E868 | Will a "Starbucks of Cash PT" Emerge? (And How to Protect Your Practice)

The Rise of Cash PT Giants: Why National Brands Are Coming and How to Prepare

Cash-based physical therapy is entering a new era. What started as a scattered collection of small, independent clinics is now on the edge of a major transformation—one that mirrors what happened in fitness, healthcare, and countless other fragmented industries before it.

In this blog, we break down why national cash PT brands are on the horizon, what it means for independent clinics, and how to position yourself to not only survive but thrive in the next decade.

Documentation Is Still the #1 Pain Point

Before diving into industry trends, we have to acknowledge the day-to-day reality for most clinicians: notes are killing job satisfaction.

Most PTs still end their day buried in documentation. It’s the top complaint in clinician surveys, and the leading cause of burnout. AI scribes like Clair are becoming essential because they give PTs back something priceless: time, presence, and sanity.

But bigger changes are coming—changes that will shift the entire landscape of cash PT.

The Bold Prediction: A National Cash PT Brand Will Emerge

Every fragmented industry eventually consolidates. Physical therapy is no different.

What in-network PT saw 15–20 years ago—buyouts, rollups, big chains—will happen in the cash world next. Industry trends, investment interest, and consumer behavior all point in the same direction: a national cash PT brand is coming, and it will happen within 5–10 years.

This isn’t speculation. It's pattern recognition.

Why Consolidation Is Inevitable

1. Cash PT is fragmented — and fragmented industries always consolidate.

Hundreds of small clinics. No dominant player. No standardized systems. That’s the exact recipe for consolidation.

2. A proven business model already exists.

Look at CrossFit vs. OrangeTheory.

• CrossFit = fragmented affiliates

• OrangeTheory = polished, consistent, scalable brand

Cash PT is mirroring this evolution.

3. Funding accelerates growth.

A well-capitalized company can:

• hire faster

• market louder

• undercut competitors

• expand quicker

• survive longer during slow seasons

Money doesn’t guarantee success, but it guarantees speed—and speed wins when scaling.

MYO: The Case Study Everyone Should Be Watching

MYO (formerly MYO Detox) is the clearest example of a brand poised for rapid expansion:

• strong business leadership

• a recognizable, modern brand

• proven systems

• heavy investment

• momentum in both Canada and the U.S.

They aren’t the only contender, but they illustrate where the industry is going.

What Happens If They Move into Your Area?

A lot of owners panic at the idea—but they shouldn’t.

Yes, competition increases. But increased investment in the profession validates demand. It signals a growing market. And most importantly…

Local, niche-specific clinics can still win.
But only if they dial in the fundamentals.

How Independent Clinics Can Protect Themselves

1. Build a Strong, Recognizable Brand

Your brand should make people think:
That’s the clinic for runners.
That’s the pelvic health specialist.
That’s where athletes go.

Blurred niches get crushed. Clear niches win.

2. Get Deeply Embedded in Your Community

National brands can't replicate:

• local stories

• local partnerships

• local culture

• personal relationships

Community is your moat.

3. Systemize and Professionalize

You need real processes:

• clinical systems

• sales systems

• marketing systems

• follow-up systems

• hiring and onboarding

Systems create consistency. Consistency builds trust.

4. Grow (At Least a Little)

Staying tiny isn’t safer. It’s riskier.

Clinics with 5–10 clinicians:

• are more stable

• can pay better

• attract better talent

• withstand competition

• have cash to reinvest

Strength in numbers matters.

5. Stay Ahead with Sales & Marketing Mastery

Most PTs can treat.
Few can market.
Even fewer can sell.

Those who can do all three dominate.

Why This Is Actually Good for the Profession

More investment means:

• higher public awareness

• more legitimacy

• stronger demand for alternatives to insurance

• better patient experiences

• more opportunities for clinicians

• higher earning potential

Growth brings opportunity—if you’re prepared.

The Bottom Line

A national cash PT brand will emerge.
Some clinics will struggle.
Some will adapt.
And some will thrive like never before.

Your job?
Control what you can control:

• your brand

• your niche

• your systems

• your marketing

• your team

• your service

Do that consistently, and no national chain can replace what you bring to your community.

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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

[00:00:00] Hey, Danny Matta here at PT Biz and I've got a bold prediction for you. Something I think [00:00:05] is going to fundamentally change the cash-based world over the next five [00:00:10] to 10 years. So over the last [00:00:15] couple weeks I've been outta town, uh, visiting different clinics that we work with around the country. [00:00:20] And one thing that I continue to have conversations with business [00:00:25] owners about is the complexity of.

Cash-based clinics in their [00:00:30] area, not just locally, but in some cases, even nationally now, [00:00:35] as I have seen the industry change pretty dramatically, um, over the [00:00:40] last decade in particular, there's something that I've noticed that's a trend that I think is really [00:00:45] kind of coming to, uh, to ahead in terms of.

Likelihood of us seeing [00:00:50] a pretty profound change in the profession over the next five to 10 years. And that is that I think that [00:00:55] there's going to be a strong, dominant brand [00:01:00] nationally for cash-based clinics somewhere, you know, starting somewhere in the [00:01:05] US that's going to grow into a national brand. Um, now.[00:01:10]

Why do I say this? So, and I'll give you a few reasons and examples of clinics that are kind of already [00:01:15] doing this, uh, one in particular. So when we look at [00:01:20] fragmented industries, uh, that, that would be industries that have a lot of [00:01:25] small businesses within it, that, that would be physical therapy at this point, right?

Not [00:01:30] necessarily in network physical therapy, but cash-based physical therapy. [00:01:35] And if you look at the history of in-network physical therapy, at one point in time [00:01:40] there were many small private practices. What happens? Well, eventually [00:01:45] you have what's called consolidation, where these businesses get sort of.[00:01:50]

Swallowed up by bigger competitors, um, or they partner so that they don't go outta [00:01:55] business. And any industry that has a lot of fragmented businesses [00:02:00] eventually is susceptible to that to some degree. I'm not saying that they're not [00:02:05] successful in network clinics. There's plenty of those out there, but there are way [00:02:10] bigger.

National chains or chains that are maybe regional that have partnered or been [00:02:15] absorbed that have a national footprint. If you really look at who owns it, and we've seen this now [00:02:20] happen in many different, uh, types of industries and in particular, if you look at something [00:02:25] like adjacent to US Fitness, so.

Back in the day, you [00:02:30] know, when I, when I was, uh, working with, uh, CrossFit, the, you know, headquarters [00:02:35] company, um, this was, you know, 2009 when I first got exposed to, uh, to [00:02:40] CrossFit. And when I started working with them, it was 2013 and. There [00:02:45] were affiliates all over the place, right? But the way that it was set up was you had an [00:02:50] affiliate, you paid a fee to be an affiliate, and then you kind of ran your gym however you want it.[00:02:55]

Well, this can lead, uh, to, to, to, uh, you know, some [00:03:00] challenges in terms of the consistency of the product that people expect. And if you look at [00:03:05] Fast forward a few years, what happens? Well, you have something like an Orange theory, which is definitely not CrossFit, [00:03:10] don't get mad if you're a CrossFit purist.

I get it. But high intensity training at [00:03:15] scale is basically what CrossFit really, you know, brought to the, um, the, the [00:03:20] fitness world. Orange Theory, they commercialized it, they professionalized [00:03:25] it, and they exploded. Right. So that's kind of what you're seeing. Uh, [00:03:30] and, and, and I think the, I think the parallel between CrossFit.

And [00:03:35] what's happening in cash-based physical therapy in particular right now is very similar [00:03:40] because, you know, we work with hundreds of clinics around the country [00:03:45] and the whole goal of. Us working with them is to help them understand how to [00:03:50] be a good business owner, how to run a business, how to understand, you know, sales, [00:03:55] marketing people, finance processes, how to systemize their business.

All these things that they need [00:04:00] to, to, to know and understand, uh, versus, you know, you could maybe go the franchise route [00:04:05] where that stuff is boxed up for people and maybe some of it is done on their behalf. [00:04:10] All the systems are built out in, in, in an example like that would be different than we're teaching [00:04:15] people how to run businesses.

So, but that doesn't mean that everybody that runs a [00:04:20] clinic knows how to run a business. In fact. I would say that the average clinic [00:04:25] owner doesn't actually know what they're doing. They are just sort of guessing. Uh, [00:04:30] they're, they're, they're trying to do what they think is best, but they've never had any formal education on how to [00:04:35] actually run that type of a business, how to essentially bulletproof it as best they [00:04:40] can long term.

So when we look at susceptibility to. [00:04:45] Uh, you know, fragmented businesses being very affected by national chains. [00:04:50] Our industry, sadly, is pretty likely to have that happen to it because [00:04:55] of a lack of knowledge. On the ha on, on, on the, the part of the actual owners, the clinic [00:05:00] owners who are clinicians first and they secondarily run a business Well, when a national [00:05:05] brand, uh, comes into the mix, they aren't clinicians first.

They're running a [00:05:10] business first. They happen to hire clinicians. Their product and service happens to be clinically based. [00:05:15] And if you want to. Really, you know, [00:05:20] lean into being able to maintain your business. I'll talk about some things that you need to be [00:05:25] aware of and, and really focus on, but let's talk about number one, an example of, [00:05:30] you know, kind of who is doing this at scale that you can look at an as an [00:05:35] example of, um.

You know, mimicking somewhat of what they're doing and, and [00:05:40] smart people with, with a lot of money behind it. Um, one of the, the groups [00:05:45] that I've recently noticed has expanded a lot is a group called Myo. Now, this group [00:05:50] has a lot of things working well for them. It used to be called Myo Detox. They just rebranded.[00:05:55]

And they're mainly based outta Canada. They just recently started, uh, to [00:06:00] open clinics in the us. This is a company that actually I was well aware of when they [00:06:05] first got started, uh, mainly because they had a, a strong, uh, founder that was [00:06:10] more of a, you know, movement influencer, um, that was teaching courses.

[00:06:15] And there also is a co-founder who's heavy on the business side. This combination is. [00:06:20] Pretty powerful. Now you take that with, uh, you know, being able to raise [00:06:25] funding to expand and internal, you know, revenue to reinvest in growth and, and [00:06:30] do so in a very intelligent way. And now all of a sudden you have, uh, a, a brand that's [00:06:35] picking up a lot of steam as well as, as well as a, a brand that is [00:06:40] hitting the.

The market at a time where people are really frankly looking for [00:06:45] alternatives to traditional healthcare, traditional physical therapy. So you have a strong [00:06:50] brand with strong systems that has a track record of success that now has a lot of money and [00:06:55] desire behind it to really push forward and grow.

During a time when people are [00:07:00] looking for that type of, of service, and it's a pretty solid [00:07:05] mix if you really look at the ability to scale a national brand. So [00:07:10] let's say that, you know, they continue to grow and they, they open up right down the [00:07:15] street from you. In, uh, your area, right? For a lot of people, that is, uh, like worst [00:07:20] case scenario for them, you know?

Um, and yeah, maybe that affects you to, to some degree, [00:07:25] maybe not. There's a lot of people that we can help and I think there's always room to continue to grow, [00:07:30] but if you look at this company in terms of what you need to think about. As a business owner [00:07:35] yourself, uh, you can actually take a lot of things that they're doing and apply it to your own business.

So, for [00:07:40] instance, do you have a strong brand? Do you have a recognizable brand that when people see it, they [00:07:45] associate their niche or whatever it is you're trying to, you know, really, uh, focus on [00:07:50] with that brand. Right. Have you done a good job being involved in your community? Are [00:07:55] you, you know, someone who.

Is, is known within your community, someone that your community wants to support, [00:08:00] uh, and that you've developed a strong reputation within your community. You have a very defined [00:08:05] niche that you focus on. You know, you're not seeing just everybody. You have a niche that you focus on. [00:08:10] You work really well, you know, with that niche.

You continue to try to get better within that niche. And the people you hire [00:08:15] are also fantastic with whatever it is that you're, you know, trying to help. Uh, these are all things [00:08:20] that are gonna really bulletproof you from anybody that, that may be, uh, competition. Whether it is [00:08:25] in network, at network, cash clinic that has a national brand versus just a local brand.

And there's a lot more of those [00:08:30] too. You can look around and you can see the scale of regional brands happening right now as well. [00:08:35] Um, whether it be, you know, in whatever markets you wanna look at. In bigger cities in [00:08:40] particular, uh, you're starting to see cash-based clinics that are moving to, you know, [00:08:45] multiple locations, sometimes locations in the low double digits.

Um, from, from [00:08:50] what we've seen is outside looking in, there's a lot of growth happening, and, and the mix is the same. These are [00:08:55] people that are great with systems, they're mission-driven, they have funding, and they're [00:09:00] taking this very seriously. And the funding is something that you're gonna see accelerate.

The ability [00:09:05] to compete. So when someone takes on funding, what that lets them do [00:09:10] is basically invest in the growth of the business, invest in people, and invest in time. So, so [00:09:15] here's the other thing. If I have a few million dollars in funding, and I know I've got this [00:09:20] office that I'm starting up in whatever city, I don't have to.

Play the [00:09:25] Bootstrap game where you know, I have to worry about every single dollar. I can't reinvest so much [00:09:30] in marketing. I can't reinvest in hiring so fast because I may run outta cash. I don't have the [00:09:35] cash flow for it. If you're highly capitalized, you have, and you have all this money, well, you can go faster.

You [00:09:40] can go faster and you can pay more to get people in the door. Your marketing can. Be less [00:09:45] effective at scale. You can pay more per person because you have the cash to be able to do that. And at [00:09:50] the end, the goal for them is growth is scale, right? And for you it might be cash flow and [00:09:55] lifestyle. So these are two different sort of approaches to business.

And you cannot play that game if [00:10:00] you don't have capitalization. Uh, and they're not gonna play your game because they want to grow faster and they want to be able to [00:10:05] show that because at the end of the day, it's probably going to be. Um, sold, [00:10:10] you know, to a private equity company or, or VC firm or a, or family office for a lot of money.

And I [00:10:15] think that there's a, there's a strong likelihood that there will be a national brand in the [00:10:20] next five to 10 years that is a cash based physical therapy brand that's gonna sell for multiple nine figures, [00:10:25] if not a billion, uh, in valuation. That is. On the table. I [00:10:30] think that's, that is what the opportunity is gonna be and not just for one brand, by the way.

I [00:10:35] think there's going to be a number of them, um, that are moving that direction. You're also seeing [00:10:40] investment in these types of businesses. This is something that for, for us, over the last few years, we've [00:10:45] gotten more involved with, um, private equity companies, uh, [00:10:50] investment bankers and learning more about that world.

And one of the things that we're seeing is that. Uh, healthcare [00:10:55] has always been a, uh, an area that, that people want to invest. They view it as [00:11:00] very stable, very recession proof. Um, and, but, but also on the same side, [00:11:05] insurance is kind of a pain in the ass. Like we all know that it's reimbursement gets cut.

They have to mess with volumes. It's more [00:11:10] regulation. Fitness is also another area, health and wellness that is, you know, heavily sought after by [00:11:15] private investors. And what's nice about a cash based clinic is it kind of fits in [00:11:20] between the two. It's in this interesting sort of between area where you don't have quite as much headache [00:11:25] logistically and administratively from, from insurance, but, you know, it's, it's more, uh, professionalized [00:11:30] than many fitness services are gonna be.

So, so you fit in this kind of sweet spot [00:11:35] and these brands are, are growing. Like just the amount of clinics that we work with that have been able to hit seven figure clinics is. [00:11:40] Something that I, you know, 10 years ago I didn't even think that was possible for one of [00:11:45] these clinics to, to grow to that point.

And I mean, to this point, like we've, we've seen it happen dozens of times [00:11:50] and it's just something that it comes down to what do people ultimately want to grow into, right? [00:11:55] And do they want to take on. The challenge of this really big growth opportunity [00:12:00] that, you know, maybe aligns with what they want or not, but it's gonna happen.

[00:12:05] I'm pretty confident, um, of that. That's just one example as far as Mayo is concerned. And if you wanna check, check [00:12:10] out, see what they're doing, like you can. Take a look at their site and their social media, and I think they've done a great job [00:12:15] with their rebrand. Really, really, uh, well done, well run company.

So if you want to [00:12:20] see an example of like at scale people that are doing this and what you can mimic some of, they're probably a pretty [00:12:25] good option to check out. So, again, for you, you gotta understand that. Yeah, [00:12:30] you gotta do what you gotta do, right? You gotta control what you can control and you can't control what other [00:12:35] people are gonna do.

So I'm not saying this to scare people. Even though that might be a piece of what's happening with you, you [00:12:40] might, might feel a little bit concerned. Um, I, I don't think that you necessarily should. I think [00:12:45] what you have to realize is this is a good thing for everybody. Because if investors are seeing [00:12:50] this and brands are able to see expansion, that means that there's a lot of people in your area that you can help as well.

It's just a [00:12:55] matter of you getting more dialed into the things that you can control. So you've gotta get better at, at marketing. [00:13:00] You've gotta get better at local marketing, digital marketing, reputation, marketing, [00:13:05] referrals, everything that is gonna drive people in the door. You gotta get better at sales.

You gotta price yourself, [00:13:10] uh, effectively. You know, you gotta learn how to communicate the value of what you do to other people and have a really [00:13:15] dialed in sales process. You've gotta hire great people. You've gotta be a great leader. Right. You have to [00:13:20] manage these folks, lead these folks. You have to make the right decisions.

You have to have the difficult conversations in a respectful way. [00:13:25] You have to give people opportunity and you have to be able to systemize and repeat what you're doing on an ongoing [00:13:30] basis, even if it's just one location. You still have to have the same service applied [00:13:35] across multiple clinicians, and that's a hard thing to do.

You have to have a lot of quality control and make sure that you are doing a lot of training [00:13:40] with your staff. The last thing that I would say. The last thing is their strength in numbers. Okay? So [00:13:45] what I mean by their strength in numbers is if you're very small, if it's you and like one or two other [00:13:50] clinicians maybe.

You're gonna be far more susceptible to competitive [00:13:55] challenges than if you're bigger than that. Let's say you have between five and 10 clinicians. [00:14:00] Now all of a sudden you have strength in numbers. Your brand looks better, your brand looks stronger. You [00:14:05] have, you have, uh, more cash flow as well to to manage it so you have more cash to be able to invest in [00:14:10] marketing.

You can pay your people more, you can have better benefits because the other thing that'll happen is [00:14:15] good clinicians might move over to other companies because they have, they have better opportunities. We've seen [00:14:20] this with athletes potential. We, we've had clinicians that have had better opportunities from, uh, [00:14:25] from other.

Uh, you know, similar type businesses that are bigger and they take 'em because at the end of the [00:14:30] day, it's, it, it's, it's what's best for their family, right? They can make more money, they can have better benefits. Maybe it's a springboard into something else [00:14:35] in their career. You gotta keep that in mind. So if you're not providing that for your staff, not providing that for your company, well [00:14:40] they're gonna find that somewhere else.

So there's strength in numbers, like you think, you know, playing defense and just staying small [00:14:45] and like hunkering down is the right thing to do. And it is not. It's not at a certain stage, you may decide that you don't [00:14:50] wanna grow any bigger than. Maybe you get to 10 clinicians and you don't want anything, you know, uh, to do with growing to another [00:14:55] location or adding more staff and that's where you wanna be, that's totally fine.

I mean, that's up to you. But if you're very [00:15:00] small and you think just staying very small. Is the safe option. I [00:15:05] don't think that that's the right move. Uh, I, I think you're more susceptible to some of these national brand [00:15:10] changes that are gonna happen by being small. You probably are gonna get swallowed up by a clinic like that.

You may have to close down and [00:15:15] go work for them, even if they want to or not, or go find a job somewhere else. When you're very small, you're, you're [00:15:20] much more susceptible to changes economically and in your area. That may happen with other [00:15:25] businesses and other brands. So overall. Net net. Here's where we're at.[00:15:30]

We're in an environment that's growing rapidly as far as interest in these types [00:15:35] of businesses. I mean, 10 years ago when I started Athletes Potential, it was [00:15:40] so hard to get somebody to come and see me. You know, just to explain to them why I didn't take [00:15:45] their insurance was so hard. Um, it, it was more of an education problem than anything else.[00:15:50]

Now, the education component's not really there. People know their insurance sucks and they're looking for [00:15:55] alternatives. What you're gonna start to see, and I don't think it's happened quite yet, [00:16:00] is you're gonna have a lot more fragmented saturation. So you're gonna have a lot of tiny clinics, [00:16:05] and those tiny clinics eventually are either gonna get consolidated by regional [00:16:10] brands.

Or national brands, unless they grow to a point where they can insulate [00:16:15] themself from, uh, competitors, which doesn't have to be huge. Like I said, you really have to be [00:16:20] probably in the range of seven figure business in order to just be able to, uh, provide [00:16:25] good opportunities, pay your staff well and you know, be able to insulate yourself and really do well in the [00:16:30] niche and the market that you wanna be a part of.

These are type of businesses that you can, you know, have for. [00:16:35] Decades. Uh, but if you wanna just say isolated just yourself in a [00:16:40] sub's office, in a clinic, I think you're gonna really struggle with that because people are gonna come and, and, and have a, [00:16:45] a challenging effect on your market share because you are so small, right?

So you're gonna have to grow for [00:16:50] the sake of safety, uh, and for long-term stability. In your [00:16:55] business, focus on your community, focus on your niche, focus on all the things I talked about as far as people, [00:17:00] processes, finance, sales, marketing. Continue to improve those, those things pour [00:17:05] into your staff.

Provide an amazing service to them so they'll tell all their friends and family how awesome you are. And [00:17:10] they're strong. Brand loyalty as well. Regionally, when it comes to a national brand. This is, we [00:17:15] see this all the time. Think about restaurants. People say what they want about chain restaurants. But look, you don't become [00:17:20] a chain restaurant 'cause your food sucks.

You become a chain restaurant because your food is good and you do it [00:17:25] consistently at scale, right? Like, Chili's is awesome, okay? But if you wanna go [00:17:30] to a local taco shop, uh, just this, just in your area and, you know, you really [00:17:35] appreciate the, the chef and the way that they like, prepare everything and their story, right?

And you wanna [00:17:40] support that business. There's a lot of people that are like that, right? But you have to have a great product service [00:17:45] and be tied into your community. Otherwise, Chili's takes you out, okay? That's what you gotta think [00:17:50] about. So if you are gonna be small, be amazing at what you do, be involved in your community, and [00:17:55] make sure that you differentiate yourself in a specific niche that you are amazing at helping.

And I'll put [00:18:00] you in a place where you insulate yourself from any sort of competition, whether it's local or whether it's national. So [00:18:05] keep an eye out. We'll see. We'll look back in, uh, five or 10 years and we'll see if I'm right. I'm interested to find out [00:18:10] myself.