No Longer A PT, but Grateful for the Path I’m On!
Written by Breanna Anderson, PT, DPT
I have close to 20 years of experience as an aquatic physical therapist, I finally paid off my student loans last year (with no help from the government), and yet I am no longer working as a physical therapist.
That’s not entirely true. I’m not practicing in the traditional “rehab” sense, but I still have my CA license, take more than the required number of continuing education courses each year, and use my PT skills every day. However, I’m no longer double-booked with two (or more) patients per hour. I don’t have to supervise PTAs or unskilled therapy aides. I don’t go home after an 8+ hour day and find myself stuck with hours of charting and other administrative work. I don’t have to worry about prescriptions, authorizations, and progress notes. I no longer play the “insurance game” and let Medicare decide how often I can work with a client, or what body part I have to treat, or how much I should get paid for my work. In short, I’ve found a way to continue doing what I love while abandoning all of the parts of being a PT that made me miserable.
While the transition from employee to business owner was definitely not an easy one, I can finally see this experience as a blessing in disguise. Losing my job created the impetus to make necessary changes in my life. I knew I was unhappy and burned out and I had to get off the hamster wheel, but I didn’t have the time/energy/support to start something new. Looming unemployment gave me the necessary push to pursue my passion and create a business that would be in the best interest of my family, me, AND my patients.
While I originally intended to continue working as an aquatic physical therapist, I knew I wanted to become a cash-based provider rather than an in-network insurance provider. I realized this would be an unpopular decision with patients, but I honestly feel that health insurance is destroying my profession. Over the last decade, I have witnessed the annual cuts in reimbursement, the time/cost of claim denials and audits, and how insurance companies have dictated how clinicians should practice. Operating costs are at an all-time high, the cost of living continues to rise, and yet, Medicare reimbursement for outpatient PT has actually declined over 12% since 2016. Practice owners have few options to stay in the black: treat more patients, work longer hours, rely more heavily on support staff (like therapy aides), stop accepting insurance, find alternate ways of generating income, and/or tighten up the budget (who wants a raise, anyway?). It’s a recipe for disaster, and it’s far from sustainable.
Cash-based models and concierge services are popping up across the medical profession, and as a consumer, I can understand the frustration. Why should I pay premium dollars for my health care plan when the providers I want to work with don’t accept insurance? But from a provider’s point of view, cash-based models are one of the only ways to ensure good quality care, stay profitable, and avoid burnout in the process.
Travis and I are both passionate about wellness and prevention, so we decided our business, Anderson Aquatics, would place a heavy emphasis on fitness-based initiatives like water exercise classes and small group training. Offering a variety of programs at different price points would allow us to accommodate more clients without sacrificing the quality of our services. We would continue to offer aquatic physical therapy on a 1:1, cash-based basis, but since we wouldn’t accept insurance, we anticipated PT would be a much smaller source of income.
Upon setting up our LLC and getting ready to open our doors, we ran into a major roadblock that forced us to reassess our business model. In 2020, the Moscone-Knox Professional Corporation Act was passed in California. Basically, any occupation that requires a license to practice (like PT) must form a professional medical corporation (PC). LLCs, partnerships, and corporations are not acceptable legal entities. Upon consulting with a corporate attorney, in order to treat patients as a physical therapist, I would need to create a second business (something like “Anderson Aquatic Physical Therapy, PC”). Since this process would take several months, Travis and I decided to move ahead with the LLC and reconsider the PC after we got our bearings as business owners.
The doubters made their opinions clear: without providing medical services like physical therapy, our new business would fail. Angry community members left nasty voicemails and emails telling us how horrible we were since we weren’t offering physical therapy. With so many other areas to focus on, like bookkeeping, taxes, and facility repairs, we were distracted from listening to the naysayers. And, yet, we also understood their concern. Change is difficult & hard to accept. But when your favorite pizza place goes out of business and a Chinese food restaurant takes over, do you get upset with the new owners for not selling pizza?
Initially I felt a bit guilty and ashamed for not using my PT title in my new business, as I’ve identified with being an aquatic physical therapist for almost two decades. However, those feelings faded quickly. I realized I can still use all of my PT experience and knowledge to improve the health and well-being of my clients, even without a professional corporation in place. My “floating bodywork” sessions consist of manual therapy techniques - Bad Ragaz, Aqua Stretch, joint mobilizations, soft tissue massage - techniques similar to those you would get at your chiropractor, massage therapist and your aquatic PT. “Aquatic personal training” enables me to work 1:1 with clients, crafting customized water exercise programs based on an assessment and the client’s personal goals. Want a combo? Let’s do body work and personal training! Guess what - it all feels a lot like what I used to do as a physical therapist, but without the endless paperwork, referrals, and insurance headaches! A win-win!
For those of you still reading, I think it’s important that I point out why this change was actually very good for YOU - my potential clients!
Accessibility. Back pain? Ankle sprain? Post op? Preventative care? You won’t wait 2+ months for an appointment (another aquatic therapy facility in town has a 5-month waitlist!). You don’t need a doctor’s referral or insurance pre-authorization. I can work with you NOW.
Lower cost. Since I don’t have to account for the associated administrative time (that dreaded paperwork!) & expenses (like HIPAA compliant software), or the costs of operating a second business, I can charge a much lower rate for personal training than I would if I were offering self-pay PT under a PC. Meanwhile, the service that I’m providing to you is identical.
Flexibility. You decide how often you want appointments and what you want to work on. Need one visit to learn an exercise routine? Sure! Want regular sessions after surgery? OK! Long gone are the days of Medicare saying we can address just one body part per session. And since you won’t be working with a therapy aide, we can make quick changes to your treatment program whenever needed.
More than just rehab! Physical therapists are uniquely trained to play a role in wellness and prevention, yet the insurance world doesn’t typically pay for these services. Showing clients how to use water exercise to improve their health, boost athletic performance, and/or prevent surgery is fun and rewarding… and a service that’s now available to you!
Better outcomes. Imagine this: you get to work 1:1 for a full hour with a Doctor of PT who has an aquatics specialty & 18 years of experience [or maybe you’re taking a water fitness class with this DPT, not a 16-year old lifeguard with only on-the-job training]. Your therapist trainer/instructor isn’t burned out and overwhelmed with managing an exhausting patient caseload, and she seems very invested in you. Sound too good to be true? It is for most traditional outpatient therapy clinics.
Previously, I was expected to oversee 75 patient visits per week. Now, I limit myself to between 16 & 20 1:1 client visits per week in addition to teaching classes (like SUP yoga!) and lifeguarding. Being able to stay truly present with my clients means they get better faster and don’t need as many appointments. I’m not handing them off to an assistant. I’m not multi-tasking and working with several clients at once. I can establish rapport, be creative, and use my critical thinking skills & experience to help my clients reach their goals.
It’s kind of funny, really. I think I’m more of a PT now (as a “personal trainer”) than I was when I worked as a physical therapist. After all, documentation and doctor’s referrals don’t make you a PT. Calling your service “physical therapy” doesn’t make you a PT. I love that my clients seem more invested than ever before, and they’re not just using aquatic therapy as a free/discounted form of personal training or massage (via insurance) because they feel entitled to it. And I’m able to shine doing what I do best — assessing, listening, teaching, and providing support. It’s been a long and winding road, but I’m so grateful for the path I’m now on.
Want to work with me? Book a group fitness class or specialty class online, or get in touch to schedule 1:1 personal training or body work. I can’t wait to meet you!
Breanna Anderson, PT graduated with her Masters of Physical Therapy and Doctorate of Physical Therapy from Ithaca College in 2006. She began her career in Los Angeles at Complete PT before moving to Santa Barbara as a traveling therapist at Cottage Rehab Hospital in 2008. Breanna’s areas of special interest include pediatric aquatics (for kids with special needs), pre/post natal care, orthopedics, post-op conditions, Parkinson’s, prehab & rehab for athletes, and balance training. She also has extensive experience working with individuals with chronic pain.
Content provided on this website is for informational and educational purposes only; it does not constitute providing medical advice or professional services. Always seek the advice of your physician regarding your health conditions and prior to initiating an exercise program.
