500 Loyal Patients

This post is unusual, made up of an adaptation of a pivotal piece by Kevin Kelly, the co-founder of WIRED magazine, called “1,000 True Fans”.  I’ve changed some of the wording for a cash practice startup. Enjoy!


500 Loyal Patients


To be a successful therapy entrepreneur, you don’t need thousands of patients. To make a living in a cash practice, you only need 500 loyal patients.

A loyal patient is a client that refers to you as “my therapist”. They tell their friends about you. These diehard patients will drive 100 miles to see you.  To them, you are an expert. They come back to you whenever they need help. They willingly open their pocketbooks because of the value you deliver.

If you have roughly 500 loyal patients like this (also known as super fans), you can make a living. That is if you are content to make a living but not a fortune.


Patient Retention


First, you have to create a strong patient base that you can earn, on average, $200 profit from each loyal patient. This per client revenue is easier to do in some specialties than others because of higher operating costs like gym space.

It is a creative challenge in every specialty area to retain satisfied clients for a lifetime. 

Patient retention makes good economic sense because it is always easier and more productive to stay connected to existing clients than it is to find new patients.


Personal Patient Connections


Second, you must develop a vibrant personal connection with your clients. That is, they must see you as their expert and pay you directly. You get to keep all of their support–both loyalty and cash, unlike the small percent of the charges you might get from a corporate owner or insurance company. 

If you keep the full $200 profit from each loyal patient, then you need only 500 of them to earn $100,000 per year. That’s a living for most folks.



One hundred loyal patients is a whole lot more feasible to aim for than thousands of new patients. Fifty loyal patients is a realistic goal to shoot for, especially when you are getting started.

You probably have the contact information of one hundred friends, family, and former patients. Start reaching out to them. If you added one new loyal patient per week, it’d only take a few years to gain 500 loyal clients.




The takeaway: 500 loyal patients is a viable alternative to a high volume practice. Instead of trying to sell your services to strangers, you can invest your energy in cultivating loyalty and referrals from your existing patients. 

Regardless of how long it takes to grow your loyal client base, you’ll find yourself working with ideal clients–who value your service and tell their friends. They will help you build your practice through genuine appreciation instead of a slick marketing technique.