Cash Pay Pain Management And Improving Outcomes With Aaron LeBauer, PT, DPT

Hey there. Before we begin today's episode, I wanted to let you know that my latest book, Radical A Guide to Overcome Chronic Pain is available for pre order on Amazon today. Radical Relief is based on three science backed methods including pain neuroscience, education, acceptance and commitment therapy and mindfulness. Radical Relief is perfect for practitioners or for people living with pain. It's filled with brief exercises that use the power of the mind as well as easy to read chapters with full color illustrations. You can pre order your copy today on Amazon.

Welcome to the Healing pain podcast with Dr. Joe Tada. Each week we interview top experts in physical therapy, pain science and integrative pain care. You'll learn the most up to date information for treating and reversing persistent pain. This podcast is for educational purposes only and not intended to be used as personalized medical advice. And now, here's your help. Host, Dr. Joe Tada hey there.

Thanks for joining me for another episode of the Healing Pain Podcast. Today we're discussing the advantages of cash based physical therapy and cash based pain management services. My guest today is Dr. Aaron Labauer. Aaron is a doctor of physical therapy and a business coach for healthcare entrepreneurs. He owns Labourer Physical Therapy in Greensboro, North Carolina where he's been helping people stay active and fit without medications, injections or Surgery since 1999. He specializes in treating people with chronic conditions and persistent injuries which have not responded to traditional treatments and therapies. With the goal of helping patients have less pain, move better and feel better in their bodies. Aaron also helps other passionate physical therapists create and grow successful physical therapy practices without relying on insurance companies. On today's episode, you'll learn all about how to start a cash based pain management practice, how cash based models can offer more for people living with pain, how you can break away from the constraints of major medical insurance and why you may decide to choose a cash based practitioner to help you treat and self manage chronic musculoskeletal pain. Okay, let's begin and let's meet Dr. Aaron Labauer and discuss cash based physical therapy and cash based pain management.

Hey Aaron, welcome to this week's episode of the Healing Pain Podcast. It's great to have you here.

Hey Joe, thanks for having me. I appreciate you bringing me on.

I am super excited to talk to you because you're the first guest that I'm talking to kind of about the business of pain and the business and practice of physical therapy and not just physical therapy. Other practitioners treat pain as well, but just kind of starting to look at what are we doing in practice how do we enhance or transform our practice? How do we help practitioners develop their skills, develop professional development, and take that into the practice, and of course, help their patients and potentially increase their profits, which is what all of us need when we function in the private practice world and in healthcare in general. There's a profit side to it as well that we have to be mindful of. But just obviously, we know you as a physical therapist. I mentioned that in the introduction. Tell us how you guys saw it kind of before that, though.

Yeah. I was born to be a physician, right? My dad, my uncles, my three uncles, and my grandfather and his brother were all physicians. And it was just kind of. That was just expected. None of my older cousins ever did that. And I was like, well, I mean, that's just the only path I see. And I got to organic chemistry, and I couldn't do the first night's homework in less than four hours. Actually didn't finish it. I decided to quit right there. I just got an A the previous semester in chemistry. And I realized then that I didn't want to spend my life studying. I wanted to spend my life experiencing. And when I graduated college, no one really knew what to do with me because I wasn't gonna be a doctor, lawyer, or business consultant. And I went out and experienced the world. And in trying to race bicycles, I realized I had to have a better job than as a temp. And I realized I could go to massage therapy school. I had always wanted to use my hands and had benefit from getting massage as a younger adult. I realized then I was like, well, I can do something I love. I can treat people who are hurting, and I don't have to go to med school to do it. So I went to massage therapy school out in California, and this was back in 1999, pretty quickly after I started taking some con ed courses and experiencing patients who were telling me that I was the first person to touch them where they hurt, and then I was the first person to help them. And when they'd been to pt, massage, chiropractic, surgeons, et cetera, and. And I realized after a few years of doing that I needed more knowledge, more education. I need to be able to help them. Like, I didn't know how to predict and tell them when they were going to be better. People kept asking me that. So I thought, you know, maybe PT school. My wife really was like, you need to go be a pt. Because I was doing more, like, what I would call structural body work at the time, or I was working with people who were injured, who are getting help from me when they couldn't get it from someone else. But I didn't have the tools to really help them long term. I could provide some pain relief. In the middle of PT school, I realized that how real this insurance game was. On my first clinical rotations, I saw 43 patients one day. And I realized that day no one was going to pay me to see one person an hour, a salary that I wanted, and no one would hire me to do this. And I was going to have to actually, you know, start my own business because everyone thought it was crazy what I was trying to do, but I had experienced it. That's what people needed at some point. They needed more time, more touch, more empowerment. And then I started my business. Fast forward now. I mean, so it was really like, I don't know where to stop because there's so much in there. But I started sharing what I was doing with people. And people were like, how'd you do this? I was like, well, here it is. And now I help coach physical therapists and private practice owners to creating more time, income and impact without relying on insurance companies.

I definitely want to get into that topic, that time, income, impact without insurance companies. But as you mentioned, there's a whole lot there in your introduction. I want to rewind and just touch on a couple spots. The first thing is. So you said three people in your family were physicians. What kind? I'm security. What kind of physicians were they?

My dad's a cardiologist. His brother is a gastroenterologist. The twin and then not my dad's twin. My uncles are twins. The other twin is a pulmonary and infection pulmonary specialist. He's not. I don't know, he's board certified, but he worked in emergency rooms and worked with infectious disease and pulmonary issues and became an allergy and asthma specialist. Their brother, he didn't have a specialty. He passed away when he was 25. Right before he graduated med school or right before they walked. My grandfather was a family physician and his brother was a surgeon. So.

Okay, so not. Not exactly in the physical medicine realm, so to speak, right? Yeah.

Right. Not at all. I mean, just. Just disease.

That's right.

You know, I saw that they cared for people and back. I mean, if we can all remember 20 years ago, like, you could sit down with your physician for more than five seconds and actually have some kind of conversation. And they would bring their. They would evaluate their patients and bring them back to their office. They'd sit them in a comfortable leather chair and they'd talk to them, not just about the disease or the thing, they talk about their family and they build relationships with people. And I saw that growing up. And I knew once I got into PT school in these clinical rangers, I knew that wasn't going to exist for me. And that was kind of, I mean, that was eye opening.

So what's interesting in Bezzi listen to your story. What's interesting to me is when I think back to physical therapy school, I first had a bachelor's in physical therapy. So I did a four year undergraduate, which those of us who are, as you mentioned, can remember back 20 years. There was a time when physical therapy school was not a doctorate degree, but it was actually a bachelor's degree. And then it transferred, you know, it evolved into a doctorate degree. And most of us have evolved with that. But there was actually a moment when I was in undergrad in physical therapy in my bachelor's program. And the school I went to, Downstate Medical Centers, SUNY Brooklyn, which is a wonderful school, had College of Nursing, College of pharmacy, there were OTs, PAs, PTs, and of course the College of Medicine. And we took some similar courses. Like everyone took gross anatomy together, everyone took physiology together. So you would interact with the other disciplines. And quite frequently the topic would come up, well, why you seem pretty smart. Like people would actually say this to me, Joe, you seem pretty smart. Why don't you go on to become a physician? And I didn't really have the words for it back then. Now I have a whole lot of words for it. I didn't really have the words for it back then. But it's interesting to me how we see a physician as kind of the top of the pyramid, so to speak, in medicine. But how our evolution with following pain management, pain care and opioids has started to maybe kind of erode that belief for certain people. And the impact that's had on the profession of physical therapy and other professions as well.

Oh, absolutely. I mean, that's something that I've seen from the beginning in a way that when I would walk into my seat, one of my first CIS told me this. Aaron, when you walk in the room, everyone thinks you're the physician or surgeon. Like this is when I was on a rotation at the hospital and it's just the way you carry yourself or something. I mean, I'm six foot three, where, you know. But like I had been on rounds with my dad and grandfather and I just, this is how you do it. And that's the big friction that I Hit with learning how to, trying to learn how to market to physicians or even in PT school and clinical rotations is that everyone thought that this one profession was the top of the chain and my voice didn't matter unless it was approved, which I don't think that's not the case anymore. We just have to, we just have to make our voice heard.

Is that a barrier that you find when you start to interact with physical therapists who are just thinking about starting a private practice or maybe just open their private practice? Is that something that they struggle with? The idea that, well, now my own boss, I have my own practice, so to speak, but yet I still haven't kind of found my voice within the other professionals and how do I communicate that with the patient or the public necessarily?

Right, yes, it is something that's there. It's getting a little bit less and less in the last five to six years, especially the younger pts getting out. I feel like they have it, but I think part of it's because they don't have the experience versus someone who's been in clinical practice for five to 10 years working in a more traditional PT clinic. And I think that it gets in the way. Where it gets in the way is people think, oh well, in order to start I just need to go market to physicians. And I can tell people like it's not going to work if you have a non traditional practice. Like if that's the way you think it is, that's. But that's like this, that's part of the mindset of like physical therapy is the technical service rather than the decision making service. And I think from our last conversation that we had on when I was interviewing you, it was like we both agree that we're decision makers or we help make decisions with patients. And that's the big distinction is do I do, am I doing what someone else is saying or am I helping patients make a decision? And if we're in the decision making service, then we have to go find patients who make the decision to come see us and then that's the best, most equitable relationship to create positive outcomes.

And so you mentioned a non traditional practice. Can you define for us what that looks like? I'm sure it looks different depending on the practitioner and what their vision is for their practice.

Yeah, I think I'm going to define what a traditional practice is to me and then pretty much non traditional is everything else and I'll get to that. But to me it's a physician owned clinic or a big hospital owned Clinic where I'm a physical therapist and I take in air quotes, orders where I get a script to put someone. I saw five shoulders today and I did five shoulder rehab programs today. I'm like, but you saw five different people. How can you give them all the same protocol? That's the old way because. Right. Physical therapists, we were physician extenders and we no longer are. But in certain states or certain practice settings, the orders and referrals come from the physicians, even if it's not required by law and people just practice and it's really easy. It's like, yeah, you tell me what to do, I'm going to do, I'll do that. And so those would be the settings that I see. And someone working that setting might say, no, I disagree. I make decisions with my patients and I get it. But it's that where that's a traditional kind of model physician owned, hospital owned, corporate physical therapy. We're seeing multiple people at a time. Non traditional doesn't only mean one on one, but it might mean I can take as much time with you as I need to up front and I can put you in a group program or a one on one program. Maybe I help you through telehealth or online programs, maybe there's a group program. Pretty much anything else that isn't our initial picture of what physical therapy might be. And I'm talking mostly outpatient, orthopedic rehab style physical therapy versus a lot of the other types of therapy that we do as physical therapists. Does that make sense and helpful?

Yeah. And my follow up question to that would be, so you've seen this change probably over the last five or six years, probably as the DBT is really kind of like, you know, solidified itself and there really aren't that many bachelors and master's physical therapists kind of left over. But are you finding that in PT school there's a little bit more of this talk of non traditional or alternative practice settings where probably back when I went to school there really was almost none.

No, I don't think, I don't think that students today are getting it like learning it in school. I think they're saying, I think what I'm hearing is that they're getting in and going, wait a minute, this just doesn't quite seem like what I signed up for. Let me go see what everyone else is doing. What is the reality? And because of the way the information can be put out on the Internet, they're finding information more. When I graduated PT school in 2008, there wasn't really any information online about cash based practice or how do we, you know, telehealth or how do we do PT and you know, like groups or courses. I mean there's, there was none of that. And I think now it's, there's more information out that's easier to find. And they're still questioning. I think the big struggle that they come out with right now that I'm seeing is I have a doctor of PT, I paid $150,000 for it, and I'm being told not to tell people I'm a doctor. Like that comes through more. And I think what that's confusing because it's not impact. It's not impact, you know, it's not empowering and it's not allowing them to say, hey, now I can go make these decisions. So I think that I do know in PT school when I was there, we were, it was very frowned upon to be put into a physician. Like we couldn't get a clinical rotation, a physician to in practice, but we still could in a hospital owned outpatient practice, which some days there's not the. I can see there's not a big distinction in my mind on those. But I think because I think the Internet's doing that job and people come out with absolutely like zero business knowledge and understanding and they need a little bit more than write a business plan for a $250,000 business with 5,000 square feet of space.

That's just the, just skimming the surface on that part.

Right.

So the aspect of identifying oneself as a doctor. So obviously their doctor of medicine is a physician, psychologist, Doctors of Psychology, DPTs, Doctor of Physical Therapy, DC, a Doctor of Chiropractic. We now have DNPS, which is Doctors of nurse practitioners. It's interesting you say that because when I started my podcast a long time ago now, I started out with, hey, this is Dr. Joe Tada, welcome to the Healing Pain podcast. And I still start every single podcast like that. And a number of people have actually asked me, why do you call yourself Doctor? Why do you start off like that? And I say, well, first of all, I earned that degree both in sweat, blood and tears as well as money, so I'll use that. But there's also a perception to the public as far as if you're looking for a skilled practitioner who can help you with your physical function, who can help you with pain and other lifestyle factors, the degree I have, actually, just so you know, I've gone to the furthest place I can go with that degree, so to speak, so that it does, in essence help the public understand that there's a certain amount of competency built into me as a practitioner.

Right, absolutely.

But I'm curious as to. Is it we haven't given physical therapists permission to use that in school, Is it we still identify the doctor as the physician and we're in essence, aside from that or less than that or below that, or is it just something that people grow into as they start to practice?

I think it's a little of all three. But I'll rank them like this. Number one, we've given them permission and at the same time there's some professor, clinical instructor, someone of influence somewhere in people's sphere, telling them, you shouldn't say that you're a Doctor, you're not Dr. Labour, you're Aaron Labourer, the physical therapist. By the way, I have a DBT degree, and if you don't know what that means, it means doctor Physical Therapy degree. I'm not a real doctor, but I play one on tv. You know, like that's. That attitude is being put onto. And that attitude and mindset is being put onto some of these young physical therapists. Not being told they have to, but they're just getting that influence so that in that clinical practice setting, they're not empowered to use the term doctor, probably because someone else is upset at how it might make them feel or look. I think that's number one. And then number two, there are places where people are getting jobs as physical therapists where if they're making critical decisions with their patients, they're being reprimanded or told. You're not following the script in air quotes, so now you're in trouble. And I had this happen with one of my residents here at his previous job. He was reprimanded for getting a patient better in five visits when the script was for eight. He's like, but that person's met all their goals. Like, you know, why do I need to see him three more times? Just to talk, you know, And I think. And then, and then I think it's a mindset, right? It's mindset. And it's okay, I can, we can all. I can be Dr. Lavar, you can be Dr. Tada. And neither of us have to be physicians to be called that. You know, we're experts, we've earned it.

Yeah. I may have mentioned this on, when I spoke with you on your podcast, which everyone should. Should go check out. I may mention when the DPT Started and I had therapists I employed at that time. I encourage courage them to. When you first meet a patient, so when you go outside into the waiting room for the initial evaluation to say, hi, my name is Dr. Alan Labauer, I'm going to be your physical therapist. Come on back to the, to the evaluation room. You know, it's a pleasure to see you and I'm looking forward to helping you. Come on back. Right then at the end of that session, if you decide you want to say hey, each time you come in, just, just call me Aaron. We'll keep it, you know, really relaxed. And I think patients like that. But it's, it's an opportunity to do both. It's an opportunity to share kind of what your knowledge is as well as an opportunity to then kind of solidify that bond with someone. I think it's really important. A lot of professionals don't. Now, of course, on all my out facing material, my website, business cards, Facebook page, it says Dr. Joe Tada. Because that's how people first see you, so to speak. I'm wondering, as we've scaled that hurdle, which I think is actually an important one, what are some of the other foundational skills that you find you're helping people cultivate as they first enter into clinical practice? Yeah, not clinical practice, I should say, but private practice. Their own business.

Yeah. I think the number one skill is transferring your ability to help someone heal with your ability to help them understand how you can help them heal. Because a lot of times we're all great at healing people or helping people heal themselves, you know, like providing the therapy, but that's not enough.

So that's subtle. Say that again first. That's very subtle what you just said in the beginning.

Yeah, we like, I can be a great healer, but, and I can, I can see that someone needs help, but that person needs to understand that they need help and that I can be the one to help them. And it's. When we get into private practice, it's like, well, I can just help you. And one of the biggest mistakes that I made was trying to help people or fix them in the first visit. But what I really need to do is get them on board with my treatment plan in the first visit. And it's almost like there's no therapy. Well, the therapy is them understanding that I understand them and that I am the one to help. And then like, oh great, I feel so much better. Dr. Lavauer, I don't know what you did, but I feel so much better already. You didn't even touch me. I'm like, I know. Yeah, because they understand. I know. But if I just lead with jargon and techniques, they're like, what are you doing? Why are you doing that? They don't understand that I know what to do with them. And then they're unsure and uncertain that I'm actually the one that can help them.

We had this conversation in my ACT program where we're discussing how do you discuss acceptance and commitment therapy with a client? What is that and how does it help them? And the truth is most people don't understand what acceptance and commitment therapy is. Even some licensed mental health professionals who are trained in more traditional psychotherapy don't understand what acceptance and commitment therapy is and explain it. Now, if you go to many professionals websites, as you mentioned, like the techniques, you'll see things, you know, listed out. I'm an OCS, which is an orthopedic certified specialist. I'm trained in McKenzie. I'm trained in pain neuroscience education. I'm trained in ACT or cognitive behavioral therapy. Should we list those things on our website? And should we talk about therapists, talk about that to patients during the first visit, or are there other things we should be talking about? And what. What are those?

Yeah, that's a. That's a great point. I think that's the number one mistake a lot of the people that I work with in my coaching programs make is their websites. Or at least they show up and their websites are, you know, a CV or a business card, online cv. It's like, I've done all these con ed courses, like, yes, and you have, you've spent a lot of time learning it. You spent quite a bit of money and in time traveling, investing, and learning some advanced therapy. But patients don't really care. Occasionally patients do care and they're looking for a certain therapy. And that's still like, not the best thing to happen because they'll end up price shopping you and they'll look for the lowest price. What we really should be doing is speaking the language that our patients speak on our websites and our marketing materials is think about what's in it for the patient, because we're not our customer. Like, I'm not my own customer. So I don't care if what techniques. My patients don't care what techniques I have. If I want to refer someone to someone I think is quality. And I want to kind of figure out, like, well, are they a therapist that maybe aligns with my values and techniques? Maybe I want to know what courses they've been. So I can say, hey, look, I know this person's been to some similar courses to me. I can't guarantee, I know they won't be the same as me, but you should get some good care. That might be important, but my website doesn't have any of that. My bio says a little bit, but it's the primary things that are on our websites and websites that work are websites that speak to patients. Wants, needs and desires. People want to get better. They need to know that you can help them. And they desire to what? Not for me to help them. They don't really want to see me. They want to be better, faster, stronger, more confident so they can be a great role model for their kids or even, hey, get on the floor and play with them without fear of blowing their spine apart or whatever image is in their head. That's what's in it for the patients. And that's what our websites should do. And that's really what our conversations need to be around, is figuring out what is it that they want and are concerned about. Because if we understand that, then we can help them. Because the ACT, MFR, EMR, DMR, DPT, all HCs, all those things are just the ways that I get people from point A to point B. They're not the thing that people are buying.

Right. And it's interesting, as a physical therapist and other practitioners who listen to this, everyone's like, well, people come to me because they want pain relief. And I'm like, of course most people with pain want some kind of pain relief on some level. But what's underneath? Like, what's underneath that other than the physical pain? What other? Literally, what other pain problems do they have? What are their pain points?

Right.

And how do we talk about that with people?

Yeah. And that's it. Like, what do people really want? Like, they don't just want their knee fixed. They don't just want the knee pain to go away. It's like, what is the knee pain going away going to allow them to do? Oh, it's going to allow me to run or go to CrossFit. I figure still that's not the goal. What does going to CrossFit five days a week. Why is it so important to you? I feel strong. It makes me feel confident. Okay, great. Why is being strong and confident so important to you? Because I want to be a good role model to my kids. Well, why is being a good role model to your kids important to you? Because the guys I grew up and didn't have One. And if I don't get these, if I don't get my knee fixed and can't go anything, I'm a crazy stress case and terrible. I feel like a bad parent. Okay, great. I can help you avoid that and I can help you do this other thing and we'll get you a little physical therapy along the way.

That's interesting. The values based care that we lead with in our session is actually the values based marketing that we should include on our forward facing material like websites and all sorts of pages that are in the ethers out there nowadays.

Absolutely, 100%.

How has the chronic pain epidemic and opioids changed the way private practice physical therapists are positioning themselves, marketing themselves? And has it kind of like lit a fire under our butt a little bit to say, hey, this is a pretty prime opportunity for us to take advantage of, really a big movement that almost every government and other types of organizations are on board with with regard to conservative pain care?

Yeah, I mean, I hope it, I hope it has. I mean it's lit a fire under me and you know, I've realized I can't do it on my own. And I think I would love to share one distinction that we changed. When I started my practice, my promise on the website was, you know, pain free or get, become pain free today. And one of the problems I found with that is I attracted people that were really difficult because they were associating like, and identifying with pain. So they were having a hard time like letting go of that part of their identity. And then there was another subset where it's like, okay, within one to two visits they feel better and they don't need me anymore. Although they still move poorly and will like, I'm like, I'm not done. They're like, oh, but you promised pain free. So when I'm, I got it, I'm good.

Thanks.

Dr. Lavauer or others that after five, ten visits are like, oh, I feel the same. I'm like, but you can run a 5k now, right? And like, yeah, but I still hurt. So that got, that was like the pain trap for me. So now it's less about pain and more about like, how can we be. For me it's be active without pain meds, injections and surgery. And that's moving me, moving us forward and getting me into a mindset with patients. I feel like I can help them even more. And so that's me. But. And I feel like as physical therapists, professional, we really have been dropping the ball on this whole opioid crisis. Like, I'll turn it into npr. And there's no physical therapists being interviewed on npr. There's no mention of alternates to the pain meds. It's just, we shouldn't give them pain meds. It's like, well, what's the thing that we should give them? It was like, they should be seen in physical therapy. Like, I know that. You know that people listening probably know that. But that's not part of this national conversation. And there's a huge opportunity there. And if someone knows someone who can get me on npr, I'd be happy to go on npr. But I am not the one that's most versed in the science around pain and healing. I'm more a business person. But I know that needs to happen, and I wish we could be part of that conversation. And there's a huge opportunity out there, even if there's five other physical therapists doing their own thing in your town, because no one is getting physical therapy when they need it, but 10% of people are probably getting it.

I had this conversation on a Facebook chat with someone, and it was turned into a little bit of a heated debate because the question was, has the American Physical Therapy association done everything it can do to help promote physical therapy as the alternative for, let's say, opioid pain medication? And I said, no. I kind of had a little bit of a, well, have you seen the campaigns out there? And they did this podcast on this topic. I'm like, yes, but what the American Physical Therapy association is putting out typically is aimed at physical therapists. Right. So they're preaching to the choir.

Right.

Which is fine. I mean, our profession needs to be educated about these topics, and there's a lot to discuss on these topics on a national health care regulation level, so that's beneficial. Have they done enough to get to the public, so to speak? Do we have physical therapies like you said, in positions that if you were called onto Oprah, and Oprah wants you to talk about conservative pain care and how a physical therapist can fill that need? Do we have people who are articulated enough to really talk about that, as you mentioned, not just kind of the science behind it, but what's the transformation that we can provide patients with? And I'm not sure we're there yet as a profession?

Oh, no, I don't think so. I think we have a few people, and I would say either they're hidden or polarizing. And I believe that the apta, when you said that first question, like, have they done enough. I'm like, they've done everything they know how to do.

Right?

I believe, but I don't believe that as an organization they're allowing themselves to be open to new ideas or new ways of reaching public and marketing. Like, there's new things and it takes a lot of momentum to move a big ship. I think that they could certainly do a lot more, but maybe they're limit. I'm going to give them the benefit of the doubt. They're saying they're limited by their knowledge of how to make this happen. Which, I mean, I'm like, I could make this happen. I just don't have the money and the resources behind me. And I could float some ideas, but you have to be willing to listen to new ideas. And like, no, they're dropping. They've dropped the ball in plenty of places.

I also wonder along those lines. Yeah, so this is, this is not 100% true, but our professional association is mostly staffed and run by PhD trained physical therapists who are academics. And we need an academic voice in the American Physical Therapy Association. We also need a business voice. We also need a clinician voice. We also need those other aspects. And I'm not saying at the lower level, I'm saying at the higher level. Like when you walk up to the higher levels of the apta, those are academics who've been in academic careers for decades. I would argue they're not in touch with certain aspects of our profession. However, there are opportunities for them if they're attuned to start to change some of that. My question, and this is somehow turned into a discussion about the apta, which I want to veer away from in a minute. But my question, and this is for all of us to kind of reflect on, because we are the APTA in essence, right? As physical therapists. Why have we not been talking about these topics before it became a national epidemic? Yeah, like that's, that's, you know, I look, I reflect on my own work, my own podcast, my own website, my own practice. Could I have done more to educate the public about some of the dangers of opioids and other pain interventions that are not necessarily health performing, health promoting?

Well, remember, it's what's in it for me, right? If I've got a job somewhere, I mean, I just, I want to get paid, clock out, right? If I have a successful business, why am I going to go spend 50 hours a week working at the top of the organization getting and probably paid what they're getting paid, you know, But As a former academic, that's probably pretty like, awesome job. Exactly what I want to do. And you know, I look and go, yeah, Joe, but I got a million views on my clinic YouTube page. I didn't know what I was doing, but I did it. And there are people out there that have higher profile, more million views a year, a week, who are PTs. And it's not even up to them. It's like up to all of us to put in the work and to share what we're doing. And when we fight amongst each other, like, my clinical way is better than yours and you shouldn't say that and you shouldn't say this like we don't get anywhere. It's not serving anyone but like our own egos.

What does a physical therapist just out of school or maybe been out a couple years and are thinking about leaving those traditional practice settings you spoke about, how can they start to do some research and investigate whether or not, let's say a cash based alternative model is for them?

I think the number one question to ask is like, do I want to put in the hard work for the big reward or am I okay putting in the work I'm doing right now for the reward I'm currently getting? Because whether or not whatever specialty you are, if you go into business for yourself is a lot of hard work, but there's a huge reward. And it's not just money, it's in satisfaction. I know every day why I get up to do what I do. And because of the frustrations I've had in the past, I'm like, I'm doing it for, I'm doing it because of the guy who was told he needed a third ankle surgery when he never had anything wrong in the first place. Or I'm doing it because I want, there's more meaning and time I want with my family. It's really, it's, it's a combination that would be number one. Number two is go to YouTube or Google or wherever and look up, you know, cash based physical therapy and see, I mean, there's a few things that you have to do like strategy wise, but number one would be like, are you in this for the long haul or you just want like a quick change? Are you running and are you running away from a bad job or you want to run towards something really amazing and you'll put in the work to get there, even if it's hard, frustrating and you feel like you're failing along the way.

Is starting a cash based physical therapy kind of on the Side, like a side hustle. Do you recommend that for people or do you kind of feel like, well, as you mentioned, a business takes a certain amount of time and dedication. If you're going to do it, you should prepare for a year and then take that step in.

Yeah, I think that right now it's not really the question of will a cash practice work. It used to be like, will it work? Okay, let me start a side hustle, see if I can get it working. It's like, we know it works. We know people. I know people work with people who are six figures in their first year, scaled it multiple locations. Like it works. If you do the business right, it's, do you want it to work for you? And why start a side hustle? Because are you getting current requests for people to see you? Like you can see, you know, four to nine people a week. You can make, you know, 60 to $100,000 extra per year and then you can easily move over. Like if you've got family and bills and things and you can't just like go cold turkey, like that would be a way to do it. It's going to take you longer to get there or you just get started. And people, if you're dedicated and you put in the right steps, you can get started with, you know, five to 15 people in the first month or two, like per week and make, make plenty and make your, make your expenses. Because nine people a week for charging, what we're charging is a little over $100,000 gross per year. And that's not chump change. That's like real income. And that's nine visits a week, not 43 a day. You know, so time becomes something a little different. My other thing that someone needs to really investigate is how much you're worth because you're not worth what someone else is going to pay you. In owning your own business, you're worth the results and transformation you help your patients and clients get. And those are two very different numbers.

I love that part about the self worth aspect of it because even that I think people kind of start out, I'm going to charge $100 for an eval and $80 for each session. And then a year or two they kind of blow that up and it's completely different. Like the model changes, the pricing changes. I'm wondering who's not right to enter into a cash based practice.

Yeah, I think if you don't want like, if you don't like uncertainty and you don't like, I mean, even like this is any business, right? So if you don't like uncertainty and you want to make the same amount every few weeks, like you don't want to go into business for yourself, like because it'll drive you crazy. But if you're okay with a little uncertainty to do more and spend more time and have more time for your family, like getting into business is great. The distinction between cash and insurance would say if you were going to say, hey, I know I want to own a PT clinic, why would I do cash or insurance? It's not about the patients that live near you, how much they make or what car they drive. It's about do you want to be involved in a tertiary relationship, a three way relationship with insurance companies, your patients and you, or do you really value having your patient also be the customer who's the person paying and you value that relationship? Because I've, that's what I value and I don't want anyone else, whether it's physician referral or insurance company influencing my decision making process with our patients. If you value that above everything else, it's going to be worth the struggle to make that work.

Aaron, it's been great talking to you today about physical therapy and private practice and cash based practice. Tell everyone how they can learn more about you.

Yeah, thanks Joe. It's been awesome being here too. I love the questions and being able to share this with you guys. The best way to connect with me would be find me on Instagram Aaron Labouer or then my website is Aaron

labouer.com okay, so make sure to check out Aaron Labourer on his Instagram and of course aaronlabauer.com thanks for joining us today to discuss private practice, physical therapy and pain care. Of course. Share this episode with your friends and family on Facebook, LinkedIn, Twitter, Instagram, wherever anyone's talking about private practice, physical therapy and pain care. I'm Dr. Joe Tada and we will see you next week.

Thank you for listening to the Healing pain podcast with Dr. Joe Tada. To subscribe to the podcast and learn more, visit integrativepainscienceinstitute.com that's integrative pain Science Institute. Sign up to receive weekly updates, leave a review on itunes and share this episode with your friends.