During college, I remember once speaking to a colleague of mine during our downtime in the mentor offices; he told me that I was an entrepreneur, and I adamantly disagreed. I told him I just wanted to do my work and leave, which makes me laugh aloud now; hindsight is hilarious sometimes.
After completing my level one and two fieldwork assignments in Houston, Sugar land, and Galveston, Texas, I had job offers to work at each facility. One was a pediatric clinic specializing in sensory integration, which was fun for me. Still, after working with kids aged from kindergarten to college seniors for over three years, I knew I didn’t want to accept that position. Another was a facility specializing in traumatic brain injury rehabilitation, where I wanted to work the most. The other was in one of the most recognized hospitals in the Houston Medical Center inpatient rehab with ample neuro patients.
I was living on Galveston island then, and my first choice was only a few minutes from my home, while the other was about fifty miles away, equating to two – two and half hours one way in Houston traffic. Yes, you read that correctly.
I accepted option number one at the neuro facility because a.) it was a renowned facility specializing in neuro patient population, and b.) I’d wanted to work there for over a year before graduating, c.) I completed my level two fieldwork there (I worked with supervision before attaining my license), d.) it was close to home. I was so excited! Then they told me entry-level pay was $50,000/year, which was a massive disappointment (remember, I was over $100,000 in debt). They agreed to pay $55,000/year. The other facility’s entry-level market rate was around $63,000/year with full benefits, but it was two hours one way with city traffic.
I accepted a PRN position at the second facility to make ends meet. I told them I’d work as many weekends as possible to gain more experience and earn more money to pay student loans, and to my surprise, they agreed and offered me regular work at a rate of $40/hour. So I was working six to seven days a week, but the good thing was that my mother lived in Houston, so I’d stay the night on Friday and Saturday to catch up with her briefly before heading back to Galveston for my weekly work.
I avoided burnout initially for a while because I was excited about my new career, but it took only a short time to see that this wouldn’t be sustainable. A few things happened that got me thinking about making some changes, 1.) I didn’t enjoy the work at the neuro facility because things were too regimented for my personality type. 2.) the work was emotionally demanding, and the pay was far too low for my needs. 3). I got paid more on the weekends with less stress, more freedom, and the latest and greatest technology, including virtual reality rooms to work with neuro patients, which I enjoyed, and more importantly, 4.) I learned about the tiered pay structure for salaried employees at the hospital and their competitors.
In short, the hospital had four tiers of pay for therapists based on time worked and additional skills employees accumulated and applied during their tenure, which maxed out around $87,000/year with full benefits. To get to level four, a therapist often would have to work for nearly a decade or more. In addition, once I learned how much one 15-minute unit of therapy billed for my time with a patient given specific medical codes, I realized my colleagues, and I was getting paid a small fraction of that amount. I didn’t think it was unfair; hospitals are large, have bills to pay, and must also generate revenue. I understood that, but I didn’t like my gut feeling when I imagined working in this setting, in one place for a decade, hoping to reach a higher tier and salary.
Things changed one day when I talked to my friend, a classmate in the OT program at UTMB. He was older than me and had worked for himself in a different industry before attending graduate school. By the time we had this conversation, I had quit my first job already; I think I had lasted only a short time. I disliked it so much that I lied and told them I had found a traveling therapy job that paid more and needed to take the higher offer. I had yet to call a head-hunting travel agency, but I had the weekend work to tie me over until I found something.
I made myself more available during the week at the Houston hospital, and they used me reasonably consistently. To my surprise, I called an agency and quickly received several messages from recruiters offering to help me find something. To make a long story short, less than two weeks later, I accepted an offer a thirty-minute drive from my home in Galveston for $75,000/year with benefits. So by making one phone call, I received a $20,000 raise to do similar work in an acute care setting. It was less stressful and paid more, so I was grateful for the opportunity, but the funny thing is that I knew I’d quit soon when I clocked in on the first day. Again, it was relatively easy and varied, leading to boredom. Again, I left the job in less than six months.
So back to the conversation with my friend. I complained to him about work one day, so he suggested we start a contract therapy company. I knew nothing about business and told him I had no interest, but he won me over time, so I decided to give it a shot; if things didn’t work, I could always find another head hunter contract gig, perhaps in another city or town. I even considered quitting therapy and applying to medical school to become a doctor, but this meant more time in school and a lot more student debt, only to return to working in the traditional medical model eventually. I chose to take him up on his invitation, and we went on Legal Zoom and incorporated Powell & Rivard Associates LLC.
Okay, now what?
We decided to list as many facilities as possible within a fifty-mile radius of our prospective homes, him in Vidor, Texas, and me splitting time between Galveston and Houston, Texas. So I gave myself thirty days to stay at home and call, email, and make cold visits to approximately 100 facilities, and my friend agreed to do the same. I’d start calling and emailing at 9 am every morning and find creative ways to get in touch with people who could make decisions about contract therapist work. After completing more of the contact list with no response, I visited them wearing scrubs, handing out our business cards, and introducing myself while expecting nothing in return.
There were so many no’s, and I wanted to quit, but I just reminded myself how much I hated doing things before, which fueled me for one more day. So from day one to day twenty-seven, I went without a single contract landed. My friend had gotten a few for us at between $70 and $100/hour to do the same work other companies were paying full-time employees between $25-$49/hour to do; the catch was that many of these facilities were away from major metropolitan areas. Just about when I was ready to give up, on days twenty-eight through thirty between us, we landed about ten contracts with companies with multiple facilities within the southeast Texas region for $75-$100/hour. I couldn’t believe it!
We started working at the facilities closest to our respective homes, deposited the money in our business account, kept tabs on deductions, and paid ourselves. It was just the two of us, and we decided to hire as many therapists as possible to help them make more money as a subcontractor with full pay transparency. Still, oddly enough to me at the time, this proved incredibly difficult for us to accomplish. I reached out to classmates, former colleagues, and new graduates, posted on forums, job posting sites, and therapy-related Facebook groups, and no one agreed.
My friend found one person, and I found none. It was an eye-opening experience. We offered more money, the option to work at multiple facilities at more than double their current rate, carpool transportation work, and were in the process of setting up health insurance too. Still, there were no real takers despite many saying how interested they were.
For around three years, I did that business with my friend and got burned out on traveling, sleeping in motels, and working crazy hours in multiple Texas cities and towns. All I did was work, travel, sleep, and spend time with my significant other when I could, but it took a toll on me mentally and physically due to the hours on the road and not sleeping well. On the plus side, I gained experience in approximately a hundred facilities with clients and patients from all walks of life. I learned how to negotiate contracts, the tax benefits associated with having a company, how to authentically sell myself, and drastically improved my clinical skills with the stroke and orthopedic patient population.
After three years, I quit that business to start my own company and moved back to Houston, Texas, full-time to try something different. So I started Rise Again Rehab and Personal Training PLLC. I completed various certifications and continued my education to improve my skills. Most notably, I became fascinated with Neuro IFRAH, which stands for Neuro, Integrative, Functional, and Habilitative. After completing the certification for adults post-stroke and traumatic brain injury with my friend, I told him that I wanted to focus on doing private sessions with clients to focus on neuro and functional training exclusively. So that’s what I did. I traveled the country, taking several suspension training courses and other exercise and movement-based modalities, and became more proficient through constant practice.
It’s all I did; study, apply, and practice. I’d film myself performing movements, look for biomechanical inefficiencies, improve upon them, and do the same with others. The nerd in me had so much fun! When I moved back to Houston, I had no clients, but I surprisingly found my client schedule full after about thirty days. At first, it started with establishing a home health contract at a much higher rate simply through word of mouth. In a matter of days, while walking through a high-rise wearing scrubs, a woman stopped me and asked me if I was a therapist because she’d seen me doing some unorthodox movements with someone in the gym. She told me her husband had a stroke and was visibly emotional. I told her that was my specialty, we started chatting about his needs, and she invited me upstairs then to meet him; we ended up working together privately two days a week for three years until he passed away.
A few weeks into meeting them, the husband (my patient) insisted that I meet a doctor of physical therapy that owned a clinic less than two miles from his home. By this time, I was studying at Creighton University online to pursue my post-professional clinical doctorate, so he thought we should at least meet. To my surprise, we hit it off immediately. I negotiated a contract with this fantastic DPT, operating a unique business model in an upscale retirement community. His business model incorporated personal training, outpatient therapy, home health services covered by Medicare and third-party insurance, and private pay services. He was looking to add occupational therapy services. When I mentioned my experience with stroke and orthopedic rehab and functional training, we agreed that I’d complete a minimum of 10 sessions weekly at his location. I ended up contracting my services there for about four years.
It was a great working relationship. Contracting with this gentlemen’s small business provided an additional income stream for my small company, a centrally located facility close to my existing clients, the opportunity to see several clients back-to-back in one location, and a tremendous amount of flexibility to come and go as I please, and to film exercise and teaching content for social media. To top it off, we got along well, had much in common, and had tremendous substantive conversations over the years.
Shortly after, I was having lunch with an old friend who insisted I meet a chiropractor who was a lifelong martial artist and enjoyed learning about various health-related matters. This gentleman had an old dojo space that went largely unused. I was looking for a room to teach group suspension training and functional training classes near my Houston home; it turned out that this dojo was less than two miles from the loft I was renting in Houston during the week. I met him and agreed to rent the space for $200/month. I could hang ten suspension trainers from the rafters in the ceilings, bring any needed equipment, and market and teach the classes I saw fit.
I started posting videos of myself on Facebook doing exercises, and some friends joined me for free. I’d post videos of our small group doing exercises together in various locations, having a good time, and boosting ads on Facebook to try and find more students. Some people would come to try a class and have a blast but needed more time to be ready to commit to coming consistently. I had so much fun teaching and working with incredible people that I didn’t care much about starting small and teaching for free to get the word out.
Slowly, I was teaching paid small classes on Tuesday and Thursday evenings with a group of five people, charging $20/person, and was looking to grow to ten people per class and offer more times to teach. Around that time, a pilates studio near the medical center found my contact information online and inquired about my teaching classes there. I visited the facility and agreed to teach there to share my love of suspension training with as many people as possible. A gym chain contacted me shortly to speak and teach their trainers about the benefits of suspension training in a large group setting. I got invited to come back the following year to run them through a class and speak again, and I had a blast.
I planned to hire one certified occupational therapist assistant (COTA) to work with me and take over my clients in the retirement community. I could have them work PRN for up to 20 visits a week and pay them higher rates. Freeing up this patient caseload would allow me to build the suspension training classes, reinvest in improving the dojo space, allow more time to make solid professional relationships, and build a corporate exercise and wellness component to my business.
I became good friends with a renowned registered dietitian in the area, and we began supporting each other’s businesses by promoting and attending each other’s events for a few years. Things worked out well, and I valued the opportunity to learn, grow, connect, and serve others daily. After interviewing three candidates, I didn’t end up hiring a COTA, but I did land another home health contract at $100/hour. Again I was hoping to find a COTA to help me with my new home health gig; I would evaluate the patient, create the treatment plan, and hand them off to the COTA to see them and provide any equipment needed while paying them $65/visit; still no serious takers. It worked in that I saw ten patient visits per week with this contract, ten at the senior facility, ten to fifteen private pay client sessions, teaching two nights a week at the dojo, and one to two nights a week at the dojo the pilates studio.
It was a lot, but I loved what I was doing and felt like I was building something. I needed to create more leverage by hiring others, transitioning to teaching more classes, and eventually offering monthly training with recorded videos and an online support group. I needed more time to record the quality of the videos; I wanted to build a digital movement library. I needed to pivot again but didn’t know the next step to take. I found an unlikely transition to virtual social media consulting which I’d like to share with you in next month’s blog.
Recent Comments