Running a Hybrid Practice with Dr. Jennifer Spencer

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Welcome guys. The Pelly Biz Podcast. I'm your host, Kelly Alhuey. Today I have a very special guest with me, one of my mastermind students. Jennifer, go ahead and introduce yourself. Tell us about your clinic and where your clinic is located.

I'm Jennifer Spencer. I'm a physical therapist. I practice in Hoover, Alabama or a suburb of Birmingham, Alabama. My practice is called Magic City pt. Birmingham is known as Magic City and that's why I felt compelled to name it that I treat pelvic floor. I also treat lymphedema, breast cancer patients and general orthopedics. But my practice I guess primarily focused on pelvic floor treatment.

Let's dive into that. How did you get into pelvic floor and then how did you also get comfortable with lymphedema and you know, also being orthopedic? Tell us more about that.

So Kelly, you know my background in the company I started with, we both started with the same company. I joined them because they offered the orthopedic residency coming out of PT school. I think most of us see ourselves going into orthopedics and sports medicine. So I wanted to do the have the ortho background. So that's why I chose that company. But in the middle of the orthopedic residency, the company approached me and said, hey, we need a lymphedema therapist. We will pay for you to go to Miami for two weeks to learn how to treat lymphedema. Will you do it? And I said, well why not? If you're going to pay me to go do it, sure. So I started treating lymphedema, ended up loving it. And I was in a certain clinic that is known as a specialty clinic that had myself treating lymphedema. I had a pelvic floor therapist treating pelvic floor right beside me. We had a vestibular therapist. So it was all the specialties in one. And I was in Atlanta. My husband then brought me to back to Birmingham, and I did not have the pelvic floor therapist beside me. And so I was like, well, I guess I've got to start doing both of them. Because in the lymphedema world, I felt like continuing education kind of capped out. So I needed something else to do. So jumped into pelvic health. But I actually see all of my worlds colliding all the time. A lot of my breast cancer ladies have pelvic floor issues just due to surgery complications. I have a patient right now who's post liposuction lymphedema of the abdomen, but he has a lot of pelvic floor issues. He's a crossfitter. So that kind of ties in all my worlds in one. But I see a lot of overlap with everything. And so I find having all three specialties very beneficial.

Yeah, I love that. So someone. I mean, any advice, Jennifer, if someone's, like, looking to also they have a pelvic health practice, but maybe they're also looking to go lymphedema route. Is there something. I know you said it's limited, so, you know, with lymphedema, is there a certification? Is there, like, is there a course that you would say, hey, I really like this one. This one really helped me. Is there any advice that you can give someone?

In our lymphedema world, we tend to say, like, only seek out treatment from a CLT or a certified lymphedema therapist. There are a lot of lesser courses, weekend courses. You can go and learn somewhat about lymphedema, but I would. If you truly want to do lymphedema, you need to do a course that certifies you as a certified lymphedema therapist. I went through the Academy of Lymphatic Studies, AC O L S. There's a couple of other ones, like the Norton School. The Vader technique is what I use. Vodder. And so any schools that employ that Vater technique or teach the Vater technique, Unfortunately, through the years, I've come across patients who have seen general PTs who have attempted to treat lymphedema with game Readies and ACE bandages or deep tissue massage. And that is not what lymphedema treatment is about. And, you know, it's made their symptoms worse. So, yes, lymphedema, there's an art to it. And so I would encourage anyone interested in learning how to do it to actually go to one of the better quality schools and get the complete certification.

Yeah, that's so interesting you say that. And I'm also curious, like, how many of, in your area, how many surgeons know about lymphedema therapists? How many surgeons are referring, like, do you have a hard time with marketing that to get people to understand that truly we can have a massive impact on these patients, Especially after, you know, with breast cancer patients.

Yes, I have a very hard time. And not just breast cancer, like the primary care physicians here, Somebody, you know, has swelling in their ankles, they're going to prescribe a diuretic and they're going to tell them to go buy compression garments. And those compression garments aren't going to get rid of that underlying fluid. So I hear and see that daily. But yes, with like, I have a current breast cancer patient. Her mastectomy, chemotherapies, radiation was over two years ago. She had double mastectomy, couldn't raise her arms past 90 degrees. And no one even said a word to her about going to pt. And she's been living like that for several years. You know, swelling in the chest wall, urinary incontinence, fecal incontinence because of all the scar tissue and pulling of, you know, diaphragm. Can't, can't descend. So.

Right.

Cascade.

Wow.

Problems. And no, no one ever mentioned lymphedema treatment, physical therapy to her at all. So I see that, yes, all the time.

Yeah. And. And there you go again. That's just another example of lymphedema and pelvic health.

They need it.

It's so connected. Right? I mean, just everything's so connected. So, yeah, that's a great example. So, so what made you make the jump and do a. What made you do your own practice? Why did you start your own practice and why did you kind of gear it towards more pelvic health and that stuff?

So again, you and I come from one of the big box companies, and they didn't really understand that pelvic floor and lymphedema needs to be treated one on one. And, you know, they want you to see 2, 3, 4, 5 patients an hour. And that cannot be done if you're Treating lymphedema and pelvic health. So that was a big catalyst. And then just I wanted to be able to create my own schedule, treat patients how I want them to treat them. But basically, I guess it was I wanted to get rid of the multiple patients an hour. I felt like I was not giving quality treatment when I was working for the, for other people. So that was a big driver. And then what was your second question?

Yeah, like, what made you want to jump into starting your own practice? I mean, most of us I know when I started, I never wanted to be an entrepreneur because I saw all my bosses always so stressed out. I was like, like, I'll never be them. And I was just never a thing. And what forced me was my own health, what really made me truly make the jump. So was there something that you had like a moment or epiphany of like, okay, today's the day, like I gotta do it, or was this like a slow build because you couldn't practice the way you wanted? They were, you know, slowly increasing the patient load. Like, what was it that kind of made you make that jump?

So when my kids were born, I started doing some PRN hospital work just for more flexibility. But I knew that was not my end goal. And when I was doing that, Covid started and the hospital implemented some Covid rules for us. And I just said, why am I doing this? Why am I still here? I've had issues, you know, with the big box companies. I'm having issues now with the hospital guidelines, with COVID and just. But also at the hospital, the fact that they. I saw therapists beside me not treating very well like that. It's very easy to be a bad PT and I was seeing bad PT and nothing was being done about it. That in other words, that was a big driver as well. But now it just hit me during COVID now why am I putting up with all of this? You know, I want to be my own boss. My husband is very financial and he's got a financial background and is very business minded. So he was a big help in getting the background work started. But it was a slow build. I started off mobile, part mobile, and I hung onto the hospital for a little work, for a little bit for PRN work and then went full time mobile.

Let's pause there. Jennifer, what made you. Because this is a big step. What made you have that PRN job and then you're doing mobile. What was like the straw that you told the PRN job that you were like, hey, I'M now done. And you fully jumping in to your practice, like, what? Was there something you had to have in place? Was there an incident that happened? Like, what made you say, okay, fine, hospital, I'm giving it up. I'm diving straight into my business?

Well, I'll say I held on to it because of the fear of completely being on my own. You know, I had that to fall back on if needed, but the mobile grew so fast that I didn't need to hang on to the hospital anymore. So. But now I had that fear of jumping ship completely. So that's why I held on for, I guess, a few more months before going completely out.

So looking back, you're probably just like, you know what? I just should have dove just straight in and just put my focus in my practice.

I probably should have. Yes. Yes.

Yeah, Just looking back, should have done.

This a whole lot sooner. Yes. Yeah.

I mean, we all should have, right? I mean, I waited eight years too, so I get it. We're all just scared. I mean, that's. That's just the reality of it. Okay, so you jumped in after working for this, you know, big box company, then working for the hospital, you jump into your practice, you're mobile, okay? Now you're mobile. Then at that point, what did you do? How long did you stay mobile? When were you thinking about getting space? Was that even an option for you? Like, were you even thinking that? Like, tell us. Continue, tell us more about kind of after mobile than what happened.

I was only, I guess, after a few months of mobile. One of my colleagues, she was actually with me with the. At the big box company and also at the hospital. She said, hey, I want to join up with you. So she. I hired her as a pt. We were both doing mobile, but we had clients that were requesting to come see us at our own space. So I found shared space in a gym. She and I split a room. So we were each there, you know, two to three days a week, and then the other part of the time, we're mobile. I felt limited at the gym again. We only had one room. We needed to each have a room to continue to grow. We needed. I needed space for an admin that was, you know, a big need at the time. So we were limited at the gym. So when that lease was up at the gym, I knew I wanted to leave mobile behind. I was tired of driving and just do completely clinic only. So I was fortunate to find, I feel like the perfect space. It's like six miles from my house. I wanted to be In Hoover, I found a space like Central Hoover. So I started full time at this clinic space. I think it was July 1st of this year.

It's a good space, guys. It's beautiful, too. It looks good. Okay, so how did you. So you found this space. You're, you know, you split from this other person. I'm assuming you. You let that, you know, you had.

She wanted to stay at the gym, so. Yes, yes, we split.

So you had. Had a split. Okay, now you have the space. Now, how many rooms do you have in the space? Do you have a gym area? Tell us about the new space.

We have a small gym area, but it's also like a front office area. It's where Jessica, my office admin, sits. But she loves to chat with patients. So even if, you know, we're out there exercising or if they're just kind of sitting in the waiting room chair, she's conversing with them. But it's kind of shared space right now. And then there are two private treatment rooms. The suite next door to us is available. And so it's my goal in the coming months to be able to expand next door and actually have, you know, Jessica will have her own kind of front entry room, and then we'll have a larger gym space and hopefully a couple more private treatment rooms with more pts.

Love it.

That is the ultimate goal.

Okay. Love it. I mean, I love that. That's great, guys. She's. I mean, you're really expanding quickly, so this is good. I mean, you're really, you know, getting on it. So when. Let's go back a little bit, because that first hiring of a PT or an admin is, like, super, super scary for people. So any advice that you could give someone that's listening to this that is, you know, kind of in your boat, but hasn't hired yet, and they're like, how am I going to do this? Like, for me, my thing was, how am I going to pay someone when I couldn't pay myself for the last eight years? Like, that was so scary.

So I guess with the PT I had at the gym, I knew what she was capable of doing. I'd worked with her for years. I knew she kind of had her own clientele that she was bringing with her. So I wasn't worried about hiring her initially when I. When she and I split and I was bringing on my office admin again, I'm very fortunate. She was somebody I worked with in the past as well. She had. She had actually approached me, you know, a few months Prior and said, look, I'm tired of where I am. I know you're on your own. If you need me, let me know. So she and I work great together. Yes. It was nervous thinking, okay, how am I going to pay her? Because I'm still, you know, trying to build volume, but it's. I'll say it, it's gone seamlessly there. She a fantastic person. She kind of does it all. She helps with marketing, she does all the administrative tasks, everything I need her to do. So she's a great asset and it allows me to do other things to help build the practice.

That's great. I mean, I think so many people, we are so fearful, and then when we look back and go, man, I should have done it sooner. Admin are so helpful for our practices. And I just want to pause here for a second and talk about this is admin can do so much like Jennifer saying, they can help you with marketing. They can email people back, they can help call people for you, they can help write blog posts, they can help do social media for you, they can help, like, literally do everything. So what Jennifer is describing is truly someone that you want on your team because it's all the stuff that, all the detail stuff that maybe you don't have time for because you're thinking about how to grow the practice and like, what's the next steps and all that kind of stuff. So, you know, I think the lesson here is don't disregard admin of, oh, they're just an admin. They're just gonna only answer the phone and just. That's the only task that they're gonna help me out with. No, there's so much value in admin, and they really are like, my admin became my manager and she is like the rock of orthopelvic. I mean, she's helped me tremendously. So, you know, I don't know. I'm a big fan of hiring admin for sure. And there's no right or wrong either whether or not to hire a PT first or hire an admin first. There's no right or wrong, but the admin can help you manage a pt, ot, pta, whatever, whoever it is. And I do think that I did find that was helpful. I mean, I hired my admin one week before my. I brought on a pt. So, you know, that was just helpful to. To have someone else doing the management.

Of that, you know, And I'll just say, when I brought on Jessica, she was like. And she started answering the phone, she. And she was like, how in the world were you answering the phones, calling these patients back and treating? And that's the thing is I couldn't. And so I was probably losing a lot of clients because I couldn't get to them, return their phone call, you know, asap. So.

Yeah, no, that's huge.

Yeah.

So let me ask you this. So for those that don't know, Jennifer is a hybrid practice. So can you tell us for people that don't know, like, what is a hybrid practice? Because some people don't know what that is. And why did you choose a hybrid practice?

So I take some insurances and I choose not to take other insurances here in Alabama. I mean, we all know we're not as advanced as some other states. So people had a hard concept or couldn't understand fully the cash pay model. And I did try to start off fully cash pay, but people didn't understand it and they just kept saying, well, I'm going to go down the road where this person takes my insurance. So I felt like I needed to take Blue Cross. It's a big one here. Most people have it to be able to gain clientele.

Yeah. And they typically pay the highest guys, just so, you know, like nationally, out of everyone, if people do take insurance, Blue Cross typically is the one that's going to be reimbursed fairly well. How much do they, I mean, just on average, you don't have to say like the exact thing, but like how much on average are you guys getting with Blue Cross? Like 150 visit, would you say?

So initial eval, I mean anywhere 160 to 190 for an eval and then it averages for a 60 minute session between 100 and 120.

Okay, that's pretty good. Other states, guys, for Blue Cross, like just an eval could be like $70. So it just depends. If you're listening to this, it just depends on your state and you would have to contact Blue Cross and make some kind of deal with them to figure out, you know, what the, the rate is for you. So. And when you're talking about hybrid, she also does take cash. So there's. Do you only take Blue Cross Blue Shield or you take something else? Jennifer?

I do take Medicare as well and a lot of times their rates are similar to Blue Cross. In our instance, no, I choose not to take UnitedHealthcare, Cigna, Aetna, anybody else. And so we just tell those clients, you know, you can pay cash upfront, we will give you a super bill on a weekly basis or at the end of the sessions, whenever you want it, to submit to get reimbursed. And a lot of times, you know, Jessica's fantastic. She'll check their insurance forum and see if they have out of network benefits, but really try to explain to them. A lot of times, you know, with Cigna Aetna, their out of network benefits will be the same as their in network benefits. And a lot of people don't realize that. So.

Yeah, no, I think that's massive.

But I think they're limited where they have to go, you know, because here very few people will accept those insurances or very few clinics will accept those insurances. So a lot of those people with those insurances think they're limited to where they can go and don't realize that they have out of network benefits.

Benefits. Yeah, I think that's a great point to bring up. Yeah. And you said something, I think in our mastermind group. But I think this is really interesting too. Like you were talking about using like flexible healthcare savings. I think people get confused by this and like the. What's the other one? The flexible healthcare savings and the.

Just the HSA or health savings.

Yes. Can you talk about a little bit on that? I think people would find that interesting on. Can they use that? Can they not use that? Like, if they're paying cash, can they use that? If they are doing insurance, can they use that? I think that'd be helpful just to kind of speak on.

So if somebody's using their insurance and they have a $20 copay or, you know, or $1,000 deductible to meet for the year. Yes. You can use your FSA HSA money and vice versa. If you are not using insurance and you choose to pay cash. Yes. You can still pay with those FSA HSA dollars.

Yep. Yeah. That's great to know for PT wise, OT wise and then also patient wise. So I think that's. That's good to know. What's been like the coolest thing that you've learned with growing this, growing your practice and what's been like just something that's been fun or something that maybe you weren't expecting to take away from this whole experience of being an entrepreneur and being a female practice owner.

I'll say it's been fun joining Pelvi biz and getting to know all of you. I'll say. In the past I did not like marketing, but I have learned to become more comfortable with it and get out in front of the public and Instagram something I never thought I would do. So I am. I have broadened my horizons and yes, certainly putting myself out there more, which is something I never thought I would do, but I enjoy it.

Yeah, you guys should go check out her ig. She posts some great videos. She does collaborations with other pelvic health therapists. I was just talking to Amanda too. You guys are doing that peds collaboration, so can't wait to see that. I actually want to post that on Orthopelvic's page as well.

So.

Yeah, just. Just let me know. And guys, this is the best part about joining a pelvic health group is you can collaborate with each other and it's only going to help promote your business. Your like, just the whole field in general of pelvic health and like spreading the word that we could help with lymphedema patients and I don't know, just getting. Getting the word that we can truly. We have a solution to lots and lots of people's problems that they don't even know that we can solve. So I think that's. That's big. So, okay, let's. Let's ask this. So what do you see? Like, what's next? You said kind of you touched upon it, like, trying to get into bigger space, but what's on the horizon for Magic City? Like, what. What's the next thing? What are we going to look out for? Any fun updates for us?

Bigger space. Yes. More therapists. That's the ultimate goal. Just something I need. I need more space to have a washer and dryer. I do not have a washer and dryer here. So that is. I. That is a big deal of mine. That's a big deal. Now I hope to continue to do some more collaborations with some businesses around town. I've gotten to know some other kind of specialty pts, different offices. So looking to do some more pelvic health workshops with some local businesses coming up. Getting the word out. Just. Yes.

Yeah. That's awesome. Wait, I want to go back to that laundry.

Are you taking that laundry home?

Because that's what I did for a whole year, for seven days straight.

Not all the time. So Jessica has a fantastic daughter who sometimes will come and get it and take it to the laundromat and I paired it. So no. And I've actually had some patients that are like, let me take that home. So it's kind of a collaborative effort.

Okay, that's good, guys, because, yeah, that was a pain in the butt hauling up, you know, all the laundry seven days a week. Up the stairs doing it. My husband was the laundry guy. Yeah, it was crazy. So, yeah, it's what you have to pay. It's like the price of a startup. And then you're like, all right, I'm getting smarter. I'm gonna hire. Now we have laundry people. People. But yeah, before we did not. So that's cool. Well, all right. Any other closing thoughts for anyone listening to this that's thinking about starting a practice that already has a practice that may be, you know, interested in any tips or tricks, like any big tip that you're like, man, if I could tell someone that was on this journey something, give them any advice. Is there one tip that you would give them?

I'll say, you know, treating four or five patients an hour is not quality pt. So get out of that situation, find somewhere where you don't have to do that. And it is very possible to work for yourself this day and age. Starting off mobile, you know, no overhead, you know, I feel like just more one on one therapy is growing. Clients are looking for that. But you know, I have a lot of clients that say they don't want to go to the big box companies anymore. So I feel like our profession is continuing to grow in that. So just instead of being like me and feel like you could, should have done it sooner, just go ahead and jump ship and give it a go.

So, yeah, don't let it hold you back and just, just go. Just do it. Yeah, I love that. All right, awesome. Can you let everyone know your website, how to find you on ig because you guys have to go follow if you have YouTube, Facebook, all the things like let us know.

So my website is www.magiccitypt.com. instagram is Magic City City PT. We are on Facebook and YouTube, but that's just YouTube. I upload videos, really just to share with clients. I'm not putting a great deal of effort in that. And then Jessica, my admin, runs Facebook because she's trying to target different clientele than I am on Instagram. I guess I'm trying to target more, I guess the younger population and she's trying to target older population with Facebook. So we're giving that a go right now. But yes, Magic City PT for IG and Facebook. So love it. And we will also.

Yeah, we'll also put it in the show notes too, so you guys can have a link. Just click on that and go follow her. All right, Jennifer, thank you so much for coming on the podcast and we'll talk later.

Thank you.

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