Why So Many Clinicians Are Ditching Insurance and Going Cash-Based

Let’s be real—most of us didn’t go into physical therapy to juggle 20 patients a day, bury ourselves in documentation, and get burned out within a few years.

And yet, that’s exactly what’s happening to thousands of talented clinicians.

In this episode of the P.T. Entrepreneur Podcast, Doc Danny breaks down the real reason so many physical therapists are moving toward the cash-based model—and why it’s no longer just a fringe idea. It’s a movement.

The Job We Were Promised… Isn’t the Job We Got

After speaking to professors, clinic owners, and PT students, one thing is clear: the traditional model is broken. New grads enter the profession bright-eyed and motivated, only to be thrown into high-volume clinics where they barely have time to breathe, let alone help people in a meaningful way.

Within two to three years, many are questioning whether they even want to stay in the profession. That passion they had during school? It starts to fade. The fire goes out.

Danny’s been there too. After seeing the inside of military clinics and high-volume private practices, he knew something had to change.

So… Why Cash?

The cash-based model offers something that traditional PT doesn’t: freedom.

• Freedom to control your schedule

• Freedom to spend more time with each patient

• Freedom to earn more without seeing more people

But let’s be honest—going cash doesn’t mean you’ll work less. In fact, when you start your own business, you’ll probably work more. The difference? You get to decide what that work looks like.

Want to drop your kids off at school? You can.
Want to stop taking patients after 2 PM on Fridays? Done.
Want to build a business around the type of care you believe in? That’s the point.

Yes, There Are Trade-Offs

Not everyone can afford cash services. That’s a reality. But here’s what most people don’t realize: once your business grows and becomes successful, you can give back. Whether it’s through pro bono care or partnering with local youth programs, you’ll actually have the time and resources to make a bigger impact than you ever could in a traditional setting.

So What’s the Other Option?

Stay in a job that’s slowly draining the passion out of you?
Change careers entirely and leave the profession?

Those are the crossroads many PTs face. But there’s a third option: redesign your career on your terms.

Going cash might be your best path forward. Not just for your income, but for your energy, your purpose, and your long-term career.

Thinking About Going Cash-Based?

If this blog hit home for you, chances are you’re already thinking about what’s next.

We’ve helped hundreds of PTs build profitable, fulfilling cash practices—and we’d love to show you how to do the same.

👉 Join our Free 5-Day Challenge
👉 Book a Free Discovery Call
👉 Listen to the Full Episode Here

This model isn’t for everyone. But if you're tired of the high-volume grind and want to fall back in love with your profession… it might be exactly what you’ve been searching for.

Do you enjoy the podcast?  If so, leave us a 5-star review on iTunes and tell a friend to do the same!

Ready to elevate your practice? Book a call at the link below with one of our expert consultants today and start your journey to delivering unparalleled physical therapy.

Podcast Transcript

 Danny: Look, when I was treating full-time, I can count on one hand how many times I ate lunch and didn't catch up on documentation during that time. Well, we wanna help you get your lunch back, and we're gonna do that with an AI tool that we created called Claire. Now Claire is a documentation AI scribe that we built and specifically trained to be able to document physical therapy notes very accurately, very quickly, and be able to.

Function in the background while you are focusing on the human being the patient in front of you. This is one of the best ways to take away mundane activities that none of us like to do, and free your time up to focus on the people in front of you, as well as free up time for you to do other things in life that you want to do.

Way more than write your notes. So if you want to try this for free, you can head to meet claire.ai. That's meet M-E-E-T-C-L-A-I-R e.ai. Get signed up for 10 free notes that you can test this out. See how it works, see how much time it's gonna save you and get your lunch back. Hey, are you a physical therapist looking to leverage your skillset in a way that helps you create time and financial freedom for yourself and your family?

If so, you're in the right spot. My name's Danny Matta, and over the last 15 years, I've done pretty much everything you can in the profession. I've been a staff, ut I've been an active duty military officer, physical therapist. I've started my own cash practice, I've sold that cash practice and to date my company, physical therapy has helped over a thousand clinicians start, grow, and scale their own cash practices.

So if this sounds like something you wanna do, listen up. 'cause I'm here to help you.

Hey, Danny Matta here, founder of PT Biz, and today we're gonna talk about why are so many clinicians moving towards the cash model? And this comes off of conversations I've had recently. I would say in the last couple weeks, I've had more conversations with professors, uh, people within the, the PT kind of space, um, from a standpoint of, um, the.

Uh, housing bodies of, of, of our, of our profession, uh, and practice owners in bigger, in-network clinics that, uh, it's been interesting to kind of see their perspective on the profession. And I had, um, I, I had one of the, the people that I talked to asked me a question that I thought was interesting and it was, why do you think there's so many people?

Moving the cash direction. And this, this is somebody that, um, that is also, you know, in the education space. So professor, and they see the same trend that I do. Um, I have been speaking to universities, PT programs. I. For seven years now. And uh, seven years ago it was odd to have anybody interested in cash-based physical therapy at all.

And now when I speak to universities, I have way more interest, like multiples more interest in people wanting to go this route at some point in time in their career. And, you know, it got me thinking, and this is, this is not necessarily. Super structured, but it, it's something that for the last few days I've just been kind of thinking about where the profession is going and, and why we're seeing so much of this, and it seems so obvious to me, to be honest.

It seems so obvious that once people are out of school for a couple years, that that the job that we're promised. Is not what you end up in. It's not where you, it's not what you thought your life was gonna look like. And for a lot of us, we start to realize that in our first clinical rotation, maybe it's, you know, one of the, the clinical rotations that you do, you end up in a higher volume clinic, uh, working with populations that you don't find as all that interesting.

And you wonder if you made the right decision. But it's kind of too late by that point, you know, uh, you're already about to graduate. You've already taken on a massive amount of debt. So you know, you. Go ahead, finish it out, get a job, and start working. And it's like this desire to, to, to really, uh, become a great clinician starts to slowly fizzle away.

It's like watching a fire go out and. It is frustrating and sad at the same time. I, I don't even know how many clinicians I've talked to that are two to three years out that are really que e even questioning whether they should still be in the profession. And it, I don't have an answer for this le let me ca caveat or this by saying I don't have a solution to this problem.

So I feel almost. You know, like this is a waste talking about it. But I hope that this resonates with some of you because you may be feeling like this, or maybe you have, and I know that I did, and it's because the setup that we have, the volume that we have to see the documentation, the administrative burden, the um.

Inability to take time off. You know, like I, I literally couldn't go to family events, uh, because I wasn't allowed to take time off when I was an intern, when I was, uh, you know, seeing patients as a, a military pt. Like, I remember not being able to go to important family events because I, I couldn't leave our patient schedules.

Right? Like, I get it. They're very restrictive. Um. And it's a challenge on people's work life balance. So the reason that I see so many people move the direction of a cash-based clinic is because I. Once they're a couple years in, I think you come to a crossroad and you say to yourself, I'm either gonna leave the profession or I'm gonna figure out how to use my skillset in a slightly different way.

And starting an in-network clinic doesn't really seem like it makes that much sense to most people because they're trying to leave that environment. Like they're frustrated in that environment. Right. And what they wanna do is they wanna work with patients in a more direct manner. They wanna see fewer people, they wanna make a little bit more money.

So. When they look for options, they start to see, oh. This makes sense to me. This could work. It's the same internal monologue that I had when I was trying to figure out what I was gonna do when I got outta the army. I knew I, I sure as hell knew I did not want to touch insurance because I didn't know the first thing about it, we don't deal with insurance in the military.

I. You know, whatever. It's just nothing I ever learned about. I had experienced working in a high volume clinic as an intern for a year and I didn't really enjoy it. I didn't wanna go back to doing that. Um, and I didn't have any other options. Like it was either that or, you know, I just was gonna do something different and for me.

The compromise of being able to see fewer people being able to have ti say over my time being, being able to have complete say over my time, which. In some cases a fallacy when you start your own business, by the way, because it's not like I worked less, I worked more, I could decide if I wanted to take time off, but I was definitely working more than I was and when I was working at another clinic.

Um, but at least I could say when I wanna do that, at least I, if I wanted to take my kids to school, I could decide to do that. I could change my schedule around. And I, I, I, I was the one that had say over that and that was very valuable to me. Um, and I definitely was able to make more money than I was working somewhere else.

So the trade off, the, it, it, it seemed like it made a lot of sense to me. It seemed like an elegant solution to the problem that I had where I could still say, in the profession, I could see fewer people, I could make more money and I could have say, over my time. So when people ask me like, why are people going this direction?

I, I kind of think to myself, what other option do they have? What other option allows them to still stay in the profession, but be able to have these other things that they would like to have from a job that, that they really love? Like, keep in mind, like most physical therapists really, really get a lot of personal satisfaction out of helping patients get over injuries and back to things they like to do.

It is one of the most personally rewarding things I've ever experienced in my life. It's fantastic. And if you feel the same way, seeing people in a high volume clinic where you barely get any time to actually like, you know, work with people and do more advanced things and listen to somebody during evals is frustrating to you.

And that's what makes us feel burnt out, not, not even to mention the documentation side that we have to deal with. So. In, in order to have this compromise, we also have to compromise on something else, which, which I always had a hard time with. I had to exclude certain populations. I couldn't see Medicare.

I couldn't see Medicaid, you know, cer certain, uh, demographics could not afford to work with me. I. And that is not that, that that is a trade off that we have to make in order to, uh, move fully to a, a cash based clinic. And I will say as your business grows, at least in the, the, the populations that can't afford to work with you, you can.

Uh, work with people for free and pro bono work, and we did plenty of that. And it was something that having a successful business allowed us to work with underprivileged kids, kids, that there's no way they, they would be able to work with us. Kids that come from refugee camps and like that is stuff that you can do with successful business.

You can't do that, uh, if you don't have the resources to be able to work with someone for free, and that, that is a drawback to a cash based clinic, but. If, if I think of what other options they have, I don't see a whole lot That makes sense. And it's a shame to see fantastic clinicians move to become a realtor, a uh, a salesperson, uh, in, in, you know, other roles in tech companies and things that they may not want to do, but it aligns with what they want their life to do more.

Um. Because we're losing fantastic clinicians that are young, that should eventually move into mentorship roles and leadership roles within our profession and make it better, and they're leaving. So it's challenging when I think about it and when I, when I think about this question of why people are doing it, it's just like, why would anybody stay in a shitty high volume clinic job?

That actually gives a fuck about their patients and wants to be able to control their, their schedule and wants to make a little bit more money and not leave the profession. You give us no choice none. And the sh the, the worst part about it is they don't have much of a choice either. So I can't even get that mad at.

High volume clinics that are driving this, this, this necessary volume. Because if you really look at the numbers on it, the vast majority of them just, they gotta see a certain amount of patients to, to pay their bills. I'm not talking about like giant ones that are obviously I. You know, private equity owned, or they have hospital contracts, or maybe they, you know, they, they, they have these unfair negotiation opportunities.

I'm talking about the vast majority of higher volume s you know, smaller, uh, in-network clinics, they don't have much of a choice and it sucks for them too, you know, but I don't know what the answer is 'cause I can't fix the insurance. Um, I can't fix insurance in the us but in your own life. You have to make a choice of what you want to do, and either way, you're gonna have to make compromises.

Uh, there's no l uh, like there's no perfect solution for what you can do. And what's important is for you to get very clear on what you want your life to look like, and then pick the option, pick, pick the vehicle that gets you as close to that as you possibly can. And for me. That meant a, a cash-based practice was the, the thing that made the most sense for me.

And honestly, it is hands down one of the best career decisions that I ever made because it did lead me to be very much reinvigorated to work with people to, to find, um, I. This passion and, and, and desire to become a great clinician and, and, and really help my, my clients, uh, and to get that back, you know, and, and I feel like we lose that after a couple years of being beat down by volume and the administrative burden of, of what we are, what we do on a daily basis.

And I feel like a lot of people have done the same thing and a lot of people have gotten that, you know, uh, desire back and that, that. Energy and that passion for the profession by doing the same thing. So I think net net it's a positive and it's, it's a great thing to see and I think we're gonna see more of it because I don't think there's a lot of great options out there.

I don't see the trend changing anytime soon. Um, I. I don't see the, you know, insurance regulation changing in a meaningful way that's gonna, uh, you know, create a better opportunity for people to be able to, to accept insurance and not have to take $70 contracts per session. Um, and you just can't run a business off of that in a low volume setting.

I. You just can't, you know, so it is what it is, but that's the problem. And the problem is, is complex. It's tricky, but in the end, I think you have to really get clear on what you want. Uh, and, and that's the most important thing. You have to get clear on what you want. And, and maybe what you want is to not be a physical therapist.

Who knows? You might have literally been 22 years old when you decided that you were going to physical therapy school and you didn't know shit about the world or what you wanted to do with your life. And now you do. And now you're gonna make a career change. And I'll tell you this much if you, that is you.

What a fantastic foundation of skills you've developed. I've seen many clinicians move outside of the PT space and be absolutely so successful in other areas because you are a fantastic cator, a communicator. You're a natural problem solver. You can multitask. You, uh, typically are very high emotional intelligence.

You, you can really do well with people. You're great at, uh, being detail oriented 'cause you have to document shit all the time. You know, like you know a lot and you've also passed a lot of hard tests. You're gonna be fine if you go and do something else, but if you don't want to actually do something else, if you actually wanna be a clinician.

You gotta make a decision about what the right path is for you. And the cash based clinic might be that solution. And it was for me. So anyway, I'll get off my soapbox. There really wasn't a point, uh, to this as organized as I usually do, but I wanna share this with you because I think it's something that might, might be going through many of your, uh, you know, your minds, your thoughts of what to do.

And, and if you've already made the. The, you know, decision to go that direction. I bet you, you thought these same things too. And uh, and when somebody asks you why people are doing it, you probably think, why would they not? Like what other option do they have? That's the way that I felt. So anyway, thank you so much for listening and watching.

As always, I appreciate y'all and I'll catch you in the next one.

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