E871 | The Key To A Successful First Hire In Your Cash-Based PT

Dec 04, 2025

cash based physical therapy, danny matta, physical therapy biz, ptbiz, cash based, physical therapy, how to start a physical therapy clinic, hybrid physical therapy, physical therapy website

The Hardest Hire in Your Cash PT Clinic (And How to Get It Right)

Ask any clinic owner who’s grown past being a solo operator, and they’ll tell you the same thing:

The hardest hire you’ll ever make is your first staff clinician.

Not your fifth.
Not your clinic director.
Not your admin.

The very first PT you bring on besides yourself.

In this episode of the PT Entrepreneur Podcast, Doc Danny Matta breaks down why that first clinician is so hard to hire, what most owners get wrong about it, and how to actually sell the opportunity in a way that the right person says yes.

First, Fix the Note Problem So You Can Show Up Like a Leader

Danny opens by talking about something every PT feels:

You can’t build real rapport with patients if you’re half-present, staring at your EMR.

That’s where an AI scribe like Clair comes in. It handles documentation for you so you can focus 100% on the actual human in front of you.

Better presence
Better questions
Better connection
Better outcomes

And if you’re going to lead a team, that’s the standard: being fully present with people, not buried in SOAP notes.

Clair helps you operate like the kind of clinic someone would actually want to join.

Why Your First Clinician Is the Toughest Hire

On paper, it feels simple:
“I’m busy. I’ll just hire someone.”

In reality, your business looks very different through a candidate’s eyes.

Most candidates see:

A tiny subleased space in a CrossFit gym or office building
No track record of paying anyone but yourself
No 401k, no health insurance, no “package”
A schedule that isn’t guaranteed
A founder who’s clearly still figuring things out

Now layer in another problem: most physical therapists are risk-averse.

They’re highly educated, often in a lot of student debt, and were told they’d have “stable jobs” with good security. They’re not typically wired like startup employees.

To them, your clinic doesn’t look like “freedom.”

It looks like risk.

The Story: When a Great Clinician Turned Danny Down

Danny shares a story that most owners can relate to.

He and his wife had built enough volume at Athlete’s Potential to justify a first hire. They found a phenomenal clinician in another state—one of the best Danny’s ever worked with.

They flew him and his fiancée to Atlanta.

The clinic at the time?

A windowless room in a rough part of town
Inside a gritty CrossFit gym
Very much a “bootstrapped sublease” situation

Danny was proud of it—because it was a step up from treating people in barracks, tents, and rooms next to laundromats in the military.

But when the fiancée walked in, the look on her face said it all:
This did not look like a safe, stable future.

They turned down the offer—even though Danny was offering a big chunk of equity (which he now admits wasn’t a smart approach anyway).

From their perspective, it meant:

Moving states
Jumping into an unproven business
Giving up a stable path for something that felt shaky

From Danny’s perspective, he was thinking:

“Why don’t they see what I see? Why don’t they see where this is going?”

You’re Selling the Future, Not the Room You’re In

That’s the core lesson.

When you’re hiring your first clinician, you are not selling:

The current space
The current benefits (or lack of them)
The current schedule

You are selling a vision.

You’re asking someone to become:

“Employee #1”
The first PT on the bus besides you
A key part of the story of where the clinic will be in 5–10 years

Think of it like this: you’re not pitching “how nice the office is right now.”

You’re pitching:

“Here’s where we’re going. Here’s what this practice will become. Here’s the role you’ll play as we build it.”

Is it still risky? Yep.
But at least now, you’re clearly naming what the upside is.

Why Your First Hire Might Not Stay Forever (And Why That’s Okay)

There’s another pattern Danny sees across hundreds of clinics:

The type of person who says yes to a sketchy-looking, early-stage job is usually more tolerant of risk.

And people who are okay with risk are the ones who eventually say:

“Why don’t I just do this myself?”

So it’s common to see:

First clinicians stay 1–3 years
Then move on to start their own clinics

That can sting.

You trained them.
You built their schedule.
You introduced them to your patients.

But here’s the reframing:

They helped you move the business forward.
They proved a second schedule could work.
They strengthened your brand and your systems.
And if they succeed, they’re part of your extended legacy.

Danny is very clear: he’s proud of those former clinicians and wants them to win.

Early hires are often stepping stones—for them and for you.

Respect the Risk They’re Taking On You

Most owners quietly think:

“Hey, I’m giving you a job. That’s the value.”

Danny admits he used to have a “that’s what the money’s for” mindset (like Don Draper in Mad Men).

But that frame misses something huge:

Your first clinician is taking a big risk on you.

Your business is unproven.
Your systems are half-built.
Your “HR department” is you and maybe your spouse.

They are betting on your ability to:

Grow the clinic
Fill their schedule
Keep the doors open
Actually become what you say you’re building

That deserves appreciation, not entitlement.

The Hardest Growth Cycle You’ll Go Through

Danny’s take:

The hardest stage in a clinic’s growth is not:

Opening a second or third location
Moving from 7 to multi-7 figures

It’s this one:

Going from solo → first clinician → toward a real standalone space.

Why?

You’re still treating a ton.
You’re trying to fill someone else’s schedule.
You’re watching cash flow like a hawk.
You’re dealing with the stress of “what if this doesn’t work?”
And if that first clinician leaves early, it feels like a massive step backward.

It’s the stage where many owners quit, shrink back down, or walk away and take a job.

But it’s also the stage where you grow the most as a business owner and leader.

How to Actually Sell the Role to Your First Clinician

Here’s how Danny says to approach it:

Be honest about where you are.
Don’t pretend you’re a big, stable machine. You’re not. You’re early-stage.
Cast a clear, specific vision.
Where will the clinic be in 5–10 years? More locations? Bigger space? Strong local brand? Spell it out.
Paint their role in that future.
“Employee #1” is status. It’s a story. It’s a unique career move. Lean into that.
Acknowledge the risk.
Tell them you understand they’re taking a chance—and that you don’t take that lightly.
Offer more than money.
Early on, you probably can’t compete on benefits. Compete on:
- Autonomy
- Growth
- Mentorship
- Impact
- The chance to help build something

Then, most importantly:

Deliver.
If you sell them on a future, do everything you can to make that future real enough that they can provide for their family and feel proud of the decision they made.

Need a Roadmap Before You Even Think About Hiring?

If you’re not yet at the point of hiring—but you want to be—Danny points you to the:

PT Biz Part-Time to Full-Time 5-Day Challenge (Free)

In five days, you’ll:

Get ultra clear on how much income you need to replace
Know exactly how many people you need to see and at what rate
Learn three different strategies to go from part-time to full-time in your own practice
See the sales and marketing systems PT Biz teaches inside their mastermind
Build a one-page business plan you can actually execute

👉 Join here: https://physicaltherapybiz.com/challenge

Final Thought

Your first hire will probably be the hardest one you ever make.

It will feel risky.
It will stretch you.
It might not go perfectly.

But you can’t grow a real brand, a real business, or a real team without going through that stage.

Sell the future, respect the risk, appreciate the people who say yes—and understand that this is the grind that builds you into the kind of owner who can lead a bigger, more stable, more impactful clinic down the line.

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

[00:00:00] So I think the hardest hire that you'll ever make is your [00:00:05] first staff clinician, and I'm gonna tell you exactly why and what to do about it. [00:00:10] On this episode of the PT Entrepreneur Podcast, [00:00:15] I'm Danny Matta, founder of PT Bz. And to date my company has had the opportunity to help over a [00:00:20] thousand clinicians start and scale and sometimes even sell their.

[00:00:25] Clinics all around the country. Uh, it puts me in a unique position to, to be able to see [00:00:30] lots of trends from a high level, and I try to share those with you on this [00:00:35] podcast as much as I possibly can because I hope it gives you a unfair advantage in your ability to make [00:00:40] decisions in business in real time.

One thing that [00:00:45] we've helped many, many clinicians do like. I don't even know how many times at [00:00:50] this point. Literally well over a thousand hires that we've helped people with at this [00:00:55] point, probably multiple thousands. And I will [00:01:00] say that the hiring process when you hire your first staff clinician, I think [00:01:05] is the hardest hire that you'll ever make.

And there's [00:01:10] a few reasons why. Number one, when you hire [00:01:15] somebody and it's just you, maybe it's you and a part-time admin. Your [00:01:20] business looks incredibly sketchy to this potential hire, and you [00:01:25] gotta keep in mind, the vast majority of people in our profession are risk averse, highly [00:01:30] educated individuals that want security.

We are not [00:01:35] typically a bunch of entrepreneurs. Some of us are maybe, but it's rare. [00:01:40] Usually we are pretty safety driven and we've gotten high levels of education [00:01:45] and in most cases we're told that we were gonna have these fantastic jobs, uh, [00:01:50] great job security for decades to come. And I say that's not true, [00:01:55] but you know, the, the.

High volume in-network [00:02:00] facility job may not be what you were sold, right? Like it burns a lot of people out. It's, [00:02:05] it's frustrating. It's, uh, it's, it's a massive amount of administrative work and, you know, we all [00:02:10] know that, that a lot of people get frustrated in those environments. So when [00:02:15] we start our own cash based clinic, right, for many people it is a sublease space [00:02:20] that you eventually then are able to springboard, uh, into a [00:02:25] standalone space.

But usually it's bootstrapped. You don't have a lot of cash, [00:02:30] and so what you're starting with is, you know, really it's not that [00:02:35] impressive looking. And I'll, I'll tell you a story about our first hire, [00:02:40] and it's very similar to what a lot of people go through. And when we hired, [00:02:45] uh, or we're going through the hiring process for our first hire, we actually [00:02:50] had a, um, a clinician that we had met.

That we [00:02:55] thought was awesome. Who actually is a fantastic clinician, one of the better clinicians that I've ever, [00:03:00] uh, had a chance to, to meet and work with in the country. Uh, [00:03:05] fantastic skill sets. And this person was living in a different state at the time, [00:03:10] so we brought him and his fiance down, uh, to, uh, to [00:03:15] Atlanta.

And they come to our space, and this is in, [00:03:20] in our sublease space on the west side of town. And this is in a, in a CrossFit gym. It's, [00:03:25] it's not the fanciest looking space ever. You know, we didn't even have a window. Uh, it was in a kind [00:03:30] of rough part of town. And I remember, you know, we brought them to the space and I was pretty [00:03:35] proud of our space.

I was like, yeah, like this is, I thought it was awesome. You gotta keep in mind, man, I was treating [00:03:40] people in, uh, you know, rooms next to laundromats in the barracks of [00:03:45] facilities prior to this with my job in the military, uh, and or tents or whatever. [00:03:50] Like, I didn't really care. The fact that we had air conditioning I thought was awesome.

And [00:03:55] I remember the look on this guy's [00:04:00] fiance's face when she walked in the space and. [00:04:05] It was not, she was not impressed at all. Not impressed. And [00:04:10] this may have had nothing to do with their decision to actually not take the [00:04:15] position. And they, they turned us down for the, the position, which was actually a incredibly bad [00:04:20] offer on our part as far as like, I mean, we had like a big chunk of equity.

We're gonna give this [00:04:25] person. We didn't know shit about what we were doing. Um, and, and he, he turned us down, [00:04:30] uh, for the position and for a number of reasons, it, it probably wasn't the right [00:04:35] decision for them. Um, but for us, I remember, like I, [00:04:40] I was kind of. Personally, you know, I took, I took it very personally [00:04:45] because I was like, I, why don't they see what I see?

Right? Like, why can't they see that this is just the [00:04:50] beginning of something that's gonna be much bigger? Which, which is athlete's potential, which is still around today, over a decade [00:04:55] later, multiple locations, you know, it's well over seven figure business at this point. And [00:05:00] they, but that wasn't what they saw.

[00:05:05] They saw a shitty little room in a rough part of Atlanta in a [00:05:10] CrossFit gym. And what we were doing at that time. That's what they saw [00:05:15] now, and that's totally fair because that's where we were. [00:05:20] If you are in this position that we are in, don't be surprised if [00:05:25] candidates aren't super interested in taking your job.

[00:05:30] Because you have no track record of being able to establish schedules for anybody more than [00:05:35] yourself. You have probably limited to no space. If it's just you. In a sublease space, [00:05:40] you have basically no capital. You know you're bootstrapped unless you're taking on capital for [00:05:45] expansion, which could be a good decision.

You are risky to these people. You're [00:05:50] risky to somebody who is risk averse. Not only that, this person was coming from another state, [00:05:55] so they were gonna move from another state to this area. To, for a job at a [00:06:00] place that looked risky. That's even, that's double the risk, right? Like, [00:06:05] so you gotta, you gotta understand that and accept that, and that's normal.

And you can't take that personally. [00:06:10] So here's what you have to do. Here's what you, you're really selling [00:06:15] them. You're not selling them on where you are today. You're selling them on the fact that [00:06:20] this is where we are now, but this is where we're going. And you get to be a part [00:06:25] of the early. Stages of that.

Imagine being employee number one at Facebook. [00:06:30] Imagine being employee number one at Amazon, whatever. And obviously we're not as [00:06:35] big as either of those, but that's the, the way in which you have to kind of look at it, right? [00:06:40] It's like you get to jump on this bus before a bunch of other people do, and we're gonna be way down here, this place that's way [00:06:45] cooler and you get to be a part of that, right?

Like that is the story that [00:06:50] you must sell people to take a risk on. [00:06:55] Your unproven business, which is frankly what it is, and that is a very hard thing to do, [00:07:00] and it's also usually a certain type of person that's going to accept that [00:07:05] position. So one of the other things that we've noticed is your first staff hire, [00:07:10] the likelihood that they stick around for a long time is pretty low.

And here's why. [00:07:15] The kind of person that's going to take a position that looks sketchy like that [00:07:20] is also the kind of person that is a little bit more tolerant when it comes to risk. [00:07:25] So they have a far higher likelihood of going and doing their own thing, uh, [00:07:30] because they're already used to a bit of risk.

They're already, they already see this. Like there's not a whole [00:07:35] lot that you've put into this, right? You're, in some cases you're figuring it out as you [00:07:40] go, right? Like, that's what we were doing and. So they might see that and just say like, well, why [00:07:45] am I, why am I not doing this for myself? Now, there's a lot of reasons that [00:07:50] that may not be the best decision for them, but I do see a lot of people move on, uh, within the course [00:07:55] of, you know, one to three years.

But it doesn't matter because there's nothing wrong [00:08:00] with that. And I will say this, we've had a number of clinicians [00:08:05] move on and successfully start their own clinics, and I'm fucking proud of every single one of 'em, [00:08:10] period. And it wasn't a waste of our time to work with them. It [00:08:15] was incredibly valuable.

They helped us move the business forward before they left and, and [00:08:20] decided to do their own thing. And every single person that did that, I wish them nothing but [00:08:25] success. They're fantastic human beings that truly are great at [00:08:30] what they do clinically. They're, they're great people and I hope that they have everything they want in life.[00:08:35]

It it going forward. And I'm very, very appreciative of their time with us because they helped us build the [00:08:40] business to the next step and the next step and the next step. And it is frustrating when [00:08:45] somebody leaves and their scheduled turnover and you have to, you know, move patients around or whatever like.[00:08:50]

It. These are things that we have to deal with as business owners, but, but even getting that first person [00:08:55] in the door and establishing that second schedule, building that second schedule, building [00:09:00] credibility through multiple providers, that this is more than just one person building a [00:09:05] brand. That is step number ones.

Even if, even if that is a short-lived stint, even [00:09:10] if that's one to three years with somebody, like it doesn't matter because the [00:09:15] people that you're going to be able to hire and attract, as your brand becomes bigger and more [00:09:20] established and you have better benefits and you have better compensation pay structure, and you look more stable, [00:09:25] you're going to attract people that are going to be more stable.

They're looking for more stability. You're [00:09:30] gonna create more stability for them early on. It is an unstable environment that people are taking [00:09:35] a risk on you, and you need to respect the fact that they're taking a risk on you. I, I ne, I never looked at it [00:09:40] this way, and this was a huge mistake. The way I looked at it was like, I'm [00:09:45] giving you a job.

You need to do these things because this is your job. It's like the, [00:09:50] the Mad Men, uh, scene where, you know, Peggy's getting mad because [00:09:55] Don Draper is not, uh, showing her enough appreciation or telling her she's doing a good job. And he says [00:10:00] that's what the money's for. Like, that's what the money's for.

You're here to do this. Why should I tell you're doing a good [00:10:05] job? And that's not a great leadership approach by the way. Like, don't take Don Draper's [00:10:10] leadership approach. Usually, uh, when it comes to your staff, like you have to appreciate these people 'cause they're [00:10:15] taking a risk on you. They're taking a chance on you.

You need people [00:10:20] to believe in where you're going, even if they're not gonna be there the whole time for you to get there. [00:10:25] So you've got to realize that you're not selling people on where they're at. You can't compete on [00:10:30] that. You're selling people on where you're going, and that they get to be a [00:10:35] part of the crazy ride that they're gonna jump into to get there.

It's gonna be fun. There's [00:10:40] gonna be a lot of unknown, you know, it's, it's, uh. It, it things that are risky are more [00:10:45] fun. Like, that's just the way it works, right? Like if you, if there's no risk, then it's boring. [00:10:50] Well, there's gonna be some risk associated with this, and they can always go and get a job doing something else.

It's, that's, [00:10:55] that's, that's not the case. Like they could always go and do something else. And this happens sometimes, like, we'll see people leave and just go [00:11:00] back to a hospital job or whatever. But that first hire, that first position that you're filling, you're [00:11:05] feeling it based on hope, based on a vision that you're, you're casting of where you're going.

You can't sell them on [00:11:10] your shitty little. Room that's there right now, you have to paint a picture of [00:11:15] what it's going to look like and that they get to be a part of it. And if you can do that, you can get that [00:11:20] first person in, you can get that first. Higher in that is is tough, right? Because you're [00:11:25] time poor, you're having to build their schedule up.

You're, you're really trying to like push more evaluations over that way. You're trying to build [00:11:30] their, their, their reputation up at the same time and the brand of the clinic. I don't think you'll ever work harder [00:11:35] than the stage of a growth cycle where you're getting that first clinician in. You're trying to grow into a [00:11:40] standalone space, trying to grow to a second clinician, trying to juggle all these things while you're still treating a lot of [00:11:45] patients.

It gets hard, super, super hard. I think that's the hardest stage, like these bigger growth [00:11:50] cycles where you're, you're going to bigger spaces or another location or like that's nothing compared to [00:11:55] that first growth cycle. I think it's the hardest. It's what washes the most people out actually. Like if people are going [00:12:00] to.

Uh, give up and quit and go back to being small or shut [00:12:05] their business down and go, go back to some other job that they, they want, it's gonna happen at this stage. It's not gonna [00:12:10] happen past that. You know, it's not gonna happen once they're at like half a million to a million in revenue and they can provide [00:12:15] these great opportunities for people and they have a lot of stability.

An established brand that just [00:12:20] generates patience without 'em having to do anything. It's definitely not gonna be, then. It's gonna be at this first growth cycle [00:12:25] and getting that first clinician in the door, especially if you have turnover before you bring another one after that. Oh my [00:12:30] God. That is a absolute.

Nightmare for people. It [00:12:35] sucks, uh, to take a step backwards like that because you've exhausted cash flow in the [00:12:40] process. Like it's just, it is rough and it's what stops a lot of people. But keep in [00:12:45] mind, in order to get where you want to go, you have to go through this stage as well. You have to [00:12:50] put the work in.

It's challenging stage and it's one of those things you're gonna learn a lot about yourself and your business as well. [00:12:55] Looking back, you'll grow more than you probably ever thought was possible. During these stages, you're probably gonna [00:13:00] age more than you thought too. Uh, have a few more gray, uh, hairs in your beard like me, but the, [00:13:05] the, the growth is gonna be immense personally and professionally.

Period. Like there's not much you can do there. But [00:13:10] keep in mind that first hire is hard. It's hard to sell them on what's going on. It's hard to keep them [00:13:15] around, but you gotta get that person in the door, and you should have a lot of respect for that person taking a risk on you and your [00:13:20] business because you're selling them on where you're going, and they have to be a part of that.

So [00:13:25] when you go to bring your first hire on, remember you're not selling them on what the business is [00:13:30] today. You're selling them on where the business is gonna be in five, 10 years and how they get to be [00:13:35] a very special part of that as being, you know, staff member number one [00:13:40] and this that is. Uh, credibility, it's status, you know, that people are [00:13:45] proud of, uh, that that is what you have to lean into because you're definitely not leaning into your 401k [00:13:50] your health benefits that don't even exist, and your poor pay compensation structure, like [00:13:55] that's what they see.

So you gotta get really good at sales in another way and selling them on the future vision of [00:14:00] your business, the impact that they can have, the ride that they're gonna be on the ride of a lifetime that they get to experience. [00:14:05] And that's how you get. Your first hire, and then you gotta deliver on really being able to provide the opportunity that [00:14:10] you say you can, so that they can provide for their family so that they can actually, you know, maintain being [00:14:15] in that role, uh, for as long as it works for both of you.

Right? But remember, you're selling them on the future, [00:14:20] not on what's happening [00:14:25] today.