Why Clinic Directors Leave for Staff Roles in Cash-Based PT Clinics

At first glance, it doesn’t make sense. Why would a clinic director—a leadership role with higher pay and status—step down to become a staff PT in a smaller, cash-based practice?

It’s a trend I’ve seen more than once, and I recently had another conversation that reinforced why this happens. The reasons are deeper than money. They’re about quality of life, career longevity, and the satisfaction that comes from practicing at your highest level.

The Scenario

A clinician I spoke with left a corporate, high-volume clinic where he was running the show as a director. On paper, he gave up leadership, higher income, and benefits. But he gained something he valued more: energy at the end of the day.

He told me he used to come home drained, unable to engage with his wife or even have a real conversation. Since moving into a cash-based clinic with lower patient volume, he now has energy left for family, hobbies, and life outside the clinic.

That trade-off speaks volumes.

The Three Main Drivers

1. Work-Life Balance
Corporate clinic directors juggle patient loads, documentation, staff management, marketing, and more. Even at “moderate” volumes (15–16 patients a day), the pace wears people down. In cash-based clinics, lower volume means PTs can actually breathe. It’s not just about fewer patients—it’s about reclaiming time, energy, and health.

2. Career Longevity
Burnout is real. High-volume settings push many PTs to the edge where they start considering leaving the profession entirely. Cash or hybrid models with sustainable caseloads extend careers. Clinicians can see themselves still loving the work 10–20 years down the road.

3. Clinical Satisfaction
Many PTs feel limited in high-volume environments—like driving a car stuck in second gear. They can’t fully use their skills, dive deeper into care plans, or address lifestyle factors like sleep and nutrition. In cash-based clinics, PTs get to operate in “fifth gear,” doing the work the way they always imagined it.

What Owners Need to Know

Here’s the key: not everyone is driven purely by money. Lifestyle, culture, and meaningful work often weigh just as heavily. But owners still need to meet candidates halfway.

• Compensation must be “good enough.” You can’t get away with rock-bottom salaries and unrealistic commission structures. Pay close to staff PT market rates, even if it’s below what a director might earn in a corporate setting.

• Growth opportunities matter. Many former directors don’t want to stagnate. Show them a path where they can step back into leadership, mentor others, or grow with the company as it expands.

• Culture is your superpower. Talk openly about work-life balance, autonomy, and energy outside the clinic. This is what sets you apart from in-network competitors.

The Owner’s Advantage

Cash-based clinics are uniquely positioned to attract talent if they get this right. Lower volume, clinical freedom, and a healthier lifestyle are powerful draws.

If you can combine that with competitive pay and a visible growth path, you’ll never struggle to hire top clinicians. In fact, you’ll likely have your pick of ambitious PTs who see your clinic as a place where they can thrive long-term.

Final Thoughts

The takeaway? Work-life balance is your secret weapon in recruiting. Many directors are willing to trade higher income for the chance to enjoy their lives, practice at a higher level, and have energy left for their families.

As an owner, lean into this. Highlight it. And never forget: you’re not just hiring clinicians—you’re inviting team members to join you on a journey.

Action Steps

• Revisit your comp structure. Is it competitive with local staff PT salaries?

• Create a clear career pathway: staff → senior → leadership.

• Sharpen your clinic’s “pitch”—focus on lifestyle, impact, and autonomy.

• Have deeper conversations with candidates about what they want their life to look like.

Resources:

• PT Biz Website 

• Free 5-Day PT Biz Challenge

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Podcast Transcript

Danny: 

[00:00:00] Hey, Danny Matta here, founder of PT Biz, and today I'm gonna talk to you about why a clinic director is willing to take a [00:00:10] job at a cash-based clinic in a staff PT role. So this is something that I've now seen multiple times. [00:00:20] At the the clinic that that I started Athletes Potential. I just was there today.

I had a great visit with a fantastic clinician who has recently come on with that [00:00:30] company. And I had an opportunity to talk to him while he was working on my back. I was there to get some. Soft tissue work done and to get some help maintaining [00:00:40] my my health.

And he was awesome. And what was cool is I had a chance to talk to him about the role he was in previously, the things that he liked, didn't like about it. [00:00:50] And why would he take a role as a staff clinician in a cash-based clinic versus giving up the clinic director position that he was in, in a high volume.

Corporate clinic [00:01:00] that has clinics all over the southeast. This is not the first time this has happened. This clinic, by the way, we've actually had multiple clinicians that have done the exact same thing that are still employed there. [00:01:10] And I'm gonna talk about why you're seeing this, the unique advantage that these clinics have and what you need to understand to lean into as well if you're trying to hire, because [00:01:20] not everybody cares about just money.

And and I'm gonna talk about the things that are just as important for many people but where we also need to meet them in the middle in order [00:01:30] to to be able to have compensation be comparable. When we look at the reasons why a clinic director somewhere will give up more income [00:01:40] in order to take a staff job, it really comes down to a couple factors.

The number one work life balance. The hours that you put in running a clinic as a clinic director, the documentation [00:01:50] time, the the things that go around marketing that, the staff training things there, there's a lot of work that goes into that job, let alone the full-time caseload that you have.

And this [00:02:00] individual is telling me they were seeing not a huge volume, 15, 16 patients a day, which to be honest with you, still a lot. But it's not. Maybe 10 to 15 people more than [00:02:10] that, which the clinic that he left I know people that have worked in the same one the same the same company and their volume is really high.

I would say probably closer to 20 to 30 visits is more the [00:02:20] standard that, that I'm aware of that. And that's a lot. And the thing that he told me that I thought was really interesting was the work-life balance side of things with being married, [00:02:30] starting a family, and wanting to be able to have energy left over for your family at the end of the day was a big driving factor.

And I've been there. I understand that that's the [00:02:40] interesting thing about it is like I can totally relate because, whenever I was seeing high volume in the military, especially in my last job when I would've sick call hours, I'd have, 20 plus people [00:02:50] come in the first couple hours of the day.

And it just was like so hard. Then I had a caseload after that. I would just come home and I would fall asleep on the couch. I just wasn't a enjoyable person to be around. I [00:03:00] had no energy left for my family. I had nothing left to share with them. At the end of the day, I just was tired and just brain dead.

'Cause they throw so much at you and for him, he said, dude, it's been [00:03:10] so cool to go home and have a conversation with my wife, see, see how her day went to be able to do things around the house that he still has energy to do. And and to really have this sort [00:03:20] of this sense of having energy and being energized at the end of the day, come back because the work is still interesting with what we do in a cash based clinic, but the volume is not quite as intense and that's huge.

The [00:03:30] second thing is longevity of career. So for some people, here's the decision they make. Do I leave the profession and do something else or [00:03:40] do I take a role in a cash-based clinic or a low volume clinic? It could be hybrid but a lower volume clinic and try to extend my career by [00:03:50] not having as much burnout from the volume.

And we know that is actually. At least, I don't know if there's research that shows this, but subjectively almost everybody that I talk to, [00:04:00] the volume of work, the volume of visits, the high volume side of things is really challenging for a number of reasons. But it is very intense.

The amount of work is very [00:04:10] intense, and it does create a lot of burnout. So when you strip the volume down and you have lower volume, it does give people an opportunity to really elongate their career because they're not actually getting burnt out as fast Now. The [00:04:20] depth of conversations and people that can be really empathic, can very much feel very burnt out from some of the complexity that you might see in a clinic like that.

But you're gonna get that in a regular clinic as [00:04:30] well, right? So that's just a personal thing. I don't think you can change that besides working on yourself to make sure that you're not taking other people's stuff on yourself and you're, you have compassion, but you're not like letting the [00:04:40] empathetic side of yourself.

Take everybody's shit home with you. So that, that does create burnout, but that is more of an internal than an external reason. The third thing [00:04:50] is clinical SA satisfaction. So the satisfaction of working in a clinic and enjoying. Using your [00:05:00] skillset to the best of your ability, not being hamstrung by the fact that you have two people in there at one time and you don't really have the opportunity to sit down and have a conversation with somebody [00:05:10] about something like maybe sleep or nutrition or movement or being able to write a treatment plan for somebody that's a little bit more elaborate, a little bit more in depth because you frankly don't have the [00:05:20] time to do it.

It to me, whenever I was in these settings where I felt limited and constrained by the environment, it was me feeling [00:05:30] like I had more to give. It's like driving a car and if, I dunno, I'll age myself here, but like a manual, where you like shift things that's a, that, that's how cars used to [00:05:40] work.

But you'd have to shift it and put it in different gears depending on how fast you were going and. If you're driving a car like that and you could only drive in second gear, you could only go so fast and [00:05:50] then you start like revving your engine and it's frustrating, right? But if you're in a clinic and you can only put your skillset into second gear and you want to go and see what you can do, that's frustrating [00:06:00] and that will actually cause you to get very unhappy with your career trajectory.

Especially if what you do is like there, there are some people that, that what they do as a clinician is their [00:06:10] job. There's other people that what they do as a clinician isn't a work of art to them, it's their art form. It's the thing that they're trying to be the best in the world at. That is the kind of person that you wanna try to hire.[00:06:20]

That is the person who's fantastic in clinics like these, that's actually who thrives in clinics like these because they feel a lot of personal satisfaction about being able to use. Their skillset and all the hard work that [00:06:30] they've put into that, to the best of their abilities and get the outcomes that people want and that they want to help them get.

And they get a lot of personal satisfaction and take a lot of pride [00:06:40] in the quality of care that they are able to give people in the outcomes they're able to get in. The ability to be that cleanup person that nobody's been able to help this person, [00:06:50] but you haven't seen me yet. Let me take a crack at this.

And they feel very competent and confident about their ability to use their skillset. That is a, I would say, overall [00:07:00] sort of theme that I see with some of the best hires we've ever meet ever made. And oftentimes they're in management roles, right? Because they've been around. They're a [00:07:10] good clinician.

They probably are punctual. They show up on time, so they get a clinic director role. And along with that comes probably a lot of administrative duties that they don't actually like. So [00:07:20] these are reasons why people would leave to come to a clinic, but you gotta meet them halfway. And there's two things that [00:07:30] you have to have in place, or at least the trajectory to have these in place, number one.

You have to have good enough compensation. [00:07:40] Okay? And what I mean, good enough, it just, you can't have these sketchy, super low base salary. 50% of what you make is [00:07:50] bonuses heavily tied to volume, and you really bring a lot of people in yourself. Like we used to be able to get away with stuff like that. It doesn't work like that anymore.

And you're really gonna only [00:08:00] attract people that are willing to take these just incredibly aggressive comp structures, which are probably very risk tolerant people. And they're not gonna stick around your clinic anyway. That's not what you're looking [00:08:10] for. So it needs to be good enough. It needs to be a salary.

That is it is good enough to where it's comparable to what they could make now. Maybe not what they [00:08:20] could make as a clinic director in a really high volume clinic. But you can't really compare those two things because the amount of output you're gonna get is not the same one versus the other.

You're seeing that amount of volume. [00:08:30] You're managing clinics, you're maybe getting a profit share amount from that clinic or something to that effect. It, you can't really compare the two, but you need to be really close to what a staff, clinic, job [00:08:40] salary would be in your area. And this is where, I really feel like the advantage to a clinic that does a good job of charging what they're worth and building up their [00:08:50] revenue per provider to a realistic amount or a really good amount.

They have an unfair advantage because if you can provide better work-life balance, you can increase career [00:09:00] longevity, you can have better clinical satisfaction. You can help them have energy left over at the end of the day. End of the day, use their skillset the way that they deserves.

You got it right. You [00:09:10] got that. All those boxes are checked. If they can make what they make in a clinic, in an in-network clinic, at the same time, they're, you're gonna have no issues whatsoever [00:09:20] Hiring. And it's really important to understand these pain points because I'm sure you felt these yourself and instead of you looking for a job doing something else, you decide to start your own clinic.

But not [00:09:30] everybody is in an environment to do that or has the desire to do that. It's difficult, if you listen to this and you have a clinic, it's just, it's not the right path for everybody and there's nothing wrong with that. But if you [00:09:40] can have a job where you work with a really cool company and you feel very personally satisfied, you're able to make a.

A good income for your family. And you, you can take [00:09:50] pride in the work that you do and you don't have to leave the profession. That, I think it's a fantastic compromise in many ways. And aside from the compensation being good [00:10:00] enough for many people, and this isn't everybody, but for a lot of people you're gonna get that leave a clinical clinic direct role and not everybody does that, but when they do that, you also have to [00:10:10] have.

Opportunities, future opportunities where they see that the company is moving in a way where they can grow with it. Now, if they take a step back and they just say, cool, I'm just gonna be a [00:10:20] staff clinician forever. Maybe they hated being a clinic director at number one. And that's actually what they want.

And as long as they have a compensation opportunity continue to grow as a, as [00:10:30] they grow with the clinic, cool. But for a lot of them, they wanna see that there's an opportunity to potentially. Move back into a leadership role as the company grows. And this is the interesting thing, as a business owner [00:10:40] sometimes, whether you like it or not, you have to grow your clinic to create opportunities for your staff.

[00:10:50] Because if you don't create opportunities for your staff, they will look for opportunities other places and. If you don't want to really grow and have multiple locations in a big team, that's [00:11:00] fine. You make that decision. There's nothing wrong with that. That could be very well the clinic type that you want the business vehicle that makes the most sense for you and your [00:11:10] family and for the goals you have.

But you're gonna take people that are a players that they end up looking for the next thing, the next step forward in their [00:11:20] career. If you can't provide that for them, they'll go find it somewhere else. Maybe they do it on their own or maybe they go and work somewhere else, right?

Because they're probably pretty ambitious and [00:11:30] they want that leadership responsibility. They wanna move into a role where they're a leader in the company. So if you can create opportunities and you can grow the business [00:11:40] and and be able to have opportunities where they can move into leadership positions in a number of ways, whatever that looks like in your clinic, then all of a sudden you can take these people that have taken a step backward with you and they [00:11:50] see a path where they can move back into a comparable role comparable position, and a comparable amount of income.

And if they see that, now all of a sudden you've basically [00:12:00] got. A com, a perfect recipe for the ability to be able to hire most people that come your way, that, that are the right fit for you, right? Hiring is incredibly [00:12:10] complex, important part of the business and getting it right is. Such a vital part of of not seeing a big step back in your business.

One, one of the bigger problems we see is [00:12:20] if people make a bad hire and then that person turns over within three to six months. It's just one of the biggest things that stalls the growth of your business. So if you can [00:12:30] have the right hires and you can give them the right pathway forward.

Even if you have retention of three years with a provider, like that's not that long. [00:12:40] But damn, that is a game changer for you in terms of the ability to continue to grow your clinic. And obviously if you create an environment you hope that people stick around for as long as they wanna work [00:12:50] and that you continue to have great, work-life balance for them and they love the culture and they are really proud of the business they get a chance to work with.

They have opportunities to grow if that's what they want to do. [00:13:00] That's a, the ideal environment. That's the cash based clinic utopia that so many of us are trying to work towards. And the net reality of that, to just be completely honest, comes down to one thing, [00:13:10] and it comes down to your ability to charge what you're worth and to generate enough.

Income to where you can do these other things. It's, you need enough income per provider so you can pay [00:13:20] them well enough without killing your margins. You need enough income per provider so that you can afford to have a cool space and a space that you can build out. And it's a place they want to come and they feel [00:13:30] proud to tell people they work there and when their family comes there, they think, what a great place to work.

You have to have the revenue per provider to be able to pour back into them with benefits to provide continued education, [00:13:40] to have, generous, programs in terms of them taking vacation to have things like 401k and benefits in place that they want and they need.

And it, it's what big businesses do. [00:13:50] They put their big boy, big girl pants on and they provide real things in a business, and you have to grow into that. You can't start with that whenever you're in a subleased office and cross a gym or whatever. That doesn't start [00:14:00] there. But eventually you have to get there if you want to attract the right talent the best talent in your area.

It's looking for these things where they have work-life balance and then career longevity. And [00:14:10] they can use your skillset the way they want, but you have to meet them halfway with compensation that's at least comparable or close to it, and a path to where they can get back to something that they're [00:14:20] leaving so that they can see growth in their own career as well.

And this is a really cool time, I think, if you have a clinic that is, a bit more [00:14:30] established. If you're just starting, you're obviously not gonna hire somebody that was a clinic director somewhere because they don't trust that your business is gonna be around. But if you've been around for five to 10 years [00:14:40] and you have a track record of.

A being there, like the stability of that is actually quite attractive to clinicians. 'cause guess what? Clinicians aren't the most risk, tolerant [00:14:50] group of people. We typically are very risk averse. We want security. You don't go into physical therapy thinking you're gonna make half a million dollars a year.

Like that's just not really how it works. And [00:15:00] that's cool because the career is very personally rewarding. And as long as they make good income and they like where they work, most people are totally cool with that. And they're happy with that. You have this opportunity if you [00:15:10] get past this scale, this stage where you're small and you're viewed as a little more risky, which I think is the hardest stage.

This starting to growing past yourself to your first one or two providers [00:15:20] and building out a standalone space. There's a lot more risk associated with that than there is expanding. Once you have four or five providers and now you're gonna open up another office, you already have proof of concept, you have a [00:15:30] reputation, you have a lot of cash flow from the business and the stability of it.

So there are plenty of opportunities to grow past that and to really attract these talented [00:15:40] candidates. But getting there, that's step one, right? Step two, you gotta really meet people with the right benefits, the right comp packages. And don't forget, when you're interviewing somebody, [00:15:50] these questions about the work-life balance side of things, the things they wanna be able to do, the the energy they wanna be able to have when they're not there. This is what [00:16:00] drives most people to want to make a change and come to a clinic like this. It is your superpower. It is such an advantage. Don't leave that on the table, please, [00:16:10] God, talk to 'em about this because that is a huge decision maker for them.

And if you skip that conversation because you're uncomfortable with what that might feel like to have a discussion on that level, man, you're [00:16:20] dropping the ball on being able to acquire. Fantastic talent in the business that can work with you as a team member. And keep in mind, I never, ever [00:16:30] say someone works for a business or for a business that I have.

I think it's a terrible way of describing the people that work with you. These are team members, they work with [00:16:40] us. We all have different jobs, we all have different roles, but we work together. Period. And for you to attract people like that, you have got to be able to have discussions with 'em about things that are the human element [00:16:50] of them.

Of the life that they want that has nothing to do with their credentials, what school they went to, the volume that they can see, compensation, all that. Let's have a [00:17:00] discussion about what do you want your life to look like? Is this the right fit for you and for the clinic that you're looking for?

'cause if it is. Cool. We would love to go on that journey with you and you can be a [00:17:10] part of this culture in this company. And if not, it's great to know that too, because we'd rather not bring the wrong person in and you'd rather not make the wrong decision. Saves us both a lot of heartache and time.

So that's it. [00:17:20] I'll summarize real quick with this. You are in such an advantage as a cash based clinic in particular. If you have low volume and you have a great work-life balancing culture period, you it, it is your huge [00:17:30] advantage. Over in-network clinics, you can be even close as far as comp goes. You are not gonna have a hard time hiring people or getting talented people that wanna work with you.

The hardest part is gonna be that [00:17:40] first three to five years where people just don't know if you're gonna be around. They view you as risky. Once you get past that, if you really want to grow. That's the stage to lean into it from a standpoint of really being able to to hire. But [00:17:50] make sure you're talking to 'em about the things that are important to them and you're meeting them with compensation that is reasonable and that they see a path to continue to grow.

I appreciate you watching and listening if you have been listening for a long time. Thank you so [00:18:00] much. The person who I saw today ironically listens to the podcast. So shout out. Thank you so much for listening. I won't shout you out by name, but I really appreciate it. I really appreciate your help today.

Fantastic [00:18:10] manual therapist. So thank you so much. And as always, thank you so much for listening and watching, and I'll catch you next time.