Table of contents:
- Brick and mortar start-up costs
- Cost range
- A little advice…
*there are a few affiliate links in here that may make me some extra $$$, just a heads up. All the products/services that I link to, I’ve personally used, still use them, and/or believe they work well and are worth the money.”
Cost-range
How much does it cost to start a physical therapy clinic? That depends on how you go about it…
Estimates range from $200 – $100,000+ based on the physical therapy business owners that I polled.
You can bootstrap your practice, or get a business loan. There are advantages and disadvantages to each strategy.
I think the cheapest you could get PT clinic start-up costs down to are likely around $200.
Rent
I chose to bootstrap my physical therapy clinic. I started working out of a powerlifting gym where I paid $20 per client that I saw. Most months, my rent payment would be under $200 and I was charging $100/hr. In this gym, I had access to all of the equipment in the gym, and access to a private room.
If I had to do this again, I’d negotiate a monthly fee with a graduated payment plan as I got started.
If you decide to rent your own space off the bat, purchase equipment, furnishings, paint, etc. you could easily get your expenses upwards of $10k+ in start-up costs depending on the size and location of your practice. Rural Kansas will be a lot cheaper than the middle of San Francisco.
I’ll give you a real-world example (actual numbers) of what my monthly costs are in my business as a solo practitioner after three years of being in business, later in this article.
$10k is nothing compared to the $250k I spent on college and grad school, but still, not a small chunk of change.
Software
The first EMR I used was google docs. If you get g-suite with one email the cost is $6/mo. You can sign a BAA (business associate agreement), which makes your google docs HIPAA compliant. This is the easiest and cheapest way to get your documentation set up.
I chose to purchase the cheapest version of acuity scheduling. I’ve since upgraded to their higher-tier plans, but it was great starting out and it was only $14/mo. You can use google calendar for free but it doesn’t have all the functionality of appointment reminders, etc. that a true scheduling app has.
Once I got rolling and had more clients I did move to WebPT as this is the platform I’ve had the most success with. I’ve tried a few others that didn’t work out so well, but I’ll make another post about that, down the road.
Website hosting also will run you around $20-30/mo depending on who you go with.
Business License
These are usually pretty cheap. Usually, it’s a yearly fee anywhere from $20-$100 from what I’ve seen. You’ll need to check with your city to see if they require a business license or not. To do that, just type in “business license [your city]” and go to the government website to read about it.
Insurance
I used HPSO insurance to start with, but have since switched over to CM&F. Truthfully they’re pretty close in cost. HPSO was ~ $850 for the year and then CM&F I believe is around there, although it may be at $1,100 per year. A total of around $75-$90/mo.
American professional is another company I have heard good things about and they tend to be on the cheaper side, too.
Equipment
Treatment table – $90-$160 on amazon. This is the one that I purchased 4 years ago and it’s still going strong.
I have since gotten a hi-lo table, but I’ll still break out this one on occasion! (it creaks a bit though… so it’s a negative for the patient experience).
Assuming you have access to a gym where you’ll be working with your clients, you won’t need to purchase any weights or bands or other equipment that really start to increase your start-up costs.
Legal
You also don’t need to incorporate your business right away, however, if you do, you can easily incorporate with Rocket Lawyer or LegalZoom and I believe their prices are under $500 and possibly as low as $150. Don’t quote me on that, but I know they’re way cheaper than what I did. I chose to hire an attorney to do this for me, but it cost around $5k. That bill hurt.
Staffing
If you’re not taking out a massive loan or have a good amount of capital already allocated to start the business, this should be the last thing on your mind. You’re going to be handling 100% of the responsibilities, i.e. wearing many hats for a while.
I think it’s important for the founder to learn all of the different roles of the company in order to, later on, be able to effectively hire someone for a specific role.
Payroll
Since you’ll likely start as a sole proprietor you don’t need to be paying yourself a salary to start. You’ll just be taking an “owners distribution,” from your business account based on the net revenue (after expenses).
I use Gusto to handle my payroll.
Budget start-up costs
- G suite EMR – $6/mo
- Google calendar scheduling – free
- Business license – ~$50
- Treatment table – $130-170 (mid-range on amazon)
- Website – $20-30/mo (if you build it yourself)
- Total – $206
Not bad!
Now, remember, this doesn’t include legal or insurance, so depending on your own risk tolerance, your costs may increase in the first month should you choose to incorporate your practice and get professional and business liability insurance.
After these start-up costs, you will have whatever monthly recurring costs that you’ve set up or negotiated including rent and any subscriptions to software that you decide to use.
Something else to think about is that if you do end up going full-time into your practice, it may take you 6+ months to be profitable (when counting in your personal expenses). Make sure you have more than enough capital saved up to cover this.
I’m a big proponent of continuing to work yourself out of your current job so that you can at least be breaking even or only losing a little bit of your capital each month as you grow. Since you are not a venture capital-backed company, it’s imperative that you keep your cash reserves healthy and stay cash flow positive. #1 reason businesses fail is due to running out of cash.
Cash practice vs. in-network insurance vs. out-of-network practice vs. online
Brick and Mortar
There are many articles defining the difference of each of these types of payment models, so i’m not going to get into that here.
It’s cheaper to start a cash practice but, it’s easier to market an in-network practice. And truthfully, even if you did start an in-network practice and had to get credentialed with all the different insurance, if you did it yourself, it wouldn’t cost you anything, other than making sure you have billing software and an EMR that can handle the claims.
I use a WebPT and Kareo combo for this. I was using therabill but wasn’t too happy with the custom reports and such so I switched over to Kareo. That’s only my opinion though, I have a friend who does about $750k in revenue per year and he uses therabill just fine with 3 or 4 other clinicians without issue.
I get very particular about software. (a bit neurotic I’m sure)
The added start-up costs with an in-network and out-of-network model are that you will likely need an EMR that integrates with billing software. You can do it without and submit paper claims but damn, that would be a pain in the ass. Additional costs will be if you hire someone to do the credentialing for you.
Online
If you decide you want to be virtual-only and work from home, your startup costs and monthly expense dramatically drop.
If you already have a laptop, you’d only need a few different software, your social media profiles, and a marketing plan.
I do see some of my clients virtually, but it’s more integrated into my brick-and-mortar. For a better synopsis of what it takes for a completely virtual practice, I’d recommend checking out this Facebook group from Rob Vining. All the information you could ever need about seeing clients virtually is in that group.
A real-world example of my physical therapy clinic expenses and income after three years in business
Total (not including my salary) – $8,509
Total (including my salary) – $16,209
Average revenue per month (2021)- $19,411
Rent – $2800
Utilities – $141
Software – ~$1,000
Payroll (solo practitioner) – $6728
Contractor fees – $2153
Here are some screenshots of my real expenses for most months.
How much revenue I need to make every month in order to pay my personal and business expenses.
Should you take on debt to start a physical therapy clinic or fund it yourself?
This completely depends on your risk tolerance. If you know how to market and sell, and are confident that you can quickly grow your business into something profitable within a couple months, then taking on debt is likely a fine option as it will allow you to grow faster.
If you’re new to business and haven’t developed any business skills, then taking the bootstrap approach and funding it yourself is likely much better.
When you see your bank account going down every month it certainly lights a fire under your ass as opposed to if you’re spending other people’s money (that you will eventually have to pay back).
Should you quit your job and go full in before you have clients?
Honestly, I wouldn’t recommend it, unless you have at least 6 months of personal and business expenses saved up. I ran out of money and started running up credit card debt about 7 months after opening my business. This was incredibly stressful and I wish I would have waited to save up for a few more months prior to diving in.
It all worked out but it was stressful as hell.
I asked my Facebook hive-mind of physical therapy business owners how much it cost them to start their practices. Here are all of their responses.
As you can see from the above examples, costs to start can vary widely depending on what type of business model you are trying to run and various other factors.
When is a good time to go full-time into your business?
If you are starting to replace your full-time income with income from your clients that you are seeing on the side and you have a few months that have been consistent with that income (3+ months), then I’d say you could start considering moving into your business full-time.
Now, if you were like me, and had a decent amount of capital saved up, and just couldn’t take your job anymore, then you may be ready to jump in sooner. As I wrote above, I should have just sucked it up and changed my mindset about my current job for a few more months as that would have made me and the business more secure.
Final Thoughts
There isn’t a one size fits all approach. In-person, online, hybrid, in-network, out-of-network, start in a gym, take out a loan… it all depends on you and what type of business you want to build.
If you have an underserved niche that can afford your services then this is of course the fastest route to profitability. Finding those underserved markets just takes a little bit of digging.
What I wouldn’t do is start a physical therapy business because you are a physical therapist and you can provide “the best care.” That’s a recipe for disaster. If you don’t have a Unique Selling Proposal (USP), and you’re just the same as all the other clinics, you might want to re-think your strategy.
There are many ways to make a living and build wealth as a therapist, building a clinic being one of those options.
Would love to hear what you think and what questions you have from this article if any! Please leave a comment below, i’d love to hear from you!
