation with. We love doing this. I think it's just a great way to give back and, uh, educate the, uh, the younger clinicians on kind of what we're doing and, and what other options they have out there besides maybe potentially.

Uh, you know, just working in a hospital system or for a big group. Um, and, uh, yeah, if you, if you have any interest, just let us know. And I hope you enjoy this one with Indiana State University. Well, thanks Nate. I appreciate the, uh, the intro. I don't know what year this is that we're doing this, right. But with, uh, Jeremy, you know, it started, I think it's maybe year six.

Um, for Indiana State, which is cool. I've had a chance to talk to a lot of schools, which I really appreciate. Um, I Probably as prepared as most people are coming into these presentations. Uh, and I'm not really even, uh, I don't think these presentations more than anything. I like to just have conversations with, you know, the students that I get a chance to talk to.

Um, and I'll share a little bit about my background just so you're kind of aware of where I'm coming from. And maybe what. What, uh, what you might want to, uh, have a conversation about, but, um, yeah, like Nate said, we met, um, at the U. S. Army Baylor, uh, program in what year was that Nate? Was that 2007? I think it was 2007.

Yeah, so 2007. Uh, and. Uh, it's so funny because I feel like, uh, Nate was like, for me, he was a huge mentor in the military. Like I didn't know, you know, I, I didn't know anything about that world aside from, you know, I grew up in a military family, so I wasn't afraid to, uh, talk to, uh, high ranking officers because I was around them pretty much my whole life.

Uh, but I didn't know how to. Conduct myself in a military environment. I, uh, I didn't know much about the, the internal workings of that world. And, uh, you know, you kind of get dropped into it and it's a very different, it's a very different environment, even though we're, you know, we're students for the first couple of years, I would say that, uh, you know, anyway, like being able to learn from somebody like Nate, who had experienced quite a bit of experience comparison to me was, was super, super helpful.

Um, so, I mean, I, I think you can look at that in the lens of mentorship in any way. Right. I'd prefer. Uh, not theory, but like experience. Right. I always gravitated towards clinical instructors that were like seeing patients, not just doing a bunch of research. No offense to them. That's necessary. But, um, I want to talk to people that are practitioners, right?

People that were doing things and be able to, um, learn from them. Like, you know, Hey, help shortcut this for me because I don't really know what's going on. And being open and willing to learn, I think is always really, really helpful. So we met in 2007, um, went our separate ways. He went to for bending. Uh, I got, okay.

Uh, stationed at Schofield Barracks, which like Nate says, stuff kind of works out for me sometimes, and that's in Hawaii. Uh, so, you know, I got a chance to spend three years with a, primarily in an infantry, um, uh, environment, uh, at, uh, Schofield Barracks. And along the way, you know, I kind of got really interested in the performance sort of approach of, uh, the clinical world.

And, you know, some of you, maybe that makes no sense. Others of you, maybe you're like, yes, I want to function in more of a performance based environment. I want to work with people that are highly motivated to make health and wellness changes. I want to work with athletes that are coming back from injuries.

For me, it was tactical athletes. It was, you know, young, motivated. Tackle athletes that wanted to get back to, uh, you know, being able to function within their, their infantry environment. And I just really liked it. I just found that I was spending more and more time in. Yeah. in a gym environment than I was in my clinic.

So I kind of have to, uh, yeah, that's right. Nate got, uh, Georgia and I got Hawaii. That's just how it worked out. But, uh, when I was there, you know, it was an interesting role cause they didn't actually have, uh, they didn't really have much set up for what was considered a brigade physical therapist at the time, which basically was, is one, um, one physical therapist that gets added.

To a brigade of soldiers, which is about 3, 500 people. And so for me, what was cool was they didn't know kind of, they kind of didn't know what I was supposed to do. And, uh, I didn't really know what I was supposed to do either. So it was kind of like, they left me alone. Um, and they just, they were like, well, if we hear good things, then I think you're doing the right thing or whatever.

And I realized really quickly that what they really cared about was physical training. And, um, how many soldiers were on profiles. So meaning like, if you're on a profile, you, you basically are restricted in what you can and can't do for training. It also, they track that for people, the ability to be deployed, right?

So, like, the readiness of the entire group to be able to go somewhere for a mission. They look at that. So I realized really quickly, if I had Good face time with leaders during physical training. If I helped physical training improve, and if I really limited the number of people on profiles besides the one that really needed it and really working through injuries that people had, that like I was pretty much, you know, those were sort of my key performance indicators, if you were and, uh, It was awesome.

It was great because no, I, it was like, it was almost like I got dumped into like entrepreneurship before I actually started my own business because looking back on it, I had like no guidance, but yet I had things that I had to accomplish and I just had to figure it out. Right. Uh, and the funniest part was no one even knew what a physical therapist was.

So I almost had to like drum up business for people to come and see me. So I would go to like physical training in the morning and we all look the same. We have the same uniform on and I would run with everybody or do whatever the workout was. And, uh, and then I would kind of stand around with everybody afterward and then everybody complains about whatever's wrong with them.

They're like, Oh man, my knees really bugging me or my damn back or something like that. And they would have no idea I was a physical therapist. And, uh, so then I would sort of like engage with them about how I could help them out and where my office was. And I had to like actually go out to find patients, which was weird.

Um, cause in a hospital environment, that's not happening. Like there's just a line out the door. You've got more people that you know what to do with, right? We're highly understaffed usually. So I think back on it and I'm like, what a sort of interesting environment to be in this incubator in some ways of what ended up happening whenever I, uh, you know, whenever I ended up leaving the military.

So after my time there was done, they actually ended up in Columbus, Georgia with Nate, somehow we got in the same place. Uh, and I got attached to, uh, to a clinic that was, you know, in my opinion, I think that, uh, I'm still in Georgia actually, I'm in Atlanta, so we like it here, but, uh, the, the clinic was high volume, you know, I look at it and it wasn't like traditional high volume.

We had sick call hours that were just like you would get crushed first thing in the morning. It just depended how many people were there, but it was attached to the Airborne Clinic. So we could have 20, 30 people come in, in the morning, you know, I mean, a line just like wrapping around the inside of the building, uh, of ankle sprains and knee issues.

And, you know, just like acute, short, acute stuff that These, these guys are only three weeks, uh, uh, these men and women, three weeks in, in, in airborne school, and they're just trying to like get through, you know what I'm saying? So it's like, you're not even really doing anything of, uh, significance. You're basically just trying to bandaid everybody up.

And, uh, and then I would have another like 10, 12 people later that day. Right. So, um, so anyway, I got, I went from this environment of being like incredibly, uh, flexible. I could do what I wanted to do. Um, I could, I could initiate a lot of injury prevention protocols. I got really interested in the strain conditioning side of things looking at like.

I mean, I was pulling like blood markers for people. I was doing like sleep training stuff with like other, uh, providers that were, you know, on the base, I was talking to people about nutrition and stress management. So you go, you go from this like really open environment to, all right, let's just sit here and just treat everybody and write all these notes and then go home, you know?

And it, and it, for me, it just was like the wrong place. Uh, so in. 2014, uh, we made a short move from Columbus, Georgia to Atlanta, Georgia by we, I mean, my wife and I, um, and we opened it. We opened a cash based practice. And, uh, at the same time, I had taken a position teaching for Kelly struts group, uh, which.

At the time was called mobility one right now. It's it's they rebranded. It's called the ready state. Uh, and most of the work I did with them was performance based work with military groups. So, my, my role was really as a director of tactical training for, for that, for that group. And, uh, I got a chance to go around all these different military groups and really do a lot of the same things that I was doing.

I was at my brigade, but, but really on a more of a consulting basis, which was, which is pretty fun. Um, and then, you know. Slowly our practice started to become more of a priority as we started to get busier and busier, uh, and eventually stopped teaching just to focus on that because we'd grown so much that it took our full time attention.

Right. So, uh, so from between 2014 and, uh, really a year ago, my wife and I ran that practice and then we were able to successfully sell that business. Um, uh, you know, and. Uh, really focused, uh, exclusively on physical therapy biz, which is the consulting company we started, uh, back in 2017. So, you know, for, for us, the evolution of, uh, of what we've done is, is varying, uh, you know, it's not necessarily, it's not a planned path.

It's just the one that we ended up following. And, you know, the, the, the questions that I get from most people really have to do with, well. What does this cash based world look like? Right. You know, like what opportunities are out there? What, what things do we see in terms of like trends? Um, and as much as I like to talk about that stuff and we can talk about it all day, I'm just as big of a fan of the, the performance based, uh, lens in which we can work with people on, which I think, I mean, it really is the vast majority of the businesses we work with.

Uh, they have some sort of defined niche that is, you know, a performance based niche, whether it's runners or youth athletes, or. They work with crossfitters or baseball players or soccer players or, uh, you know, uh, active adults that are trying to stay active and as long as they possibly can, like whatever it might be, but focusing on these four big variables of, of, of movement, uh, of, uh, of nutrition, of sleep and, uh, stress management.

And when we get a chance to really focus on those with people in the clinic, this is something that I don't think that you learn in school. I didn't learn this shit in school at all. Zero. Aside from the, the, the movement side to some degree. But even that was, um, you know, it wasn't, it wasn't a big emphasis.

I remember learning about the functional movement screen. I don't know if you remember when Johnny Owens came over and went through the functional movement screen. Johnny Owens is a, is a, is a, is a fucking ninja. Like that guy is like on another level and go figure he's doing all this blood flow restriction training stuff.

Like, but at the time he was just explaining the functional movement screen and I couldn't even, even Fathom what was going on. I had no idea how this was connected. All I knew was he was way smarter than I was. And like, I had to figure some of this stuff out. So, you know, you start going down that path of like great cook stuff and then you have SFMA and then that led right into like DNS stuff and, uh, uh, you know, PNF.

And then you, all these damn acronyms throw all the acronyms in there and PRI and, you know, all these things that then they flow together. And then how does it all connect? And like, that's the challenge I think in a lot of ways is trying to figure out how you can. How do you take all these like super smart like subdisciplines and then make it work in the niche that you want to, you know, work and so that in its own right, I think is really hard.

And as a student is probably where you need to spend most of your time is. really trying to figure out how to be a great clinician. Uh, we can talk business all, all day, no doubt, but I'll tell you this much. If you're a new grad, we do see new grad, see new grads be able to start their own practice and make it work.

They typically have some sort of depth of knowledge and something else already. So meaning, uh, let's say you're, you're a competitive runner. And, you know, you work with runners, uh, as a coach and you just happen to bolt on a, you know, uh, physical therapy degree, uh, to go along with that, you can be a mediocre physical therapist, but you're like an amazing, uh, running coach.

So, like, you can work with runners as a physical therapist and because you have so much depth of knowledge in that, the mechanics of that and the actual niche. You tend to actually be able to get, uh, become successful much faster than somebody that's just kind of like a generalist and trying to figure out what they want to do.

Uh, and in that case, it tends to take a lot longer for them to actually find success unless they have that defined niche. So I think coming out of school, you know, you have to decide. I guess the best way to put it is like, who, what are you trying to become the best in the world that and I, I think that, uh, what I mean by that is like, do you want to be the go to person for like throwers?

You're you just want to work with baseball players. You love throwing mechanics. You love everything about it. You know, you want to, you want to know the subtle nuances of. Everything, right? Like, what is the elbow doing, wrist, you know, mechanics, the, the shoulder, how, you know, all assessing the spine and, and how that, that goes with throat.

Like, I'm talking like obsessive over like one thing, like you want to be amazing at that one thing and figure out what you just get nerd out on. What, like, what is it that you want to learn about? It doesn't feel like a struggle, you know, uh, that's the thing you got to figure out. And I think it can be kind of hard because you might be interested in a few different things.

Um, and then finding mentorship for people that are. Doing things that are really unique like that, that seems to be the key. And every time I talk to students, there's like, well, tell me, how do I price myself for cash PT service? I'm like, well, are you even fucking decent at what you do yet? You know, like, don't take it the wrong way, but like.

If you're trying to sell burritos that suck, you're going to have a hard time selling a burrito that doesn't taste very good. But if your burrito is awesome, you don't even need marketing like Chipotle and you got a line around the door. Like they're entire Chipotle's entire marketing strategy was just to have better food than everybody else around.

Go figure it. It worked out, you know, like that. That's, I think the question you have to ask yourself is just. What are you trying to be amazing at? And that's rare. It's like super rare. People will, people will see that they'll realize they're like, you're kind of an alien, but they want to work with you.

They're like, man, why is this person so obsessed with elbow mechanics? Weird. You know, like, but my elbow hurts. I got to work with them. Like, that's, I think what you got to understand as a student is. Uh, before you decide that you want to try to have a successful practice, you got to be an awesome physical therapist, which, hey, if you're looking for a mentor for that, Nate's probably a pretty good place to, uh, to look, uh, you know, and any number of people within the group that he teaches for, uh, and other content groups out there, it's just finding that first, I think is really, uh, is really key, you know, after that, then the nuts and bolts of a practice, you know, it's funny people, you know.

The assumption is that cash based practices are more, um, uh, they're, they're more simple, they're, they're easier to start and run, they're definitely easier to start, um, than insurance based practice because you don't have to deal with all the legalities of getting set up with insurance and, and reimbursement and all of that, um, the running of it is not much different.

Especially at scale, you still have to understand how to manage people, how to, uh, understand finances of a business, uh, understand, you know, your vision, your mission, what you're trying to do, uh, none of that changes really, right? So, like, yes, the start is a little bit different, but other than that, like, it's, it's not much different in terms of running any business.

I think it's all similar. So for, for those of you that are interested in a business of some sort. You know, I think a number one, become great at what you're going to do first and then get really clear on who you're trying to be the best at, because you've got to market to that person. The biggest mistake that we see is that you try to be the go to person for everyone, and then you just turn into white noise.

You know, you're like, well, I can help. Yeah. Let me help that. The mom that's trying to get back to running half marathons. And then let me help little Johnny over here who plays lacrosse. I mean, I don't know a first thing about lacrosse. And then let me, let me help like, you know, this person you're like, yeah.

Oh, they're, you know, they've got a knee replacement and, but they're under 65. So they, they want to see me and they want to pay cash. What are you awesome at? Like, you can't just be a generalist in this type of a, um, uh, of a, of a business in, in terms of a cash based practice. We see those tend to not do well unless you're huge and you have individual people that are niche specific to certain things.

Then you can be a generalist clinic because you have someone who's awesome at golf and someone who's awesome at running, and someone who's awesome with barbell athletes. But for someone to do all that, I think is really challenging. So, um, I guess that's, I'll somewhat leave you there in terms of, uh, my advice, if you're thinking about doing any of this stuff and not to like.

I don't want it to come off negative, uh, either, you know, if I, I hope I didn't just squish your dreams, you know, into a thousand pieces. If you're just like, I'm gonna start right out, but I don't actually know what I'm doing yet. Um, I'd rather you actually focus on becoming awesome at what you do, find mentorship.

Uh, and then if you wait a couple of years, let's say you wait two years. And you become really good at working with a specific niche group. Like you're so much better off than trying to do that from the get go and then learn how to work with them while you try to start a business. It's just, it's too hard to do.

Um, you're much better off trying to become really good at whatever that is first and then start the business to go along with it. Um, Is there anything in particular you want me to touch on, Nate, or do you, are you cool if we just like open it up and we can chat, uh, you know, about where they're at and what questions they have and what they're trying to get into?

Oh, we can absolutely go to questions. Um, guys, go ahead and chime in with what you've got. If, uh, uh, lemme mute this chat up if I don't hear from you. Um, I've got questions myself. So as I told you before, not many opportunities like this, so please take advantage of it now. Well, what I might even do. Yeah.

If you don't have a question, I'm going to start picking guys out. All right, Emily, uh, you're outside. I like that. Let's talk about what your, what are your goals? What do you graduate? First of all, and then what are you going to do? I think you actually just described me. I felt like you were talking to me.

Um, I'm a competitive runner. First of all, I graduate in May. Um, I'm a competitive runner. Um, I currently coach runners. I coach about a dozen runners remotely. Um, I'm interested in working with runners. I'm also interested in a lot of other things, but I'm interested in doing cash pay. Um, probably sooner rather than later.

And so, I felt like you were speaking to me when you talked about, you know, finding your niche, leveraging your knowledge and your clientele, and just becoming really good at what you do. So, that's kind of, I was taking notes. That's kind of like the, the path I think I might follow once I'm out of school.

Yeah, so this is great because I actually don't, yeah, I didn't like, uh, it's funny. It's like, it's like the, the magician that like plants somebody in the crowd or whatever. And they're like, Oh, you got the ace of spades behind your ear. Like I didn't do that because I actually don't know you at all, but this is awesome.

This is perfect because what we can do is let's talk, let's, let's talk shop a little bit about like, if you're going to start in a relatively, you know, short timeline. Then we can kind of we can kind of get into the nuts and bolts of like, what does that look like? Because for some of you, you may not be where where Emily is in terms of understanding, you know, a specific niche that we know is proven within this.

But what's cool with with this type of a model is. You don't have to, you don't have to have these huge clinics for them to be, uh, number one, able to replace your income working somewhere else, usually quite a bit more, um, and be able to scale like I can think of dozens of running specific clinics around the country that we've worked with personally that kill it because runners get hurt.

All the time. You know, what is it? What are the stats? Like 80 or 90 percent of runners get hurt training for a half marathon or a marathon, not even like in the race. Like it's, it's shooting fish in a barrel. Like it's not changing anytime soon. Um, so it's a great niche. And the fact that you already have depth of knowledge there is huge.

So let's talk about this first of all. So like, what area are you thinking about going to? And like, what's the size of that, of that area? Um, I mean, I want to live in Utah or somewhere out west, like right out of graduation, um, but then I probably will end up back in the Midwest, um, maybe Bloomington. Um, that's where I spent like eight years.

I love it there. I know of a couple people who do cash pay models there and it works really well. Um, there's a lot of runners in Bloomington, so I would say for like the long term, just Bloomington, Indiana. Okay, cool. So one thing when if you decide, okay, I'm going to go, I'm going to do my own thing. Um, anytime that you go somewhere new, you have to add on like extra time for how long it's actually going to take for you to, to hit that sort of critical mass of people that know who you are.

Um, there is a distinct advantage to starting any business, not just the cash based practice, um, in an area where you have, uh, you have it. People that know you and that know that you're good at what you do. Uh, I'll give you a really, really good example. We worked with, uh, we worked with. A clinician that came from the Boston area and she was like killing it.

She had a wait list for her schedule. She took a vacation to San Diego and she was like, it's way better here. So she decided to move. So she moved to San Diego. No one knows who she is clinically. They have no idea that she is really good at what she does. She doesn't have all these sort of connections of people around her.

And she struggled for, to get to where she was at in Boston. It took her about a year to get to where she, uh, she was. Clinically, as far as her schedule is concerned, because she had to build that ecosystem around her. Right? So just, just so you're aware, one thing, if you move somewhere new, just don't get defeated.

If you're like, why is I'm awesome? What I do? Why doesn't everybody know that? Because they don't know you yet. Right? So, so that's, that's totally normal. The other thing too, is. If you're going to bounce around something that you might want to think about doing is like, maybe you do something on the side, not necessarily try to establish like the biggest clinic and see how they see how that goes.

Because if you decide you want to move back somewhere, it's really challenging to try to either shut down what's not hard to shut down. It's very challenging to try to sell a practice, um, you know, what you can do. And we've actually had quite a few people that have moved and have been able to sell and exit a practice because of that.

So if you're going to move and only be somewhere for a short period of time. Something to think about. Maybe you try it on the side. And if you try it on the side and it goes really well, well, maybe you don't go back to wherever you think you're going to go, because maybe for you, the best opportunity is where you're at.

And we don't really know sometimes. Right. So, uh, okay. So let's talk about this. You move out to Salt Lake or wherever you're going to be in Utah. Ask Nate. He probably knows all the best places in Utah. I don't know a damn thing about Salt Lake. Okay, cool. So I nailed it. Salt Lake. So, okay. You go to Salt Lake.

What are you going to do? How are you going to get people to, to work with you? What are you, any idea what you want to, you know, start doing? Um, I mean, I'm interested in neuro as well, which I know is totally different. Um, I'm interested in a lot of things, but, um, my thoughts have been, so I have a friend that works out there.

She's a PT. She works out there in a hospital and then she also works at a rehab. She has two jobs, two PRN jobs, and she also works at, like, a rehab center. Um, and so when I go study for the boards next summer, I'm gonna go live out there with her for a little bit and try to just, like, build connections.

Um, and then I also could just see myself going out there and working in an orthopedic clinic and just, like, getting reps and... You know, kind of building my knowledge, having mentors, um, working for somebody else, definitely. And then, like, keeping my coaching business on the side. Um, and then once I, like, moved back to Bloomington, which would probably be, like, three to five years, um, Trying to kind of start my own thing there because I was a strength coach there for like four years before I went to PT school.

So I already have connections there. Um, and I think, especially if I keep my coaching business, like a lot of those clients are in Bloomington and that would just make that transition like easier. Hey, sorry to interrupt the podcast, but I have a huge favor to ask of you. If you are a long time listener or a new listener, and you're finding value in this podcast, please head over to iTunes or Spotify or wherever you listen to the podcast, and please leave a rating and review.

This is actually. Very helpful for us to get this podcast in front of more clinicians and really help them develop time and financial freedom. So if you would do that, I would greatly appreciate it. Now back to the podcast. Okay, cool. I really don't know. Well, that's the thing, right? We have no idea. Uh, because you might move out there and hate it.

You might move out there and you know, you've loved it and you get in involved in a community that just feels like the right place, it's so hard to tell. Right. But I think that if at least you have an idea of what you want to focus on. It's going to be helpful, uh, because you do have a, you do have a proven niche.

You have a, you have a background that supports that, which is great. And if you're already doing coaching, there's a couple of ways to look at this. Cause like I always find, you know, there's, there's not one path, which is one of the reasons why I always find entrepreneurship so fascinating. It's basically like this big game that you get to play, you know?

Um, and you know, the, if you look at it like a game, I think it's probably. The healthiest way to approach this because, um, sometimes it sucks, you know, but sometimes you lose an uno and your, your, your son drops a, you know, draw four wild card on you at the last, last card of the game and it hurts, right? So the, the, the game of business can suck.

Sometimes you get turned down, you get, you get, uh, Rejected by a lot of people. Um, so if you keep in mind that it's just a game, it's going to help a lot. And there's not just one path to get where you're trying to go either, right? Um, it's just a matter of being like aware of kind of where you want to end up and, and training that direction is helpful.

So here's what I would tell you. I think you got two options that make a lot of sense. Number one, if you want to go straight into it, you go out there, you get a job that is, uh, like some sort of hospital based nerve. Maybe it's neuro. Maybe it's, um, you know, some sort of skilled nursing facility somewhere.

You don't want to be for very long. All right. But but it pays decent. And it's kind of like You know, you do your work while you're there, you leave and you don't ever think about it after that. On the side, you start your practice and the best way in a new area to really start to build reputation is to get involved in the community of people that you're trying to actually work with, but don't show your shit to them all the time early on.

This is really important. Don't go in there to a running group and then, you know, talk to everybody about why they need to come see you because you're awesome running coach slash PT, right? It's like, no, literally just run with them and have a beer. And that's way better for you than talking to them about your business.

And it's so backwards, like, yeah, that sounds way better, right? It's like, go for a run, have a beer and then you get clients. Yes. That's going to work way better than you trying to tell everybody why you're so awesome. What you do. Um, the other thing is. You could look for a, like a very running solid, uh, uh, clinic that you can work with.

And as a, like a mentorship sort of, uh, opportunity, potentially what you might be able to do is even work out some agreement with them to where once they're discharged, you can handle programming that are running for them, coaching their strength training. Like, are you doing full on like program build out right now?

Okay, so this is a, this is a sneaky way. I saw this work really well, uh, with, with one of our clients just years ago, and he was at a big post op, like ACL primary, uh, in network practice. But, you know, when they run out of insurance. They discharge them, you know, or like that this clinic they were at least so he basically set up, uh, training conditioning programming on the back end remotely would manage their tail end return to sport stuff.

And then there was some sort of agreement. You have the clinic. I don't know exactly how it was set up, but basically he was a. Value add versus like trying to compete with them and end up working really well for that for that individual. So you might be able to just take clients that are going to be in discharge.

They find out that you're a coach and then you're coaching hat. You can use that. But because you have a PT, uh, you know, credential as well, you can charge more than the average running coach can, unless they're just really awesome because people respect the fact that you have this additional training and credentialing.

So the other thing with that, that might be really cool for you to really focus on is. That can go anywhere with you. So if you decide you want to move somewhere else, like those clients, you don't have to get rid of them, you know, you don't have to send them somewhere else, try to sell your, your client list to another clinic if that's what you decide to do.

Uh, so in that scenario, you know, moving people to like remote training from a clinic like that, or maybe just people that you're working with locally, that could be a really good. So either one works for you, you know, would work, but I do, do you feel confident in the, on the like injury side with runners at this point?

Or do you feel like you still have a ton to learn? I mean, I still feel like I have a ton to learn for sure. I would never say like, I feel, you know, completely confident just because like, I'm not even graduated from PT school yet, but I do have. I do feel pretty good about like my pattern recognition just from getting injured many times myself and like people I know getting injured and my clients getting injured.

So, um, but still have a ton to learn. Totally. Yeah. So I, I'm a huge fan of finding mentorship, even if it's somebody, even if it's something you have to pay for, uh, as a, you know, let's say you can't find a great running clinic in that area or running, you know, a physio or, you know, chiropractor or whoever, some sort of clinician that might really fit what you're trying to learn.

Um. Then you might have to go out and find it yourself and then just get a job, you know, working somewhere else, but being able to get yourself to a point where I think I think the sweet spot for most people, everybody's a bit different. It's anywhere between two and five years out of school. I think that once you're somewhere in that range, you have.

You're still like, uh, new enough out of school where you're not super set in your ways, but you've been exposed to like the, the sort of like newest research, the newest way of looking at things and the newest options to help with, uh, whatever these injuries are that you're dealing with. Um, but you're still like.

Probably like really interested in learning more. So I think that two to five year spot is a sweet spot for a lot of people to really just decide to do their own thing. Maybe for you, it's a bit accelerated because you're already familiar with that. But man, the investment of mentorship and finding that and like getting really good at what you do.

It just comes back to you like so, so much more on the back end with your, with your own business. So that's kind of my advice for you. I think it's awesome. You're going to kill it. I'm excited to see what we'll see where you're in, uh, you know, in a year or two and, uh, see, see what you're doing with your, your clinical practice.

And if I can think of anybody I'll have to look, Nate, I'll message you if we have anybody in, um, in Salt Lake. I feel like we do have a practice there. It is brand new that I don't think I've met the owner yet, but, um, anyway. I'll, I'll check that area out and if there's anybody that's there that has a cash practice that we know of that is looking to hire, um, I'll, uh, I'll, I'll, I'll see if I can connect you guys and maybe it's a fit.

Thank you. I'll be looking too. I really appreciate it. Thank you. You got it. Let me dig into, uh, let's see, Brooke, go ahead and open up your. So does cash practice work best in performance settings? Can it be neuropopulation, stroke, clinics, Parkinson's? Okay, cool. Well, is that, is that what you're interested in?

Are you interested in, uh, more of the neuro side, Brooke? Yeah, I don't necessarily know if I want to start a business anytime soon, but I think if I did, I would be more interested in that. Sort of setting. Cool. Um, so first of all, ironically, I think everything is neuro. I don't know if you noticed that if you feel that way, Nate, but like the, the further, further I got out of school, I was like, God, everything is neuro shit.

It's like relearning everything. And even working with, like, I remember working with stroke patients and, uh, just, and, and, uh, Parkinson's. And I was like, man, this is just like regressions of shit that I do with people that are like far more advanced and it still works just as well. So, um, I think that.

It's very hard to, um, to get a, to get a cash based practice exclusively cash based practice to work when it comes to neuro Parkinson's is probably the one that I would say I would deviate towards saying yes, a bit more for. And the reason I say that is because of the overwhelming amount of research that supports.

Exercise for that population, right? Um, and especially exercising community. I think if you could mix those two together with the Parkinson's setting that that can actually work really well. Um, but as, as far as the other ones go, we've, we've worked with plenty of people that are, that are, uh, neuro specific.

And the challenge is if it's a hybrid practice, then yes, I think that it definitely has a better fit because, you know, you have, let's say, It's peds or, you know, let's say it's geriatrics neuro, um, there's going to be some amount of like government insurance. That's going to have to be a part of that. So the idea of a hybrid practice makes a lot more sense.

Um, but straight straight cash practices. I don't think that they they work as well again. Parkinson's is probably the one I would buy us to work say, like, if you really like that population, you could definitely make that work. But there's a handful of people that I've had a chance to work with that are even doing just like remote programming work for Parkinson's specifically.

Right? So all digital businesses. Um, there's a lot you can do with that. Now, does a cash based work better in performance settings? Um. I think so. I think actually the one setting that it works the best in is women's health. Uh, or I don't know if that's the right term. Sometimes I don't know if I'm saying the right thing or not.

Like, you know, cause men have a pelvic floor too, but like if you were pelvic specific, uh, you know, uh, physical therapy, but in particular women's, uh, women's health clinics, they tend to kill it. I don't know if anybody in here has any interest in, uh, women's health, but, um, it's funny. No, no one that I went to school with did.

And I remember. We had a professor and she straight up said, like the greatest job security in our profession is, is women's health. And I, to this day, I'll never forget it. I'm pretty sure it was, uh, general Tehan who, uh, she goes, there's way more vaginas than women's health practitioners. And you'll never, you'll never meet the demand.

And I was like, I'm not interested, but ironically, I know there are nobody in our class was, but there's people that I went to school with that are absolutely niche down in that and are doing great. Uh, because it's a great, it's a great niche that I think is the easiest, not the easiest, it's the one that has.

the highest likelihood of success in a cash practice from what I've seen. Um, and I would say performance based clinics fall pretty close after that. If you can do a really good job of working with a specific niche, like let's say runners or maybe it's like barbell athletes or whatever. I mean, you can build a practice off many different niches, but I think the performance side is easier.

Uh, the women's health side, the pelvic floor specialist side is, uh, is a great niche as well. Um, and neuro is tough. Peds is tough too, you know, and. It is what it is. It's not the right fit for everybody in every niche. Uh, cause you're going to have to take like, obviously Medicaid, if you're doing peds. I mean, unless you're in a super affluent area and nobody cares, that's kind of rare though.

Um, I would say it's, it's a little tough. So, um, anyway, what, are you more interested in like general neural or is it Parkinson's specific stuff? Like what do you, what do you, what do you like? What do you want to do? Um, I mean, I'm not really sure. I worked with a lot of chronic stroke this summer and some spinal cord TBI and that sort of thing.

Um, but I probably want to get. A few years of decent experience before I would even think about, you know, starting a business and trying to figure out what population I like best. And he wasn't really cool. Um, uh, it's mainly like neurospinal cord, uh, injury center down here called the shepherd center, um, which is, uh, down here in Atlanta.

That's a really cool spot. Uh, we, we know somebody that works there. They really. Really cool work. I mean, in the military, we think there's so much TBI work and, uh, you know, just brain injury. So there's obviously there's a lot of blasts and stuff that are going off. Uh, so, you know, if you're into that stuff too, I would look at potentially even concussion work, uh, because one thing that I've seen that's, uh, obviously over the last five, 10 years in particular, um, people have become far more aware of the, the effects of concussions.

Uh, and Um, the, the cash based world, if you incorporate concussion screening, and if you're a concussion, you know, you can go through training to learn more about that and become more of a specialist within that. That's a great niche that has a lot more to do with kind of similar things, but it's more like, um, I guess like sport neuro, I don't know, it's the best way to put it.

Maybe just came up with a new niche. Uh, you can go ahead and trademark that that's yours. But uh, no, I think that, uh, I think that that could be a really good one just depending on what you're interested in. Thank So cool. Well, good luck with that. Uh, all right, Dakota, what you got, how would cash practice work at home health?

Hmm. That's tough. Where's your, where are you at Dakota? Oh, I'm right here. There you are. Sorry, man. I just kind of thought of it like on the spot. You know, so it's a good, it's a good question. I don't know if I know enough about this to be able to give you a good answer. Um, because there are, Uh, there are ways to do to do mobile practices, I guess would be a good way to put that traditional home health for a lot of people.

It's like post surgical going into work with somebody, whatever, um, a lot of that. It just depends on their insurance. It depends on their age. There's out of network opportunities with home health. There's a big group called Fox rehab that does this where they go to people's homes. Um, and I believe they do an out of network Approach, which is basically they build differently than if they were in a contract with an insurance company, not to get into all the like specifics of it because I don't actually know their, their business model, um, too well, but if you're looking at mobile, uh, in terms of like home health, many people will pay for mobile visits.

Um, mobile is very proven that people see value in that you're saving them time. Uh, the challenges with mobile come down to. Your it depends on the density of the population. So if you're in a very, like, spread out area, you could be spending significant amount of time in your car. Um, you know, and and there's somebody there actually, we're helping move from a mobile practice to a brick and mortar practice who's in more of a rural area, more of a suburban area.

And, you know, he's spending 30 minutes each direction, uh, going to see people. So an hour in his car, an hour for the visit. Uh, so in order to really. Be able to make enough of an income off of that. You have to charge quite a lot, uh, to, to be able to justify that. Now I've also seen this work really on the flip side, very well in population dense areas.

Uh, we have, uh, a guy that we worked with years ago. He actually just sent me an email recently and he's in a, like a major city in the downtown area, it's a lot of like. Uh, people live there, but it's also a big work area and he's killing it. Like he's scaled his practice up to a hundred to 150, 000 a month in revenue.

Uh, all mobile, uh, just going around to these different offices. And it's the reason it works for him is because they're very close. So he can be very efficient going from one visit to another, and he can charge a premium because he's going to somebody's house. So you gotta think like. Down, like downtown New York, uh, San Francisco, uh, Chicago DC is a good, another good one.

A lot of population density where you can get around pretty quickly. Um, and people are very time sensitive. That's another big one with mobile. You find people that are super time, time sensitive. They'll pay a premium for that. So I would tell you if you're gonna do it, It seems to only scale best in a, uh, population dense area.

And if you're in a more rural area, it's tough because you're going to spend a lot of time in your car and you're probably not going to be able to charge the premium you need to be able to justify your time as well as other people's time when you have to hire people from a service fulfillment standpoint, does that make sense?

For sure, because I think it's like actually kind of like what my cousin is doing, like he has like a mobile kind of thing, but I don't like really know much about it. So what is it a pretty big city or is it kind of more spread out? Um, it's like in like the Indianapolis area. So, I mean. Yeah, it's big enough, but right.

I don't really know much about it. Yeah. And there's, I think there's, um, it definitely works. There's no doubt about that. I think it's actually one of the easier ways to start. The challenge we run into is that people want to scale past themselves. Like, if you just want to do this yourself and you want to replace your income, you want to drive people's houses and.

You can actually make good, a good living doing this, but you're basically just creating a job for yourself, which is okay too, because there's something to me, there's a difference between these businesses. There's a lifestyle business and there's what we consider like a true business, business, right? So a lifestyle businesses, you're basically, uh, Solopreneur, you're doing all the work yourself.

You know, you're getting paid for that. You're probably making a good bit more than working for somebody else, but you're taking on all the risk, all the everything, like it's just you, maybe you have like an admin or something like that, it's helping with some of the logistics, um, a true business is where you're able to bring other people that are fulfilling on services into the business.

This is where you, you get the, the elusive passive income, right? The, the, the non active income, I guess is a better way to put it. Um, that doesn't come in these types of settings. Unless you're incorporating some sort of technology or something like that. Uh, but with service based businesses, it requires a person to service it or provide the service and that person can't always be you in a true business.

You have to have other people. And that means you also have to have the margins, the profitability to be able to pay them. Because if you said, you know, your cousin's like, Hey, I'll give you a hundred bucks to go treat this person at their house and he makes a hundred dollars, that's not a business. It's a.

That's called a non profit, uh, right? So he's just basically doing you a favor, um, versus there would have to be a difference there in order for there to be profit to reinvest in infrastructure in the business and to actually have a profit in the business for that person taking all the risk. So I think it depends what you're trying to do, but you can definitely make it work.

Um, just depends on if you want, you know, to grow past yourself or if you want to have more of like a lifestyle business, which is totally fine too, because some people, they love that. I know a guy that does mobile to this day, uh, up in the New York area. And he just he loves it. He loves his people the people he works with.

He makes great great money Um, but I tell you what if he ever gets sick, he's not making any income, you know If he ever gets hurt, it's it he doesn't make any money, right? And then he goes on vacation doesn't make any money. And I mean he just kind of weighs that as one of the factors Awesome. Thank you.

Cool, man. Good luck with that. Uh, all right, lindsey. Let's see. What is the success rate of cash ace? In areas that are not above average income. It's a good question. Um, okay Give me a little more context here. What do you mean

lindsey more right open it up for me? I don't know Yeah, let's let's let's chat. Um, yeah, I was thinking like so With the performance based models, it seems like, you know, those would be more successful in the richer areas, just like, those are people's hobbies, you know, that they're investing more in, um, so I didn't know if, but then, like, I was thinking, like, pelvic health and those other niche areas where it's like, people are, they can't do their day to day activities because Um, they're in pain or having other issues, so I didn't know if, like, maybe those would be more successful in a more variety, bigger variety of areas versus, like, the performance would be more successful in the richer areas.

Um, I didn't know if there was, like, a differentiation that you've noticed or anything. Yeah, it's a good question, you know, and I think that, so I had a very, uh, I had a preconceived idea of who is going to come into my office to work with me when I started, right? I thought to myself, well, it's only going to be like a super affluent person, you know, they can afford to pay at the time I was charging 175 a visit.

The very first guy that came to, uh, to see me as a patient was a defense contractor, uh, that taught, uh, basically like, uh, firearms training for, um, for police departments, like county and city police departments. Not the most affluent person in the world, not only that, but he drove from like rural Alabama to spend, uh, three hours with me.

Um, and a lot of it had to do with the fact that like, I was, you know, I, I was coming out of the military. I was working with a group doing a lot of tactical stuff and he had all kinds of injuries. He had been in the army, uh, for, for a handful of years. He had, he had a few injuries and we spent three hours together and like he paid me 525 in cash.

Uh, at the end of our three hours, gave me a big sweaty bear hug and I never saw him again and you know, he drove back to wherever he came from. And in Alabama, his name is Sam. Uh, but I think that's, I don't know if there's like, there's definitely better areas and not as good areas, I guess, but I wouldn't necessarily just say to myself, like, I've got to go to like the most affluent zip code because I don't think that necessarily, um, is.

I mean, it may be it's easier in some ways, but, uh, I, I think that. You'd be surprised what people will, uh, what people you would, will work with in a cash practice because insurance in a lot of ways has gotten so bad that, uh, people, they have a lot of skin in the game, no matter what their deductibles are really high.

Um, you know, they, they have, they have a lot of, uh, of additional money that they have to pay for healthcare. Uh, we used to see deductibles that were like 500 to 1, 000, like 10 years ago. That's very rare, uh, to see now, you know, most people are three to 6, 000, um, for their deductible. So you got to keep in mind, no matter where they go, they're paying out of pocket.

So if they're going to go somewhere, that's like a, uh, insurance based practice. And they're, that person is going to be seeing two other people at the same time. And they're going to be paying, you know, out of pocket for that visit. Uh, they're still going to be paying out of pocket, whether they're seeing being seen there, or if they were to come to a clinic like we have, and it's like one on one for the whole hour.

And we can probably see them in, you know, a third to half the number of visits that maybe they're going to go somewhere else. Like the value equation has changed quite a bit, uh, for what people think, you know, a cash practice, you know, where it can succeed. I was actually, I've been very surprised to see how well cash practices have done in smaller towns.

And what I mean by smaller would be like, Not super tiny, uh, but somewhere between like 10 and 50, 000 people, somewhere in that range, um, they've actually done really well. And I think part of it is that. They have basically no competition. If you're competent enough to be, uh, comfortable to start your own cash practice, you're probably a really good clinician.

So you're really good. You don't have a lot of competition and there's a community element to that where it's like you live there. You're one of them. They want to support a local business. And so it tends to work really well. I would say like one of the more successful people we've seen is I think in the County, they have like.

20 or 30, 000 people. Um, and I mean, he scaled his practice to like, it was him and two other providers when we, we finished working with him. And I think he did that within like two years. So to put it in context, like he went from himself to, uh, it was probably close to like maybe 500, 000 practice, like top line practice within two years in an area of 20, 000 people.

Some of that effect. All right. I didn't, could you talk to me a couple of years ago? No way. I thought that was possible, but I'm just telling you, I think insurance has just gotten so much worse, which sucks for everybody, but in this scenario, I guess it's a positive, um, so I think you can make it work in smaller areas.

For sure. Depends on your niche, depends on your skillset. Uh, you might actually have to be a bit more of a generalist because you may not have just a bunch of runners that want to work with you there, right? So in that case, maybe you have to. Be really good with specific niche, but also good with working with some other, uh, you know, uh, sub niches as well.

So hopefully that answers your question. And I think I wouldn't be deterred by a tiny town unless it was literally like 2000 people and no one else for miles or something like that might be tough.

See you multitasking. It was more, I was just like. I don't know, kind of checking in to make sure like, do I need, should I, if I were interested in this, is it like worth planning to like move like to a richer area? But yeah, from what you say, it sounds like it's doable. Yeah, for sure. And it's like I said, yeah, the income level is a factor.

I actually find more than anything. It's education level people that are like, because you can have higher education, but not necessarily higher income and. But being more educated, uh, tends to be like one of the variables we see an area that will work out well. Uh, you know, so like how many, you know, master's degree percentage or higher, you know, college graduation percentage that tends to work out more in your favor.

Um, and I don't know what it is. It's like. Uh, educated and active tends to work really well. That's our practice. We didn't know this whenever we went there, but it was like very active, but also a lot of like highly educated people. Also, they tend to have awesome insurance and they didn't care. They would still come see us, you know, like, I mean, tons of people we worked with, uh, they would work for Emory hospital, which is like a great hospital, great healthcare system, and it's just, we had something that they didn't have and they would still come and see us.

So, you know, I think you can make it work in a lot of different ways. So good question though. Um, let's see. Oh, this is Nate. You're just dropping some info in there. No, I think, I think that's all the questions, man. Nate, you got anything else? No, man. I super appreciate your time on here. We we've, uh, we've gone our full 50 minutes, 51 actually.

So thank you so much. This was great. I appreciate the questions. Thanks for having me on again. Um, so funny to like, it's so great. Good. It's like Emily in particular is cool to be able to kind of break down your trajectory of where you're at because you're probably closer to being able to start with an issue you have, which is cool to see, you know, so just just so you guys are aware.

Maybe just see what she does over the next couple years and see if I was right or not. This is good. There's a lot of pressure on both of us now. So hopefully you pull through because it's not on me. But anyway, I'm just kidding. The, the biggest thing for you guys, I hope that, I hope this was helpful. Uh, I hope that, uh, you know, I don't know, maybe you want nothing to do with this, which is cool too.

Cause I, I, I can tell you there's plenty of people in our profession that shouldn't be doing this at all. Not in a bad way. Like it's just not for everybody. Cause you know, running a business, uh, is it's stressful. There's no guarantee. Um, you know, it's isolating. It's hard to share your wins. No one wants to hear you complain about the bad stuff.

Like I'm not going to sugarcoat it for you. Like You know, there's negatives. It can really strain relationships, uh, can make it kind of hard for you to talk to certain people that, that are not, you know, in, in, in the world of entrepreneurship, uh, and you've got to kind of figure out how to manage your own mind when it comes to that stuff too.

And it's a challenging thing to do, but I'd tell you this much. Here's the other thing. If you, if you even have like the slightest thought to yourself, like, I really want to see what this is all about. You're screwed. You don't have a choice. Uh, it's like, it's like a disease. It's like you have an infection and I'm just not going to go away.

One thing that we, that we see with a lot of people is like, you know, we work, we work with a lot. Most people are kind of like my age or younger for whatever reason. Right. And I'm 38, so I'm not old. But, um, I think that once they get more, once you get more established in your career. You know, when you're like 20 years in the profession, it is so much harder to go back and then say, all right, I'm going to start all over again.

And I'm going to, I'm going to take a chance on myself. And we work with some of those people and I got a lot of respect for them. Cause it's pretty rare, but I'll tell you what, if you feel it, if you're like, I don't know, I feel like I need to do something like this. It didn't go anywhere. And it's probably going to bother you if you don't at least try.

Uh, you know, so if that feels like you, then, you know, hopefully this was helpful.

Right on. Hey guys, uh, Danny's on multiple social media platforms. If you want to follow him, if you have specific questions for him, go ahead and email me and I'd be happy to relay those to him. Uh, big round of applause, even though your mics are off for, uh, Danny really appreciate his time and help with this and, uh, take those knowledge bombs and do what you will with them.

Well, thanks, Nate. I appreciate you having me on six years or whatever in a row. We'll make it seven, uh, next year. We'll do it again. Uh, guys. Hey, thank you so much for your time today. Congrats on almost graduating from school. You're right there. It's like the hardest time. It's like senioritis is so bad, but just, uh, Finish it out and then you're you're good to go.

So anyway, thanks, man. Appreciate it. And i'll see you next, uh, Well, I guess i'll see you soon, but i'll see some of you hopefully, uh soon as well. Sounds good. Hey guys next week We'll see you next week Hey, peach entrepreneurs. We have big, exciting news, a new program that we just came out with. It is our PT biz part time to full time five day challenge over the course of five days, we get you crystal clear on exactly how much money you need to replace by getting you ultra clear on how much you're actually spending.

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