Curious About Coaching?

Considerations When Expanding Your Physical Therapy Practice

By Connor Jackson

Physical therapists begin their relationship with patients in a healthcare setting, assisting them with recovery, pain management, and mobility after an injury or illness. But when physical therapy brings relief and progress, patients often want to maintain that forward momentum — even when it is no longer medically necessary.

Hoping to maintain their established relationship with you, they may ask whether you can keep working together on their strength, conditioning, and wellness needs. For a private practice owner, this is not only an opportunity to grow your business, but it also allows you to seamlessly support your patients in their wellness goals.

You may be wondering what to look out for when beginning this new endeavor. In other words, what are the considerations when expanding your practice from physical therapy into coaching or wellness?

DRAWING THE LINE BETWEEN PATIENTS AND CLIENTS

The largest consideration when expanding into coaching/wellness is determining how to draw the line between your physical therapy patients and your coaching/wellness clients. We encourage the use of these different terms to help differentiate between those receiving medical care and those receiving wellness services. Patients are those who receive physical therapy services within a healthcare framework with the goal of addressing an ailment, injury, or diagnosis. In contrast, clients are those who seek coaching and wellness services from you — in part because you’re a physical therapist, but also because you have put yourself forth as having an expertise in physical conditioning and movement. If you are considering entering the realm of coaching, we encourage that you engage in the exercise of writing out how you’ll distinguish patients from clients, or an alternative vernacular that accomplishes this differentiation.

EVALUATING YOUR SCOPE OF PRACTICE

To draw this line, you must first evaluate what is within your professional scope of practice as a physical therapist. This will differ vastly from state to state. Illinois, for example, defines a physical therapist’s scope to include the following:

• Examining and evaluating individuals with impairments, limitations, disabilities, or other health and movement-related conditions.
• Alleviating and treating these impairments through a variety of specified techniques.
• Reducing the risk of future injury, including through the promotion of health and wellness maintenance.¹

Once you determine which services you will offer to your patients and to your clients, you should carefully examine your state practice act, as well as the practice acts of other professionals. If your coaching/wellness services fall outside the scope of physical therapy, they may still fall within another professional’s practice act (e.g., chiropractor or athletic trainer), so you should define your coaching services to avoid those areas of overlap.

DOCUMENTING AND COMMUNICATING THE DISTINCTION

Once you’re clear about which of your services are physical therapy and which are coaching, there are a few key places where you should communicate and document it:

• Your internal policies and procedures. Clarify the important distinction between patient care and coaching services to ensure that all employees understand which forms to provide, whether to bill something to insurance, and how to document the individual’s visits in your internal systems.
• Informed consent documents. Consider offering separate patient-specific and client-specific intake forms. This ensures that patients transitioning into clients understand the impact and significance of this change. The patient-facing policies, informed consent, payment terms, and privacy notices will also be different, as will any other relevant documentation.
• Website and marketing materials. You’re offering physical therapy because you’re a licensed physical therapist, but you’re offering coaching services because you’re educated in movement, conditioning, or a sport- or diagnosis-specific wellness service (e.g., balance or gait training, CrossFit conditioning, or postpartum yoga). Be sure that your website, social media, and other marketing materials indicate the difference.

REEVALUATING YOUR PRACTICE’S ORGANIZATIONAL STRUCTURE

If you are expanding your services to include coaching or wellness, it may be a good time to reevaluate the organizational structure of your practice. Depending upon the state in which you operate, there are a variety of ways in which your practice may be organized, including the following:

• Limited liability companies (LLCs)
• Professional limited liability companies (PLLCs)
• Professional corporations (PCs)

PLLCs and PCs are reserved for licensed practitioners offering professional services. In some states, like Illinois,² professional services must be performed through one of these entity types. In other states, licensed practitioners are allowed to organize under an LLC, PLLC, or PC.

CAN YOUR CURRENT LEGAL ENTITY OFFER COACHING SERVICES?

States differ regarding what types of services may be provided under a single PLLC or PC. Some states allow related professions, like clinical psychologists and social workers, or physicians and podiatrists, to operate under the same entity.³ Others have more lenient restrictions, allowing practices to engage in the licensed profession and any other lawful business under the same entity. In these cases, your existing PLLC or PC, established to provide physical therapy services, could extend to include coaching services, too.

However, some states explicitly limit the scope of services provided by an entity. For instance, PLLCs and PCs in Florida must be organized to perform a single, specific professional service, and all members must be licensed to provide such services.⁴ If your practice operates in a similar state, then you may need to provide your coaching services under a separate entity.

CREATING A NEW ENTITY FOR COACHING OR WELLNESS

Regardless of whether you’re allowed to operate a coaching business within your existing physical therapy practice, it’s sometimes best to create a new entity (like an LLC). This is especially true if you were already planning to create a new business name, file for an assumed name, or register a fictitious business name for the coaching services. A separate entity allows you to clearly delineate your services in a very public-facing way, and it minimizes the chances that a coaching client may inadvertently believe that they’re a physical therapy patient. The entity established for coaching would offer no professional (i.e., licensed) services.

REVIEWING YOUR LIABILITY

Finally, you should review your current insurance plan to determine whether it extends to coaching services. Your current professional liability policy likely covers the scope of your physical therapy services, but it may not cover your coaching services. Consulting with your insurance provider about additional insurance options is a simple way to ensure that your growing practice is adequately shielded from liability.

THE TAKEAWAY

Exploring the expansion of your physical therapy practice may seem daunting. However, with the proper forethought, guidance, and support, it can be an incredible opportunity for you, your patients, and your future clients. See the Appendix on how you can fill out your own scopes of practice. 

Law student Annika Reikersdorfer contributed to this article.

References:

¹225 Ill. Comp. Stat. 90/1 (2022).

²805 Ill. Comp. Stat. 185/ (2015).

³805 Ill. Comp. Stat. 185/13(b) (2015).

⁴Fla. Stat. §§ 621.051, 621.06.

Connor Jackson is a founding partner of Jackson LLP Healthcare Lawyers, where he focuses his practice on the business side of health care law. Connor is licensed in New York, Illinois, Texas, Michgan, and Wisconsin. He can be reached at Connor@JacksonLLP.com.