small & insignificant

Are you feeling a little bit small and insignificant? As competition for dwindling reimbursements and good jobs becomes more intense many therapists are feeling undersized in the winner-take-all economy.

Mergers are happening–not just in private practice but up and down the healthcare spectrum. It seems that if you want your clinic to survive you need to become a multi-clinic chain to just get your foot in the door.

Big data is the latest buzzword in healthcare. Governments, insurance companies, and healthcare organization are all rushing to embrace large quantities of data. They are scrambling to understand the medical industry in ways they could only dream about before.

Big data with it’s high stakes data analytics threatens what many therapists value most–meaningful one on one connections with their patients. It’s easy to feel like your life’s work is just another data point.

The truth is probably all of us go through times when we feel small and insignificant.

I often feel like I don’t contribute much when I hit the publish button to send a blog post into the world wide web. When I managed my own practice there were many times when I wondered if I was making a difference. I was anxious about what to do next and if I was going to make it another year.

I felt incredibly small and anonymous.

In business, one of the main arguments I hear against the cash practice business model is “It doesn’t scale”. I also hear it’s “Better to work on your business rather than in your business.”

There’s an underlying assumption that bigger is better.

It’s not often that you’ll hear shouts of celebration of “I made $300 today!” or “That patient has made a life transformation”. Instead, what often translates to “business success” these days is the marketing pieces about 6-figure practices and big contracts.

We need to remember that the majority of those 6-figure superstars and multi-million dollar corporations started small. It’s rarely mentioned but almost always true that most large multi-site companies had humble beginnings.

Being one of the “big guys” doesn’t necessarily mean that you are one of the “bad guys”. Nor doesn’t it mean that therapists who make a decision to stay small are somehow inferior.

While starting small and growing bigger is a path that some choose, there is a growing movement among therapy entrepreneurs that are starting small and choosing staying small. Let’s take a look at five reasons why therapy entrepreneurs think smaller is better.

5 Reasons to Stay Small

1. It’s More Affordable

New graduates are facing huge school loans to pay off when they enter the work force. It’s very difficult to start up a traditional therapy practice with a large school debt. The numbers just don’t work. Many graduates give up on their dream practice to slave away for 20 to 30 years just to pay off their loans. Many times they have to work in organizations where it feels more like a job than a career. After a few years of the grind, their fire for the profession starts to die out. They feel trapped without hope for change.

Starting a business is easier now than ever before because of the Internet. Validate your practice idea with your ideals clients, treat your first 100 clients then work towards your next 100. Becoming your own boss is easier and can be done at a much lower risk/cost when you start small.

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2. Do The Work You Love

That’s the dream of almost every therapist isn’t it? Being paid well to help people while doing the work you love.

Large in-network contracts means someone else determines what you can do, how many patients you see and what you’re worth. If you want to get paid you’ve got to dance the dance.  Sure, you may still try to do what you love but the realities of a volume based clinic usually demand professional compromise.

Alternatively, therapists are choosing to become an authority in a niche that allows them to do their best work. They focus on ideal patients that need and value their unique skill.

Staying small means the ultimate choice is yours. You’re responsible for the quality you deliver and your results.

3. Live And Work How You Want

Professional and personal freedom is very important to today’s therapists. Having that elusive work/life balance is very important(especially for millennials).

Many therapists want much more than a therapy job that pays the bills. They have a high priority on family and career flexibility. Many therapists have no desire to climb the corporate ladder but are building their own ladders through a cash practice model.

One of the benefits of owning your own practice is being able to do the type of work you want and wherever and whenever you want.

Staying small, with it’s lower overhead, can provide an opportunity to arrange your work hours around your family commitments and other personal interests. Many cash practices are an expression of the owners lifestyle and beliefs. Medical yoga therapists often integrate their passion for the yoga lifestyle into their therapy practice.

4. You Can Innovate

The ability to create innovative solutions to society’s health problems is crucial to our therapy profession. You probably know how challenging it is to implement a new creative approach in a large hierical organization. Often times it’s not worth the effort to fight the turf battles.

For me, taking one of my ideas, seeing if it would work in real time created a tremendous amount of work satisfaction for me. Having an environment where I could express my creativity was extremely valuable to me.

When you’re small you can stay agile and make changes as you go. Since risk is lower you can afford to try out new ideas, modify and learn what works and what doesn’t. You have the freedom and responsibility to launch a new program or service.

If your creative solution works you get to see the direct benefits to you and your clients.

Cash Practice Checklist Launch Checklist

5. Face Time With Your Clients

By staying small you’re able to stay in touch with every single client. Knowing first hand what your clients need and want is a tremendous advantage over larger organizations that are following the latest therapy trend.

The larger you become the more time you’ll spend on administrative and personnel issues. There are therapists who love to lead organizations and love business. They are wired manage people and businesses.

There are other therapists who  just love seeing clients. It’s what energizes them. Helping people is the reason that they went into the therapy profession. If getting bigger means giving up patient interaction they want nothing to do with it. To them smaller is better.

When I see the work of talented therapists like John Childs or Adriaan Lowu it’s difficult for me not to compare. My little practice seems so insignificant. Try not to compare yourself with other therapists or other businesses. It’s our diversity of talents and experiences as therapists that makes us strong.

Whether big or small the most important thing is to be yourself. YOU ARE BIG ENOUGH. There’s no reason to make yourself feel small.

Take time to do a thorough self-assessment and discuss the results with your spouse or trusted colleague.  Your strengths, your uniqueness, your interests, and your skills are the foundation to build your career. The unique contribution that only you can make is the only measure of success. Not size.

I’m curious, do you want to stay small? Why or why not? Leave your comment below.


As therapists we have tremendous opportunity to use our abilites, education and expertise to enhance client’s lives. What a privilege? If your are in the therapy business to serve people, then my new book On Fire: Ignite Your Passion with a Cash Therapy Practice will help you.

On Fire takes a close look at innovative therapists who are using alternative ways to deliver high-value care to their patients. Cash therapy services have emerged as a viable alternative to accepting business as usual.

If you are intrigued by the attention that cash-based practices are attracting On Fire is a great primer to help you get up to speed on the key issues and how if might impact your practice. The book is available on Amazon. If you are interested in getting your own copy join my email list and I’ll keep you up to date on the special pre-order bonuses I’m giving away.

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Cash Practice Checklist Launch Checklist