As told to Lisa Fields, by Karen Litzy, PT, DPT, owner of Karen Litzy Physical Therapy in New York City
Late at night, I’d have the same debate in my head while trying to fall asleep: Should I make the leap and turn my side hustle into my main business, or should I keep the stability of working for a bigger company? The list of pros and cons would play over and over. I desperately wanted to go out on my own, but the risk-averse side of me came up with every reason not to.
One night lying in my bed, it just hit me: I could spend the rest of my life being petrified and making lists of reasons NOT to go after my dream, or I could just try it. And so, I quit my day job and never looked back. That was eight years ago.
A Growing Venture
I was working as a physical therapist for an outpatient clinic. One day, I started treating my cousin’s friend in her home. After a few months and years, this grew to more people, treating them all in their houses or offices. My business model was entirely by word of mouth.
I loved the private sessions I provided because it let me focus on one patient at a time. It was so different from what I did in my busy clinic, where I saw two to three patients an hour. Previously, I’d typically see 14 patients per day, and I was often burned out by closing time. My side-gig appointments were energizing because I thrived on providing personal attention to patients.
While still employed at the clinic, I decided to make my side job official and used a lawyer to incorporate my business as a private physical therapy concierge practice. I kept seeing more patients through my business and reducing my hours at the clinic until I was working there 10 hours a week. That’s when I started wondering if I’d ever have the nerve to quit the clinic and go all in on my concierge practice. I was nervous about working for myself because I’m based in New York City, which -- as you know -- is a really expensive place to live. What if I couldn’t retain enough clients and my business wasn’t sustainable? It was frightening. Also, very few physical therapists were doing home visits when I got into this line of work, so I had no role models to emulate. For years, my part-time job was my safety net.
The Turning Point
By 2010, I started thinking about my business in a different way. I'd been working the two jobs for five years and had managed to grow my physical therapy practice to about 20 to 25 visits per week. So, I compared the hours I worked in the clinic to the number of concierge patients I’d need to see to earn the same amount.
As it turns out, I was spending 40 hours a month in the clinic. When I crunched the numbers, I realized I earned the same amount by seeing concierge patients for seven or eight hours per month. Whoa! That was eye-opening for me, and it gave me the confidence to resign from the clinic and focus on the work that I found more enjoyable.
My Business Model
I typically see five to eight patients per day. It’s hard work. I’ll start at 7:30 a.m. and end at 8 p.m. But the beauty of my business model is that I can have time off in the middle of the day to run errands, go to the gym, or get paperwork done.
I offer straightforward physical therapy sessions and wellness, which are popular with older adults who want to stay physically active and work on fall prevention. Some patients who are discharged from traditional physical therapy stay on for wellness visits.
The question everyone always wants to know is: What do you bring to your appointments? They think I lug a million things around with me, but the truth is, I travel with very little. Because I’m in New York City, most of my patients have gyms in their buildings, and most of those gyms are well-equipped. If a patient doesn’t have a gym, we use a yoga mat, resistance bands – small things. Some patients ask if I’ll bring a massage table, but I can’t carry that on the bus or subway. I tell them where they can purchase a table for less than $200. If they can afford my services, it isn’t cost-prohibitive.
I see patients on a cash-pay, out-of-network basis. There’s no shortage of busy professionals who would rather have someone come to them, on their time, and pay out of pocket.
Because I’m not inundated with 14 patients a day, I have time to explore other ventures, including hosting a podcast called “Healthy, Wealthy and Smart,” which has 30,000 to 40,000 listeners. I talk about topics that are relevant to physical therapists who are starting their own businesses. It gives me a creative outlet, which I enjoy.
For the first eight years that I ran my business full-time, I flew solo. But, last October, I decided to onboard another physical therapist I’ve known for years. I needed someone to take on clients because I was at the point where if I got a new patient, I wouldn’t be able to fit them into my schedule for a couple weeks. I’d been working weekends for a while and wanted the time to myself again. I felt good asking this particular physical therapist to work with me because I’m comfortable with his skills and I know he’s kind. That’s the quality I considered most important: I can teach anyone how to do something my way, but you can’t teach someone to be a nice person.
The business model we agreed to is this: any patients referred to my colleague -- who don’t come through my business -- are solely his. But if they’ve come through me, I get a commission for each of his visits.
My Advice to Other Physical Therapist Entrepreneurs
Tip #1: Think about joining a professional organization.
Honestly, my American Physical Therapy Association (APTA) membership has been invaluable. If you join the private practice section, they have tons of resources, and many are free. I’ve used lots of that information to develop my business plan.
Tip #2: Hire a good lawyer and a good accountant.
You’ll need them to work together to ensure your corporate entity is formed properly and that it’s best for your situation, based on where you live. Have the lawyer write a policy and procedures manual, so if you hire someone, you’ll have it ready. If you don’t like balancing your books, have your accountant do that for you. Mine does my books every quarter for a nominal fee, which I’m happy to pay so I don’t have to do it.
Tip #3: Know what your startup expenses will be.
If you’re starting a concierge business like mine, your biggest expense will probably be your attorney. I spent maybe $2,000 on an attorney. Because I didn’t have overhead, I started seeing profits right away. If you’re planning to rent space, see if you can rent a room within a gym, yoga studio, or physical therapy office, paying for the space only when you’re with patients.
Tip #4: Consider the types of insurance you might need for your business.
When you go to buy professional liability insurance, I suggest talking to someone by phone to ensure you get everything you need for your specific business. I also have disability insurance. It’s expensive but worth it. A couple years ago, I had shoulder surgery and couldn’t work for eight weeks, but I was paid because I had insurance.
Tip #5: Build a referral network with other professionals.
I get direct referrals from surgeons and personal trainers, and I’m good at referring patients back to doctors and other physicians I trust. Sometimes I meet with physicians to talk to them about my business, but I’m starting to interview them on my podcast to show them I can offer them something of value: putting them in front of 40,000 listeners.
Tip #6: Get involved in your community.
One of the best things you can do for your business is to get out in your community. Go to networking events and meet people. The goal of your physical therapy practice is to be a part of the community. They have to get to know you before they’ll come to you.
The Best Lesson I’ve Learned
Focus on doing what you do best and delegate the rest. Take my website as an example. Originally, I created it completely by myself, but it was pretty bare-bones. A couple years later, I paid $1,500 for a complete website reboot.
Once my colleague joined the practice, we redid the website completely. And luckily, he’s a website genius. He was able to completely revamp and modernize the site, and he worked on the back-end SEO to bring the website up from the fourth page of Google results to the first page within a week. I paid him $800 to $1,000 for that work.