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Apr 29, 2020

I was recently fired from my position as a Home Health Physical Therapist for the first time in my career.


It was nothing that I said or did, but instead it was a combination of Medicare changes to the Home Health PDGM (Patient-Driven Groupings Model), followed by the COVID-19 virus, essentially causing the loss of two contracts in my area with Home Health Nursing Agencies. I am not the only Physical Therapist to suffer this same fate. Many PTs were laid off, let go, furloughed, placed on hold, all because of a nasty virus that caused a state of emergency across the United States.


While my story is a little different than your average PT, professor, and small business owner due to needing benefits for my wife, who is a Type-1 diabetic, I was actually not terribly worried.


“But F Scott, you don’t have a job, how are you not worrying right now?”


One word: Optionality.



Hopefully by now, on the back end of the COVID-19 pandemic, you are realizing that, whether you are a physical therapist or even a small business owner, that you have got to not only be flexible, but also be adaptable and ready to diversify. Much like the stock market, if you invest, you would not JUST invest in technology stocks or automobile stocks. You would do your best  to diversify your portfolio in case one industry was wiped out. As we saw with one of the routinely safest jobs in America, almost every setting of physical therapy was affected by the pandemic, and if you hadn’t diversified your career as a versatile PT or a business owner with some online products and services, you were likely greatly affected.


The bad news is, the best time to start diversifying your career was 2-3 years ago. The good news is, the second best time to diversify your career is TODAY! Let me explain what I mean by diversifying your career...


It helps to look at your skill sets as a whole like an upside down pyramid with the small, narrow, pointed tip at the very bottom representing your typical 9-5 clock in/clock out clinician. The next larger area of our upside down pyramid would be a 9-5 clinician who has bettered themselves by obtaining a residency and a clinical specialization or a fellowship, has maybe begun by taking some CEU's on one certain population or niche, or who has developed a formal or informal mentorship with someone they respect in the field.


Further up the pyramid we find a clinician who has started branding themselves as the expert on a certain injury, diagnosis or patient population; they have their own blog and podcast on their specialty, they are the one people seek out when they have a question on that one thing and are often referred patients by other clinicians, sometimes even from out of the state or country. They have written a book on their area of specialty and offer online courses on their specialty, and they live, sleep, eat, and breathe their specialty.


And the final level of our upside down pyramid does all of the things we mentioned earlier at such a high level, and communicates their standard operating procedures so well, that they are actually removed from the day to day operations. They likely employ people to do the work they used to do, and they work ON their business instead of IN it. 


That is the main goal. To get you out of the technician phase of a job that you have been taught is the next progression following school, and into the manager position, who leads the technicians like a maestro to an orchestra, and eventually onto an entrepreneur or CEO who oversees it all. Even if you don’t plan on owning your own business or becoming a CEO, there are many benefits to thinking like one (even in a 9-5 clinical situation) and, at the very least, to starting a side gig or a side hustle in which you can operate like a CEO.



They likely employ people to do the work they used to do, and they work ON their business instead of IN it. 



First off, starting your own business or side hustle allows you to be taxed at a different rate and also allows you to write off items you need to purchase for your business.


Second, it allows you to have a test tube within which to try out some of your newly learned skill sets. For example, let’s say you are going to start offering copywriting services to other healthcare businesses. One of your services is an email sequence that will go out to a list of recipients after they opt in for a downloadable PDF version of your top 10 shoulder stretches in order to try to convert them to new patients. If you have already written this sequence for your business and you saw it get good results, you can then sell that same sequence customized to another business looking to offer the same.


The same goes for digital marketing. If you are running Facebook ads for your business, then you will likely be able to translate that skill to other businesses who don’t know how to run Facebook ads effectively. Maybe you write a blog and are able to profit off of the affiliate links you have included in the blog, and could show other businesses how to do that as well. Maybe you have created online courses for your clients to purchase, and you can now show other businesses how to begin an online course business. 



The possibilities are endless, but the moral of the story is that you have to write out a plan, and implement it. You need to decide if getting some more letters after your name (letters that the public has no clue what they stand for) means more to you in becoming a better clinician, or if learning how to digitally market, write copy, or start a blog or podcast and get paid more while you do it makes more sense to you. Or better yet, the best of both worlds where you take those CEUs, you get all the letters after your name, then you find a new and creative way to digitally market it so that the public is aware of your skill sets and what you have to offer. 


I personally don’t think I will ever get rid of my 100% cash pay, out of network Mobile PT business, but that is simply because I love working with patients and don’t want to completely lose my hands-on skills and, more importantly, my communication and soft skills. But if it comes down to a $200 one on one patient visit for an hour and a $1500 two hour consulting gig on injury prevention and wellness to prevent workman’s comp injuries, I think it is apparent which option I will choose. 


This blog is not meant to overwhelm you at all. At the end of the day, physical therapy is going to be a viable profession. But if reimbursement rates continue to go down, and student loans continue to soar, what is your plan to overcome this dilemma?


The next several blogs will be addressing problems just like this and answering all of your amazing questions to make sure you know the trials and tribulations of the physical therapy and healthcare professions and some options to overcome them from a seasoned and experienced veteran. One that wishes these types of resources were available to him 15 years ago. Looking forward to your questions, and as always, reach out if I can ever be of assistance.


-F. Scott Feil PT, DPT, EdD


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