cash pay practice

Why Every New Grad NEEDS a Cash Pay Practice

Have you dreamed of being your own boss? Setting your own hours, keeping more of the profits you generate, and having the pride of being a business owner? Well if so, then you’ve likely thought of starting your own practice.

Maybe even your own cash pay practice.

If your physical therapy school was anything like mine, there was always the handful of students who knew from the beginning that they wanted their own practice (I was one of them). Our professors often advised us to get a couple years of experience, save some money, get a certification, then open your practice.

Well, I think all of this is wrong, and believe that every new graduate should start their own practice. Actually…

Every new graduate should start a CASH PAY practice!

I probably just violated every piece of advice you’ve been given, but let me explain why.

Cash based physical therapy is a hot topic right now, and it should be. If you’ve researched this topic at all, you’ve definitely come across the cash PT greats: Dr. Aaron Lebauer, Dr. Jarod Carter, Paul Gough, and Dr. Mike Reinold.

These physical therapists are on the forefront of the cash pay movement and have proven the cash pay model can be highly profitable and sustainable.

This model evolved out of necessity and opportunity. We all know that insurance reimbursement for physical therapy is declining. This has forced many private practice owners to pack their schedules in order to remain profitable.

One of my CIs told me he had to see at least 1 patient every 30 minutes, every day, just to cover overhead for the month. That was 20 patients a day before he made a profit. Because of this, he saw one patient every 15 minutes, and close to 40 patients a day! Crazy.

This type of model does not benefit anyone. Patients get bad care, PTs burn out mentally and physically. It is unsustainable.

The cash PT model solves this problem.

Most importantly, patients benefit. Since patients are paying out of pocket for care, they are seen one-on-one with a physical therapist for the entire session. They usually require fewer visits, and potentially save money and time versus going to the in-network clinic.

The physical therapist benefits because she needs to see fewer patients per day, can provide a higher level of care, and create more personal time to avoid burnout.

It’s easy to go on about the benefits of owning a cash pay practice, but what I really want to explain is why you, a new grad PT, should start your own cash practice! When thinking about starting a practice, it’s easy to feel overwhelmed. Starting a business is no small task, but it doesn’t have to be complicated.

A new grad could easily start a full brick-and-mortar practice or start a mobile practice as a “side hustle.” Cash pay PT practices come in all shapes and sizes. This model allows you to start small and then grow as your caseload increases.

Here is why all new grads should start their own cash practices:

1. You are better than you think!

When I graduated I thought there was no way patients would pay cash to see a new grad. I also thought I needed to be a manual therapy fellow in order to get results. I’m sure you’ve had similar thoughts.

But here is the reality.

Even as a new grad PT you are extremely skilled and knowledgeable enough to get patients great results. I started my cash practice after working for about one and half years in the outpatient setting.

I took my first physical therapy job in that particular outpatient clinic because I was promised “mentorship” by the senior therapists.

However, once I started working I was the only PT at my location, and I had very little if any direct mentorship. This was not what I envisioned for my first job. I was worried that my patients wouldn’t get better and I wouldn’t know how to manage them when things got tough.

I’m happy to say that I was completely wrong. My patients did great and my clinic ran smoothly.

As a new grad, you are fully capable of being on your own.

The limitations you place on yourself are usually self-induced. Be confident in your knowledge and what you offer. You are more than capable of starting a cash practice right now. (I will discuss how to have a mentor while still working independently in a future article).

2. Patients want and will pay for your services

One of the most common things cash PT haters say is, “you’ll never get people to pay cash for physical therapy.”

Well, those people are flat out wrong. Patients will definitely pay for your services if they understand the added value in the cash model.

When patients are educated that paying cash means one-on-one time with the PT, fewer visits, more hands on treatment, and easier scheduling, they are willing to pay. In fact, many of your patients have probably paid cash to see you even as a PT student.

Plus most patients have very high deductibles and may pay $125 a visit until it’s met. In this case, it’s probably cheaper for them to pay cash for your services.

Ask any patient what they value most in the standard in-network PT visit. They’ll say it’s the one-on-one, hands-on treatment from the physical therapist. When they understand this is an option for every treatment session, they will usually be excited to pay for it.

3. Side hustle

So maybe you don’t want to go all in on a cash PT practice right out of school. That’s understandable. But every new grad PT should have a small cash PT practice outside of their full time physical therapy job.

This could be a mobile practice, seeing patients in their homes or offices. Or you could sublease space from a gym or a room in a massage studio (I’ll discuss how to work out these deals in future articles). Both of these options are low cost, and the experience/respect you gain will be very valuable for your career.

One of the most obvious benefits to doing this is the extra money. Let’s say you have 2 patients, each gets 1 treatment a week for 4 or 5 weeks, and you charge $100 a visit. That’s an easy extra $800 a month for only doing 2 hours of work a week.

You can use this money to pay your student loans, save for a house, make your car payment, or for investments. As you get busier you can work part-time or PRN for an employer, and part time for yourself.

This will create much more flexibility, more free time, and give you a taste of being a business owner.

4. New opportunities

When I started NOLAPHYSIO, a mobile practice, I thought I’d only be seeing a couple patients a week as side money. However, within the first two months of being a business owner so many new opportunities came up.

One that I was most excited for was a partnership with a local bike shop (I love cycling and race for a local team). When the owners of the shop found out that I had my own company they wanted to help me grow it.

Soon I’ll be helping with bike fits, and they even offered to rent out their upstairs studio to me if my practice grows to that level.

Another opportunity that presented itself was to write for NewGradPhysicalTherapy. I love writing and actually studied journalism in undergrad. Now I have the ability to share my experience of starting a cash practice and help others do the same.

None of these things would have been presented if I didn’t take a leap of faith and go out on my own. The same things will happen to you when you put yourself out there. Maybe it won’t be a bike shop, but it could be a dance studio, a run store, a CrossFit gym, a corporate firm, and the list could go on and on.

There are endless possibilities, but you have to be willing to take a risk and step out on your own.

The cash model may seem intimidating at first, but that’s only because it’s different. The cash PT model truly creates freedom for the practitioner and better care for the patient.

Physicians, dentists, chiropractors, and massage therapists have all been able to establish successful practices based on cash models because they offer more personalized care with better results. It’s exciting to see so many physical therapists eager to join this movement.

We all can recognize the shortcomings of traditional insurance based practices. Truthfully, many of our patients can too. If we as physical therapists are so unhappy with the traditional model we must be willing to create an alternative answer.

I’ll put it this way. If any of these sound appealing to you…

  • Create a career focused on helping people
  • Having more free time
  • Improving patients’ outcomes
  • Running your own profitable clinic

…then it’s time to start your own cash pay practice!

Check out our FREE comprehensive resource for anyone wanting to start cash pay practices! It’s thorough, downloadable, and tailored to new grads!

About William Gonzaba

William Gonzaba
I'm Will Gonzaba, owner of NOLAPHYSIO, a mobile - cash based clinic based in New Orleans, LA. I love learning about business and creating amazing patient experiences. As I begin to grow my company, my goal is to one day help other PTs do the same. When I'm not working on my company, I'm usually cycling :)


  1. Jeff Rubi

    When will you be posting your next article? I have been attempting to research on how to start a potential cash pay on the side and have been looking for a good resource to learn from.

  2. William Gonzaba

    Hey Rubin! The guide is complete! We are just forming it now, and it should be online soon! Keep a look out!

  3. Reena Tenorio

    Where can I find the next article to this one? I am super anxious to see the guide you are putting together. Thanks for sharing great content!

  4. Darryl Richmond

    Will, you hit the target with this one! Once I get passed boards I am going to take off, seriously take off! This in-network (run of the mill) PT is degrading the very field that we are trying to progress.

Leave a Reply

Send this to a friend