Episode 18
Allison: Good morning, good afternoon, and good evening, and welcome to the Therapy Matters Podcast, your one-stop resource for expert insights and advice on everything therapy and rehab. I’m your host, Allison Jones, and today, I’m joined by Ben Weinstein, owner of Myomechanix Physical Therapy + Training. Ben, thank you for joining me today.
Ben: Yeah, absolutely, Allison, excited to be here.
Allison: Excellent. We’re happy to have you here today with us as well. So Ben, you’ve been a practicing physical therapist for several years. You’re the owner of a thriving PT practice in Nashville, Tennessee. Why don’t you take a few minutes to give our audience some background on who you are, what your experience is, and tell us a bit about Myomechanix.
Ben: I’m originally from the New York City area, and I went to school at New York Medical College up there after University of Delaware for undergrad. After about six months working in the tri-state area, I moved on down to Nashville on a whim after visiting a buddy for three days like everybody else does.
I ended up working at Vanderbilt in their inpatient setting as their spine therapist where I would give the patients some pre-education and then post-op ambulation. From there, I went to a bigger group, which I stayed with up through the pandemic, moving from a staff therapist into a director position, and then transitioning from there into some travel therapy before opening up my own place, and we’re in downtown Nashville. Through that, Myomechanix, we really work with the weekend warriors and people who are already working with personal trainers or doing their HIIT classes, the athletic or formerly athletic population, just trying to keep everybody moving and feeling good.
Allison: Today, we’re going to focus on the concept of making the transition from an employee to a private practice owner. As you explained, this is something that you’ve done with your journey to Myomechanix. We wanted to share your story of how you came to this decision, what it’s like running your own practice, and some challenges and opportunities to being independent. Does that sound like a good idea?
Ben: Yeah, absolutely.
Allison: All right, great. You used to be a director at a large practice. Today, you own your own business. My first question to you is why did you make this change?
Ben: There’s a whole host of different reasons. Over the time that I’ve come out to practice, our reimbursement rates have continually dropped and been cut. The use of PTAs has been very much changed in how those practitioners are allowed to work. In that time when I came out, I was seeing 10 to 12 on a day. At the end of my career in outpatient, insurance based, I was seeing 16, some days, 17. While the idea was we’re helping so many more people, I felt that I was probably helping less because I wasn’t able to spend adequate time or programming with each person that I was seeing that day. On top of it, you’re very much limited when revenue is decreasing to receive the pay bumps and value that you feel like you should be earning as a more experienced therapist.
With all of the things that were happening and the insurance model being the way it is, I decided to take a step away from it and open a cash-based model where I get paid and then the clients I have also get to choose their practitioner. It puts everybody else in the driver’s seat where you call your insurance up and they give you your list of in-network providers, and they may not be necessarily the best provider, but they take your insurance so you end up going to them.
I’ve found that through the transition, I’m able to work with the population that I enjoy working with, and they’re able to receive the best care that they can and feel in control of the care that they’re receiving.
Allison: Excellent. There’s a couple of things that I want to dig into there. First up, you said that you are a cash-based business now. That’s a really big change going from insurance-based to cash-based. Tell me a little bit about some of the challenges and opportunities with making that transition over to cash-based.
Ben: There’s definitely a lot of challenges, and I don’t know if it’s necessarily for everybody. You really have to be in that eat what you kill mindset in the sense of you have to be confident in your clinical skills and know that they are worth what you’re going to charge. Where the issue and the difficulty comes is you’re essentially up against someone who’s saying, well, we also do physical therapy, and it’s $30 a session as your copay, and that may be all that they pay, at least up front, and then having to tell someone for this session, it’s $200 an hour plus. It isn’t necessarily a sales pitch. You know that you’re going to give them good care, but you have to show them the value, whether that is you’re going to get them better faster, they’re going to spend more one-on-one time with the physical therapist, or you have more expertise in the area that they want to return to.
It really is more explaining to people why it’s a good deal for them in a sense. But there are people, and I do understand it is expensive that unfortunately, you’re just not going to be able to work with. Some of the positives are if you are going to see 70 people a week and get paid $30 a patient, you can see a quarter of that give really good care and also create a little bit more freedom in your lifestyle.
For me, I just never saw myself being able to maintain the caseloads that I was seeing at the time, so this has been a much better work-life balance. Of course, there are things out of my control on doing care and billing and marketing and things, maybe the more 40 hours a week, but I know that the people that I’m seeing during the week are getting the best care that I can give.
Allison: That leads into my next question with you’re seeing a smaller set of clients, a more select group of clients or patients, and that is an intentional, I guess, consequence of the way that you set up your business. How does that impact your patient care?
Ben: I think it makes it better for me, honestly. I know that those are the patients that are in my wheelhouse. It’s like tearing your ACL and then going to someone who has never done an ACL rehab before. I go to the classes that they’re taking. For most of my patients, I either work very closely with their professional trainers, so I know exactly what their workouts look like, I know what they need to get back to, and I know exactly what their goals are. I’m able to change my treatment routine to get them back to those things. Where if you go to a bigger group and you get stuck with the first available person, and they’ve never either taken up your class or they’ve never done the things that you want to do, they may not know how to adequately get you back to that.
Allison: You’re very focused in the types of patients that you’re treating. You’re not treating every physical ailment. You’re very specific in the types of patients that you’re taking on, correct?
Ben: Yeah. I mean, I definitely am working more with weightlifters and people who are lifting weights as part of their routine, whether that’s in a high-intensity setting or a powerlifting setting of some sort. But that definitely is my, I’d say, niche and the people that I enjoy working with. With that, I do those things, and that’s how I train, so it makes it easier for me to program and utilize those things.
Allison: What was the biggest challenge or the biggest surprise when you opened your practice?
Ben: Just the fact that it worked as well as it did as quickly as it did. Like I said, I was stocking up on ramen expecting a couple months to be profitable. I had made savings and things of that sort in order to be ready for it, and it just worked. I was able to get rolling and start working with the people and making connections with gyms, all the things that I was really looking forward to do. That was now a year and a half ago, and it’s changed in the sense of maintaining relationships and still putting in the time and the effort, but it’s definitely different in that sense at the moment.
Allison: When we were talking during our prep call, we talked about maybe putting in your time. You can’t just come out of school and go right into your own private practice. There’s some work that you have to do ahead of time and maybe put in your dues and work for a larger organization, perhaps, first.
You talked about that aspect of it. You didn’t think that you could just go right into private practice.
Ben: Yes, and there are people that do it. I think it’s a bit of a disservice to think that you are the best person to care for someone after three years of PT school and very minimal patient experience. I felt that after getting the education I had, passing a board certification for an OCS, taking a whole bunch of annual therapy classes that I was then prepared to take the leap. Along with having the management experience on somebody else’s dime, you get to understand what P&Ls look like and the actual business end of a physical therapy practice rather than just the patient care. We don’t learn much of the business in physical therapy school. I was blessed with the fact that my father owns his own pediatric practices, so I understood reimbursement and insurance and marketing seeing him do it. But there was a lot to learn, and the learning curve was really large.
I definitely think that if you have to learn how to do all those things without having a really sound clinical background, it can get lost in the sauce. You may give mediocre care and be really good at marketing, or you may just be mediocre at both, and it might not work as well as you’d hoped it would.
Allison: So take advantage of that opportunity of working in a clinical setting working for somebody else, learn as much as you can, and then apply that if you want to go into it.
Ben: It doesn’t have to necessarily be a big group. There are cash-based practices that are great and they have good mentorships, and it’s smaller and you’re seeing those people. I think that they’re lesser as far as the opportunities, but if you go search them out, they’re there. Putting in your time and earning your stripes, I think, is important.
Allison: Excellent. All right. We can’t let this go by without me asking a question about marketing because I am a marketer, so this is something that’s near and dear to my heart. I have to ask a little bit about how do you go about marketing your practice and bringing in new clientele, new patients?
Ben: Yeah, absolutely. For me, I took a really local approach. I’ve been working in the area. I have been to a bunch of workout classes. I have friends who are personal trainers and in the fitness industry. I just started going to everything, talking to the owners, setting up workshops, just being there, being present and showing value. If someone had a question or they came to a workshop, working with them through those questions and not expecting anything out of it.
I think people understand when there’s someone there who’s actively trying to help them, and then they will search those people out, whether it’s in a week or a month or a year. I have people, oh, I saw you at this workshop six months ago. I didn’t have an issue then, but something arose, and I remembered it’s something you planned on. You really have to go in with the idea that if you become part of the local community, the local community will take care of you.
I am also not a big Instagram person. The idea of I’d rather spend a whole day at a gym with people than posting to thousands, it was something I just fell into with that. Other people have done really well with building an Instagram following and having people actively reach out to them, and that is definitely a great way to do it also. It just wasn’t something that I was either comfortable or had much experience doing.
Allison: Gotcha. Okay. Excellent. So a lot of that in-person networking is really effective. What advice do you have for PTs out there that are considering starting their own practice?
Ben: I think the biggest thing is it’s going to be scary. They have to understand that if they’re truly unhappy with where they’re at right now, the worst thing can happen is that they don’t try, and then they end up right back where they were. I am positive, if I sent out my resume right now or answered one of the recruiters’ phone calls that I could be employed in two weeks. We have the degree, and it’s always going to be there, and there’s always going to be a need for physical therapists. If you try it and it works and you end up working for yourself, great. If not, at least you don’t have that worry that you didn’t.
I was fearful of it for a long time, and after I did it, I wished I’d started sooner. But there’s always going to be that thing in your head, well, I need stability, and I need to take care. I completely understand in a very lucky– well, not lucky, but a scenario that I have to take care of myself and my dog, and there is very little bills. I’m not putting it away through school or stuff, so it was now or never.
My company went through a much larger buyout, and the company that did so, I was just not willing to go with the flow of what they were doing. It was like a rock and a hard place, and I got pushed into it, pushed out of the nest. I wasn’t ready, and luckily, I flew.
I would say just take the jump. If you truly feel like you are ready clinically and that it’s something you want to do. If not, there’s always places you can work for great clinicians, and we need those people too.
Allison: Excellent. All right. Yeah, take a chance. You never know what could happen. It worked out really well for you. Any final thoughts for our listeners before we wrap up?
Ben: Nothing I can think of. I do better when I’ve got a question, so put me on the spot there. But I would just say the reimbursement rates and the way that insurance works unfortunately isn’t going to change, or at least it doesn’t seem like it’s going to change. We’re one of the few careers where everything– I went and got my haircut this morning, and it was more expensive than it was a week ago, and they gave me the same haircut. Where you’re not giving any different care than you were a week ago, and they’re telling you that you’re going to be paid less year over year.
So really taking it into our own hands, I think that performance therapy, or at least performance-based therapy, if you’re getting someone better faster or you can provide a value to a patient, you should charge that value. And really, the only way to do that is through a cash-based model where you give the client a super bill, and then they take the insurance on. I think that in the setting we’re in now, and especially when I came out of school, you were like, oh, if you’re going to go work in orthopedics, you’re going to go work for this big practice, and they’re going to offer you what they want, and it’s going to be very similar to what they’re offering everybody. They had a new grad starting salary, and it’s definitely changed. More people are coming out now thinking this can’t be the only way to do it. We need to change whatever vision 2020 was. I think a lot more people are willing to take the risk as well.
So I would just say get a good baseline on your clinical skills, really learn how to talk and connect with people, and find and charge your value.
Allison: Excellent. Yeah, healthcare is a very difficult industry to be in, and like you said, reimbursements are very tough. It’s getting squeezed, costs are going up. It’s a very difficult space to be in, and it does need a little bit of an evolution to figure out how to solve these problems. Certainly looking at a cash-based model is an interesting approach and one that I think a lot more folks are taking a closer look at.
We appreciate you sharing your thoughts and sharing your business success with us today. I really appreciate it, really appreciate you being on the show. Thank you for joining us. And thank you to the audience for tuning into the Therapy Matters podcast, your one-stop resource for expert insights and advice on everything therapy and rehab.
We look forward to seeing you on the next episode. Thanks so much.
Ben: Appreciate it.
Allison: Thanks for listening to Therapy Matters. Do you like the podcast? Give us a five-star rating, subscribe, and tell all your friends about the show. Want to be a guest or know someone that would be a great guest speaker? Contact me at allison.jones@raintreeinc.com. That’s A-L-L-I-S-O-N.jones@raintreeinc.com.
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