Which Practice Is Right for You?

Which practice is right for you

3 Creative models of private practice in today’s market.

By Esther Adler, SPT

Physical therapists are becoming increasingly creative with business.

Clinicians are taking concepts from traditional brick and mortar, making some changes, and then using them creatively to treat patients with models including concierge physical therapy services and a combination of gym/coaching and rehab services. Different forms of physical therapy practices offer unique opportunities and challenges. Understanding that we not only have choices in practice settings and specialties but also in business designs gives clinicians freedom to build their practice in any way they can dream up. Understanding each design can help you decide which model is best for your private practice.

Brick and Mortar

The brick and mortar model is a typical outpatient clinic. There are treatment rooms and a gym space for therapeutic exercises. Employees range from several hundred for a large company to one or two for a small business. Larger companies typically accept insurance and have a team set up to work with patients, including physical therapist assistants and aides, while small companies may use the cash-based approach with physical therapists working with their patients exclusively.

Erica Meloe, PT, MBA, MA, owner of Velocity Physical Therapy, provides a great example of a small brick and mortar, cash-based practice in Manhattan. Together with her partner and a few employees they run their business as a hybrid model, where the patients pay cash, and they submit claims to insurance companies on their behalf. Advantages include having money up front, and the flexibility to spend more time with their patients. Evaluations are typically 60 minutes, with treatments ranging from 30-60 minutes. One challenge Erica manages is when patients don’t understand the value of physical therapy and what it can offer. The public doesn’t understand why they should pay cash for a service they feel insurance should cover. This requires education on the uniqueness and importance of treatment, which gives the patient the results they are looking for.

Concierge Physical Therapy

Concierge is a term becoming more common in the physical therapy world. Many physical therapists offer their services at the patient’s home. These models are almost always cash based with slight differences between them. Dr. Karen Litzy, PT, DPT, founder and owner of Karen Litzy, PLLC, began her concierge practice years before others were using the term. Dr. Litzy meets patients in their home and offers wellness services, including golf evaluations.

Karen’s true concierge practice is how she coordinates all aspects of patient care, connecting them to other wellness professionals, doctors and coaches of all kinds. Former patients still reach out to Karen if they are looking for health care recommendations such as a yoga instructor or medical doctor. She also hosts a podcast, Healthy, Wealthy & Smart, runs seminars and courses, such as the Women in PT Summit, and is an international speaker. Through this model, she’s been able to scale up, by doing other things besides direct patient care. This allows her to monetize other areas of her business and reach more people.

Gym/Wellness

The popular gym/wellness model is where therapists collaborate with different gyms, or have their own gym/therapy business. Rena Eleázer, PT, DPT, from MatchFit Performance is a great example of this model. Rena collaborates both with CrossFit and other private gyms to help her clients reach peak performance, whether it’s injury rehab or optimal sports performance. Rena meets her patients in the gym or on the field, depending on what their needs are.

She also works directly with several sports teams to help the athletes reach their optimal performance. This model allows for flexibility, although it requires adaptation to the unique gym structure and policies. As physical therapists we have the unique opportunity to work with athletic trainers, personal trainers, and directly with athletes to mold and enhance performance while reducing injury.

There are many ways to succeed in private practice physical therapy. Having a brick and mortar company is the traditional way but is definitely not the only way. We aren’t taught to think like this in physical therapy school, but the more we can think of different ways to become successful as a business owner the better off the industry is, warding off burnout as well as providing better care to patients.


Esther Adler, SPT, is a doctor of physical therapy candidate (2019) at Columbia University, an Amazon best-selling author of her book Breaking the Chains to Freedom and a teacher of yoga, Pilates, and meditation. She can be reached at estheradler@estheradler.com.