E20 | Jarod Carter of the Cash Based Physical Therapy Podcast

On the 20th episode The P.T. Entrepreneur Podcast I get to sit down with one of the OG's of the cash based P.T. Jarod Carter. If you are a P.T. and don't know Jarod, get your head out of your... then go check out his podcast Cash Based Physical Therapy. It is one of the single greatest resources for P.T.'s on the planet and definitely helped me when I was starting out.

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Episode Transcription:

Danny: [00:00:00] Hey guys, Doc Danny here with the PT Entrepreneur Podcast and today we've got one of the OGs to put it that way, of cash PT practicing. So Dr. Jarod Carter, and, and I'll give you a little plug, Jared Carter, and his podcast and all of his online content. I said when I got out of the army, and I first was looking for how to establish like a clinic that I wanted to work in and felt, felt like I would enjoy the number one resource I use was all Jarod's stuff, and his podcast wasn't out at the time, but it's fantastic. If you haven't listened to his podcast, he goes into the cash-based PT; it is called the Cash-Based Practice Podcast. It has some 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, stuff, it's so valuable.

So I'm excited to chat with you today. So Jarod, thanks for jumping on the podcast.

Jarod: [00:02:19] Thank you for having me, man. I appreciate that. Very nice intro. Oh yeah, no, it's, it's my work could be of assistance in inspiration early on for, you

Danny: [00:02:27] know, it was, it's, it was beneficial. And, you know, I, I love that, you know, the path that that model is out there because I think, you know, for you and I, we've been in this longer than I. We can get into this a little bit later. Still, it's scary when you think about starting something on your own, but even more frightening when everybody tells you.

No one's going to pay you cash. Why would they just not use their insurance?

Jarod: [00:02:46] Right? So

Danny: [00:02:47] w w what you put out helped me, you know, gain a lot of confidence that that would work.

Jarod: [00:02:52] I think that that's been one of the biggest, bonuses, of my podcast is that the majority I do monologues. Still, the majority of it is interviews of others besides myself.

We've had success in the model, including yourself. And. And that, that is the inspiration that, that people get from it, of seeing, Oh wow, this person's doing it. That person does it. It's not just one dude down in Austin or, you know, only a handful of people. I mean, it's a living thing, and more 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 is a model that is viable and becoming more and more feasible. And we can talk about why that is. But yeah, it's, it's been a cool ride, to see all the people, you know, practicing the way they want to practice and living, you know, living their, their daily business life the way they want to live it.

rather than, you know, chasing reimbursement or having to see, you know, 20 patients a day, or, you know, all the, all the horror stories where we're so familiar with,

Danny: [00:03:54], you know, I've, I put an Instagram post up the other day. There's just like some, some like a branded, like, you know, whatever little saying.

And, and I said something to the effect of, you know, it's sad how many physical therapists leave school and within a couple of years wish they'd pick something else. And, and, and, and it resonated

Jarod: [00:04:10] more than I thought with people

Danny: [00:04:11] I just had like. Tons and

Jarod: [00:04:13] tons of

Danny: [00:04:13] comments of people like, you know, just expressing how disgruntled they were with the fact that they had to see, you know, so many people and that they didn't get to use their skillset and the way that they thought that they would, they didn't get to use all these manual skills that they've worked so hard on gaining.

They were just managing these big groups of people. And, you know, how often do you get people that reach out to you

Jarod: [00:04:32] that

Danny: [00:04:33] are in that situation and just like looking for

Jarod: [00:04:35] help. All the time. And I'll tell you this is, this is kind of on topic kind of off, at my website, the, you know, I've had probably over a hundred.

Oh yeah. Not that probably actually weigh well over a hundred blog posts, whether it's using in a written article or, you know, 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, but more. And it's titled, is PT school worth it? It's not even, and it's not also about the cash-based model. It was 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 dental take on.

Versus what I'm going to make, and I'm just not sure. And so I gave him my answer, and that's the article, the blog post itself. And, and then I, I opened it up to colleagues and me, I found it out on social media and that, that post has like, think over at the time of this recording over 180 comments. If I remember, maybe I'm thinking of the Medicare post, but it's like, it's up there in the, certainly over a hundred and it's so exciting.

How some PTs are just so adamant about it is so worth it, and they just, they love it so much, and yet it's a larger and larger debt load and blah, blah, blah. And then some people are just like vehemently, just like against, against the no way. I would do it again. And, and it's, it's attractive to kind of read the different comments and, and, but I, but it turns out that, that the search.

The phrase is P T school worth. It is a prevalent one that comes up, you know, number one since it's the exact title of that post. And so, you know, I, I don't know if, if that post has inspired many to do it or dissuaded. I'm not sure, you know, what it's done. But it's been interesting to see how much 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 today. I like. You know, I like what I've learned and I would like to practice it in a certain way, but I can't. And, and so that's where, you know, practices like ours can be kind of a beacon of hope and this kind of information can help guide people to, to set up, you know, setting up a, an opera or a business, where they really can enjoy being a physical therapist.

Again,

Danny: [00:07:05] it's also tight, the fact that individual other, you know. Health, professional careers where you want to call it, like in particular, something like massage therapy where practice acts can be very restricting for us. When in some states,

Jarod: [00:07:18] you know, it's better to not

Danny: [00:07:20] have that, you know, credentialing.

I

Jarod: [00:07:21] mean, it's, it's, it's,

Danny: [00:07:22] it's so, it's so backward to think of it that way. But, I mean, I. I, I've, I've had people ask me the same question, you know, and, and, you know, I think a lot of it depends on what their longterm goals are, but, yeah, I mean, like, sure. It individual States, man, I mean, I know in Texas you guys have some limitations, but somebody could see a massage therapist and

Jarod: [00:07:38] not need anything.

It's, it's unbelievable. And I'll try to keep this short. I'm very,

Danny: [00:07:43] Oh, you're angry. I'd like to hear about it.

Jarod: [00:07:46] I'm passionate about this. You know, Texas is one of the last States where you can't take. You can't initiate treatment. You see, we can evaluate this. This statement of every state has direct access.

Pisses me off. That is such bullshit. That is absolute crap. We do not have direct access to Texas to start treatment. People can come in for an evaluation. But you know, most of the time when people come in, they want to, you know, they want a taste of what you're going to give them and to, to have that referral before we can actually touch them or even tell them a stretch when they can go down the road and say to the massage therapists all about their pain. They're going to try and dig in with an elbow, or they can tell their trainer. They're going to try and give them exercises or even use their hands on them.

You know, it's infuriating. And we, at as a cash-based practice, most of ours. Our referrals are from nonphysician sources, so probably 50% or more of the people that call saying, I'm ready to book. I want to see you guys. For whatever reason, they don't have a referral. And then we got to take them 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, I'm looking into some, different options where we're setting up, we're setting up relationships with, with concierge and, and a fee for service physician practices now to send them in and quickly get the referral, but it's still, you know, it's yet another 50, 75 plus dollars and a trip for that person.

It's still a hurdle that's just. Ridiculous. And you know, I don't, I mean, we only meet the legislature only meets twice a year, I'm sorry, every other year. So we only get a shot at changing law every other year, and we, we haven't even come close. I'm not yet, it's a long process to get the law changed.

We haven't even gotten it. To a vote on either the Senate or floor. Yeah. And, and you know, I'm in the TMA is just so powerful and so, freaking rich. And they, they consider this a top priority to block every time. So I don't know if it's ever going to change. We still are a successful cash-based practice, even with that considerable hurdle.

So in a way, I think that can also be an inspiration for others if you're in a state where it's like. You know, not a, not an issue, and you can get those direct access to patients without the referral. That's, that's huge. One, one kind of side note. I'm going to a telehealth conference, in a month, specifically to meet with executives and CEOs of telehealth companies to explain why here's a situation.

Do you want, do you want me and maybe a lot of my audience to send you a bunch of these consults, you know, for physical therapy referrals, because this would be huge—a business boost for anyone that agreed to it. And if we could just send someone a link and say, look, you know, book an appointment with, with this company, it's going to be, you know, whatever, 35 bucks.

And they'll send us a referral if you're appropriate for physical therapy or shores. You know, some, 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 same—telehealth legalities. I have to look into that, but I'm, 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 Texas. Well, it's interesting you bring that up because a couple of years ago before

Danny: [00:11:00] the

Jarod: [00:11:01] The practice act changed in Georgia; we didn't have this. We have better access now.

Danny: [00:11:04] I'm direct access now, and.

Jarod: [00:11:06] I have a

Danny: [00:11:07] patient that, that owns telehealth, a telemedicine company.

And I brought the same thing up to him. This was right before it changed, and you didn't necessarily need it at that time. And it's interesting cause they have like these little kiosks that they'll put in, you know, offices and stuff and, and, he, you know, he felt like he could work. The issue sometimes comes down to, and I don't see how Texas is, but sometimes the provider has to be in that state, specifically.

So, you know, I don't know if Texas is like that, but if that was the case, and now may be involved, complicated things where I have to be at. Texas-based providers. I mean, but I think it's a great way to get around it. And you know what? Sometimes the resistance of things makes us creative. You right? And, instead of just giving up and.

I'm getting frustrated and saying, you know, our hell with it, and we're just not going to do it. If you can get creative and can solve a problem that can potentially turn into a whole other, a way to help other people and another, you know, an offshoot of the business, you know what I'm saying? So I love him.

He creates, I don't mind people, you know, a problem. I think a problem is an opportunity if you can solve it.

Jarod: [00:12:00] Then

Danny: [00:12:00] you have an option to have another business right there with it as well. So that's awesome that you know where you're, you're going after the love to hear how you do.

Jarod: [00:12:09] Right. 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 the, our state of licensure. I'm not sure if MDs have the same 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, well, what if I just started a telehealth business myself? And I'd have to partner. You have to partner with a, with a physician, cause 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 would 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 how that to the plate. Yeah. Yeah. Right. Crazy.

Danny: [00:12:57] Well, you know, you bring this up, this idea of, you know, even like, you know, being creative and figuring out some of this, you know, a ton of telehealth stuff and ways to get around these, just like silly.

Limitations that are placed on us that we could probably just yell back and forth about for an hour. But,

Jarod: [00:13:11] you know, the, you

Danny: [00:13:12] have now had practice for a little over seven years, and I'm interested in picking your brain a little bit on what, what do you feel the biggest. Changes or potential evolutions that you've seen within this cash model that has happened over the past seven years?

Jarod: [00:13:27] The most significant changes, in terms of the cash model, other than just the fact that more and more people are doing it and seeing, wow, this is possible and having success in it. I would say it occurred since the affordable care act. And so, luckily for us, for in cash based model or those interested in it, and something I mentioned earlier is that it's actually, I feel she has become more comfortable.

For a cash-based practice to be successful because of the rise in deductibles and copays and just the general worsening of coverage for physical therapy. You know, these days, with so many more people having these Coke, sorry, deductibles in the thousands of dollars that they haven't met if we can do an excellent job as a cash-based practice in educating.

The public and those who are calling in and ensure that we're cash-based and they're like, Oh, well, I need to use my insurance. It's like, wait, waits. You know, 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, I would encourage you since you've shown interest in our model of our one on one sessions, manual therapy approach, I'd help you to, to call your insurance and ask them how much out of pocket expense are you going to be paying.

Until you meet that deductible, if you go somewhere if you go to a physical therapy practice that is in-network with your insurance because until they reach the deductible in, in a lot of cases, I'd say most matters, they're going to have to. You're going to have to pay 100% 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, and you know until they meet the deductible or whatever. But in general, that, that's what they're going to be told by the insurance company. And so it's like, okay, well. How much, how much are those bills that are being sent to insurance companies from your regular PT clinic?

Usually $200 or more. Sometimes much more, especially if it's like in a hospital system or something. So, I mean, when with that being the case. It's like, what kind of, what kind of, you know, going back to what you're saying that the patient, you can say, look, you know, I'm not, I'm not dogging all other PT practices. Still, a lot of these practices you need to ask if you're considering them if they're in a network, need to ask, how many patients and hours 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 going to be in a gym-style setting with five other patients at the same time. And an attacker, an assistant is 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.

You just get hit with a huge bill. So, you know, 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, with a doctor of physical therapy, becomes cheaper than what you'd be paying otherwise. And in the cases that have people that don't have high deductibles, or they met their 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, you know, insurance-based practices are 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 kind of a wash or not much difference in terms of the financial side of things. And then it's like, well, do you want to leave?

You know, again, what kind of care do you want? And do you want to have to leave work? Three times a week versus one time a week. Right? So those are the kinds of things that nowadays in the last three years are all these changes. And you know, the typical insurance plan has occurred that we can utilize this cash-based practice owner and our staff members can use when they're answering the phone.

So that's a that's I would say is one of them, one of the biggest, not the most significant transition or changes, shifts that I've seen in our model, in the last few years.

Danny: [00:17:22] The question is you're, you're, you're, you know, giving them those are so valid because, you know, think about how many people

Jarod: [00:17:30] have a bad

Danny: [00:17:30] experience and then it's bad enough that they get kind of, you know, not a lot of attention.

They have somebody go teach them how to do tricep press downs for lower back pain, even though they're plenty strong enough. Like it's some stupid crap like that, right? And then they're in there with a bunch of other people and, and, They don't get better, but then it's worse than anything. You're right.

Six, six, eight weeks later, they get, they get these bills that they owe and there's no transparency.

Jarod: [00:17:54] You know? I think that that

Danny: [00:17:55] is the biggest issue with the cash model. And I, I love that you bring all these things up because they're so valuable. You know, you say one, you know, one 65  people may hear that in there.

They, they balk at it, but you know, you're going to spend 10 minutes with your orthopedic surgeon, and you're going to get a bill for $175. And so what, what does that

Jarod: [00:18:15] equate to

Danny: [00:18:16] for the, for nothing really, that they're going to tell you that, that you have going on? So I think we're very valuable and I think that the, what you're bringing up is huge and, and then, the conversation has become so much easier when you guys do that with your practice.

Do you, do you, tell them, say, Hey, call your insurance, or do you. Actively tried to get in touch with their insurance for them and layout, you know, Hey, this is what you owe.

Jarod: [00:18:40] That's a great question. And so far at this point, just being, I have one practice manager and, and you know, office administrator or you know, combo, right?

Practice manager, office administrator. We are not. We're not attempting right now to verify benefits, but I do think that that will be something in the future that we will at least look at as a possibility. Because if, you know, if we can look at the overhead that it would take for someone to do that and bill on an out of network basis, or just verify benefits, if nothing else, that, that I think could probably be the.

The tipping point for a lot of people that don't want to do it themselves, and they're just, you know, 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, you know, look at doing that.

Well, you bring up

Danny: [00:19:36] this kind of topic of staffing. You know, which is growing and scaling and, there are difficulties with that and so on. Right. And we kind of talked a little bit about this,

Jarod: [00:19:45], you know, before we started recording. And,

Danny: [00:19:47] and, sow where you're at now, the scaling of your business. Like what, what is your biggest frustration that you've found

Jarod: [00:19:55] with

Danny: [00:19:55] growing a team and, and because you spend so long where it was, you know, just you and, and, and we're, we're cruising and, you know, it was like pretty easy, easy gig.

And now. You're growing for a purpose, but

Jarod: [00:20:06] there are growing pains associated with any growth. Oh yeah. Yeah. So most significant kind of frustrations, I would say, if you asked that of me or anyone doing similar things in terms of growing up. A practice, but especially a cash-based practice, I'd say, although I'm sure that this is a very similar deal with, with people who are doing traditional insurance-based methods.

Then my answer to that would probably have changed about every six months, you know, 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 administrator. And I would say that my current answer to that is something that we did discuss right before this is, and this will be good for people to hear who are looking to go beyond.

You know, solo practitioner and scale things up and, and I back up and just say, just for context, I was a solo practitioner for five years and, and on purpose, I probably could have started the growth, you know, and adding another therapist after about a year and a half or two. But, but I was active, you know, working on my online business and, and kind of.

You are just seeing patients four days a week. After that first year and a half or so, I didn't have to do much in the way of networking or marketing at all. It was just, you know, 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 kind of keep you afloat. So I wouldn't have to do much other than just show up and see patients. And then I worked on my other business businesses, on the side, and it was a, it was an excellent cruising kind of thing like you said. And I was, you know, after the low overhead, was paid out and, and whatnot.

I was, you know, I was reporting, I was, I had a six-figure income, and so then. When I decided, okay, well, if my hands aren't going to take this my whole life, I want to, I also don't want to have to be at the, at the clinic, you know, five days a week and, and, or four days a week. And I really would like to scale this thing and create a, a, very self-sustaining business with minimal input from me.

It's like, 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. You know so much more, and I can't feel it. 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, if you're in, you know, if that's your model, to needing a much bigger space. To require a lot more supplies to needing, you know, a waiting, a bigger waiting room space for the receptionist. You know, all these things that you're, your overhead, and going from one to two therapists is probably going to do way more than just double.

Yeah. And then there's, you know, there, there's the whole conversation that maybe we won't get into now about how you're going to pay that therapist. Are you going to have them on a set salary and be potentially losing money as you try to grow there? Their schedule a, are you going to, are you going to pay the kind of a commission basis, which is a little safer upfront, but harder to scale long term and get buy-in of, of, you know, this is a person working for this practice, not, not having their practice within this practice.

Right. So, that's something to be aware of if for those out there that are thinking about scaling is that your, your overhead is going to go up way more than double immediately. When you bring someone on, and you're going to need to bring two people on. And what I, in my experience, I'm happy and lucky that I had, you know, started this online business because it's allowed me to kind of life on that and not have to take a salary myself, but, you know, just pay myself minimally as needed along the way in the last year and a half and not crap my pants because I'm not making anything. Still, for him, you know I've run the numbers, and it's not until, not until I get another.

PT who, and have their, their schedule, you know, pretty decently busy. Am I going to be able to like pay myself what I would consider, you know, a decent PT salary again? And that's just, that's just the nature of the numbers, and it's something to be aware of, and it's not, it's not something I knew of ahead of time.

And so thank goodness I had, you know, other sources of income. Because it would have been, it would have been tight along the way otherwise. So I'd say that has been a big surprise and frustration along the way and something that hopefully others can plan for better than I did.

Danny: [00:24:43] What's important for people to hear this stuff,

Jarod: [00:24:44] because

Danny: [00:24:46] I think all too often we talk about all the positives that come along with.

Entrepreneurship and business owner at being a business owner and the flexibility and you know, all the, all the cool things that come along with it. But you know, what isn't cool is losing money

Jarod: [00:25:00] every month, you know? And,

Danny: [00:25:02] I've been there too, where, you know, we're in growth cycles, and things are going the opposite direction, and you're like.

Doing the math and you're thinking, okay, I've got like three months and yeah, and, and, and you know what? It's scary. But you do those things because you have to, to, to build something where it's sustainable without you there. And you're right. Like, especially someone who has substantial hands-on as you are, you know, it's.

Do you want to be doing that when you're 50 years old? You know, and seeing that many people and, and, and being tied down to a schedule and people love that stuff. Don't get me wrong, I enjoy physical therapy, but yeah, you have to make that decision, man. Do you want to, you want to stay in that kind of lifestyle business, or do you want to kind of grow and scale?

And that kind of brings me to my next question, which is really, how scalable do you think these practices are? Because I believe, as of recent, we've shown we can scale to multiple providers, but I look at some of these big, you know. 10 20, 3,000 plus clinic conglomerates that are insurance-based.

And I don't know if the scalability is there for cash-based practice, but potentially, maybe it is. I would, and I'd love to hear what you think about that.

Jarod: [00:26:08] Yeah, that's going to be, I think that's going to be a situation that big that changes over time because I F I don't foresee, the insurance-based model becoming.

Are remaining a sustainable option for a growing number of types of practices out there. Anyone, who's, who's not in a, you know, an extensive training like you just described, or hospital system that has the bargaining power or a scenario where they can, Maine, they can maintain decent enough reimbursement rates.

They're going to keep getting squeezed, and more and more and more practices are either going to have to. Create some sort of cash-based revenue, whether it's through PA PT treatment or not, to survive, or they're going to have to sell or close or whatever. And so I think that what's going to happen over time is we're going to see a larger and larger number of people that are forced to be at least a hybrid cash-based practice and, and a more substantial and more significant amount of.

Insurance plans that provide little or no coverage for physical therapy. I think we're going to see massive cuts in what physical therapy in terms of physical therapy coverage for Medicare. And I'll do, just to give a spiel on that. I mean, as you know, 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, the amount of people drawing off of Medicare is going to double over the next, I think it's 20 years. Whereas, so in that means the number of people paying into social security and Medicare is going to decrease per capita drastically. So that we end up with, with, I think it's going to be like 2.1.

People are paying into the systems for every one drawing out. Whereas back in like 1960, four people were settling into the policy for every one drawing out. So there's this really, a scary shift in the demographics and people of those systems that make it mathematically impossible for there not to be significant changes to what Medicare pays out of their banks.

You know, I mean, and the biggest. The biggest payouts from Medicare are to providers for services. That's the biggest one. So all providing all providers in all of our services are going to be on the chopping block. Who do you think is going to get cut first? Is it going to be things like physical therapy, or is it going to be things like, you know, surgeries and medications that keep people alive?

Not to say that we don't have an incredibly valuable service, but guess what's going to happen so. It hadn't happened yet to, in no small degree, they've, in most billing units, they've at least kept up with inflation. Not much more than that, though. in fact, I think they pretty much just track inflation, and some of them have been, have not even kept up with inflation in terms of like a manual therapy code or their X or whatever.

So, but some, I mean, at some point as this massive shift in the population and this enormous change in what's being taken out versus put in happens, we're going to see some significant differences. 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 you're, you know, you have private insurance, you're going to be paying a lot of what you, what is spent. Out of your pocket. Maybe some coverage remains. I think there'll be some coverage, but I think that it's going to get crappy for how much our services are covered.

And so what I think is going to happen is that we're, we're going to end up being one of those services. It's kind of, and I seem to like. Not in terms of what's provided, but in terms of what you pay for it. I'm out of pocket. We're going to be kind of like massage therapy, and personal training is, it's like no one expects.

Sometimes those things are covered by insurance in a rare case. Right. But in general, people know that if you're going to get a massage. You're paying cash, you know, if you're going to use a personal trainer, you're spending money. And I think that that's going to become more of a publicly acknowledged, just kind of mindset that physical therapy is something that you mostly pay cash for.

Maybe there's some coverage, but not a ton. And so. At that point, the scalability of the practices, kind of like I described earlier, which is the changes we've seen in the last few years, it's going to become more comfortable because more and more of the general population are going to have that mentality of, okay, look, this is just something we'll pay cash for.

But could it scale to, you know, a hundred clinic practices? I don't know about that. I mean, that's, that's a massive, colossal operation, but I could certainly see, you know, you know, cash-based practices and people who are business savvy and pushing hard. Yeah. I was going to ten plus clinics. Yeah, I could see that.

I w I would, I wouldn't expect that anytime real soon, but I do think eventually it could get there.

Danny: [00:31:00] Well, I almost feel like it would be better. Let's say you're. You know, the prediction is 100% accurate. Right. And it sounds like it potentially is going to be that way and which, which is good for us. Maybe not so, 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. It's different. Do you know? 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 years, and I look at it, and I think, man, we're, we undervalue ourselves significantly. I used to be a personal trainer. I mean, I did that when I was in college, and I was a Butthead. A 20-year-old kid working at this golf retirement community selling $5,000

Jarod: [00:31:50] personal training packages for like

Danny: [00:31:51] six months of me telling them how to do bicep curls,

Jarod: [00:31:54], you know?

And so,

Danny: [00:31:55] I mean, what people value is different. I think it's in our, it's a disadvantage to us, the fact that people assume it's, it's 100% covered by insurance and it would, it sounds like it would be better if, if it did go the other way around, but you know, that being said, okay, let's, let's say that.

This, this happens. People right now are these cash-based practices. Do you, do you think they should niche down and try to become well known, really kind of sought after for a particular area? Or do you feel with this, these changes, is it something where you can get these kinds of generalists in terms of orthopedic issues and still have success in the practice?

Jarod: [00:32:32] That's a good question. Let me also preface it with, with, and I hope that I'm wrong. I, I mean, I, I don't think, I think that there's, it's still going to be possible for people to have success, in both models. And I hope just for the general public that it, that our services aim for and for, you know, our profession that our services are always covered nicely, by insurance and Medicare.

I hope that I don't see it mathematically happening, but I hope I'm wrong. But to answer your question. A niche down or go broad? Well, I think that that depends on each practice owners. The aim, you know, and what they want their day to day to look like. And if they, if, if you have an objective of, of being a ten clinic practice, if you're going to niche down, I mean, I'm always a big fan of, of.

I was going strong in a niche or in, or in maybe more than one slot. I don't think that it's, it's certainly not impossible to do, you know, have multiple niches that you're well known in. So I'm, I'm a big fan of that. It does help, I think, especially in the beginning, if you can establish yourself as like the GoTo providers for XYZ, you know, CrossFit or for runners or golfers or whatever.

But, if you're going to go, if you want to go big, then you have to consider it. You know, how big is the niche or you know, a potential market that you want to target. You know, and if, if you're going to go big, you probably are going to need multiple niches over time that you develop, which is possible.

Or you're going to need to be the generalist. And we're, we are kind of. Right now, I'd say we're generalists, you know, 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, you know, if I get someone who's, who's fantastic, a CrossFitter and great therapists and has, you know, Inroads in those communities. I might consider, you know, going after that niche or, you know, X, Y, Z, you know, a specialty that someone comes in, you know, vestibular or whatever, you know, it could be so many things. I would consider creating multiple niches to grow. But the item you have to be careful about there is that if you're building slots 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, to be skilled in, right. So you have to kind of think longterm and understand that, yeah, people are going to come and go for various reasons. You might have to let some go, and you don't want to build a niche precisely over, you know, around one person.

So like, Ben, my PT, now he's excellent with runners and that, that's what he's. You know, one of the things he's passionate about creating. So I was like, all right, let's do it. Let's, let's build out a running niche. And we've been working on that, but whoever I hire in the future, even if they bring, you know, a specialization in something else, they're going to see, you know, how to be a badass with runners, you know, and, so I will make sure that any niches that we introduce, everyone is going to be able to, to utilize or to, to, to, you know, service those patients.

At a high, high level.

Danny: [00:35:41] Well, I want to shift gears a little bit and get into the one thing I want to talk to you about, which is entrepreneurship and not necessarily just patient volume and physical therapy practice.

Jarod: [00:35:49] You know, volume, which, which is a

Danny: [00:35:51] a big part of what you and I both do. But when we look at the potential opportunities for physical therapists too.

Build businesses, and, you know, you and I both do things online as well. There, there's, there are opportunities there besides patient care for physical therapists to be able to utilize their knowledge, their set, and leverage it into other types of, entrepreneurial kind of adventures.

 

Where do you see are maybe like one or two potential areas where PTs can.

Build a business and, and generate revenue, in particular, that's sustainable at, at what their salary is, if not more like a PT. That is not necessarily just patient care.

Jarod: [00:36:27] Oh man, that's, that's a fun topic. And there are so many possibilities in that realm. You know, I'll just, just building off of the niche conversation, creating a monthly membership, kind of group, or community.

Sir, you know, that is based on that niche. So let's, let's like to use your, you know, your niche and CrossFit as an example. Now, obviously. Kelly starred already has mobility. Why? But that doesn't mean that you know, someone out there couldn't have in their community, between the patients they see in their friends, in the CrossFit communities.

You know, a $10 a month private Facebook group. Where you know, every week you, you provide X, Y, Z information, whether it's a, a written article or a new video or whatever, and other people can share. And the Facebook group has specific rules to make sure that people stay engaged and comment and, and, you know, bring up questions.

And you could have, you know, 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, the other revenue generator that is technically an online thing, but it's very mixed and also can feed your offline brick and mortar business.

You know you could have people that join that group, love it, and then they get hurt at some point. And who are they going to see? Of course. Right? I mean, most likely. So, 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 had another great example, one of them, one of the people on, on my podcast, Sarah Kane. She R, I'm sorry. Gravelman K, I can't remember which now she's married, I can't remember which, sorry, Sarah, if you're listening to this. But she has done such a fresh, neat 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 groups. You know, sessions with groups of Parkinson's patients, in different areas. But she has this great online business where she is providing digital, you know, content, whether it's a video or written to people all around the world with Parkinson's.

And, you know, she has courses, and you know. Different, different things that people can sign up for and monthly memberships, and it's freaking awesome. Yeah. So she's, I don't know, you know, I have not asked her. I don't know what kind of revenue she does on that, but she is, you know, at least from the outside looking in her style and the content she produces, her emails, it's like imposing stuff.

And again, it's like people will find her in Austin because they noticed that online, you know, membership. First, and then they're like, Oh my God, she's an Austin. I'm going to use her here, and we're going to do one on one sessions. So you've got a lot of examples of ways that you could do that. Like for us, one thing that we're probably going to do once we kind of get through a little bit more growth and type of systemization of things is to have, you know, a running an online running community, where, been mostly in, in any future PTs.

They're providing like weekly videos and calls. And, you know, feedback to the members of our running group. And, you know, if they're, if those people are here in Austin, of course, they can come to see us for treatment if they're dealing with different issues. We partner one thing to kind of keep in mind with this as if like.

If you're wanting to kind of create something very similar to two groups that you already partner with or sponsor, like running groups. In our case, you kind of has to be careful there about what you're providing. So like we, we may offer, for those who aren't part of a run group already, we might provide training plans, you know, 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, you know, weekly mobility or weekly strengthening for runners, kind of new, homework assignment or, you know, whatever the case may be. I mean, you can get creative with it, but those are just some, 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, you know, creating an online community that people pay to be a part of and then providing them regular, beneficial, helpful content.

Danny: [00:40:48] Yeah. I love that. That's the audience curation, right? If you can develop an audience, and we have, we all have an audience as physical therapists, and we've all worked with, people wouldn't get to spend a lot of time with them.

That can be valuable, you know? So I love that. I love that people in our PT should say, can look at ways outside of just patient care to not only drive their business but also create an additional revenue stream for themselves. So, dear, this was an excellent conversation, man. I want to allow you to let people know where they can Find out more about you, where they can reach out to you if they have questions, you know, just, get in touch with you online. Before we arrive, get done with the call.

Jarod: [00:41:20] Yeah, sure. So since you're, those listening are podcast listeners, you can find my, my podcast. We just searched for the cash-based practice podcast.

If you're interested in that model, or, you know, we, we really, we kind of delve outside of that model too with a lot of just entrepreneurial. Type conversations. And then if you'd like to check out more information or, you know, check out the books I've written, you can go to dr Jared carter.com and find everything there.

Social media, you know, just do the same search, and yeah, I'm kind of in a lot of places, so, yeah, connect with me. It'd be fun.

Danny: [00:41:53] Yeah, this is great. And I will say, you know, there's plenty of busy people, and Jared is one of them. And. I know in the past,

Jarod: [00:42:02] you know, before

Danny: [00:42:03] I was ever on your podcast before, you know, you were on mine or us, you know, developed a friendship, you would reach out, and you would get back to people.

Jarod: [00:42:09] And I think that's just so

Danny: [00:42:11] awesome. I tried to do the same thing with everybody as well. So yeah, it's, you know, you hear people say like, reach out and then nothing, but I can tell you for sure, Jared, somebody will get back to you, so reach out to me if you've got a question. Guys, thanks so much for joining us today on the PT entrepreneur podcast.

Until next time, thanks.