Leveraging Telehealth to Reach an Underserved Microniche Market

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How the author used web-based tech and marketing to reach and treat a microniche patient population

By Elizabeth Plowman, PT, DPT

I opened my telehealth physical therapy practice in 2019 with two purposes in mind:

1) reach patients who need physical therapy services but cannot easily access an outpatient facility, and 2) continue
practicing in the profession I love as a physical therapist with a disability.

In 2018, I was diagnosed with myasthenia gravis (MG), a rare debilitating neuromuscular disorder that causes severe
weakness and rapid fatigue of voluntary muscles that worsens with repeated use of the affected muscle. It can affect any
voluntary muscle but tends to mostly affect the proximal muscle groups of the hips and shoulders, diaphragm, eyes, neck
flexors, and mouth.1 I was unable to continue practicing physical therapy in the “traditional” sense due to this
condition, but I was able to practice via telehealth as it was far less physically demanding. My aim was to treat
patients like me: those who desperately need physical therapy care but have difficulty accessing it in the outpatient
setting (and do not qualify for home health care). There are many patients who would benefit from physical therapy, but
because of chronic pain, fatigue, weakness, transportation difficulty, etc., getting to the neighborhood physical
therapy clinic is a daunting prospect and can often cause more exhaustion and/or pain than the physical therapy
treatment can address. I was on a mission to help these people.

Initially I geared my telehealth practice toward patients with chronic pain conditions, such as fibromyalgia. However,
through my own journey with MG, I discovered that many physical therapists have little to no understanding of this
condition and are, therefore, poorly equipped to handle its unique presentation and the needs of patients with MG. Due
to the relative rarity of the disease, MG patients are spread out across the country. With the ability to obtain
licensure in several states through the PT Compact, I was able to extend my practice across state lines to reach MG
patients. Currently, there are 21 states actively participating in the PT Compact with 18 states at some point in the
legislative process to approve entry.2 Through telehealth, I am able to provide care to MG patients who do not otherwise
have access to a physical therapist with the training and skillset to treat their condition.


In marketing to a microniche population such as individuals with MG, typical marketing methods, such as paid social
media ads, newspaper ads, fliers, and health fair events are not effective at targeting such a small section of the
population unless those publications and events are specifically for the target market. I opted for a more organic
marketing approach by providing webinars, creating informational online content to share in various online MG
communities, and speaking at virtual MG support group meetings. Once I presented at one or two meetings, I was invited
to speak at more meetings in other states. I never once asked anyone outright to become a client, but because I provided
quality information specific to their needs and demonstrated that I provide physical therapy care designed for people
with MG, they came to me. And then they referred their friends.

Initially, people with MG were not my target patient population. It was my “side gig” pet project because I wanted to
help people like me. As a patient (physical therapists need physical therapy, too), I had experiences with several
physical therapists who had no idea how to treat someone with MG and prescribed treatment plans that would have made me
worse if I had not been a physical therapist myself with advanced study on the condition.

In the online MG forums, I encountered several people with similar experiences with physical therapists who did not know
how to effectively treat them. This was actually how I found my first MG patient for my telehealth practice. And over
time, what started as a passion project became my primary practice focus. If not for the telehealth practice medium,
this would not have been possible. MG is a rare condition with an estimated prevalence of 14-40 per 100,000 people in
the United States, according to the National Organization for Rare Disorders (NORD).3 With such rarity, it would not be
feasible to have a profitable physical therapy practice focused on this market; however, via telehealth and the ability
to practice across state lines with the PT Compact, I am able to do this.

With a 100% virtual physical therapy practice, online presence is everything. I established Facebook and Instagram
profiles as “The Myasthenic PT” to create a public image and an avenue by which to disseminate informative content and
to interact with the various online MG groups. I also created a YouTube channel to publish periodic informative webcasts
that are sharable on social media. At the end of the day, people may not remember my name, but they will remember “The
Myasthenic PT.”


When the time came to bring an assistant on board, I opted to keep this position virtual too. Since I operate out of a
home office and do not actually have a brick-and-mortar clinic, hiring someone to work remotely made sense. Currently I
employ a virtual assistant who handles tasks such as social media and email marketing, lead follow-up and nurture,
communication with patients and physician offices, scheduling, website management, and data entry and collection.
I was affected by the unprecedented winter storm in February 2021 with subsequent extended power outage and severe
structural damage to my home (which is also my office). The beauty of a 100% telehealth setup meant that I was able to
pick up my practice again at my temporary lodging with very little time lost. Also, since my virtual assistant does not
live in the same area that I do, he was able to keep working and communicate with patients and leads on my behalf while
I was out of commission (and desperately preserving my dwindling cell phone battery). If not for my practice model, I
would likely have lost at least two to three weeks of patient care.

While I made the move to telehealth out of necessity due to disability, it is a practice model that I love. Not only
have I been able to continue practicing as a physical therapist, which I love, I have been able to reach an underserved
microniche market desperately in need of quality physical therapy care. And the commute to work is amazing. 

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1Myasthenia Gravis. Mayo Clinic.
Published May 23,
2019. Accessed February 22, 2021.

2Physical Therapy Compact. www.ptcompact.org. Accessed February 22,

3Kaminski HJ. Myasthenia Gravis. National Organization of Rare Diseases (NORD).
Published January 21, 2021. Accessed March 1,

Liz Plowman

Liz Plowman, PT, DPT, is the owner of Pain Boss Physical Therapy in Texas. She can be reached at
(832) 458-1480, Liz@PainBossPT.com, www.facebook.com/PainBossPT,
www.facebook.com/TheMyasthenicPT, and Instagram @TheMyasthenicPT