Why keeping my costs low keeps your pocketbook full- Five reasons that going to a cash-based physical therapist will benefit your health and your budget.

I'm not going to say that starting my own physical therapy practice was easy, but truth-be-told it wasn't the hardest thing I've ever done either. It wasn't like trying (and failing, as I recall) to get an A in Dr. White's Neuroanatomy class. Nor was it like giving up sugar, peanut butter, cream in coffee, etc while on the Whole 30. It was never like watching my parents try to pretend that they aren't tearing up when I leave at the end of a visit. 

Nope, opening my own practice was hard in some ways, and easy in others. I am a very financially risk averse person, which sounds contradictory coming from someone who just transitioned away from a steady income, retirement benefits, and paid holidays. However, my focus on keeping my business costs low and quality of service high made this transition less-than-terrifying. In fact, I'd actually call it exciting and inspiring. 

To summarize, when I opened Leah Sawyer Physical Therapy I made a commitment to use funds only if it improved my skills as a therapist. Don't get me wrong, I have spent a great deal of personal savings. I have certainly taken risks. Yet I've invested in things that I believe in and that I know are necessary, such as continuing education courses, a Certified Public Accountant (they say know your weaknesses, cookies and accounting are mine), and a lawyer who specializes in entrepreneurship (she is the absolute bomb, check her out HERE). Anything in the "expense" column for Leah Sawyer PT must meet one of the following criteria:

  • Does this directly benefit the recovery of our patients?
  • Does this directly improve our ability to provide high quality, affordable therapy?
  • Is this necessary for the short and longterm function of the business?

If the service or item does not qualify, it gets left on the actual or figurative shelf. 

So how have I been able to open my doors with relative ease, and how does that benefit get passed onto you, the patient? There are five main ways:

1. Savings in rent. I have elected to be a somewhat mobile practitioner due to the grace of a few local business owners: Robin Frazier of Franklin Massage Center, Lee Wilson of Nashville Running Company, Kathy Mead of Fit For You Nashville, and Darren Purcell of Train Smart Nashville to be specific. This has allowed me to offer a convenient location to most Nashvillians, from Cool Springs to Belle Meade to Edgehill to East Nashville. Accessible health care is one of my many passions, and accessibility includes geographic accessibility... i.e. location.  

Accessibility also includes economic accessibility, or cost. My rent is not a monthly, fixed fee. Instead, I pay rent on a per-patient basis. This means that the business I rent space from is always making money, and so am I. How symbiotic! How do you, as the patient, fit into this happy equation? Let me explain- I am not pressured to see a certain number of patients in order to "make rent". Nor am I hindered from taking a few days to travel, attend a continuing education course, or just holing up to write. I am only driven to treat patients and treat them well. As a result, I am able to pass those savings on to you by charging substantially less than market value. Go ahead and check the full price of your last physical therapy appointment, or get an accurate quote from a physical therapy office that follows a more traditional model of treatment. Let me know how I compare. 

2. Purchasing supplies that are high in quality, not cost. Recall my above criteria for what qualifies as an appropriate expense. I practice with very limited and simple supplies, including: massage cream, ASTYM tools, tape, theraband, a table, and most importantly...my hands and my mind. I have invested greatly in the latter two. What I have not invested in is an expensive ultrasound machine, e-stim (electric stimulation) device, red light laser, cold laser...the list goes on and on. Why? Because these modalities have very poor research supporting their effectiveness and benefit patient recovery far less than an equivalent amount of time spend on manual therapy, corrective exercise, and simple patient education. 

Would it be easy for me to purchase a shiny new machine, hook you up on it for 15 minutes, and walk away while I do my notes and charge you per minute? Sure. Do I think that is ethical and a model of quality therapy? No. That's why I will never purchase one and you will never have to pay for it.

Check your last physical therapy bill for the full price of your e-stim, ultrasound, or other modality. Was it worth it? Did it directly help your healing, or is it hard to say?

 3. I pay no management salary, whatsoever. Full disclosure- my brilliant boyfriend does my monthly books and I pay him handsomely in well cooked meals, compliments, and back scratches. I DO pay to have my yearly taxes done, as I want to ensure full compliance with the law. I also have a lawyer at hand and have paid for membership and multiple sessions of mentorship at the Entrepreneur Center. 

Other than these expenses, which I deem necessary, I pay no salary to anyone whatsoever. Not even myself. I have a scheduling system which costs me $30 per month, a square reader which was mailed to me for free, an online documentation system which costs me $49 per month, and and iPhone. That's it. That's all I need right now. I'm saving tens-of-thousands of dollars per year by doing it myself or figuring out a efficient, online way to do it on the cheap. My business operations require a few low monthly expenses, but no salaries. The savings? You guessed it, they get passes onto you, my friend.

4. I provide one hour, 1-on-1 treatment sessions. One of my biggest motivators for becoming self employed is my refusal to see 2 patients at once, to pass my patients off to a tech or aide, or to see a patient for a completely inappropriate amount of time. There is an immense value to getting your questions answered, having your full person assessed, and having the opportunity to ensure that you are doing your exercises correctly with the person who actually prescribed those exercises. A single session of physical therapy using this model is worth the equivalent of multiple sessions at a chain PT establishment; an establishment where you will sit in a room with a dozen other people waiting to be told what exercise to do next, even though you have already done it three times today, while your PT runs around trying to appease multiple patients at once. I know because I've worked there and I'll never do it again.

 I don't need to ask you to come see me 2-3x per week, because my performance review doesn't depend on it. Turns out, your recovery doesn't either. You may have a "cheap" co-pay for each visit to your in-network chain physical therapy practice, but after 10 visits that co-pay starts to really add up. And you know what? So does the time it takes to travel to and from, sit in the waiting room, and do clam shells on your treatment bed until your PT is finally, FINALLY ready to treat you. I see patients for fewer visits and get better results because I have the luxury of treating how I want to treat according to what is best for my patient, not what is best for my "numbers". I simply don't have to play that game, and neither do you. 

 Postface (it's the opposite of preface, I looked it up)- This is not to say that I don't value inter-disciplinary treatment. I do. I have a network of personal trainers, massage therapists, coaches, and even other fellow PTs whom I refer patients to regularly. Yet I value those services as separate entities that compliment each other, not services that should be offered (and billed) during a single session.

5. You will have a personal, old-school relationship with your health care practitioner. Sure, tried to win the 1.3B lotto like the rest of us (don't lie, if you didn't buy a ticket you at least though of it). Still, I genuinely enjoy what I do and make a personal investment in the each of you. My reviews support this. My patients are welcome to text/email/facebook/snail mail/etc me questions and updates anytime. In fact, I encourage it. I am frequently able to suggest exercise changes and answer questions without the need to schedule a paid-visit. Once you are my patient, you will always be my patient. I prefer to run into you at a group run as friends, not on my table for an injury, and I'll help facilitate that in any way I reasonable can. 

Ultimately, how you pursue health and spend your healthcare budget is your choice. Seeing an in-network provider may be a sound decision for you. It also may end up costing more money for disappointing results. How do you decide? As always, you arm yourself with knowledge. Knowledge is power. Refer to my previous post "Do You Take My Insurance? Understanding Your Policy, Your Deductible, and How To Best Spend Your Healthcare Budget" for a better understanding of how insurance really works for you. 

Until next time, 

Your Friendly Neighborhood PT