The Aaron LeBauer Story & Why You Can Start a Cash Practice Too | Aaron LeBauer

I grew up in a medical family, so my father, uncles, and grandfather, and great uncle were all physicians. It's kind of expected that we all became physicians, and no one in my generation did. I went. I think I got an A in chemistry. And the first night of organic chemistry, I was sitting there just thinking, oh, man, it's gonna take me four hours to do just the first night. And I got an A in this last semester. It's just been two and a half months over the summer, and I gotta go relearn all this stuff. And I just realized at that point, I didn't want to do this. I didn't want to work that hard for something I didn't really believe in. So I finished school. I got a history degree. It was the thing I could do that was the most enjoyable. And I could take all the fun classes like music, drama, public speaking, etc. And I went out to get a real job, and no one wanted to hire me because I was either overqualified or under qualified or too serious about racing bicycles. And so I ended up being a temp and then a bike messenger. And then one day, I had an epiphany. Prior to that, I had taken a yoga class in school for credit. And, you know, we had massage therapists come in to do a workshop with us, just, you know, like. Because our yoga teacher was just all about relaxation, because we were. I went to Duke University, and it's like, everyone's got to get an A. If you don't have an A, you don't. I don't know. You don't. You don't matter. And Meanwhile, I was 1200 out of 1400 students with a B plus. And so I was introduced to massage at that point, but also by my mom earlier on in high school and in college when I was racing bicycles and I had a massage that transformed my season one year when my legs had felt really heavy and I just couldn't train really hard. So fast forward again to when I was a bike messenger. I tried to get a real job. I had spent years as a temp where everyone thought I didn't know the Alphabet. And I had this epiphany. It's like, oh, I can heal people, I can use my hands, and I can still do what I love if I go to massage school, because I only need to see four to five people a day, five days a week, four or five days a week, and earn a living. So it allows me to have the lifestyle I want. So I did that. I raced bikes at the Pro Am level in the United States. And then after a while, I had met my wife and got to a point in my career as a massage therapist where I was helping people who had already been to physical therapy, chiropractic, massage, acupuncture, orthopedic surgeons, back surgery, injections, etc. And they were telling me, aaron, you're the only one who's ever touched me where I hurt. You're the only one who's ever helped me feel any better. No one's ever given me any answers. And now you've pressed on this place where it hurts, and I feel so much better. I shouldn't have done X, Y and Z. So I heard that enough. And my wife was like, erin, you need to just go be a physical therapist. Like, physical therapy was never on my radar. And at this point, I was probably 34, 33, and she was telling me to go. And we were living in San Francisco, and there was nowhere in San Francisco that I could go to PT school and stay living where I lived without having to do two years of prerequisites. Whatever was happening out there, the prerequisites for PT school in the Bay Area were such that I wasn't even close. Like, I went. I had a history degree. I was pre med most of the way other than organic chemistry at Duke. And I didn't have close to half the classes I needed to get into PT schools out there. So I was gonna have to move. And I was like, not gonna happen. As life happens, things changed. We changed cities and decided instead of staying in California, my wife didn't want to move back to la. We had moved to the Central coast for a year. It was a nice vacation. So instead of throwing the dart at the map, we moved to Greensboro, North Carolina, where I grew up. Figured we'd try it. We moved here. And she said. She still said, erin, I opened my massage practice. It did great and was doing well. And she's like, you still should go back to PT school. So I looked into Elon, Duke, and unc, and I only needed two classes to get into Elon and four to get into UNC and Duke. So it was game on. I applied. Elon said, we can enroll you in December. You just need to apply today because we have two more spots, whereas Duke and UNC were going to take another year because they were already full for the next. The next entry. So I went to Elon. I got out. Here's where it gets interesting. First clinical rotation, I was in Atlanta, Georgia. And I think you know, I was working, you know, wearing a tie, wearing a button down shirt. Not really my style, but I'm okay with it. All right? I can work hard, like eight, nine hour days. My dad was a physician. He's like, we did 100 hour days. I fell asleep writing my name because I was up for two hours two nights in a row. So I was like, whatever, this isn't as hard as my dad had it, but there was one day where I saw 43 patients and it was probably the third or fourth week of my first clinical rotation. PT School saw 43 patients one day. And I'm sitting there at 9 o' clock at night writing notes because I had 43 notes to write, because I see four people an hour and I didn't have time to write notes. And I'm just like, I can't do this. Like, I got into this profession because I was already seeing people for an hour and I got in this to help them more than what I could do. And here I'm seeing I'm going to be able, I'm not even going to be able to do a quarter of what I expected I was going to be able to do. And I'm going to have to cut corners and change the way I think about it. And that was the day I decided I can't, I can't do the insurance thing. I was like, I gotta figure something else out. I don't know what, but it wasn't something that, that I thought was gonna be possible for me. And the other part of it was as I was. But I was like, there's definitely hope. There's hope someone's gonna hire me. Like, maybe I can find a local primary care physician practice and get in as a primary care physical therapist and be the, be the person people see when they have back pain or neck pain, migraines, headaches, etc. And you know, I looked at, well, is the hospital going to hire me for $40 an hour to do what I want to do? And I was like, no, I'm already making 85 an hour while I'm in PT school. Like, why am I going to take a pay cut and see people for less and go at it and do what I think is less than what people need? So my final clinical rotation was out in California. It was six months long, way too long for a clinical rotation. But because I already knew how to treat patients and luckily Allen, who was my clinical instructor, knew that we had met at PPS at the Private Practice Section meeting in 2006. And. And he was like, you need to come and work for me. Do a clinical rotation here. So I was at PPS, I think it was 2000, was it 2006 or 2007 with Bob Duvall, who was my first clinical instructor to speak about adding cash based services to your traditional practice. And I met Alan. Alan said, okay, I just heard you speak, I heard you ask questions. You need to come work for me. He paid me a stipend and did a business. About 50% of it was about how to create a business. So I was lucky in that aspect. And it was still a business model that I didn't see that was going to be sustainable for me long term. So that being said, I want to impress upon you guys that one, if you feel like something's not right or something needs to change, you have the power to change it. And two, if you want to be in business starting now, learning business skills and principles is vital to your success. Because that's what allowed me to start my 100% cash practice right out of PT school. So when I graduated in December 2008, I studied for a month for the licensure exam and I took it in January. And by February, I was open with my cash practice about two months before my first child was due to be born. And it was a lot of pressure. And everyone told me at the time, you know, that's not possible. I had another clinical instructor tell me that no one's going to pay more than their copay for physical therapy. And people tell me it's unethical to charge cash for physical therapy. Most people told me it wasn't going to work, or they just look at me funny and they didn't want to tell me what they thought. So my professors, as we were back in school getting ready to finish and graduate, had asked, oh, Aaron, where did you. Did you get a job? Where did. Where'd you find work? What are you going to do? And I was like, oh, I'm working at Levour Physical therapy. And they were like, huh? I said, yeah, I'm starting my own business. Oh, great. Are you all set up with insurance? No, I'm not. I'm not doing the insurance thing. We're just gonna do straight direct pay cash. And they were like, I did these weird stares. The big lessons that I want you guys to know, and you're gonna have to trust me on this because we could talk hours about this and I could explain why, but the big lessons I want you to understand are you're investing A lot. In your physical therapy education, one of the mistakes people make is they go, okay, now I'm ready for business. And I don't want to invest $1,000 in running business. You're investing tens of thousands, if not hundreds of thousand dollars in your physical therapy education, which is great. And if you ever want to go into business, you can go and make a lot of mistakes and learn on your own dime or you can invest into a business education. That doesn't mean you need an mba. An MBA will teach you theory about business, but it won't teach you actually how to run a business. So you just have to be aware. So it's time. It's with a coach, mentor, reading books, taking courses, et cetera. The other thing I want you to understand is that price is not the objection. And the big problem is no one knows what physical therapy is. And there's really no way in hell I would pay a $50 copay. Or even right now my copay is $150. I'd never pay that to go get hot packs, leg lifts, ultrasound and be sat on a bike. There's no way I would pay that. It's not worth it because I can do that on my own. I know how to do those things. Those aren't really skilled physical, that's not skilled physical therapy, in my opinion. And there's no way I would do that. So the problem is patients don't know that we do something even more powerful than that, which is help them avoid surgery. Injections, medications help them perform better, run faster, stronger, longer. What you have to know from your patients to get them to buy into your plan of care or to get them to pay you cash, or both is what they really want and why it's important. Because there's a big difference between someone's orthopedic surgeon telling them, go get physical therapy after I work my magic on you. And then they go and it's like $10 copay and someone saying, no, alright, I'm struggling. So that person who's being told by someone else to come get physical therapy doesn't know why they're there. You ask them. When I ask them, why are you here? They're like, well, my doctor told me to, or my wife told me to be here. Okay, great. Well, what? Well, we have to ask the right questions to figure out what is important to them because they are the ones making the choice. And in a cash based practice, the patient is the customer, not the physician or referring provider or insurance company. The patient is the deciding factor. And you have to know what their why is, their motivation and the things that they really want so that you can sell them a plan of care and keep them compliant. Because 20 bucks is 20 bucks. And some people wouldn't pay $20 for physical therapy, and some people don't value your time when you do that. But if you can charge hundreds of dollars for physical therapy, it's not a problem if you understand exactly what your patient wants and why they want it for themselves, it's not the issue. What happens is people get disassociated from the value of what you do because you're being paid a salary or an hourly. Here, the patient is paying a copay and this third entity is receiving a bill for hundreds, if not thousands of dollars an hour for your time. And they have this. There's this relationship here and then this person goes, but that was an extra $2,000. And they get angry. And then this is a struggle collecting payments. And then this is the therapeutic relationship. And it's a triangular relationship that is often incongruent. So if you guys are following me, what I'm getting at is many physical therapists, once they've worked for a while, get out and think that patients don't want to pay their co pay. So why can't I charge anymore? Well, the problem isn't the price, it's the lack of understanding of value, even at the copay level. Are you guys getting this? So there's a few things. You are absolutely valuable with what you do. You don't need to be an expert at manual therapy to help a patient. You only need to be one step ahead of the person you're helping. So as soon as you graduate, even now, you have as much expertise in physical therapy as you need to create a business. You need the business education to be successful in business. And value is a problem in our industry. People don't really understand it because of the triangulation and relationship with insurance. And that's why I started a cash practice, because I believe that the most authentic, true way to treat a patient is to contract directly with them and work for them without any outside influence of whether I'm going to get paid or reimbursed or I'm going to make someone upset because I disagree with their diagnosis or their referral. So the other big thing I want you to understand is this isn't just about Aaron Labourer. You know, it's not just Aaron Labourer doesn't have some magic sauce that only people will pay for. It works in every city. I had someone ask yesterday, well, will it work in Brooklyn? And I'm like, there's a million people in Brooklyn. Obviously it's going to work in Brooklyn. Because two weeks ago someone said, well, I live in a town that's only 3,000 people. Will it work here? Anything? Whether you're paying, whether you're doing a copay or charging cash or selling a widget, it only works when people understand the value of what they're getting. And if we are disassociated with the cost of therapy and what we earn and what our patients pay and what the patients get out of it, it's much harder to keep those things congruent. And this is a practice model that we can grow and scale because it's about learning sales and marketing. Because I've been a great. I knew how to treat patients before I came to PT school and PT school absolutely helped me be more effective and the Con Ed helped me be more effective. And the only way I can get people to understand that is by speaking to them, to their wants, needs and desires. Which isn't more range of motion isn't necessarily less back pain because you can get less back pain through an injection, a surgery, medication, some orthotics, a strap, a tape, some cream, Tylenol, Advil, all kinds of crazy things. Well, why do they want to come see me? It's because I understand that the back pain is keeping them from doing CrossFit. CrossFit is not being able to do. CrossFit is keeping them from feeling independent and strong. And that's important because they want to be able to run or jump over a fence if they need to. And why is that important? Well, the person I asked that to didn't want to give me that answer in public. So if we can get that deep with our patients, that's how we get a buy into any kind of plan of care, whether it's a copay for 50, $25 or cash based practice for 300. 350, even 500 a. Sam.