The Power of Niche


How specialized practices attract diverse patient populations.

By David J. Denton, PT, DPT

Building Trust: The Fabric of a Culturally Competent Clinic

A physical therapy practice that embraces, welcomes, and fosters diversity in its patient population is one that exemplifies cultural competence. Cultural competence includes executed behaviors, staff attitudes, and core policies and procedures that are married together, succeeding in and striving to achieve the mission and values of the entity.1 Embracing diversity benefits both the patients receiving care and the professionals working effectively in cross-cultural situations.

As such, embracing diversity and achieving a culturally competent practice takes time, effort, and a commitment from all stakeholders involved. The process is dependent on excellent patient experience, word-of-mouth endorsement, trust, and how the office has set apart its care relative to other practices the patient may have chosen instead.

How to engage and connect with today’s patient.

As a physical therapist, a key point to remember is that we are humans treating, listening to, and healing humans. There is an unwritten rule regarding the bedside manner, responsibility, and empathy that comes with parents, loved ones, and individuals entrusting their health and well-being to us as clinicians. Along the way, we need to listen intently, reevaluate the diagnosis, follow the evidence in decision making, and coach the patient through hard days, emotions, tears, and pain.

In order to sustain diversity, openness, and cultural competence in the practice, some fundamental principles need to be measured and met. These principles include: making the patient’s family the prime system of support; patients making care choices based on cultural forces; driving practice in the service delivery system by culturally preferred choices; clinic services matching and aligning with culturally diverse needs depending on the individual patient; and as always, cross-cultural interaction being incorporated via cultural knowledge into policy making, education, and practice.2

In private practice, the goal is to make all patients who come through the door feel valued, relevant, and equal. During the examination, patients are listened to, involved in their plan of care, and are active participants in the advancement of the program. They attest to care on their terms. Today’s busy clinician juggles daily documentation tasks, authorization letters, and phone calls; unfortunately, patient engagement and the effort of practicing “culturally competent” are not at the forefront. Through leading and practicing on behalf of the patient, advocating for them, and driving inclusion from the start, clinicians can help the patient develop positive health behaviors, which will subsequently drive clinical outcomes, patient satisfaction, and results.

The impact and value of inclusion and support.

Physical therapy practice in our technology-oriented culture treats a much more health-focused and educated patient. For those PTs who go the extra mile, their practice will attract people of various cultural beliefs, political views, religions, and ethnicities. For example, it is valuable to understand clinician gender preference based on beliefs. Nowadays, these are issues students are learning during their clinical affiliations. Changing demographics have required physical therapists to become more culturally competent and aware of belief systems. This evolution will reverse the notion that “practicing physical therapists do not necessarily reflect the ethnic diversity within the population.”3

Through educators, clinical instructors, and curriculum, future and current physical therapists will understand, exemplify, and practice with the appropriate amount of patient inclusion. They will support patients intellectually and emotionally through the recovery process. Now more than ever, PTs need to ensure patient privacy, modesty during manual interventions, and potential blood sugar effects in patients who may be fasting as a religious observance at various times during the day. Patients may need special accommodations, which may require scheduling at more opportune times, offering private rooms for treatment, or embracing learning about their beliefs, prayer schedule, or transportation.

My clinic was a niche clinic focusing on manual intervention, dry needling, and vestibular treatment. In the past, I have treated patients of numerous ethnicities and religious faiths, non–English speaking patients, and varying age ranges. Primarily, these patients came due to a past positive experience shared with them by a family member or friend. However, one point of common ground between everyone was discussion, participation, and sharing in the recipe board on the front desk since most everyone loves food!

Embracing diversity and creating trust.

As a vestibular therapist, on top of the diverse population that it brings, there needs to be an additional trust factor. One successful strategy in addition to individualized care, intent listening, and empathy was the PT-led vestibular support group. Patients from all age ranges, diverse backgrounds, and cultural beliefs would come together to share success stories demonstrating that there was hope of feeling better and that they were not alone. The fabric of a culturally competent small or individualized center fostering diversity is built on trust. Diversity is embraced by including all, going the extra mile to brush the snow off of a patient’s car, knowing when a group likes to shake hands on evaluation or not, holding a door open, including the entire family in the plan of care, and showing that all are welcome. The most important thing other than positive results and patient experience is trust. Trust will carry through the community and be your practice’s secret sauce.


1Leavitt R. Developing cultural competence in physical therapy practice. Journal of Physical Therapy Education. 2006;20(2):81-82.

2Curatti PR. Clinical education and cultural diversity in physical therapy: clinical performance of minority student physical therapists and the expectations of clinical instructors. Journal of Physical Therapy Education. 2008;22(1):85.

3Staff PTT. Cultural Competence in Physical Therapy [Internet]. APTA. [cited 2019May29].

David Denton

David J. Denton, PT, DPT, is the director of clinical education and the assistant clinical professor of physical therapy at Hanover College in Hanover, Indiana. He can be reached at

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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