Ron’s Cash Based Story

“Success is a function of persistence and doggedness and the willingness to work hard for twenty-two minutes to make sense of something that most people would give up on after thirty seconds.” 

-Malcolm Gladwell, Outliers

Start-up and quitting my 9 to 5  standard insurance model job

After receiving my Doctorate in Physical Therapy, completing and orthopaedic residency, and practicing for 4 years, I had enough of standard healthcare.  I was tired of being overworked and under paid.  I knew I had enough when I was continuously being tripled booked with patients, and I knew that I could still get my patient better with more manual therapy, but I had another patient behind me on a table and my next patient is walking in the door.  So I had to pass them on to a tech to go just do some exercise.  I was tired of the insane documentation that took forever to do and my bosses trying to tell me to bill 4 units per visit when I was getting them better in 2.5.   This was not the way I wanted to practice nor treat patients.   I had enough and it was time for a change.

PURSUITR LOGO TRANSPARENTI knew I wanted to open my own business but should I open a standard insurance based practice or open a cash based practice.  The standard insurance clinic would still give me the freedom of a small business owner, but I would still be limited by insurance companies, have to hire staff just to verify insurance and fight for reimbursement, and it would be the same mess and the same system that I just was working in.  There has to be a better way.  I started researching about a cash based practices and concierge medicine practices.  I really liked this concept and it would give me the freedom that I wanted, it would give me the opportunity for One-on-One patient care, to not be restricted by insurance companies, and I would not need such high overhead to get started.  If I was ever going to do this, I would have to do this small business/cash based practice now when I was 31 years old, married with a mortgage, but no kids yet.  This was the perfect time for me but could a cash based physical therapy practice really work?.  Would patients pay cash for my treatments when they could go somewhere else and use their insurance?  How would patients find me?  Could I make enough money (because I had bills to pay and I am apart of the new generation of PT students who come out with $100,000+ in student loan debt), and how do I start.  So I invested $2000 of my own money for start up capital and I started Pursuit Physical Therapy in 2013.

Bootstrapping without a business bank loan, AKA “The Grind”

waiting areaI got everything started from registering as an LLC, to consulting with a lawyer and CPA, bank accounts, designing a logo, buying equipment, making my own website, business cards, etc.  I decided to not take a business loan to avoid more debt and just reinvest profits back into the business.  Where was I going to open my clinic at?  Orlando was already over saturated with hospitals, outpatient hospital PT clinics, chiropractors, outpatient PT clinics, acupuncturist, and physician owned clinics.  Even massage therapist were treating patients and personal trainers were calling themselves “corrective exercise specialists” and offering post op rehab.  I know! This big clinics were dominating the local market so it was going to be hard.   I was blessed that one of my former patients owns a lot of buildings around the area so I asked him if he had any space that I could lease.  He just leased a beautiful building to a fertility physician who has may have extra space right now.  I was introduced to the fertility physician and he was happily willing to lease a room to me, as he was starting his own private practice too.  So I found my clinic space:  one room, upstairs with 18 steps to get to ( Yes, this was not ideal for a PT clinic), in a Fertility Center building, but the building was beautiful and  the lease was affordable for me to start.  So I moved in all of my equipment and 2 chairs, finalized paperwork, and then Pursuit Physical Therapy was open for business in April 2013.


success-failure-signSo I quit my job and had no money coming in now.  I still had bills, a mortgage, student loans, and no income coming in with a business that had no patients, no referrals, no physician contacts, and no marketing.  My wife was not going to like this, but it was time to get to work.  I picked up some PRN PT work at some local skilled nursing facilities to help pay some bills.  So I started hosting guest lectures at certian niche marekts, joining the local chamber of commerce, getting involved in local groups, and started ready books on marketing.  Basically I had no clue what I was doing.  I did so much marketing that showed no results.  I bought a window perf banner for the back of my car with Pursuit Physical Therapy on it with the phone number and website (Still to this day after 3 years, it has only brought in 1 new patient!).  My website so horrible and it said the same thing as everyone else.  Welcome to Pursuit Physical Therapy, we do this, I am this, we do manual therapy, I did a residency, call now!  I sponsored local events and races for a low expense, with no one taking any interest.  I wasted so much time trying to market (at the time I thought that was good marketing) with no results.  Occassionally a prospective patient would call asking about PT but they would get turned off as soon as I said cash based practice.  I knew that I could help people, and show great outcomes, and I viewed myself as a great physical therapist, but still no patients.  I charged my time and my per treatment session at $75/hour and I was giving away FREE EVALUATIONS just to get people calling and coming in.  I really had no clue what I was doing nor how to run a business.  In my first 3 months, I made $350, $175, and $350.  This was not working.  I quickly learned that you can be the best physical therapist in the word and you could help so many people, but if no one knows about you, your business will not make it.  I was struggling with my business and wondering why patients were not coming in!

Learning from mistakes and how will patients find me?

I did start running into other small business owners from networking who would help me out with marketing strategies, what works, what kind of mindset to be in, the sales process, and some better books to read.  I start interviewing successful CEOs and attending seminars.  I started learning how to market with effective marketing strategies and how to sell.  I attended some local lectures from sales experts and I started really learning how to sell my product and services.  I started surrounding myself with people who are an expert in sales, have a successful business mindset, talking to millionaires, and successful entrepreneurs. Another big break I got, was attending a business lunch and learn with a friend at a local radio station.  This was around a time when I was questioning what I was doing, is this the right thing that I should be doing, can I make it in a cash based setting, should I continue, etc and BAM! Looks who wins free radio time over a a 2 week period! ME!  Talk about your prayers being answered! Even though it wasn’t during peak hours, it was free airtime that could really help get my marketing efforts going.  So with my marketing strategies started to be effective, learning how to sell, and continuing to strive for business knowledge with reading books, I broke my first $1000 month in my 4th month and by the 7th month I was generating over $3000/month in revenue.  I started writing great content, learning SEO to drive traffic to my website, learned how to start PPC on Google, and how to take advantage of social media.  I was growing and starting to generate revenue

Growth and Success.  It really works!

074be3fMy business was growing and now I started doing well and my WOM was starting to pick up.  By now I have fine tuned my marketing approach, corrected my sales process,  implemented my marketing strategy, and I was running my business full throttle and it was working.  Early in my second year I broke the $5000/month and by the end of the second year I was reaching $10,000/month and I reached my break even point.  Profit!  I wish I would have known this stuff earlier when I started in the first year.

This is the time when I started to become obsessed with studying successful people, why some businesses succeed while others fail, personal growth, and success books.  I stopped ready marketing books and switched to personal growth and success books.  I wanted to learn what qualities make certain people successful and if I could do this then I could continue to grow Pursuit and run a successful business.  I started watching Shark Tank and honestly, learned a lot from this show.  I always imagined myself on the show if front of the sharks and what they would say to me. (Even though they do not do health care businesses and I understand why! Why would anyone get involved or invested in a insurance based healthcare business with insurance limitations, declining reimbursement, and Medicare is going bankrupt.  I mean, it what business to do you deliver the product or service and not get pain, finish the service roughly a month later, still not get paid, wait 1-3 months for payment, and then get paid 50% of what you billed or even get denied reimbursement!)  My business was doing great and I was so busy that I didn’t even have time to market anymore.  I was generating over $15,000/month of revenue and growing strong!  I was developing a great name and reputation for myself in Orlando and I was helping a lot of people get pain free again.   It was time to move and expand.

Expansion and hitting almost a QUARTER MILLION IN SALES!


So in April 2015 I expanded my location (it was time to get out of the Fertility Center and the 18 steps) to more space and I hired another physical therapist.  I also have a well known massage therapist working with me too.   I have mastered my system of sales, marketing, and how to run my cash based PT business and now Pursuit is generating easily over $15,000 of revenue a month and still growing.  My first year it was truly a proof of concept business.  I made plenty of mistakes, failed multiple times, and wasted thousands of dollars on unproven marketing.  I struggled for that first year with the business and trying to make ends meet.  I’m not going to lie, it was hard.  Probably the hardest thing I have ever done in my life.  But I pushed through and made it.  My second year I learned how to sell and run a business efficiently.  My business grew and I started to perfect my system and generate profit.  My third year we continued to grow reaching $150,000+ in yearly sales.  In my 4th year we expanded again, brought on a 3rd PT, added new services, and almost reached a 1/4 million in sales in 2017.  A cash based PT clinic DOES work and even in an over saturated market.  This is my passion and my dream.  I will continue to grow Pursuit Physical Therapy as I build my team of expert physical therapists, only treating with One-on-One care, showing better outcomes than standard healthcare.  I believe this is how outpatient physical therapy will survive healthcare reform.  Now, the sky is the limit and I want to help others do the same thing.  No more double and triple booking patients.  No more being overworked and underpaid.  No more insurance limitations.  No more struggling to pay bills and the insane amount of student loan debt we have.  You can practice and treat patients the way its suppose to be.  I want the outpatient physical therapy profession to survive and to show that we can add value to the healthcare system, showing great long term outcomes, that are cost effective, and have proven results.

Set your goals high and lets create true value innovation in healthcare!


Ron Miller, DPT, OCS

“So stop tolerating excuses within yourself, limiting beliefs of the past, or half-assed or fearful states.  Use your body as a tool to snap yourself into a place of sheer will, determination, and commitment.  Face your challenges head on with the core belief that problems are just speed bumps on the road to your dreams.  And from that place, when you take massive action -with an effective and proven strategy-you will rewrite your history.  It’s time to no longer be one of the many but to become one of the few.  One of the few who step up, own your true capability financially and in every area of your life.  Most people start out with high aspirations but settle for a life and lifestyle far beneath their true capabilities.  They let disappointment destroy them.  Disappointment is inevitable when you are attempting to do anything of great scale.  Instead, let your disappointments drive you to find new answers; discipline your disappointments.  Learn form every failure, act on those learnings, and success becomes inevitable.”

-Tony Robbins, Money Master the Game

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