Trying to make sense of the debt/odds of opening a cash practice

[Daniel M. Pitta]

I've put a tremendous amount of effort into where I am now, where I'll be applying to ~5 schools in July for the 2017 cycle. As a non-traditional student, I had to go back to take post-grad work, juggling multiple jobs and paying out of pocket for prereqs. maintaining a 3.7 gpa and getting solid scores on the GRE. I feel confident that I will get into at least one program this cycle.

However, I am aggressively paying off my remaining 20k in student loans from undergrad, from a degree which ended up being of little use to me (a kick in the balls). Almost 50% of my current income is being put towards paying off high-interest loans, so it's a bit of a sneak peek as to what life will be like once completing DPT school. I'm trying to make sense of the astronomical amount of debt I could be looking at if I don't get into one of the cheaper in-state schools here in Maryland. Even though I love the profession (have worked as a tech for 2 years, done personal training for 5 years working with primarily post-rehab patients, shadowed acute-care inpatient, etc.) I have read many disconcerting reviews of the profession from current PTs on this and other sites, as well as mostly negative things about the outlook of the career in general from PTs I've worked with or shadowed, whose opinions I respect. This makes it very stressful for me, as it's difficult to imagine myself doing anything other than PT, especially with how much I've already put into it.

My friends tell me to go the PA or AA route instead (stronger income, less schooling/debt), but that's almost completely switching gears, and I have zero experience in either of those fields. I'm just looking for opinions and positive feedback from some of the current students that have been in similar situations.

Also, to make sense of dealing with the debt that comes with DPT school, to me it would be paramount that I open my own practice. With insurance reimbursement and DPT salaries potentially declining (from everything I've read/heard), it only really makes sense to enter the field for me if I can open my own cash practice. I realize that's easier said than done, but in that scenario I at least can be my own boss and don't need to rely on Medicare or other stingy insurance companies for my livelihood, and it may make it easier to pay off said student loans. I've wanted to be in this field for years, but it needs to make financial sense as well. I want to have a good work-life balance and be able to invest, save for retirement, etc. without being handcuffed by loans and a mediocre salary. I will also be 30yo at the time of matriculation, for what that's worth.

Thanks in advance.

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[mn977]

I've put a tremendous amount of effort into where I am now, where I'll be applying to ~5 schools in July for the 2017 cycle. As a non-traditional student, I had to go back to take post-grad work, juggling multiple jobs and paying out of pocket for prereqs. maintaining a 3.7 gpa and getting solid scores on the GRE. I feel confident that I will get into at least one program this cycle.

However, I am aggressively paying off my remaining 20k in student loans from undergrad, from a degree which ended up being of little use to me (a kick in the balls). Almost 50% of my current income is being put towards paying off high-interest loans, so it's a bit of a sneak peek as to what life will be like once completing DPT school. I'm trying to make sense of the astronomical amount of debt I could be looking at if I don't get into one of the cheaper in-state schools here in Maryland. Even though I love the profession (have worked as a tech for 2 years, done personal training for 5 years working with primarily post-rehab patients, shadowed acute-care inpatient, etc.) I have read many disconcerting reviews of the profession from current PTs on this and other sites, as well as mostly negative things about the outlook of the career in general from PTs I've worked with or shadowed, whose opinions I respect. This makes it very stressful for me, as it's difficult to imagine myself doing anything other than PT, especially with how much I've already put into it.

My friends tell me to go the PA or AA route instead (stronger income, less schooling/debt), but that's almost completely switching gears, and I have zero experience in either of those fields. I'm just looking for opinions and positive feedback from some of the current students that have been in similar situations.

Also, to make sense of dealing with the debt that comes with DPT school, to me it would be paramount that I open my own practice. With insurance reimbursement and DPT salaries potentially declining (from everything I've read/heard), it only really makes sense to enter the field for me if I can open my own cash practice. I realize that's easier said than done, but in that scenario I at least can be my own boss and don't need to rely on Medicare or other stingy insurance companies for my livelihood, and it may make it easier to pay off said student loans. I've wanted to be in this field for years, but it needs to make financial sense as well. I want to have a good work-life balance and be able to invest, save for retirement, etc. without being handcuffed by loans and a mediocre salary. I will also be 30yo at the time of matriculation, for what that's worth.

Thanks in advance.

Why not talk with PT business owners who own cash-based practices in your area and those who do not own cash-based practices? In my experience, people in general are more willing to pay for personal training sessions rather than physical therapy sessions (as they reason that insurance pays for that). This is the impression I get in talking with physical therapists that I have observed and in my previous experience as a personal trainer for a high-end gym in an affluent area. I knew a PT who did cash-based, but he was very niche market, working with triathletes and runners in NYC. He didn't charge very much though ($60 per treat, not much greater than how much some insurances reimburse; though the zero paperwork and hassle is a huge plus). As with any business, there are also business expenses to consider and start up costs and time spent on administrative work with no pay. Don't expect to make much first few years owning a business.

 

[apta_pharaoh]

Good question but can't you do both cash and insurance based? My facility does that now some use medicare until it runs out then they pay, some just pay, some just use insurance.

Regarding other professions a chiropractor I worked with made people sign up for a year and had monthly payments and it was great because even when they stopped coming he got paid for a year (like a gym). Ironically this same chiropractor told me if he could do it all over he would have become a PA. I thought about PA many times.

What are your stats your stats? I applied to 10 schools got waitlisted by most but ended up getting into my #1 an 2 schools. That was lucky I think. I would suggest applying to more schools if you have the money for it to increase your chances of getting in.

 

[beestrng]

My Pt friends say that Pelvic floor therapy makes mad bank. Idk any who specialize in it tho...

 

[DesertPT]

I have read many disconcerting reviews of the profession from current PTs on this and other sites, as well as mostly negative things about the outlook of the career in general from PTs I've worked with or shadowed...
...DPT salaries potentially declining (from everything I've read/heard)

I call bull crap. The internet is in general very negative when it comes to these things, so don't take it too seriously. Pissed of people are a whole lot more likely to take to their keyboards than all the folks who are happy and content, particularly on anonymous forums. Social media can sometimes be a better spectrum of responses.

I have seen little evidence that the overall career outlook for physical therapists is bad. I also don't believe that salaries are declining. Stagnating maybe, but not declining.

Every field has many pros and cons, but I for one am very excited about the future of physical therapy. I could ramble on for days but suffice it to say that once you start reading things besides internet message boards you'll have a lot better perspective.

Try joining the Facebook group "Doctor of Physical Therapy Students". You'll see a lot of people who are very excited about the profession (once you sift through all the posts of people selling used board exam study guides, promoting random manual therapy gurus, asking what a typical salary is and trying to find housing for clinicals, lol).

 

[DesertPT]

Also, for the first couple years at least, owning a private practice will do the opposite of help you pay off student debt. And getting the financial backing to do so as a brand new grad with huge loans could be a tall order. There are tons of resources on the internet that cash based PTs are putting out there though (often for the right price of course!)

 

[Grizzlyman]

If you have never started or ran a business, doing so with intent on immediately making more money is probably unlikely. I'm sure you will be successful running your own clinic but it can be extremely difficult if you do not already have financial flexability. The biggest issue is getting patients and building referral sources. Remember these referral sources already have relationships with PTs, so you are essentially going to have to build a relationship enough with them that they are willing to stop referring to their old source and start referring to you. You are also going to have to maintain these relationships and make them valuable to the referrer. This takes time and intentionality.

As to a cash only business. It is possible but you are really trying to attract a very small group of possible patients. Nothing wrong with that but that would take much more time to develop a practice. Getting paid cash can be equally as difficult as insurance and sometimes not as profitable. From a businesses perspective you would target a niche customer base, not necessary their payment methods. You need to be the expert in the niche if cash only means more cost for a consumer. It will also drastically affect your referral sources as you will be refusing to help the majority of patient's that are referred to you. Just something to think about.

Since you understand how much debt sucks and understand the importance of paying it off, you may be better taking a job for a few years in a clinic to become really efficient as a PT and have mentorship. While doing this you can still do home care a few days after work or on Saturday for extra cash to pay off debt. It will still be less hours than starting your own clinic. You can also start building relationships with referral sources so you can hit the ground running once you are debt/free and more experienced. You can actually start building those relationships now, and while you are at school. Target potential referral sources, become friends, help them out as much as you can and let them know your plans. This is not easy but it is the basis of every successful business. Advertising is extremely expensive and has low bang for the buck in comparison.

I also think, once you own your clinic that you may be able to increase income, not necessarily from going cash only but adding additional services. Just some ideas but you could have offer yoga classes/pilates/or personal training prior to or after clinic hours (This means hiring someone not doing this yourself). It could be branded the same as your clinic. You can partner with a running shoes store and have a retail section. There are many potential streams of revenue if people trust and like you and can find value in your offer.

In general medical care and especially PT is a volume business. If you wan too make more than a PT you need to have enough volume so that you have a few PTs working for you. It is much easier to have a few worker bees than hunt for those few people willing to pay the premium cash price especially if they perceive the value equal to the clinics that accept insurance.

Good Luck, You will do fine but you really have a lot to consider on the business side.

 

[jblil]

My Pt friends say that Pelvic floor therapy makes mad bank. Idk any who specialize in it tho...

One of my classmates took a job as a Pelvic floor PT when we graduated. I'll have to ask her how she likes it... As for me, you'd have to pay me big bucks to stick my fingers in other folks' nether regions!

 

[Daniel M. Pitta]

Why not talk with PT business owners who own cash-based practices in your area and those who do not own cash-based practices? In my experience, people in general are more willing to pay for personal training sessions rather than physical therapy sessions (as they reason that insurance pays for that). This is the impression I get in talking with physical therapists that I have observed and in my previous experience as a personal trainer for a high-end gym in an affluent area. I knew a PT who did cash-based, but he was very niche market, working with triathletes and runners in NYC. He didn't charge very much though ($60 per treat, not much greater than how much some insurances reimburse; though the zero paperwork and hassle is a huge plus). As with any business, there are also business expenses to consider and start up costs and time spent on administrative work with no pay. Don't expect to make much first few years owning a business.

What you've suggested is exactly what I've been doing since the Spring semester ended...from what I've gathered, finding a niche and developing mastery of it are key to success in cash-based practices, as well as catering to affluent populations (which is probably obvious). To me, the peace of mind that comes with the autonomy of being your own boss and building your own brand are worth the time it takes to become a successful business owner/entrepreneur. Dealing with micro-mangers and/or overbearing bosses is not a long-term option for me at all, given my personality.

If you have never started or ran a business, doing so with intent on immediately making more money is probably unlikely. I'm sure you will be successful running your own clinic but it can be extremely difficult if you do not already have financial flexability. The biggest issue is getting patients and building referral sources. Remember these referral sources already have relationships with PTs, so you are essentially going to have to build a relationship enough with them that they are willing to stop referring to their old source and start referring to you. You are also going to have to maintain these relationships and make them valuable to the referrer. This takes time and intentionality.

As to a cash only business. It is possible but you are really trying to attract a very small group of possible patients. Nothing wrong with that but that would take much more time to develop a practice. Getting paid cash can be equally as difficult as insurance and sometimes not as profitable. From a businesses perspective you would target a niche customer base, not necessary their payment methods. You need to be the expert in the niche if cash only means more cost for a consumer. It will also drastically affect your referral sources as you will be refusing to help the majority of patient's that are referred to you. Just something to think about.

Since you understand how much debt sucks and understand the importance of paying it off, you may be better taking a job for a few years in a clinic to become really efficient as a PT and have mentorship. While doing this you can still do home care a few days after work or on Saturday for extra cash to pay off debt. It will still be less hours than starting your own clinic. You can also start building relationships with referral sources so you can hit the ground running once you are debt/free and more experienced. You can actually start building those relationships now, and while you are at school. Target potential referral sources, become friends, help them out as much as you can and let them know your plans. This is not easy but it is the basis of every successful business. Advertising is extremely expensive and has low bang for the buck in comparison.

I also think, once you own your clinic that you may be able to increase income, not necessarily from going cash only but adding additional services. Just some ideas but you could have offer yoga classes/pilates/or personal training prior to or after clinic hours (This means hiring someone not doing this yourself). It could be branded the same as your clinic. You can partner with a running shoes store and have a retail section. There are many potential streams of revenue if people trust and like you and can find value in your offer.

In general medical care and especially PT is a volume business. If you wan too make more than a PT you need to have enough volume so that you have a few PTs working for you. It is much easier to have a few worker bees than hunt for those few people willing to pay the premium cash price especially if they perceive the value equal to the clinics that accept insurance.

Good Luck, You will do fine but you really have a lot to consider on the business side.

Duly noted...my original plan was/possibly still is to team with either a chiropractor or another PT with a different skillset to maximize services that I can offer. One of my first tech jobs was for a PT/Chiro joint practice that also offers nutrition (RD on staff), massage, personal training (after-hours) acupuncture, cupping, and knee injections (PA on staff). It was a fascinating place to work and a great learning experience. It also made me a much better trainer. They are making bank and have built up their referral sources, though it took a few years. That would be a dream come true for me to run a one-stop shop practice like this.

 

[Daniel M. Pitta]

Good question but can't you do both cash and insurance based? My facility does that now some use medicare until it runs out then they pay, some just pay, some just use insurance.

Regarding other professions a chiropractor I worked with made people sign up for a year and had monthly payments and it was great because even when they stopped coming he got paid for a year (like a gym). Ironically this same chiropractor told me if he could do it all over he would have become a PA. I thought about PA many times.

What are your stats your stats? I applied to 10 schools got waitlisted by most but ended up getting into my #1 an 2 schools. That was lucky I think. I would suggest applying to more schools if you have the money for it to increase your chances of getting in.

It's a possibility...that is actually a great business model and a Chiro that I worked for did something similar. Also most commercial gyms do this with new personal training clients to hedge against people that are flakey and cancel/reschedule on short notice, so that the gym and the trainer don't get screwed. The gym where I'm currently training is a non-profit and clients renew on a per-package basis, which can be annoying. Much more responsibility falls on the trainer to keep their schedule tight, which can add stress and anxiety. I think contracts are the way to go, because many people aren't going to prioritize PT sessions unless they're in debilitating pain, unless of course you can build value in them coming to see you (marketing).

My prereq GPA is a 3.7, undergrad was 3.0 (graduated with a BA in Social Sciences that I never used), GRE : 157V 151Q 3.5 Writing...I messed up by not practicing the essays at all and focusing ~90% of my time and energy on going over the math because I struggle so much with even basic algebra. But those stats should be good enough to get accepted to at least one program, especially the less competitive ones back home (western NY).

Also, for the first couple years at least, owning a private practice will do the opposite of help you pay off student debt. And getting the financial backing to do so as a brand new grad with huge loans could be a tall order. There are tons of resources on the internet that cash based PTs are putting out there though (often for the right price of course!)

So far my top 5 schools are: Baylor-Army, UMES, UM-Baltimore, NOVA Southeastern (Fort Lauderdale), Daemen and D'Youville (Buffalo). UMES would be first choice because the tuition is a fraction of any of the other programs, and Baylor-Army would be great due the military benefits and getting out with zero grad school debt. Getting out with zero debt and a pension would make opening up a practice much more feasible.

 

[Grizzlyman]

Duly noted...my original plan was/possibly still is to team with either a chiropractor or another PT with a different skillset to maximize services that I can offer. One of my first tech jobs was for a PT/Chiro joint practice that also offers nutrition (RD on staff), massage, personal training (after-hours) acupuncture, cupping, and knee injections (PA on staff). It was a fascinating place to work and a great learning experience. It also made me a much better trainer. They are making bank and have built up their referral sources, though it took a few years. That would be a dream come true for me to run a one-stop shop practice like this.

Very interesting practice. I have wondered why more PT clinics do not have massage and chiro on staff. Personally I am very suspicious of chiro, but if a patient wants the service and believe it helps, it could be good business driver. Also, hiring a chiro and PRN massage is relatively inexpensive. This is the dark side off owning a business that most people never think about.

 

[beestrng]

One of my classmates took a job as a Pelvic floor PT when we graduated. I'll have to ask her how she likes it... As for me, you'd have to pay me big bucks to stick my fingers in other folks' nether regions!

The ones I have seen tend to be female.Read that they dont take insurance or its not covered maybe.

 

[redrose424]

The ones I have seen tend to be female.Read that they dont take insurance or its not covered maybe.

I'm actually very interested in that specialty, although I believe it is the one with some of the fewest certified PTs. Good to know you've heard they make good money!