How To Build A Profitable & Sustainable Cash-based Physical Therapy Clinic Using The ‘Go-To’ Clinic Formula

How To Build A Profitable & Sustainable Cash-based Physical Therapy Clinic Using The 'Go-To' Clinic Formula

When you’re building a private practice you can never rely on luck. You can’t rely on guesswork. You can’t rely on insurance companies, insurance plans, or if you’re based in the US, Medicare, to get those patients through the door.

After leaving my full-time positions in professional sport I spent years building my own private practice. I won’t pretend it was easy. There were a lot of sleepless nights and a lot of sacrifices.

Years on, the lessons I have learned have had a big impact. Now, as a coach and mentor, I strive to help therapists avoid those costly mistakes I made. You shouldn’t have to lose sleep worrying if you’re on a sinking ship.

So in this article, I want to put some of those worries to rest. I’ll lay out the formula and the simple steps that led the ProSport clinic to success and how you can implement these principals your cash-based practice.

Read on to find out…


How Do You Build A Successful Cash-Based Physical Therapy Practice?

I won’t pretend to be a business specialist. I’m a therapist first, but over the course of my career in private practice, there are a few lessons I have learned.

I spent years building the ProSport practice. It was hard work. All the way from one room above a running shop to a team of therapists helping hundreds of people in pain in the North of England. So how did I do it?

Well… It wasn’t guesswork. I wasn’t hoping it would all go well. I made some mistakes. But I learned from those. To drive my cash-based practice to success I knew I had to simplify it all.

Below you can see my response to those lessons, the structure of the go-to clinic formula. It’s a visual representation of what you need to build a profitable and sustainable cash-based physical therapy business.

So how can you make this formula work for you?

The Go-To Clinic Formula For Building Profitable and Sustainable Cash-Based Physical Therapy Practices

The Law Of Value For Cash-Based Practices

Before we get into the simple steps you can take to build a highly profitable and sustainable physical therapy practice there is one fundamental rule that you must understand. This is a rule on which I built both the ProSprot Academy and ProSport clinic.

That rule is the law of value for cash-based clinics:

‘Your true worth is determined by how much more you give in value than you take in cash payment’ – The Go-Giver

In the mentorship and the ProSport clinic, it is our policy to give people more value than we would ever take in payment. We don’t just teach or treat, we give every patient or therapist the keys to their own success. If you want to build a successful cash-based practice then you must stick by this rule.

But just knowing this rule isn’t enough. You’ll need to keep track of it. To do this we use the net promoter score or NPS. I have talked about it in real detail in a previous article which you can read here

Essentially you are asking someone to rate your business. On a scale of 1-10 how much would they recommend your services to their friends and family? If you’re getting low NPS scores then you have a problem. Get 9s and 10s and you know your business is going to grow.

Now you have that, let’s take a look at those steps that will help you build the go-to clinic and become the best provider out there.

Step 1 – A Clinical Step-By-Step System For Your Physical Therapy Services

There are three ways you can grow a business…

1 – Increase the number of customers.

2 – Increase the average order of value/how many visits and sessions patients have.

3 – Increase the number of times people buy from you/customer retention.

Seems obvious right? Yes, but the thing that shocks most therapists is this… It isn’t all about new patients.

The ‘new patient’ craze is the biggest mistake most therapists and providers make. They have a site, a premises, maybe a few therapists and they begin spending money on Facebook adverts. They make a real push for the attention of new patients. This is a risky business.

The reality is before you event consider business models or marketing you must have the ability to uphold your side of the bargain. As a PT practice, this is having the confidence and clarity to achieve real long-lasting results with every single patient. If you can’t achieve these results then all of that money you have paid to reach new patients is wasted.

In the Mentorship and the ProSport clinic, we use a simple step-by-step system to achieve consistent long-lasting results.

I know that every therapist working at my clinic has this step-by-step system. They have confidence and clarity, they understand the WHY behind everything they do, they build confidence in patients, they set patient expectations and cement buy-in and adherence. They achieve meaningful long-lasting results with every patient.

The step-by-step system is easy to understand, easy to implement, repeatable, and gets consistently meaningful results when it comes to patient care. No matter which therapist a patient sees they will get the results they need.

You shouldn’t have to be looking over every clinician’s shoulder, losing sleep over whether or not your staff are doing the right thing.

This is the first key to those referrals, reviews, retention, and an ethical increase in revenue.

Building The Go-To Therapist For Cash-Based Practices

Step 2 – Thinking Business & Implementing Systems Within Your Practice

Although it may be a steep learning curve, to create a successful PT practice you’ll need to have some knowledge of business systems. But this shouldn’t be overwhelming. You just need some fundamentals…

These fundamentals will help you find and address issues within your practice. They allow for smooth running and a great team culture.

Most importantly, understanding your business and it’s systems allows for a consistently great customer experience. If you’re not delivering a consistently great customer experience then it won’t be possible to grow your practice.

So, what do you need to know to build a cash-based physical therapy clinic?

Always Build Your Business For Long-Term Sustainable Growth With The End In Mind…

I’m a therapist first and foremost. I needed to develop business skills but the end goal was always being a therapist and a coach. With that end goal in mind I now sit as CEO, therapist, coach, and play a small role in the marketing.

Initially, I had to sit in leadership roles but now I have a leadership team that runs both the academy and clinic. Of course we have weekly meetings but ultimately I’m a therapist and a teacher so I designed my cash-based practice with that in mind.

But this is a process and it all starts with four key points;

Mission / Vision / Strategy / Leadership

Get clear on your mission. Get clear on your vision. Get a stratgy that will help you achieve both of those, be the leader you need to be and help others realise their potential as leaders.

Once you are achieving the mission and working toward your vision, you’re making money with meaning.

ProSport Staff

Building A Team For Your Cash-Based PT Practice

One of the most important things in business is your team. Your network of employees represents your company to patients but they also form the core of your staff culture. There is a big difference between attracting the right and wrong staff.

One of the powers of having a vivid vision for your business is that you will be able to attract staff who want to be part of something moving forward. Once your staff know where they’re going then it will create a culture of people who care.

Never settle for less than an a-team player. At ProSport we have a clear picture of what an a-team player looks like. We have it written down and we hire and fire by this. If times get tough we all come back to it.

Ask yourself, what does your A-Team Player look like? Once you know what you’re looking for it becomes a lot easier to find. It is all about having a repeatable system to find and onboard A-team players and a system to grow staff into leaders.

Positioning Your Business

Before you even start thinking of marketing or sales you must think about your positioning. Believe me, I have seen cash-based practices fail at this time and time again.

Positioning is how you want to be seen by your ideal customer. For example, Mcdonald’s and a gourmet burger restaurant both sell the same thing but are positioned differently. They are represented in completely different ways.

Ask yourself… what are you going to world-class at and what are you not going to be world-class at? What do your services offer? Are there some services that you may not offer? Maybe you cater to different needs. Are you going to be the cheapest?

If you are going to be the low-cost option then it isn’t a bad thing. But if you are, then you will need different systems in place.

If you can get positioning right then when your ideal customer comes across your website or services then there is no competition between you and any other cash-based practice. You’re the obvious choice.

Positioning your cash-based physical therapy business

Business Systems

This is an area in which a lot of therapists struggle. We’re in health and wellness services, right? We’re not business graduates. Well, there is far more that goes into just one appointment with one patient than most people think.

So here is a brief rundown…


As a therapist, you deal with patients. You don’t need the restrictions of having to run everything day-to-day. In fact, worrying about your operations is one of the reasons therapists get distracted. You need the opportunity to do your job.

Your cash-based PT clinic should run without you. You should have systems and personel to make sure it does. You should have control over your business without being controlling.


As a rule, someone will sit as head of fulfillment. It is their role to understand the value chain, and they’ll keep a close eye on the net promoter score. They are the first line of defense when it comes to dealing with issues in cash-based practices.

Getting low NPS scores? They should pick that up and take action. They protect the net promoter score at all costs.

Understanding fulfilment systems in your cash-based physical therapy clinic


Of course, this is how you are selling your services as a cash-based PT clinic. You’ll need this to convert your potential customers into real patients.

The one important thing to note is people. People make the practice wheel turn but you cannot throw a sales script to your staff. This can be damaging to cash-based physical therapy practice. You must work with them. That is where your leadership comes in.


This is how you reach your potential patients. Everyone knows the benefits of marketing especially when it comes to using the internet, social media, or network site. But thinking this is the answer to all of your issues is wrong.

In fact, I have made this mistake myself. I started marketing without having any business model or systems in place. It was like like filling a bucket full of holes. I just couldn’t stop all of the problems.

You don’t have the systems in place, your patients aren’t happy with your service so you end up working with them to appease them. You’re putting out fires everywhere. It leads to stress, overwhelm, and leaking costs.

Before taking on marketing, you have to earn the right to grow. Just like patients, providers and therapists want instant gratification. I can’t tell you how risky this is. Always delay gratification. Get the systems in place, earn the right to progress then take on marketing.

Once you have all of those, you’re on to step three.

A big mistake in cash-based physical therapyherapy clinic

Step 3 – Keeping The Main Thing The Main Thing

Ultimately, once you get this formula in place your cash-based PT business will gain momentum. Once you have this momentum all you need is to keep focused and doing what you’re doing.

Focus on the NPS. Focus on giving people more in value than you take in payment. Focus on those long-lasting results. Focus on providing the best care and the best treatment for all patients. Give every patient the opportunity to be successful in the real world.

‘Momentum is really a leaders best friend. Sometimes it is the only difference between winning and losing’ – John Maxwell

With the right systems in place, momentum and focus, success is only a matter of time.

Final Thoughts On Build A Profitable & Sustainable Cash-based Physical Therapy Clinic Using The ‘Go-To’ Clinic Formula

Life is full of uncertainty. People and situations change in an instant. But that doesn’t mean your cash-based PT clinic has to be built on quicksand. In fact, it means more of your focus should be on eliminating these uncertainties.

Maybe you can’t rely on insurance companies, or in the US, medicare to find patients but what measures can you put in place to make sure those patients are coming through the door and what can you do to make sure that these people are better off than when they arrived?

I spent years building my own private practice and I can tell you it wasn’t easy. But from those hard lessons I created the Go-To clinic formula. It is these simple steps that have saved me, and other clinic owners a lifetime of sleepless nights…

  • Give more in value than you take in payment.
  • Implement a clinical step-by-step system for repeatable results with all patients.
  • Define your mission and vision.
  • Build an A-Team around you.
  • Position your business.
  • Implement those all-important business systems.
  • Keep the main thing the main thing.

It is that simple…

Finally, never forget that building your cash-based private practice is a process…

Clinic growth isn’t just a funnel on Facebook that promises to double your business in 90 days, it is a process. If you have more leads and potential patients then you’re going to have to contact these people. If you don’t have the sales system in place to cope with this then you’re wasting money.

I built the ProSport clinic and my Go-To clinic formula on eliminating these costly mistakes… Just like the step-by-step system we teach in the mentorship, every step is the next logical progression. We build successful patients and they build a successful clinic.

Building a business is about building a life. It is a tough road but if you have those systems in place and you have the focus then the benefits outweigh the negatives. Ultimately, a profitable and sustainable cash-based physical therapy practice is freedom.

If you want a FREE 30 minute, no-obligation strategy call, in which we can work together to outline just how you can become the Go-To Therapist and how you can build the Go-To Clinic, follow the link below, book in and start your journey today.

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About The Author

Dave O'Sullivan

Dave O’Sullivan, Chartered Physiotherapist with a master’s in Strength and Conditioning, worked as a sports physio for the Wallabies Rugby Union team (2023 World Cup), England Rugby Union (2019 World Cup) and England Rugby League (2017 World Cup). He built a leading clinic in Huddersfield, UK, and developed a unique step-by-step approach with his own sporting and non sporting patients.

Dave now teaches his methods globally and has helped over 1,000 physiotherapists and other health professionals, giving them confidence and clarity to help patients who have failed traditional approaches.