Why Do PTs go into Private Practice?

Mar 14, 2024

As someone who has been a physical therapist for nearly 25 years, I pay attention to trends in the industry. The most notable trend, at least in private practice, is the exponential growth in PT-owned cash practices. I get it - I stepped into this arena myself nearly 20 years ago so I see the value and benefits of this business model to both patients and providers. However, I am a bit surprised that there is a trend away from group practices and toward solo-preneurs. It’s caused me to take a step back and ask a bigger question - why  are people moving into private practice / cash practice / self-owned practice  in the first place?

Coincidentally, a colleague asked this exact question in a Facebook post today.  The answers were varied, but tended to focus on autonomy, opportunities for growth and “wanting a more flexible schedule.” So many people want to be their own boss, but do they really understand what this entails? 

I then thought about my own story. How did I end up down this path? It was not because I wanted to work for myself, or because I sought better working hours. My first leap into private practice ownership came to be when I was presented with an opportunity I could not pass up. A trusted colleague and mentor was growing a new practice and she gave me the chance to invest. It was a risk with a potentially large financial payoff. It was certainly better than the position I was in at the time - a cash practice, ability to practice how I wanted, teamwork and mentoring. It was never about being just me; it was always about the vision she laid out and where I saw myself fitting in there. I had many talks with my husband, and we made a decision to invest in this growing, one of a kind practice. Unfortunately, the business eventually strayed from that vision and I ended up choosing to sell my shares and start over alone. Once again, it was not about autonomy or not wanting to work long hours. I already was my own boss. I was working more than I ever had (since it was “mine”); in this situation it was about survival. I needed to get out of a bad situation. I had no plan, no goal, no idea what was next, except my list of patients and a subleased treatment room in another friend’s office.

A lot has happened since then, but I still find myself at times questioning why someone would want to go it alone, or start from scratch, when they could be a part of a team. Not every business owner is greedy, not every practice is designed to burn out its clinicians. There are people and places that want everyone to win. Moreover, not every clinician is cut out to become a business owner.  Venturing into private practice requires a different skill set and a tolerance for risk. In my own situation, I learned business skills on the spot; there was a lot of “fake it till you make it.” I worked…. A lot. I learned who I wanted on my team; I want strong clinicians by my side, and a group of teammates who are willing to teach AND learn. 

I guess what I am trying to say is that not everyone starts a business because he or she has an entrepreneurial mindset, or because they are sick of bad bosses and would rather answer to themselves. Some people see an opportunity, and others crave flexibility and the ability to lead. Some people are not in a position to take a financial risk while others may crave more stability. Whatever situation you find yourself in, I encourage you to one, stay true to yourself, and two, choose a work environment that makes sense to you. Take time to look around. The best situation may not be what you initially imagined. 

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