E528 | Jarod Carter Re-Cast InterviewAug 16, 2022
This week, we bring you another re-casted interview from 2017 with Jarod Carter! If you are a P.T. and don't know Jarod, then go check out his podcast Cash Based Physical Therapy. It is one of the most incredible resources for P.T.'s on the planet and definitely helped me when I started.
Beyond hosting a podcast and running a website dedicated to Cash-Based Physical Therapy Jarod also owns his own practice in Austin, TX, and also is an author of an e-book.
- How laws governing physical therapy change from state to state and make getting new patients really hard for the cash-based physical therapy model.
- How to scale up a practice
- Some ideas for P.T.'s to monetize their skill set in non-traditional ways
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Danny: [00:00:00] So I was having a conversation with one of our staff members about documentation and he had come over from a in-network practice that he was working at and he was talking about just how long it would take him to document and click through and the workflow and how, just how time consuming it was and how much easier it's been with the software that we use, which is PT everywhere.
And I know for us, we're very aware of. Sort of time leaks within our staff and our own schedules. And it's just one of the worst things you can do is just waste time on things when you could be doing them more efficiently. One thing for us is we have to document. It's something we need to do and you need to do it as efficiently as you possibly can because that's where you're gonna save a lot of your time.
We were seeing our staff members save upwards of an hour a day as far as cleaning up his documentation, making it more efficient. What if you got an hour of your day back just from documentation? What if all of your staff did the same thing? Highly recommend you take a look at PT everywhere.
It's been a huge time saver for us and really has made a big difference in our efficiency of our practice. You can check 'em [email protected]. I think you're gonna really like what they have to offer. [00:01:00] So here's the question. How do physical therapists like us who don't wanna see 30 patients a day, who don't
Jarod: wanna work home health and have
Danny: real student loans create a career and life for ourselves that we've always dreamed about?
This is the question, and this podcast is the answer. My name's Danny Matte, and welcome to the PT Entrepreneur Podcast.
Jarod: What's going on guys?
Danny: Dot Danny here with the PT Entrepreneur Podcast and today is another recast interview, one that I did with Jared Carter back in mid, actually mid 2017. So
Jarod: this is going. Way back in
Danny: the vault. These are the episodes you can't listen to right now because the first 250 are no longer available.
We have a little over 500 episodes now, so you can really only listen to about half of the podcasts that we put out. And [00:02:00] as we
Jarod: work on in fixing that and making it to where you can listen to all of them, I wanted to re-share a couple of these. The ones that I really found
Danny: helpful and
Jarod: got a lot of feedback on.
Back in the day when we first, started
Danny: this, and Jared is someone that I think, first of all, number one, he's just a really good person. He's somebody that I, think has done a lot for the profession and, is he is a, he's a family oriented person. He wants to see, physical therapy.
Progress and grow. And I have a massive amount of respect
Jarod: for him. Just
Danny: as a clinician, but also just as a man and a father and a, and a leader. I was very, excited to do this interview because the very first podcast that I was on was actually Jared's podcast.
Right when I kind of start got out of the military and. I had actually bought an ebook that he had on cash-based practices, and that was the first sort of like information that I ever gained and looked at. And definitely the very first investment I ever made in the business was this ebook that he [00:03:00] had.
And I'm not sure if he even has it anymore. I'm sure he has much more detailed things that are helpful. But and, and the
Jarod: thing with Jared too is like we both work within this.
Danny: Business consulting, sort of cash-based practice realm. And I'm a huge, believer in abundance and that you'll find the right person for you,
Jarod: and not everybody's
Danny: the right fit for me.
Not everybody's the right fit for Jared. But I refer business back, forth to him all the time. I think this is how a relationship should be, and not necessarily this sort of competitive, cutthroat, talk bad about somebody else, even though I, they frankly are probably very
Jarod: similar to you.
That's not how we
Danny: should do things, and I'm excited to highlight him and what he's doing. I highly recommend you check him out. He has a great blog. He has a great podcast. And
Jarod: this was an interview early for me. I was very excited for this one because he was actually someone that I
Danny: considered or one of my first mentors as far as cash.
Cash based, physical therapy is concerned. And if it wasn't for him and his ebook, I probably wouldn't have a practice, I just want to say, thanks to Jared for putting that out. I'm sure he is helped many other people besides [00:04:00] myself. This was a really cool interview. You get to share his story and learn a little bit more about, him and what he's doing and why he moved the direction where he was.
He was sharing some misinformation as well as, still having a practice in Austin. And I hope you enjoy this one. I know it's basically five years old. But it's funny how these concepts in business, like they haven't changed much. They still apply and he's he's someone that I think is definitely in the mastery level of understanding these and you can learn a ton from him.
So I hope you enjoy the podcast. And as always, guys, thanks so much for listening andwe'll catch you next week. We'll right into it. Hey guys. Doc Danny here with the PT Entrepreneur Podcast. And today we've got one of the OGs I'll, like you put it that way, of the the cash PT practice scene.
It's Dr. Jared Carter and I'll give you a little plug. Jared Carter and his podcast and all of his online content, I say when I got outta the Army and I first was looking for how to establish like a clinic that I wanted to work in and felt like I would really enjoy the number one resource I used was.
All of Jared's stuff, and his podcast wasn't out at the time, but it's awesome. If [00:05:00] you haven't listened to his podcast, go listen to the cash-based PT or ca cash based physical therapy podcast. It has some really valuable content. And if you're in that stage where you're thinking about starting a practice or you're just in and you're, trying to get some ideas and stuff, it's so valuable.
So I'm really excited to chat you today. Jared, thanks for jumping on the podcast. Thank you for having me, man. I appreciate that. Very nice intro. Oh, yeah, no it's, I'm glad my work could be of assistance and inspiration early on for you. No, it was, it's, it was really helpful and I love that that, that model's out there because I think, for you and I, you've been in this longer than I, and we can get into this a little bit later, but it's scary when you think about starting something on your own, but even scarier when everybody tells you.
No one's gonna pay you cash. Why would they just not use their insurance? What you put out really helped me with, gain a lot of confidence that would actually work. I think that's been one of the biggest bonuses of my podcast is that the major I do monologues, but the majority of it really is interviews of others besides myself.
You've had success in the model including yourself and. And that really, it's the inspiration that people get from it of [00:06:00] seeing, oh wow, this person's doing it, that person's doing it. It's not just one dude down in Austin, or, just a handful of people. It's a growing thing and more and more people are trying it and having success in it.
I'm not saying it's not hard and it's not a struggle to go into such a different model, but it really is a model that is viable and becoming more and more viable. And we can talk about why that is. But yeah it's been a really cool ride to see all the people, practicing the way they want to practice and living, living their daily business life, the way they want to live it rather than, chasing reimbursement or having to see, 20 patients a day or, all the horror stories we are, we're so familiar with.
Yeah. And I put a. Instagram post out the other day. There was just like some, like a branded whatever little saying and I ba I basically said something to the effect of it's sad how many physical therapists leave school and within a couple years wish they'd picked something else.
Yeah. And it resonated more than I thought with people. I just had Tons and tons of comments of people like, just expressing how disgruntled they were with the fact that they had to see so [00:07:00] many people and that they didn't get to
Danny: use their skillset in the way that they thought that they would, they didn't get to use all these manual
Jarod: skills that they, worked so hard on gaining.
They were basically just managing these big groups of people and, how often do you get people reach that reach out to you that are in that situation and just like looking for help. All the time. And I'll tell you, this is on topic, off at my website the, I have probably over a hundred Oh yeah not probably actually way well over a hundred blog posts, whether it's, it was in a written article or the show notes for a podcast.
Right? And consistently, every time I look at my Google Analytics, there's one blog post that is, Absolutely number one gets far more traffic. Than any others. Maybe not far more but definitely more. And it's titled, is PT school worth it? Yeah, it's not even, it's not even about the cash-based model.
It was literally just a friend of mine who was like in his early thirties at the time, was wondering like, Hey I'm interested, I really would like to be a physical therapist, but at this point in my life, I'm looking at the amount of debt [00:08:00] I'll take on. Versus what I'm gonna make and I'm just not sure.
And so I gave him my answer at, and that's the article, the blog post itself. And then I opened it up to colleagues and I founded out on social media and that. That post has think over at the time of this recording over 180 comments. If I remember. Maybe I'm thinking of the Medi Medicare post, but it's it's up there in the certainly over a hundred.
And it's so interesting how some PTs are just so adamant about it being so worth it and they just. They love it so much and yeah it's a larger and larger debt load and blah, blah, blah. And then there's some people that are just like, vehemently just against, no way I would do it again.
And it's interesting to read the different comments and but I, but it turns out that the search. Phrase is PT school worth? It is a very popular one. And that comes up, number one, since it's the exact title of that post. And I don't know if that post has inspired many to do it or dissuaded I'm not sure, what it's actually done.
But it's been interesting to see how much [00:09:00] attention that topic gets and how many people. Do find themselves in a scenario where they're like, man, this sucks. I've got over a hundred K in debt and I hate my day-to-day. I like, I like what I've learned and I would like to practice it in a certain way, but I can't.
And so that's where, practices like ours can be a beacon of hope and this kind of information can help guide people to really setting up setting up a, an oppor or a business where they really can enjoy being a physical therapist. Again, it's
Jarod: tough the fact that certain other Health professional careers, or you wanna call it, like in particular, something like massage therapy where practice acts can be very restricting for us when in, in some states, it's actually better to not have that cr credentially.
It's exactly it's so backwards to think of it that way. But I, I. I I've had people ask me the same question, and I, I think a lot of it depends on what their long-term goals are. But yeah, sure in certain states, man, I know in Texas you guys have some limitations and, but somebody could probably go see a massage therapist and not need anything.
It's [00:10:00] unbelievable. And I'll try to keep this short. I'm obviously very, oh, you're obviously angry. I'd like to hear it. Go ahead. Yeah. I'm passionate about this Texas being one of the last states where you can't. You can't initiate treatment. We can evaluate this. This statements of every state has direct access.
Pisses me off. That is such bullshit. That is absolute crap. We do not have direct access in Texas to start treatment. People can come in for an evaluation. Most of the time when people come in, they wanna, they want a taste of what you're gonna give them. And to have that referral before we can actually touch 'em or even tell 'em a stretch when they can go down the road and tell the massage therapist all about their pain and they're gonna try and dig in with an elbow, or they can tell their personal trainer and they're gonna try and give them exercises or even use their hands on 'em.
Yeah. It's infuriating. And we at, as a cash-based practice, most of our. Our referrals are from non-physician sources, so probably 50% or more of the people that call saying, I'm ready to book. I wanna see you guys, for [00:11:00] whatever reason, they don't have a referral. And then we gotta take 'em through the process of trying to get one and we lose thousands of dollars a year in my practice.
For that reason. So I'm actually looking into some different options. We're setting up we're setting up relationships with concierge and fee for service physician practices now to send them in and quickly get the referral. But it's still, it's still another 50, 75 plus dollars and a trip for that person.
It's still a hurdle that's just, Absolutely ridiculous. And I don't, we only meet the legislature only meets twice a I'm sorry, every other year. So we only get a shot at changing the law every other year. And we haven't even come close. Not even, it's a long process to get the law chains we're, we haven't even gotten it.
To a vote on either the Senate or floor yet. Wow. And the TMA is just so powerful and so freaking rich and they consider this a top priority to block every time. So I don't know if it's ever gonna change. Obviously we still are a successful [00:12:00] cash-based practice, even with that huge hurdle.
Sure. In a way, I think that can also be an inspiration for others. If you're in a state where it's like, not not an issue. And you can get those direct access patients without the referral. That's huge. One, one kind of side note, I'm actually going to a telehealth conference in a month specifically to meet with.
Executives and CEOs of telehealth companies to explain, look, here's the situation. Do you want me and maybe a lot of my audience to send you a bunch of these consults, for physical therapy referrals? Because this would be a huge business boost for anyone that agreed to it. And if we could just send someone a link and say, look, book an appointment with this company, it's gonna be, whatever, 35 bucks.
And they'll send us a referral. If you're appropriate for physical therapy, of course. Sure. So I'm hoping I can work something like that out. I don't know what the legalities of all of it are in terms of Telehealth legalities. I gotta look into that. But I'm desperately searching for more and more solutions to lower that hurdle, but ultimately I don't see the law changing for a long time here in [00:13:00] Texas.
It's interesting you bring that up cuz a couple years ago before the Practice Act changed in Georgia, we didn't have this, we have better access now direct access now. And I actually have a patient that owns a telehealth telemedicine company and I brought the same thing up to him. This was right before it changed and we didn't necessarily need it at that time.
And it's interesting cause they have these little kiosks that they'll put in, offices and stuff and he, he felt like it could totally work. The issue sometimes comes down to, I don't know how Texas is, but sometimes the provider has to be in that state specifically.
I don't know if Texas is like that, but if that was a case, then that would maybe complicate things where it'd have to be a Texas based provider or something. But I think it's a great way to get around it. And you know what, sometimes. The resistance of things makes us be creative, right?
And instead of just giving up and. I'm getting frustrated and saying, alright, hell with it. We're just not gonna do it. If you can get creative and solve a problem that can potentially turn into a whole nother way to help other people and a another, offshoot of the business.
You know what I'm saying? So It's true. I love it. Creates, I, I don't mind peop, a problem. I think a problem is a opportunity to, if you can solve it, then you have option to [00:14:00] have another business right there with it as well. So That's awesome that, to hear you're going after that.
I'd love to hear how you do with that group. Yeah, we'll see. Yeah, you're right. And with legalities, and I know that like as far as I understand it at the time of this recording, as a physical therapist, we could not provide telehealth services outside of our state of licensure. I'm not sure if MDs have the same exact limitation, but, so if that's the case, then I'll have to, look at what providers could we connect with that we're in, that are specifically in Texas.
And I even thought about what if I just started a telehealth business myself? And I'd have to partner. You have to partner with a physician cuz you can't. You can't employ physicians without being a physician or having a part of the company owned by a physician, but I've got some physician buddies that would potentially be open to it.
So if I can't find it, we might have to create it, even though I don't think I have time for another business, but we'll see. Yeah, let's add that to the plate. Oh God. Yeah. Yeah, it's crazy. You bring this up, this idea of, even being creative and figuring out some of this, telehealth stuff and ways to get around these just like silly.
[00:15:00] Limitations that are placed on us that we could probably just yell back and forth about for an hour. But, the, you have now had practice for a little over seven years, and I'm interested to, pick your brain a little bit on what do you feel the biggest changes or potential evolutions that you've seen within this cash model that have happened over this se this past seven years?
The biggest changes in terms of the cash model, other than just the fact that more and more people are doing it and seeing while this is possible and having success in it, actually, I would say occurred since the Affordable Care Act. And luckily for us, for in the cash-based model, are those interested in it.
And something I mentioned earlier is that it's actually, I feel, has become easier For a cash-based practice to be successful because of the rise in deductibles and copays and just the general. Sure. Worsening of coverage for physical therapy, these days with so many more people having these co sorry, deductibles in the thousands of dollars that they haven't met.
If we [00:16:00] can do a good job as a cash-based practice in educating. The public and those who are calling in and unsure that we're cash based and they're like, oh, I really need to use my insurance. It's wait. Let's just chat real quick. What kind of plan do you have in terms of your deductible and if they have a high deductible?
I would say, look, I would really encourage you since you've shown interest in our model of our one-on-one sessions manual therapy approach, I'd really encourage you to to call your insurance and ask them how much out, out of pocket expense are you gonna be paying? Until you meet that deductible if you go somewhere.
So if you go to a physical therapy practice that is in network with your insurance, because until they meet deductible in, in a lot of cases, I'd say most cases they're gonna have to, you're gonna have to pay a hundred percent of the bill that the physical therapy practice is sending to the insurance.
Sometimes they'll come back and give like a cash pay discount, until they meet the deductible or whatever. But in general, That's [00:17:00] what they're gonna be told by the insurance company. And so it's okay. How much are those bills that are being sent to insurance companies from your standard PT clinic?
Usually $200 or more. Sometimes much more. Especially if it's like in a hospital system or something. So when, with that being the case, It's what ki what kind of going back to what you're saying to the patient, you can say, look, I'm not dogging all of the PT practices, but a lot of these practices you need to ask if you're considering them, if they're in network, you need to ask how many patients an hour do they see per.
Provider, will I be seeing my physical therapist for the entirety of every visit? How long are those visits, et cetera? Because you might find that you're gonna be in a gym style setting with five other patients at the same time. And a tech or an assistant is actually providing most of your care and until you meet that $2,000 deductible, you might be paying $200 an hour for every one of those sessions, but you won't see those bills for six to eight weeks.
Yeah. You just get hit with a huge bill. These are the questions I'd love you to ask. Before you make that decision, because you might find that our $165 for an hour one-on-one with a [00:18:00] doctor of physical therapy becomes actually cheaper than what you'd be paying otherwise.
And then in the cases that of people that don't have high deductibles Or they met the deductible. I always encourage them to ask what the PT copay would be, because sometimes those are 50 to $75 nowadays and when most of those traditional, insurance based practices are a asking them to come in two or three times a week, and we usually see people on average just one time a week.
It also becomes a wash or not much difference in terms of the financial side of things. And then it's do you wanna leave? Again, what kind of care do you want? And do you wanna have to leave work three times a week versus one time a week? So those are the kinds of things that nowadays in the last three years is all these changes in, the typical insurance plan has occurred that we can utilize as cash-based practice owners and our staff members can utilize when they're answering the phone.
So that's a, that's I would say is one of the, one of the biggest, not the biggest transition or changes shifts that I've seen in our model in the last few [00:19:00] years. The questions you're, giving to them. Those are so valid because, think about how many people have a bad experience and then it's bad enough that they get not a lot of attention.
They have somebody go teach 'em how to do tricep press downs for lower back pain, even though they're playing strong enough, like it's some stupid crap like that, right? And then they're in there with a bunch of other people and They don't get better, but then it's worse than anything. You're right.
6, 6, 8 weeks later, they get these bills that they owe, and there's no transparency. I think that is the biggest issue with the cash model. And I love that you bring all these things up because it's, they're so valuable. You, you say one, 1 65 the people may hear that in their.
They blk at it, you're gonna spend 10 minutes with your orthopedic surgeon and they're, you're gonna get a bill for $175. And so what does that equate to for nothing really that they're gonna tell you that you have going on. Umhmm I think we're very valuable and I think that the, what you're bringing up is huge and the conversation has become so much easier when you guys do that with your practice, do [00:20:00] you tell them, say, Hey, call your insurance?
Or do you. Actively tried to get in touch with their insurance for them and then lay out, hey, this is what you actually owe. That's a great question. And so far at this point just being, I have one practice manager and office administrator or combo. Practice manager.
Office administrator. We are not, We're not making the attempt right now to verify benefits and, but I do think that will be something in the future that we will at least look at as a possibility because if, we're, if we can look at the overhead that it would take for someone to, to do that and actually bill on an out network.
Basis or just verified benefits if nothing else. Sure. That I think could probably be the tipping point for a lot of people that don't want to do it themselves and are just, they're in the mindset of, oh, if I use my insurance, it'll certainly be cheaper, even though that's no longer the case in a lot of cases.
So we don't do it now, but down the road when we have enough PTs generating the revenue to justify it, then I might, look at doing that. You bring up [00:21:00] this. Kind of topic of staffing, which is growing and scaling and there's difficulties with that in its own right. And we talked a little bit about this, before we started recording.
And so where you're at now the scaling of your business, what are is your biggest frustration that you've found with growing a team? And cuz you spent so long where it was, just you and we're cruising and actually, it was like pretty easy easy gig.
And now, You're growing for a purpose, but there's growing pains associated with any growth. Oh, yeah. Yeah. So biggest kind of frustrations, I would say, if you ask that of me or anyone doing similar things in terms of growing a. A practice or, but especially a cash-based practice, I'd say, although I'm sure that this is a very similar deal with people who are doing traditional insurance-based practices.
The, my answer to that would probably have changed ev about every six months, since I've started, which has been, it's been about a year and a half since I brought on my first pt, and then a few months after that brought on a full-time [00:22:00] administrator. And I would say that my current answer to that, Is something that we did discuss right before this is of and this will be good for people to hear who are looking to go beyond solo practitioner and scale things up.
And I'd back up and just say, just for context, I was a solo practitioner for five years and on purpose I probably could have started the growth, and adding another therapist after about a year and a half or two. But I was actively, working on my online business and just seeing patients four days a week. After that first year and a half or so, it really didn't have to do much in the way of networking or marketing at all. It was just, being a solo practitioner, if you get great results and you give people a great experience it's, it doesn't take in a lot of cases if you do the right things, it's, it doesn't take.
A crazy amount of time before word of mouth can keep you afloat. So I wasn't having to do much other than just show up and see patients. And then I worked on my other business businesses on the side and [00:23:00] it was a nice cruising kind of thing, like you said. And I was after the low overhead was paid out and whatnot, I was, I was reporting o I was, I had a six figure income.
And so then, When I decided, okay, look, my hands aren't gonna take this my whole life. I want to, I also don't want to have to be at the clinic, five days a week and or four days a week. And I really would like to scale this thing and create a very self-sustaining business with minimal input from me.
It's it's not just about getting that next therapist, it's now I've got another therapist. Now I'm having to, on the admin side deal with, so much more, and I can't really field all these calls, okay? I have to have now a full-time practice manager, administrator, receptionist type person.
And then, so now you're going from a small space, even maybe doing home visits if you're in, if that's your model to needing a much bigger space, to needing a lot more supplies, to needing, a waiting, a bigger waiting room space for the receptionist. All [00:24:00] these things that your overhead.
In going from one to two therapists is probably gonna do way more than just double. Yeah. And then there's, there, there's the whole conversation that maybe we won't get into now about how you're gonna pay that therapist. Are you gonna have 'em on a set salary and be potentially losing money as you try to grow their.
Their schedule. Are you gonna, are you gonna pay them kind of a commission basis, which is a little safer upfront, but harder to scale long term. Sure. And really get buy-in of, this is a person working for this practice not having their own practice within this practice. That's a, that's something to really be aware of if, for those out here out there that are thinking about scaling is that your overhead is gonna immediately go up way more than double when you bring someone on and you're really gonna need to bring two people on.
And what I, in my experience I'm really glad and lucky that I had. Started this online business because it's allowed me to live on that and not have to take a salary myself or, just pay myself minimally as needed along the way in the [00:25:00] last year and a half and not crap my pants because I'm not making anything but for them, really I've run the numbers and it's not until I get another.
PT who and have their their schedule, pretty decently busy. Am I gonna be able to like, pay myself what I would consider, a decent PT salary again? And that's just the nature of the numbers and it's something to be aware of. And it's not something I really knew of ahead of time.
And so thank goodness I had, other sources of income. Because it would've been, it would've been really tight along the way otherwise. So I'd say that has been a big surprise and frustration along the way in something that hopefully others can plan for better than I did. It's important for people to hear this stuff because and I think too, all too often we talk about all the positives that come along with. Entrepreneurship and business owner being a business owner and the flexibility and, all the cool things that come along with it. What isn't cool is losing money every month, and yeah.
And I've been there too where, we're[00:26:00] in growth cycles and things are going the opposite direction, and you're like, Doing the math and you're thinking, okay, I got three months. And yeah and you know what? It's scary. But you do those things because you have to in order to build something where it's sustainable without you there.
And you're right. Like especially someone that's as heavy hands on as you are, it, it's. Do you wanna be doing that when you're 50 years old? And seeing that many people and being tied down to a schedule and people love that stuff. Don't get me wrong. I really enjoy physical therapy, but yeah, you have to make that decision, man.
Do you want to, do you wanna stay in that kinda lifestyle business or do you want to grow and scale? And that, that kind of brings me to my next question, which is really how scalable do you think these practices are be because I think as of recent, we've shown we can definitely scale to multiple providers, but I look at some of these big, 10, 20, 3000 plus clinic conglomerates that are insurance based.
And I don't know if the scalability is there for cash-based practices, but potentially, maybe it is. I would, I'd love to hear what you think about that. Yeah, that's gonna be, I think that's gonna [00:27:00] be a situation that be, that changes over time because I don't foresee the insurance based model becoming, Or remaining a sustainable option for a growing number of types of practices out there.
Basically anyone who's not in a, a large practice like you just described, or a hospital system that really has the bargaining power or a scenario where they can main, they, they can maintain decent enough reimbursement rates, they're gonna keep getting squeezed. And more, and more and more practices are either gonna have to Create some sort of cash based revenue, whether it's through p PT treatment or not to survive, or they're gonna have to sell or close or whatever.
And so I think that what's gonna happen over time. Is we're gonna see a larger and larger number of people that are literally forced to be at least a hybrid cash-based practice. And a larger and larger amount of insurance plans that provide little or no coverage for physical [00:28:00] therapy. I think we're gonna see huge cuts in what.
Physical therapy in terms of physical therapy coverage for Medicare. I'll do, just to give a spiel on that. As I've done a ton of research on the cash-based business model and Medicare, and in the process of really looked at the stats and the amount of people drawing off of Medicare is gonna double.
Over the next, I think it's 20 years. Whereas the and that means the amount of people paying into social security and Medicare is going to drastically decrease per capita. So that we end up with with, I think it's gonna be like 2.1. People paying into the systems for every one drawing out.
Whereas back in 1960, there were four people paying into the system for every one drawing out. Wow. So there's this really scary shift in the demographics and people of those systems that literally make it mathematically impossible for there to not be major changes to to what Medicare pays out of their banks.
And the biggest. The biggest payouts from Medicare are two providers for services. [00:29:00] That's the biggest ones. So all providing all providers and all of our services are going to be on the chopping block. Who do you think is gonna get cut first? Is it gonna be things like physical therapy or is it gonna be things like surgeries and medications that actually keep people alive?
Sure. Not to say that we don't have an incredibly valuable service, but guess what's gonna happen? It hadn't happened yet to to a large degree. They've, in most billing units, they've at least kept up with inflation. Actually, not much more than that though. In fact, I think they pretty much just track inflation and some of 'em have not even kept up with inflation in terms of a manual therapy code or a Therex or whatever.
But some, at some point as this huge shift in the population and this huge change in what's being taken out versus put in happens, we're gonna see some major changes. And I foresee that 20 years from now, physical therapy is going to be much more of a look. If you need physical therapy, you're paying out of pocket for it.
I don't care if you're in Medicare or [00:30:00] you're. You have a private insurance, you're gonna be paying a lot of what you, what is spent out of your own pocket. Maybe some coverage still remains. I think there'll be some coverage, but I think that it's going to get really crappy for how much our services are covered.
And so what I think is gonna happen is that we're gonna end up being one of those services. It's seen not in terms of what's provided, but in terms of what you pay for it out of pocket. We're gonna be like massage therapy and personal training. Arts. No one expects, sometimes those things are covered by insurance in a rare case.
But in general, people know that if you're gonna go get a massage, you're paying cash, if you're going to use a personal trainer, you're paying cash, and I think that's going to become more of a publicly acknowledged, just mindset that physical therapy is something that you mostly pay cash for.
Maybe there's some coverage, but not a ton, and at that point, the scalability of the practices, like I described earlier, which is the changes we've seen in the last few years, it's gonna become easier because more and more [00:31:00] of the general population are going to have that mentality of, okay, look, this is just something we pay cash for.
But could it scale to, a hundred clinic practices? I don't know about that. That's a huge operation. But I could certainly see, cash-based practices and people who are really business savvy and really pushing hard yeah, going 10 plus clinics. Yeah, I could see that.
I wouldn't expect that anytime real soon, but I do think eventually it could get there. I almost feel like it would be better, let's say you're, prediction is a hundred percent accurate, right? And it sounds like it potentially is gonna be that way and which is good for us.
Maybe not not necessarily so good for insurance-based practices, but the, what I look at is the idea of massage therapy, personal training, and the amount of questioning and just this, the amount that you have to inform people about yourself to get them in is totally different, and not only that, but I know people that pay.
Over a thousand dollars a month for personal training every month. And I've done that for years and I look at it and I think, man, we're, we undervalue [00:32:00] ourselves significantly. I used to be a personal trainer. I did that when I was in, in college and I was a butthead 20 year old kid working at this golf retirement community selling $5,000.
Personal training packages for six months of me telling 'em how to do bicep curls, and what people value is totally different. I think it's in, in our, it's a disadvantage to us. The fact that people assume it it's a hundred percent covered by insurance and it would, it sounds like it would be better if it did go the other way around.
But, that being said let's say that this happens, people right now, are these cash-based practices, do you think it's better for them to niche down and try to become really. Known, really sought after for a very specific area. Or do you feel with this, these changes, is it something where you can get these kind of generalists in terms of orthopedic issues and still have success in the practice?
That's a good question. Let me also preface it with, I hope that I'm wrong. I really, I don't think I think that there's, it's still gonna be possible for people to have success. In both models, and I really hope just for the general [00:33:00] public that it, that our services and for, our profession, that our services are always covered nicely by insurances and Medicare.
I really hope that I don't really see it mathematically happening, but I hope I'm wrong. But to answer your question niche down or go broad. I think that depends on each individual practice owners. Aim, and what they want their day to look like. And if they if you have an aim of of being a 10 clinic practice if you're gonna niche down, I'm always a big fan of.
Really going strong in a niche or in maybe more than one niche. I don't think that it's certainly not impossible to do, have multiple niches that you're really well known in. So I'm a big fan of that. It really does help, I think, especially in the beginning, if you can really establish yourself as like the go-to providers for X, Y, Z, CrossFit or for runners or for golfers or whatever.
But if you're gonna go, if you want to go big, then you have to consider. How big are, is the niche or [00:34:00] potential market that you want to target, and if you want to go really big, you probably are gonna need multiple niches over time that you develop which is possible, or you're gonna need to be the generalists.
We're, we are right now, I'd say we are generalist, manual therapy specific providers. We treat things from head to toe and then we have a sub niche focus with runners right now. And as I hire more people in the future, if, if I get someone who's an amazing CrossFitter and great therapist and has, in roads, in, in those communities, then I might consider, going after that niche or, X, Y, z, specialty that someone comes in, vestibular or whatever, it could be so many things.
I would consider, I. Creating multiple niches in order to grow. But the thing you have to be careful about there is that if you're building niches and putting a ton of energy and marketing efforts and money into that niche, you don't want it to be something that only one practitioner who could leave at any time to be skilled in.
So you have to think long term [00:35:00] and understand that yeah, people are gonna come and go for various reasons. You might have to let some go. And you don't wanna build a niche specifically over, around one person. Ben, my pt now, he's great with runners and that's what he's, one of the things he's really passionate about treating.
So it's like, all right, let's do it. Let's build out a running it. And we've been working on that. But whoever I hire in the future, even if they bring, a specialization in something else, they're gonna know. How to be a badass with runners, yeah. And so I will make sure that any niches that we introduce, everyone is gonna be able to utilize or to service those patients at a high level.
I wanna shift gears a little bit and get into one thing I want to talk to you about, which is entrepreneurship and not necessarily just, Patient volume and physical therapy practice, volume which is obviously a big part of what you and I both do. But when we look at the potential opportunities for physical therapists to build businesses and, you and I both do things online as well.
There there's opportunities there besides patient care for physical therapists to be able to utilize their knowledge, their skillset[00:36:00] and leverage it into other types of.
Danny: Entrepreneurial kind of adventures.
Jarod: Wh where do you see are maybe like one or two potential areas where PTs can build a business and generate revenue in particular that's sustainable at what their salary is, if not more as a pt.
That is not necessarily just patient care. Oh man that's a fun topic. And there are so many possibilities in that realm. I'll just building off of the niche conversation, just creating a monthly membership kind of group or community. That is based on that niche.
So let's like use your, your niche in CrossFit as an example. Now obviously Kelly Star already has mobility wide, but that doesn't mean that, someone out there couldn't have in their own community between the patients they see and their friends in the CrossFit communities, a $10 a month private Facebook group.
Where, every week you provide X, Y, Z information, whether it's a written [00:37:00] article or a new video or whatever, and other people can share. And the Facebook group has certain rules to make sure that people stay engaged and actually comment and, bring up questions. And you could have gr you could have weekly group calls, you could have weekly group meetups.
So these are all things that would be an extra additional. So yeah, an additional revenue generator that is technically an online thing, but it's very mixed and also can feed your offline brick and mortar business, yeah. You could have people that join that group, love it, and then they get heard at some point and of who are they gonna go see?
Of course. Most likely. You can, you could set up those types of online services that are both fed by your patients. As well as feed your PT practice. So that would be one example. I, another great example. One of the, one of the people on on my podcast Sarah King, she, or, I'm sorry, Graphman, I can't remember which.
No, she's [00:38:00] married, I can't remember which. Sorry, Sarah, if you're listening to this, but she She has done such a cool job. She's focused on working with Parkinson's patients now here in Austin. She has a home-based visit business. She goes to people's homes and she also does small group sessions with groups of Parkinson's patients in different areas.
But she has this awesome online business where she is providing digital. Content, whether it's video or written to people all around the world with Parkinson's and she has courses and, different things that people can sign up for and monthly memberships and. It's freaking awesome.
Yeah. So she's, I don't know, I have not asked her, I don't know what kind of revenue she does on that, but she is really, at least from the outside looking in that her style and the content she produces her emails, it's like really impressive stuff. And again, it's like people will find her in Austin because they found that online.
Membership first, and then they're like, oh my God, she's in Austin. I'm gonna use her here. We're gonna do one-on-one sessions. [00:39:00] So you've got a lot of examples of ways that you could do that. Like for us, one thing that we're probably gonna do once we get through a little bit more growth and kind of systemization of things is to have a running an online running community where Ben mostly and any feature PTs they're providing like weekly.
Videos and calls and, feedback to the members of our running group. And if they're, if those people are here in Austin, of course they can come see us for treatment if they're dealing with different issues. We partner, one thing to keep in mind with us is if If you're wanting to create something that is very similar to groups that you already partner with or sponsor, like running groups, in our case, you kinda have to be careful there about what you're providing.
So like we, we may provide for those who aren't part of a run group already, we might provide training plans, as part of the service. But then some people who are already part of the running groups that we sponsor, they've already got their training plans, but we're providing say, a weekly mobility or weekly strengthening for runners kind of new [00:40:00] homework assignment or, whatever the case may be.
You can get really creative with it, but those are just some, just a few examples of what you could do, and you could do that in pretty much any niche that you're in is just pr, creating an online community that people pay to be a part of, and then providing them regular, really useful, helpful content.
Yeah, I love that. It's the audience curation, right? If you can develop an audience we all have an audience as physical therapists, we've all worked with people and gotta spend a lot of time with them, that can be valuable, so I love that. I love that people and or PTs should say, can look at ways outside of just patient care to really not just drive their business, but also create an additional revenue stream for themselves.
Jared, this was an awesome conversation, man. I wanna give you an opportunity to let people know where they can Find out more about you, or they can reach out to you if they have questions. Just get in touch with you online before we get done with the call. Yeah, sure.
So since you're those listening are obviously podcast listeners, you can find my podcast, we just search for the Cash-Based Practice podcast. If you're interested in that model or, we really, we delve outside of that [00:41:00] model too with a lot of just entrepreneurial type conversations.
And then if you'd to check out more information or, check out the books I've written you can go to dr jared carter.com and find everything there. Social media. Just do the same search and I'm in a lot of places yeah, connect with me. It'll be fun. Yeah, this is great.
And I will say, there's plenty of people that are busy and Jared's definitely one of 'em. And. I know in the past, before I was ever on your podcast, before, you were on mine or we had, developed a friendship, you would reach out and you'd, get back to people.
And I think that's just so awesome. I try to do the same thing with everybody as well. So yeah, it's definitely, you hear people say reach out and then nothing. But I can tell you for sure Jared, somebody's gonna get back to you. Reach out to me if you got a question. Guys, thanks so much for joining us today on the PT Entrepreneur Podcast.
Until next time, thanks for listening.
Danny: Hey, Pete, entrepreneurs. We have big, exciting news, a new program that we just came out with That is our PT Biz part-time to full-time, five [00:42:00] 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.
We get you crystal clear on the number of people you're getting to see, and the average visit rate you're going to need to have in order to replace your income to be able to go full-time. We go through three different strategies that you can take to go from part-time to full-time, and you can pick the one that's the best for you based on your current situation.
Then we share with you the sales and marketing systems that we use within our mastermind that you need to have as well. If you wanna go full-time in your own practice. And then finally we help you create a one. Page business plan. That's right. Not these 15 day business plans. You wanna take the Small Business Association, a one day business plan that's gonna help you get very clear on exactly what you need to do and when you're gonna do it.
To take action if you're interested and sign up for this challenge is totally free. Head to physical therapy biz.com/challenge. Get signed up there. Please enjoy. We put a lot of energy into this. It's totally free. It's something I think is gonna help [00:43:00] you tremendously, as long as you're willing to do the work.
If you're doing the work and you're getting. Information put down and getting yourself ready to take action in a very organized way, you will have success, which is what we want. So head to physical therapy biz.com/challenge and get signed up today. Hey, real quick before you go, I just wanna say thank you so much for listening to this podcast, and I would love it if you got involved in the conversation.
So this is a one way channel. I'd love to hear back from you. I'd love to get you. Into the group that we have formed on Facebook. Our PT Entrepreneurs Facebook group has about 4,000 clinicians in there that are literally changing the face of our profession. I'd love for you to join the conversation, get connected with other clinicians all over the country.
I do live trainings in there with Yves Gege every single week, and we share resources that we don't share anywhere else outside of that group.So if you're serious about being a PT entrepreneur, a clinical rainmaker, head to that group. Get signed up. Go to facebook.com/groups/ptentrepreneur, or go to Facebook and just search for PT Entrepreneur. And we're gonna be the only group that pops up under that.