Giving the Green Light to Your Ambition

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Open your niche with a strategy to ensure success and minimize risk

By Brent Bednar, PT, MPT

Is opening or adding a niche practice on the horizon or a future goal? Does it seem within reach but when moving to put action to ideas, you become sidetracked by the road signs warning you of a rough road ahead?

Now, when the light turns green, you sit at a standstill, white-knuckled because you don’t know if you’re ready for what’s ahead or even where to start. Previously attainable aspirations feel overwhelming and dreams deflate like a punctured tire. Yet, you know there are clinicians who realize the goal of a thriving niche practice. What’s their secret to seeing the green light and, with roadmap in hand, speeding towards adding a niche practice?

Jocko Willink, author of Extreme Ownership, states, “It is essential to develop a standardized planning process.” Take the advice of this former navy seal. Develop a planning process leading to steps and predictors to improve the probability of a successful niche practice. The implementation and execution of the steps through specific questions and their correlating answers plunge a dream to reality.


To create a strategy, outlining key questions and the answers to those questions is pivotal. First and foremost, determine what the niche practice will be. Next, determine what population will be served and why the market needs this niche practice to ensure demand is present. Once the sustainability of the practice is ensured, ponder what will set the practice apart from other practices in the area. Clearly communicating this information to future patients and potential referral sources is essential. Also, include training or certifications to emphasize expertise. Through this clear communication, relationships formed within the community can bolster and create a network of support for the practice.

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Secondly, spending time contemplating company culture is equally important. Positive culture among therapists and employees fosters positive profits. Competent therapists are not enough. Determine the company dynamic desired to attract talented therapists and staff and use those values to evaluate if they would be a good fit for the company. Because this cultural dynamic will directly impact the experience of staff and patients, it is vital to write down and practice these core values weaving them in decisions from day one. Take note to spend an equal portion of time drafting culture and strategizing a business model. Culture and strategy live in symbiosis, meaning both live and benefit from each other.


Questions have been asked and answers given regarding a business strategy and a cultural code. Now is the time to plan and cultivate systems for acquisition of patients. In many ways, it will feel like a primal exercise of hunting for the areas where the patients interact and live to gather referral resources. Where can a consistent stream of patients be found? If local businesses offer services within your niche, look to partner or offer resources. Within the community, seek connections through social media to cross paths with patients and other businesses. What information or expertise can be traded to gain clients without jeopardizing profits? Who in the network knows the secret spots that will yield a consistent crop of patients?

All of these resources complement growing a robust system to consistently produce new patients week after week. By fostering relationships with each of these resources, all your “eggs” won’t be in one basket. Diversification is key to being an effective hunter and gatherer of referral sources and patients. Create a referral system from social media, Google Adwords, healthcare professionals, community programs, physicians, past patients and random, unexpected relationships providing a deep well of patients. Remember, dependence on one source for more than 25% of clients elevates risk.

With the list in hand, begin to target these areas using the concept of “Fire bullets, then cannonballs” by Jim Collins, in Great by Choice. Fire bullets, which are inexpensive and low risk, at narrowed areas and then measure results. Gauge objective success with the number of patients from those specific targets. When wins appear, use data to fire cannonballs with the same deadly accuracy for even greater return. Continue to refine the target through data versus spraying cannonballs at each shiny object perceived as a potential referral source.


Building an informed budget to project financial success is imperative. Going in blind or being overly optimistic can create uncertainty. Having a realistic projection will guide decisions about staffing, startup costs and other purchases. The scope of this article is not to outline an exhaustive spreadsheet with startup expenses, monthly balance projections or a New Clinic Performa. While these tools will be vital for later stages, start the process by forecasting visits and revenue to build the foundation.


Begin the process by using a simple spreadsheet to formulate a customized budget for projections with revenue being the primary focus of the budget. Plainly stated, revenue will be a result of the patient visits per month multiplied by the amount received per visit for services. Refer to Figure 1 for an example with visits and revenue averaged by week and month as well as a 12-month projection. The new patients received weekly, the plan of care for follow up visits and the revenue expected per visit is a direct correlation to the business plan. If projections look bleak, refine the business plan to ensure a solid care model with a business plan that will be successful. Success hinges on juggling patient care, culture, referral sources and being a savvy business owner. Dropping the ball in any area will procure a failed outcome.


Businesses break down for three reasons — poor planning with great execution, great planning with poor execution, or worse yet, poor planning with poor execution. Follow Jocko Willink’s advice to standardize planning processes. The path to a successful niche is not as bumpy as you may think. Map out the journey versus following your internal GPS. Utilize the resources of the APTA Private Practice Section and learn from other practice owners who have blazed the trails before you. As fellow private practice owners, we will be cheering you on and looking forward to hearing about the entire expedition. 

Brent Bednar, PT, MPT

Brent Bednar, PT, MPT, is CEO and partner at Lincoln Orthopedic Physical Therapy in Lincoln, NE. He can be reached at

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