The business of cash based physical therapy: It’s not about the money but motivation

Cash based physical therapy is popular – the new fad of physical therapy replacing dry needling as the new thing to do.  Last month I was asked to be on a panel concerning the business of cash pay practice.

AND it got me thinking – what do I like this type of practice? Why are other people interested it? Why do I have students applying for internships at our place? Why did I leave a solid and very busy practice in an insurance based clinic?

A book about what motivates us in today’s world, Drive by Daniel Pink, gives some clues and it’s not the money. Instead the psychology of motivation is key to understand.

Pink highlights 3 primary motivators (motivation 2.0):

  1. Autonomy – the freedom to direct our own actions
  2. Mastery – the ability to focus on getting better and better
  3. Purpose – the need to have engage in work that is important and matters

Cash pay physical therapy hits each of these for me.

Autonomy – I control my daily practice to the highest degree possible.

Mastery – My office has numerous tools that allow me to create a study plan, implement daily, purposeful practice with feedback (the keys to mastery and expertise).

Purpose- I help people that have typically failed treatment at other places. It is an incredible feeling.

My last job turned from being a very motivating experience to a soul sucking drop into the abyss.  Perhaps the most confusing part was that I loved part of the job. When I interacted with my patients, I engaged with my work at a high level, moved into flow states, and the hours passed by. But the most common clinic meetings focused on billing and the insurances companies controlled part of my plan of care.

In the billing meetings I learned all of the complicated in and outs of what to use for my ICD 9 coding along with what reimbursed the best for each different insurance company. Instead of spending my time on pubmed or reviewing my notes, I spent time reviewing the productivity numbers.

This actually began to morph what I viewed as my purpose; I became the incredible billing machine.  This was the metric that obviously mattered the most to the clinic not the research or the patient outcomes or even the patient satisfaction ( I am not saying this was the intent of the clinic, but the focus on these areas but the emphasis on this).

To take is a step further, the volume of people I saw made reflection impossible.

Combining this with constant interruptions (I counted 60 once in a 30 minute window while working) and the lack of control in who scheduled when and pressures from insurance on approving more visits, mastery and autonomy were both crushed.

The practice I have now is about maximizing these motivators because I love walking into the clinic.  I get better as a clinician, which means I help more people, which means I get more freedom, which means I focus more on more craft, which lets me help more people…………..and on and on.

Whats not to love?

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