In this solo talk, pelvic floor therapist and Orthopelvic founder Kelly Alhooie argues that medical and allied‑health education leaves clinicians unprepared for private, cash‑based practice. She outlines the critical gaps—lack of business training, ineffective patient communication, and a narrow, siloed view of health that ignores nutrition, hormones, the nervous system, and interdisciplinary collaboration. Alhooie explains how insurance‑driven care restricts treatment scope, while a cash model lets providers address the whole person. She stresses the need to craft clear, outcome‑focused narratives for patients, build referral networks, and act as a care‑team coordinator rather than a lone hands‑only practitioner. Drawing on her own experience of self‑teaching pelvic‑floor therapy and creating a holistic practice, she urges clinicians to break out of the “box,” learn business skills, and coach others to achieve financial freedom and better patient outcomes.
Chapters
What medical school didn't teach you about running a cash-based practice. Let's get into it. Medical school, let's be honest, taught us nothing about running our own practice. What do they teach us? They taught us about how to actually treat the patients, put the patients first, don't be friends with the patients, and just freaking give the patient whatever they want and don't care about you. They taught us everything opposite into growing an actual cash-based practice. I've got no training in that. They— what they did do is teach us the manual skills and the clinical reasoning skills on how to solve through problems or diagnoses or do differential diagnoses. That is what they taught us. Okay, here's what they did not teach us. There's a slew of a list that I believe you will have to know to grow your own cash-based practice, whether or not you're a chiropractor, PT, OT, uh, med spa, whoever, naturopath, doctor, whoever you are. Okay, this applies to everyone. The biggest thing, number one, is communication. Learning how to communicate effectively with showing patients the pathway and the journey per their diagnoses on where they're at now and where they're going to go. What methodology are you using specifically to get the patient from here to here? And can you explain that in a very clear, very concise way that allows you to say, This is it, this is the path, and the patient feels super confident with that. 99% of providers have no clue how to do that. What they will do is this instead. Well, here, right here, this is the ischial tuberosity, and this levator ani goes into here, and this go— and the patient is like this. And they're looking at you like you got 5 heads. And you've completely lost them. Instead, you saying, patient, this is where you're at. You're peeing yourself, you can't work out, you can't lose weight, and what we're going to do is you're going to be able to go back to the gym, you're going to be able to jump rope, you're going to feel super confident in there, and you're going to get your strength back, and you're going to be able to pick up your kids, and how freaking amazing is that? Which one speaks to the patient more, what do you think? The second one. B, option B. And I find the biggest issues and the biggest things that I teach most of my clients is really it comes down to how to communicate effectively, how to say things in a different way, how to word things differently, how to approach things differently, how to try to not offend people, but you always will, um, how to handle certain situations, uncomfortable situations, like all the different things. It boils down to communication. So I believe That's the first thing that they missed. The second thing that they missed was cash-based practices. I don't know about you, but I went to school in 2009, and this wasn't even a topic, wasn't even a thing. And so it was all about what the insurance company wanted. So how they taught us at medical school was everything to get approved For medically what the insurance company wanted. So the insurance company is— was dictating the care and still is to this day of what the providers can do because our hands are tied behind our back. We all know that as a provider. The, the patients don't know that, but we know that as a provider that our hands are tied because we have to have certain codes of what we specifically do, and that is the way we can only do it. And so the insurance company has a hold of us. And they also dictate how I believe these, these medical schools are teaching because they're the ones funding it. And so the reality is, if you go cash, you can do whatever you want. You could— for us in the therapy land, we could treat someone's head, knee, ankle, and hip all in the same session. If you're under insurance, you can only say nope. We only have an order for the neck, so we're only going to treat the neck, and that's all we can do, and that's it. Isn't the neck connected to the rest of the body? So how can we just treat one body part? How does that make any impact in the, in the client? Is it not a whole? Do we not look at other systems? We just look at the musculoskeletal system? What about the nervous system? What about food intake? What about inflammation? What about hormones? We just miss all the other systems? Like, again, it makes no sense. So this is also a negative that in school they did not teach us how to connect all the pieces of the puzzle, which is why at Orthopelvic my logo specifically was a puzzle piece, because I saw there was a massive gap and a massive disconnect there where if you're a therapist, they're going to teach you about the nerves and muscles. If you're a chiropractor, they're going to teach you a lot about the joints nerves, and muscles. If you're a naturopath doctor, they're going to teach you a lot about herbs and homeopathic medicine. If you're a medical MD, they're going to teach you a lot about different medications that you can provide for your patients, but they're going to teach you nothing about nutrition. So every doctor has their bias on what they actually have trained for And so if you go see that doctor, they're going to be more biased to that. And so I think patients really have to understand this. And you as the provider— and this is what I did not want to be because I had lots of medical issues and all the providers I saw, I started to see this with. So I experienced this firsthand that no one was talking to each other. No one was outside the box thinking outside their scope because they believed it's outside their scope. So we— how dare we do that? It's like— Treat the freaking patient and make the patient better. Like, this is what makes me so upset because I'm like, I was that patient that no one was willing to go outside the box and think differently. And I wish I had someone fighting for me saying, you know what, you should actually try this and do this and do this. But that wasn't a thing. And so I wanted to be that for my clients. I really wanted to be the person That I can talk to you about hormones. I could talk when hormones wasn't a thing. I would talk to all my clients about that. I could talk to you about your bowels. I could talk to you about your skincare routine. I could talk to you about and no, I wasn't going outside my scope. And if I if I didn't, and I could talk to you about nutrition. You don't have to be a rocket scientist to to know about nutrition. You know, so especially in these days, I mean there's ChatGPT, and if you believe that. You are not giving the most accurate advice, then refer out and create the network. And that's— this is again what they didn't teach us in medical school— create the network that you actually build. So your value just doesn't come from your hands. This is a massive lesson right here. Your value comes from you building out the person's team. So I'm not a sex psychologist, nor do I want to try to be the sex psychologist. So let's say I had a client coming in, she had pain with intercourse. Well, she will be coming to see me for the musculoskeletal, the nervous system regulation, and tools, tips, and tricks, maybe lubrication, hormones. Like, maybe she'll come see me for that, okay? But maybe there's a psychology piece that I also need to address to it, so I'm going to put the sex psychologist on so that together We can double hit or double side this client so that she gets the best outcomes. And I find 1% of providers know how to do this or willing to do it because they were never trained that way. And there are very few people that want to go outside the box. And again, being a patient, it was so disheartening when I saw all this. And I had to be the one to put the pieces of the puzzle together, which I guess is why I know a lot about a lot. Because I was just fighting to try to get my own problem solved, which then in return helped me solve patients' problems and did a lot of outside-the-box thinking. And ultimately, it helped them get the best outcomes, and they were very happy. And so I think medical school really does a massive disservice in so many different things. And even subjects that we cover. You know, we—you know—for those that don't know, I'm a pelvic floor therapist. Like, I didn't even have any course in pelvic floor. Wasn't even mentioned. It was all after school. I did all my training, and I had massive mentorships and all that kind of stuff. It wasn't in school. I didn't learn that in school. So again, disconnect. Did we learn nutrition in school? No. Maybe a day, maybe two days of it. That's it. Did we learn about the nervous system? No. So like there is so many systems, and I get they can't give you everything. However, I think it was just too specific, and a lot of the stuff like we don't. I had to learn everything: neuro, peds, cardiac. I mean, we learned all the systems, but do I use it? No. But then they don't. Teach us how to practice that way. It's like, only focus on one system because that's what your realm is. It just doesn't make sense. It's like, okay, well, if you're gonna put us in school or all these systems, then why are we not connecting the dots when we're actually treating clients? Again, it just doesn't make sense to me. So that's a whole nother thing. And then they didn't teach us how to build our own practice. They— the goal was literally— that wasn't even a thing. Who are you going to go work for? And everyone was comparing. I remember like when we were graduating, everyone's comparing. Oh my God, well, what salary are you getting? Who are you going to go work for? Oh, you go do travel because you can make more. And it was just like this thing. No one, not one person in my class was like, let me go build a business. By the way, I was the first person in my graduating class to have a business for probably at least the last 5 years. And then I think there was one other out of my whole class, graduating class, that started a business. That's it. The rest are still working for other people. That's how little and small of a pool this is in cash. And I'm like sitting over here like, hello, like they're just robbing you of your life. But that's what we were trained. And most people just want to stay stuck in what we're trained and do what's comfortable. And it's those— it's the 1% of people that want to get outside the box and do it freaking differently. Those are the people I want to hang out with. Those are the people I want to coach. Those are the people that I'm going to freaking change their life. And when I say change your life, I mean, I mean it. Like, I want to change your life. I want to change your family's life because I know it, because I've been on the other side of it. I've escaped the box. And when you can escape the box, a whole freaking different world is opened up. That's why I'm so passionate about this. It's because it changed my life and it's changed so many of my freaking clients' lives. And to see their eyes light up and to see, oh my God, like I can now do this. It's like a miracle. It's freaking amazing. It's awesome. And so that's what why I'm here. That's why I'm doing these videos for free so that you guys understand that you've got to get outside the box. Stop listening to what school taught you. You've got to learn new skills. You got to get your butt into gear and learn new skills. Yes, it's like going back to school. But in a way that's actually going to make you money, not keep you broke. So let's get on it, guys.
