Finding Your Place in the World: Starting and Growing Your Private Practice

I’m a big promoter of niche practices, and I’ll say right from the start: If you’re not niching down your practice, you certainly should be. If you’re good at one thing, that’s your niche, and that will be the reason people pay you for that exact specialty.

Maybe you're familiar with the fact that when orthopedic specialists perform surgery, they have what we call in daily parlance “the hand guy” or “the wrist guy” or “the knee guy.” It means they know their own areas thoroughly, and they’re always in demand for their particular niches. People in other disciplines tend to neglect to do this, to their detriment. I’ve found that niching down too deep is really impossible. The more specific the service you offer, the more you will attract people who need that service and are willing to pay for an expert in it.

For years, I thought I understood niching down, but I really didn’t. I’d heard other people talking about it, but in the back of my mind, I still thought it was slightly nuts to say, “I treat head and neck injuries only.” I was the first person to argue against niching down. It seemed so dumb; why would I want to lose all the other patients? It did not hit me until I started partnering with other physical therapists.

I once partnered with a friend to start a practice, and I took the task of writing our promotional materials and website copy. I was writing everything as if I were running the clinic. The people who were coming in were basically patients for me—but I was never there. The therapists who worked there kept getting patients with types of injuries they didn’t treat. So I wanted to address the problem. I asked the staff what they did treat, and it turned out to be injuries that would be encountered by high school athletes. I proceeded by calling a staff meeting to inform everyone that we will only be taking high school athletes. Even my business partner thought I was crazy when I said this. In his mind, we were giving money away when we turned away patients that way. But I asked him to give me one month just to see how it worked.

That one month changed everybody’s mind. Our numbers quadrupled in the span of thirty days—just because we changed and narrowed our message down from, “We do everything,” to “We only treat high school athletes.” Sure, other practices in the area would take high school athletes, but why would you go to them when you could go to the clinic that specializes?

The experience I had with that practice was a great lesson for me. That experience has changed the way I work with my clients; it has changed the way I partner with people and has even changed the way I run my own practices. Why say you do everything when you can say you do something you like to do? It’s amazing when that happens: everyone’s happy and you make more money.

1. Finding Your Own Profitable Niche:

I’ll give away the secret right here: nobody knows what niche works right off the bat. Even I didn’t know. I’ve made mistakes, thinking one thing is going to be a home run or is a sure-fire solution and finding that it doesn’t work. It can be difficult to admit you don’t know something, especially as a qualified practitioner. But there can be a lot of power in it as well. Once you’ve admitted you don’t have your niche, the vista of opportunities opens up to you. Sometimes you just have to go through that process.

When searching for a niche, test out everything. All you want to do is see what works. Especially if you’re a small practice that’s just starting out, maneuverability is your greatest asset. You’re going to see whom you attract, and what kind of patient feels the strongest connection with you. The formula for attraction is notoriously elusive, but once you start to understand how it’s operating, you can harness its power for your practice. Personally, I make year-long strategic business plans for my own practice—and I know what huge changes can take place by the six-month mark.

Your niche is personal; it relates not to what will make you the most money, but to what you’re best at, and what you like to do. Combine that with something in demand, and you have it made—but of course, it’s not always that simple. I can’t tell you in just a few lines how to find your niche because it’s such an individual and really unquantifiable process.

2. Sub-Leasing and Finding a Space:

Sub-leasing is a great ideal solution for a huge number of people who are just starting their own practices. You don’t have to pay for electricity, and you don’t have to pay for furniture. I’d say it’s the best way to go if you’re an absolute beginner.

If you absolutely can’t sub-lease, look into renting out a similar place at a day-rate for a while. Almost any healthcare practitioner could easily do that for what they would get in reimbursement, even if it was private-pay or insurance based. You’d basically only need to see one patient a day to cover expenses and that’s a home run. Plus, with the networking that’s involved in a place like that, you would meet a large number of people who could help you grow your practice later on.

The third possibility, which is one that I didn’t even think of when I started my practice, is to go to your patients instead of asking them to come to you. It might conjure up images of the old country doctor making house calls with his little black bags, but the concierge practice, as it is called, is a legitimate option, and it’s one that I’ve taken advantage of as well. But remember what your ultimate goal is. And a concierge practice is hard to scale and sell someday.

Any way you choose to do it, the most important point is that you also need a home base. You want to avoid the image of the unprofessional, itinerant, traveling-salesman doctor.

3. Telemedicine and the Global Practice:

One thing to remember when finding a location for your practice is depending on your specialty, you may in some cases be able to leap over the question of location altogether—both yours and that of your client.

I spoke not long ago with Jessica Drummond, the CEO of the Integrative Pelvic Health Institute, who explained how she also does private nutritional consulting for clients all over the globe: “I do it either over the phone or on Skype. I have about ten to fifteen private patients I work with really in-depth, getting to the root cause of their issues, and doing a lot of coaching.” It’s obviously not a replacement for your physical office, but if you have a specialty or service that allows you to consult over long distances using the telephone or VOIP and web-conferencing services such as Skype, there’s another great potential income stream for you, with very little overhead.

They're developments in telemedicine that you could profitably take advantage of for your business. My own state of New York is one of several where a new state law allows practitioners to bill insurance for telemedicine. Previously, the prevailing concept was that if you could treat someone over the phone or over Skype, you could charge a fee—but you couldn't bill the insurance companies. The companies simply didn't recognize telephone or Skype consultations as a legitimate treatment. This new law is going to bring a lot of changes to how people are currently practicing— or to how we should be.

4. Corporate Practice and Beyond:

Of course, the options I have been discussing are not the only ways in which you can find a place to start your entrepreneurial practice. A lot of professionals have approached me in the past with a question about how to start their own practice within a corporate office. That’s a natural idea to think of. It means you’re going directly to where there’s a lot of money, which, if you play your cards right, can be spent on your practice’s service.

I want to give you the example of a friend and colleague of mine, Dr. Kelly Lease, who runs Kelly Lease Physical Therapy. One of the things that I admire strongly about Kelly is that she’s a strongly driven person who goes directly to what she wants. And what she wanted originally was to be a dancer. She went for it all the way, designed her life around being physically fit and active—and dancing. When Kelly was seventeen, she injured her ankle and was told she would never dance again. As I hope you haven’t had the chance to find out for yourself, it’s very tough to have dreams crushed at such a young age. But when she received physical therapy for her injury, it made such a difference for her that she actually was able to return to competitive dancing again and then to teach dancing.

The gift that physical therapy gave her, as well as the knowledge she acquired of flexibility and the human body, encouraged Kelly to want to make that positive difference for other people’s mobility and to become a physical therapist herself. I think it’s wonderful that she found that pathway from a personal disappointment to a great career as a physical therapist. The best news is that Kelly is still involved in dance. And her whole story makes her a great example of what I’ve already written about here—finding your niche. Her deep firsthand knowledge of the challenges faced by dancers who require physical therapy gave her very attractive qualifications as a professional right from the start. And her success in that field today is a great example of how one little step can change a whole career.

Kelly’s ability to specialize within a niche eventually landed her jobs as a physical therapist for Broadway’s famously intensive, dance-heavy production of The Lion King, along with corporate companies such as Plus One, Goldman Sachs, and Johnson and Johnson as well. There she ran a practice within the company as basically a fees service—a completely cash-based practice within a corporate context. At this point, you may be thinking, “Sure. But how can I get involved in this part of the industry from where I stand now?” Not everyone will follow Kelly’s exact path, and most people trying to get involved in corporate practice will be coming to the company itself.

There’s no one single way to get a position as a corporate practitioner, but the key element is getting your foot through that crack in the door. You can do that through a company like Plus One or through networking, or you can simply do it by getting on the horn and showing them what you can bring. Kelly eventually went on to start her own private practice.

I think Kelly’s a great example for all of us, whether we’re interested in a corporate practice or not. She found a perfect niche for her skills and experience, made it work for her, grew a successful practice, and knew when to branch out on her own to a completely private business. The strategies and principles that worked for her were the same ones that you’ll need in your own practice.

For valuable marketing advice to help you with finding your niche or developing your business, be sure to check out my podcast The 30 in 30: Marketing for Physical Therapists. (https://podcasts.apple.com/us/podcast/30-in-30-marketing-for-physical-therapists-your-host/id1395657715)