E891 | What To Expect From PT Biz At CSM 2026

The Future of Cash-Based Physical Therapy (And Why Now Is the Moment)

If you’re a physical therapist thinking about entrepreneurship, autonomy, or building something bigger than a job, this is one of the most important conversations you can hear right now.

In this episode of the PT Entrepreneur Podcast, Doc Danny shares what he’s seeing across the profession, why cash-based physical therapy has evolved dramatically over the last decade, and why the opportunity ahead is larger than most clinicians realize.

This episode was recorded ahead of CSM and reflects not just where the profession has been, but where it’s clearly headed.

Why Most Clinicians Feel Pulled Toward Cash-Based Care

Most physical therapists didn’t choose this profession to rush visits, click boxes, or feel disconnected from the people they’re supposed to help.

They chose it to build relationships. To solve problems. To get people better.

But the traditional healthcare system makes that harder every year.

Cash-based models flip that equation.

They allow clinicians to spend more time with patients, personalize care, and focus on outcomes instead of volume. And increasingly, patients are actively looking for exactly that kind of experience.

This isn’t a trend. It’s a shift.

What’s Changed Over the Last 10 Years

When Doc Danny first opened his clinic, the goal was simple: replace his income and do meaningful one-on-one work.

Back then, most people believed cash-based practices weren’t scalable. That they were just jobs in disguise. That there was no real enterprise value.

That belief turned out to be wrong.

Today, PT Biz has worked with dozens of clinic owners who have built seven-figure and multi-seven-figure practices using cash-based models. Not hypothetically. In real markets. With real patients.

The business model evolved. Systems improved. Marketing matured. Consumer demand increased.

What once looked like a ceiling turned out to be a floor.

Why Entrepreneurship Is Growing Inside Physical Therapy

Entrepreneurship still represents a small percentage of the profession, roughly 4–5% by most estimates.

But that number is climbing.

More clinicians are choosing self-employment, niche practices, and hybrid business models that give them control over their time, income, and impact.

Compared to professions like dentistry or chiropractic, physical therapy is still early in this shift. That’s exactly why the opportunity exists.

Early adopters always face uncertainty. But they also get the upside.

The Power of Niches and Specialization

One of the biggest advantages of modern cash-based practices is specialization.

Runners want running experts. Athletes want performance clinicians. Active adults want providers who understand longevity and movement, not just symptom management.

The market rewards depth now, not generalization.

Clinicians who build practices around clear niches not only stand out more easily, they deliver better outcomes and build stronger businesses.

You Can’t Skip the Early Phase

One of the strongest messages in this episode is simple but critical.

You cannot skip the start phase.

Every scalable practice starts small. Every successful owner learns fundamentals first. Marketing, sales, operations, pricing, and patient communication all matter early.

Trying to jump ahead without mastering those basics is the fastest way to stall out.

Nail the foundation, then build.

Non-Traditional Career Paths Are Becoming Normal

This episode also highlights something many clinicians feel but rarely say out loud.

It’s okay not to know exactly where your career is going.

Some clinicians stay clinical forever. Some build teams. Some sell businesses. Some move into education, consulting, or entirely different industries.

The skillset is transferable.

Doc Danny shares how his own career path shifted in ways he never could have predicted early on, and why that flexibility is one of the most powerful parts of entrepreneurship.

Why Presence Still Matters More Than Ever

Even with great business systems, nothing replaces being fully present with patients.

Documentation, admin work, and EMRs quietly steal that presence in most clinics.

That’s why tools like Claire, an AI scribe trained specifically for physical therapists, matter.

When documentation is handled automatically, clinicians stay engaged, patients feel heard, and owners regain time to lead instead of chase notes.

👉 Try Claire free for 7 days

Final Thought

The profession is changing whether you participate or not.

Patients want better care. Clinicians want better lives. Cash-based models sit at the intersection of both.

You don’t need every answer today. But if you’re paying attention, learning the fundamentals, and staying open to opportunity, you’re positioning yourself exactly where the profession is headed.

And that’s a powerful place to be.

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: [00:00:00] Hey, what's going on? Dr. Danny here with the PT Entrepreneur Podcast and. Today we're [00:00:05] talking about CSM. I'm headed [00:00:10] to CSM if you're listening to this, it's a week before we, uh, will [00:00:15] be there before it starts. Uh, so middle of, middle of February, I believe it's the [00:00:20] 12th, 13th, 14th of February. Um, but this year I, um, I [00:00:25] was asked by the A PTA to come and present on a few different topics for, in particular, [00:00:30] cash-based, um, you know, business models.

And, uh, I've been doing a lot of prep [00:00:35] work for this because. I have, I think, six things that I'm doing. So [00:00:40] two of those are book signings, uh, which is awesome 'cause the A PTA bought, um, [00:00:45] like a 150 or 200 books that I'll be giving out. So if you wanna book a physical copy, [00:00:50] um, I would love to give you one and I'll be doing that on, um, on Thursday.

[00:00:55] So, Thursday afternoon. Between 12 and one 30, I'll be signing books and giving [00:01:00] books out. Any of the ones that we have left over, we're gonna just give out along the way to anybody that [00:01:05] wants one that morning. I'll also be doing a, a talk on starting a clinic in a gym [00:01:10] with, uh, with EGG. So he and I both started our, our clinics in, um, little [00:01:15] sublease offices and gyms.

And, uh, you know, I think it's a, a, a sweet spot [00:01:20] for a lot of people to be able to. Get their clinic started there. Um, you know, it's low [00:01:25] overhead. Uh, you're not taking a huge loan out. You can do it as a side hustle, [00:01:30] you know, you have a target audience there, which is great. You know, it's sort of like I, I, I referenced, um, having [00:01:35] a Chick-fil-A in a mall, you know, they're always busy because they got a lot of foot traffic and then their target audience is like right there.[00:01:40]

So, you know, it's the same thing. And, and, uh, we'll be talking about that actually twice. So I'll be talking about [00:01:45] that Thursday, uh, morning as well as, um. On Friday [00:01:50] afternoon. So Friday after lunch I'll be, uh, talking about the same thing. And we're doing that actually in the gym [00:01:55] area, which is awesome. So a couple years ago, Kelly Stare convinced the A PTA, that they should have a gym [00:02:00] area in, uh, the vendor hall, which I think is a very smart idea.

You know, the performance [00:02:05] based, uh, portion of the profession has grown a lot. Uh, I think it's, uh, something [00:02:10] that, that makes a lot of sense. We do a lot of work with people from a longevity standpoint, and a lot of that has to do with [00:02:15] movement. Um, so, you know, for, for us to, to present there makes, makes a lot of sense.

[00:02:20] Um, the, the, the last thing, which is, uh, well, there's two actually. The last, uh, uh, big presentation that I have [00:02:25] to prep for is actually, um, an hour and a half block they gave me to talk about the, the business [00:02:30] model itself and really the. The growth that I've seen over the last, uh, decade of [00:02:35] having had my own clinic and being involved in this space.

And, um, you know, for me, [00:02:40] one of the things I wanna share was, I thought was interesting. If you can't make it, by the way, uh, if you're gonna be there, [00:02:45] uh, I would love to, to say hello, meet in person. I'm a real person. [00:02:50] Like, I'm a real, I'm a real person. You can see that face to face if you want, uh, if you're gonna be there, that's awesome.[00:02:55]

Um, and if, uh, you know, e even if you're gonna be there and you wanna stick around through [00:03:00] Saturday, we're actually gonna be doing a, uh, half day workshop on getting a clinic started. So if you're. [00:03:05] A newer grad or somebody who's been thinking about doing this, uh, this is a really cool opportunity. Saturday morning, we're gonna be [00:03:10] at one of our coaches, uh, clinics in Anaheim area, uh, going over the, the, the starting phase [00:03:15] with not just myself but my business partner, e Gigi, and our head coach, Courtney Morris.

So it's a really cool opportunity to get [00:03:20] some very, very knowledgeable people to take a look at what you're doing and share what you know, we think these steps should look like if there's something [00:03:25] you're interested in doing. But on Friday, um, I get an hour and a half block to talk about the, the, [00:03:30] the business, uh, you know, model and what's changed and what we see as far as the [00:03:35] evolution of it.

And I, I did some, some digging. So I wanted, I was interested like how many people have, have we worked with [00:03:40] directly that are either current clients or people that are alumni of our PT Bs mastermind [00:03:45] program that have a seven figure business or multiple seven figure uh, practice. [00:03:50] And, um, I was like really surprised because.

I haven't even dug into everybody, and I've already found [00:03:55] dozens, which is pretty compelling to say that the business has evolved [00:04:00] quite a lot. I have, um, I've definitely, you know, seen it [00:04:05] change a lot. And when I first got started, you know, I, I was very, [00:04:10] I was very okay with the fact that. I was just creating a job for myself.

In fact, I had a lot [00:04:15] of people tell me that that just wasn't gonna be a business that could scale. Uh, it's not something they would really [00:04:20] have enterprise value and be sellable one day. But, you know, what I saw was I could replace my income and more, [00:04:25] um, I could work with people one-on-one, which was very important to me because my clinical [00:04:30] skillset, like I'd worked really hard to become a good clinician and I wanted to use it.

[00:04:35] So I was okay with the trade off. Um, and I accepted it and it just so happens that the, [00:04:40] the, the business, it evolved and people were wrong about it. Uh, [00:04:45] I was wrong about it. I didn't know if it'd be scalable either. But it's much different [00:04:50] now. Uh, and many things have changed that I, that I, I'm excited to address.

But, um, I, I just [00:04:55] thought it was really interesting and it's something that should make you feel motivated if you're, if [00:05:00] you're in business right now, um, if you're thinking about starting a business like this, [00:05:05] that I think we're in an interesting place where the, um, the market is [00:05:10] growing. Uh, for what people are looking for this type of work, uh, they, they want a healthcare [00:05:15] provider that's going to be more, you know, one-to-one more personalized to them.

They, they want a healthcare [00:05:20] experience that isn't, um, you know, it isn't bad and most of them are. Uh, [00:05:25] and also we are becoming this, this really interesting natural [00:05:30] fit to help people with injuries, obviously, but also to help them achieve their health and wellness goals. [00:05:35] Uh, going forward, which is a great place to be as far as like longevity is concerned and really, [00:05:40] uh, being, being focused on the ongoing work with people, which is, which is amazing for the business and amazing [00:05:45] for, for the clients we get a chance to work with.

So, um, I just was really impressed that there were that many people that have [00:05:50] grown businesses to that size and it's really, uh, it's, it's a proud thing for me to see because. [00:05:55] I didn't do the work, you know, but to see them take these principles that we teach, these, these business [00:06:00] concepts that are, uh, you know, we like to think of it as like business school for, for cash-based clinicians like, [00:06:05] and run with it and grow and like, just become even better entrepreneurs is amazing.

You [00:06:10] know, and I, I'm, I'm just really proud of everybody that has, has been able to continue to drive their business [00:06:15] that direction and, and see the growth that honestly, nobody really thought that, uh, we'd be able to do. [00:06:20] So the, uh. The other thing that I thought was interesting is, I'm, I'm looking at these, [00:06:25] these stats is, um, one of the reasons the A PTA wanted me to present [00:06:30] is the fact that entrepreneurship is becoming a, a bigger and bigger portion of the [00:06:35] profession.

They see that for sure. I've seen that for a long time and have advocated for [00:06:40] it. Um, and you. It's still a small sliver of the overall [00:06:45] profession. It's like four to 5% based on the best data that I could find, uh, of the [00:06:50] profession that's self-employed. Um, you know, which is, which is small in comparison to many other professions like [00:06:55] dentistry or veterinary or, uh, chiropractic.

You know, we're, [00:07:00] we're there. Those are at least a third to two thirds in many cases of the profession, of their [00:07:05] profession that are self-employed. And, you know, vast majority of us are, are not. We work for big hospital [00:07:10] organizations. We work for big, uh, corporately owned, uh, you know, clinics maybe work [00:07:15] for smaller private practice, but the vast majority of the jobs are, are in huge [00:07:20] organizations.

And, uh, it's trending in a direction where that four or 5%. It probably is [00:07:25] gonna end up being eight to 10%, you know, over the next five, 10 years. As people [00:07:30] shift more towards these smaller businesses, this more sort of, uh, self-employment, uh, path that we [00:07:35] see a lot of people doing. It's a trend not just in our profession, but many other ones.

And, um, I'm [00:07:40] excited for it. I think it's great. It's, it's a, it drives more competition. It. Creates opportunities where people can [00:07:45] focus more on niches. I think it's a great thing for, for patients that, that want more sort of [00:07:50] like, really like isolated, uh, skill sets that that can help them [00:07:55] specifically. You know, if you're a runner, like, and you wanna work with someone who is a [00:08:00] badass running clinician, like there's gonna be many of those that you're gonna get a chance to, uh, to work with and choose to [00:08:05] work with.

And if that's you and you want a business that can be built around that skillset, you can [00:08:10] definitely do that. Like, we see tons of examples of that even today. So, you know, I, I, I think it's, it's really [00:08:15] interesting. Obviously I have a lot to share in this, in this presentation where I'm gonna just talk about kinda where [00:08:20] I see the profession going, but also the key things, ability to focus on.

At these stages to, to get the early, [00:08:25] the early phase nailed down because, um, you can't skip it. You know, like [00:08:30] you can't have a big business without having a small business first. I mean, unless I guess you buy it. But in that [00:08:35] case, uh, it's a very different, uh, example and, and, uh, also hard to do if you don't have any money [00:08:40] or access to money, right?

So like you really can't skip this start phase, you gotta nail it. And it's definitely changed over the [00:08:45] last, uh, you know, 10 to 12 years since we've been involved in this space. Um, the last thing is. [00:08:50] I get to do a panel with two really cool people, so Sue Fone, uh, and uh, [00:08:55] Megan Brown. So these are two, uh, absolutely like very successful [00:09:00] clinicians within our space, but have done so in a, in, uh, more of a non-traditional path.

[00:09:05] Uh, and that's actually what we're talking about. So, uh, you know, the, the, the career field is [00:09:10] opening itself up to. Different opportunities that are not necessarily, [00:09:15] um, just clinical, right? Go in and work clinically, right? You could do something like Sue and work in professional [00:09:20] sports and uh, and, and, and go, go that path.

You use something like Megan and you can, uh, you know, [00:09:25] be an entrepreneur and do so in more of a fitness forward way. Or she's not [00:09:30] treating patients, but she has group-based, um, you know, Pilates classes that she has and she's [00:09:35] scaled to multiple locations. And, and, uh, is, is, is is very successful with how [00:09:40] she's leveraged her, her own skillset, uh, within the profession.

Right. Even for me, like I'm [00:09:45] doing things now that I never thought that I would do. Like when I, in 2010, when I [00:09:50] graduated from the, the Army Baylor program, you know, if, if I could go back in time [00:09:55] and tell myself, Hey man, you're gonna be, uh, talking a lot about. Cash-based physical [00:10:00] therapy business, and you're gonna be doing a lot of like consulting and education and mentorship work with, uh, [00:10:05] with clinicians and you're not gonna be treating patients anymore.

Um, I would not have [00:10:10] believed myself. Like that's just, this is not where I thought I would be. Right? I thought I would be career military officer. [00:10:15] Uh, I thought that I would be in the clinic forever. Uh, you know, that's all that I would do. [00:10:20] And, uh, it's funny how you end up, where you end up, right? Uh, with the opportunities that you have and, [00:10:25] and the things that you say yes or no to based on.

You know, whatever your, your values are [00:10:30] that, uh, that, that, that you have and the goals that you have along the way, they can shift and change. [00:10:35] So the three of us will be doing a panel on, you know, sort of the non-traditional path. And for many of you, [00:10:40] you may end up in a more traditional path. You may just stay on the clinical side, which is great.

There's nothing [00:10:45] wrong with that. I think it's actually the most personally rewarding job on the planet. Uh, you may decide you want to. [00:10:50] You know, go the entrepreneurship path and, and you wanna build a team and you want to work with more people and you want to be able to have a [00:10:55] business. And, uh, there's a lot of, you know, things that, that are different about how you're gonna use your skillset there.

Maybe you end [00:11:00] up, uh, you know, selling that and moving into, into something else, some other, uh, type of business. We've seen [00:11:05] this with even our own clients that have successfully built, sold businesses and moved into other industries [00:11:10] and are now successful in those industries, having started another business, uh, you know, like it, it just depends on what you do.

But I can tell [00:11:15] you the skillset is transferable into many things and, uh, I'm excited too. [00:11:20] You know, get a chance. I'm very honored to get a chance to, to have, uh, uh, to, to be on a panel with, [00:11:25] with these, uh, these two other clinicians and, uh, and to, you know, to be able to kinda share our sort [00:11:30] of non-traditional.

Paths of where we ended up, because for many of you, uh, uh, maybe you end up [00:11:35] doing the same thing. Right. And, and, um, and if you can kind of hear how we got there, it's, it's, it's interesting 'cause it's not [00:11:40] planned, uh, and for any of us, as far as I know, and it's something that, you know, you should feel [00:11:45] okay if you don't really know what you want to do.

I think that can make people feel quite stressed out. Um, you know, and, and I think it'll be [00:11:50] helpful to, to, to hear that. So, uh, if you're gonna be there. You know, let's, uh, you know, let's, [00:11:55] let's connect. I'd love to meet in person, come to one of the, uh, the blocks that I have. [00:12:00] I promise you it's gonna be a lot more interesting than someone breaking down a research study.

[00:12:05] No offense to research studies, but come on guys. I'm not gonna be talking about stats. It's not gonna be boring. [00:12:10] We're gonna give you some actionable things that are, honestly, if this is the direction you wanna go, they're gonna help [00:12:15] you. Um, you know, on the business side, they're gonna help you have more success there.

You're gonna be able [00:12:20] to make more money, have more impact, uh, and have a much more clear idea of what you can do and [00:12:25] where you're trying to go. Um. If you're a student, I know a lot of students go to CSM and what a great [00:12:30] opportunity to just soak it all in. Uh, really just, you know, try to figure out what you wanna do.

Even if [00:12:35] you don't know if this is what you wanna do. You know, you, you probably have a better idea after you hear some of these, uh, the, these [00:12:40] presentations or a little sidebar conversation you, you may have. That's actually what I'm looking forward to most [00:12:45] when I go to events like this. The presenting side of things is, it is what it is.

[00:12:50] Like it's, it is, uh, beneficial I think from a, from a standpoint of. Uh, lots [00:12:55] of people can hear what you have to say, but I personally enjoy, uh, just [00:13:00] one-on-one conversations with people that, uh, you know, I can learn more about what they are trying to [00:13:05] do, where they're at in their business journey, um, and, uh, [00:13:10] and, and just, you know, hear, hear what they're trying to do.

And if I can help in any way, I, I, I am [00:13:15] always, you know. Willing to do so and really enjoy, uh, doing that. So, uh, [00:13:20] anyway, I fully expect that I'm gonna be exhausted, uh, after three days [00:13:25] of, uh, presenting and, uh, and, and getting a chance to meet a lot of people and, [00:13:30] um, you know, and, but it's, it's, it's a good form of exhaustion, right?

Like it's, it's a, it's, it's positive [00:13:35] and, and I'm excited to do it. So, um, the A PTA, like I said, uh, I appreciate the, the [00:13:40] invite. It's, it means a lot to me that they see the. Sort of, I don't know, [00:13:45] niche within a niche within the profession of what we're doing is something that's growing and important. Uh, I've really been impressed with [00:13:50] their leadership team and just the ability that, that, that they've had to want to lean into this and, [00:13:55] um, and organize all this, which is, um, amazing.

Like, have you ever been to csm? You know, how big this thing is. [00:14:00] And for me to kind of see the behind the scenes of how it's all organized is just like, it's a huge thing to pull off. Um, so, [00:14:05] you know, difficult to do a lot of respect for people that are doing that. So if you're there, awesome. [00:14:10] Uh, if, uh, if not.

Probably too late to come. I don't know. I don't know how, [00:14:15] how, if they have any, uh, tickets left or whatever. But, uh, either way I look forward to it. I just wanna share some of the things that I'm seeing [00:14:20] super bullish on the profession, as always. Like the more I dig into this stuff, the more I'm just like, we are so fortunate [00:14:25] to be, to, to have picked the, the time that we're in [00:14:30] the.

The skillset that we have and the, the, the [00:14:35] changes in healthcare that are occurring. All these things are really aligning for what we do, especially as [00:14:40] performance-based clinicians that are sort of functioning slightly outside of the traditional healthcare system. [00:14:45] Um, the consumer's looking for that, and that isn't gonna stop [00:14:50] anytime soon.

So anyway, hope to meet you in, uh, in Anaheim. Uh, if you see [00:14:55] me. Come say hello, you know, come to one of my, uh, one of my talks, or, uh, grab a [00:15:00] book. It'll be totally free. Would love to sign it for you. Uh, even though I have terrible handwriting, you might not be able to make out [00:15:05] what I say. Either way, I'll give you a book and I just wanna say thanks to anybody who is gonna come [00:15:10] or stop by.

Would love to meet in person. And as always, thanks for listening. Catch on the next [00:15:15] one.