I was a staff PT who loved the work.
I was a physical therapist. I had a wife, four kids, patients who appreciated me, and work that felt meaningful. I was helping people get better. For a while, that felt like enough.
Then I started seeing things I couldn’t make peace with. I watched too many decisions get made to protect the bottom line instead of the patient. I told myself every healthcare business had limits and money mattered. I tried to leave it at that.
There was one situation I couldn’t.
I was asked to do something I couldn’t do.
I evaluated a woman who had suffered a massive stroke. She was dependent with bed mobility and transfers. She wasn’t walking. Her daughter had brought her home and was trying to care for her.
The daughter was desperate. Her husband was angry with her for bringing her mother home instead of placing her in the first nursing home that would take her. The whole family was under pressure. The daughter was hoping we could help her mother become less dependent. Not because life would go back to normal, but because life might become more manageable for everyone.
I knew skilled therapy could help. Not fix everything. Not undo the stroke. But help. With the right therapy, this woman had a chance to become more mobile and less dependent on a daughter who was already carrying too much.
I left the patient’s house and drove straight to the office to talk to my boss.
I knew the insurance situation wasn’t ideal, but we were a not-for-profit agency, and I hoped that would matter. It didn’t. I was told to teach the daughter a few exercises and discharge the patient because the payer was poor.
I pushed back. I explained that a few exercises wouldn’t be enough. I explained that you can’t teach a daughter in a couple of visits what I’d spent years learning in school and in practice. I explained that without significant intervention, this woman wasn’t going to get substantially better, and the family’s life wasn’t going to get substantially better either.
The answer was still no.
I was the evaluating therapist. I knew what the patient needed. And I still couldn’t get the decision made for the good of the patient.
That stayed with me. I felt helpless, and I also felt angry. I didn’t want to spend the rest of my career carrying clinical responsibility without the authority to do what I believed was right.
It wasn’t going to be that way. I decided to start my own home health agency.
I started without much idea of what I was walking into.
I didn’t have a business degree. I didn’t have investors. I didn’t have a polished plan.
I had conviction, clinical experience, and a strong sense that there had to be a better way.
I talked it through with my wife, my family, and a couple of close friends before I went down this path. I researched as much as I could. The internet was barely part of normal life then. I made phone calls. I talked to people. I read state and federal rules. I figured out what it would take to get licensed and completed the paperwork. I talked to clinician friends who might be willing to help me in the beginning.
I had a rough idea of how home health worked clinically. I didn’t understand how much I didn’t know about the administrative side, the billing side, the marketing side, staffing, compliance, or cash flow.
I saved what money I could. I worked Saturdays and Sundays for a long time to help fund the business and pay other people. I didn’t take a salary for a long time.
I was doing the best I knew how to do. But I didn’t know many people who had started businesses, much less healthcare businesses. I didn’t have anyone who had been where I was, who could help me see what mattered and what didn’t.
Without that, I learned slowly and paid for mistakes I didn’t have to make.
The early years nearly broke me.
Staffing was one of the first problems. I couldn’t afford to hire full time, so I spent a lot of time talking to friends, friends of friends, and anyone else I could find who might want part-time or PRN work. I needed clinicians available before I could take referrals, but I also needed referrals before clinicians had a reason to stay on the roster.
For a long time, I was the flex in the system. If something needed to get done, my name was on it unless I got lucky and somebody else stepped in. That meant patient care. It also meant recruiting clinicians, shopping at Sam’s for paper towels, answering questions, solving problems, and cleaning the bathrooms.
Literally cleaning the bathrooms.
Referrals were a chicken-and-egg problem too. I needed patients to bring in money and momentum. But every new referral also created pressure. We needed staff to see the patients. We needed cash to pay the staff. We needed to protect referral relationships. I couldn’t turn down referrals without worrying the referral source would stop calling.
The business was growing faster than I could keep up with.
Payroll was the worst. I earned money working Saturdays and Sundays and paid it out the next Friday. As we grew, I couldn’t make enough on my own to bridge the gap. I used credit cards. Then a bank loan. Then a personal loan from a guy who knew a guy. I paid all of it back, but those were brutal days.
Even without taking a paycheck, payroll terrified me. Fixed expenses were hard enough, but I could usually cover them. The variable expenses grew as the patient volume grew, and that was the dangerous part. We needed patients to survive, but too many patients too quickly could have sunk us.
The business got more of me than my family did for too many years.
For years, if I had twenty minutes between appointments, I could pull into a Walmart parking lot, put the seat back, and fall asleep almost immediately. I was tired from the time I woke up until the time I went to bed.
I had started the company because I wanted to do things differently. For a long time, I was mostly trying to keep it alive.
What I was actually getting wrong.
I made plenty of tactical mistakes, but tactics weren’t the main thing keeping me stuck.
The bigger mistake was how I’d built the company. I was the flex in the system because I’d built a company where I had to be. The staffing wasn’t reliable enough yet. The processes lived in my head. The referrals depended on me showing up. Everything came back to me because there was nowhere else for it to go.
I’d built it that way because I didn’t know to build it any other way.
And as long as it stayed that way, growth didn’t make my life easier. Growth made the company bigger and made the pressure bigger. More patients meant more payroll. More staff meant more questions. More referrals meant more responsibility. Every improvement created another thing that came back to me.
I had to learn to operate as the owner, not as the clinician who happened to own the company.
That meant building a team I could trust. Making decisions based on what the business needed, not just what was on fire that day. Putting processes in place so the work didn’t live only in my head. Leading people instead of stepping in to do their work for them.
Most of what I teach now, I learned by getting it wrong first.
The company started to work.
The first real shift was people. I built a reliable core of clinicians and admin staff, and that changed everything. I didn’t dread every new PT referral. I had people I trusted. I had more room to think.
I also started paying myself something. Not much. If you divided what I paid myself by the hours I was working, it was around ten dollars an hour. But ten dollars an hour was a big improvement over nothing.
The next shift was referrals. They started coming in more steadily. Not flooding in, but enough that we could feel the company beginning to work. Early on, eleven referrals in a month would have felt like progress. Later I remember stopping by the front desk and hearing we’d gotten eleven in one day.
That told me something had changed.
Steady referrals gave us room to hire more, build better processes, and handle more business without letting things fall through the cracks. I kept treating patients because I loved treating patients. I kept treating because I wanted to, not because the company had no other way to function. That was a big difference.
Over time, I did less and less admin work. We built a team. We built processes. People knew what to do without sitting next to me and asking every question. My job was leadership and patient care, which was what I wanted.
Eventually there was a stretch of a couple of years when I stepped away from the office almost entirely, and the company kept going and growing without me there every day.
That didn’t happen by accident.
What made it valuable enough to sell.
By the time I sold the company, it had value, and not because I was still holding every piece of it together.
We had built a strong reputation in the community. We had a good name with referral sources. We were a place clinicians wanted to work. Most of the staff stayed because they loved the work and they loved the people they worked with. Most of our best hires came from current employees referring their friends.
We also had a system for how the work got done. Every role had what we called Desk Procedures. Each person had a binder with the repeatable parts of their job written down. If somebody went on vacation, got sick, took leave, or eventually left the company, the work didn’t disappear with them. The business had a way to keep going.
We still had key people. Every good company does. But the company didn’t fall apart when one person was gone, including me.
That mattered to the buyer. They could see the company had people, processes, healthy margins, and a reputation that didn’t depend on me personally making everything work.
I built it, grew it, ran it, and sold it for seven figures.
I’m proud of that. I also know what it cost to get there, and I know how much of that cost came from not having the right help sooner.
Other owners started asking how.
Before I sold the company, other owners had already started coming to me with questions.
Some of them asked the big version. How are you doing this? How did you build this? How did you get the company to run this way?
Most of the time, they brought specific problems.
How do I get more customers? What do I do about an employee who isn’t carrying their weight? How do I find good people? Why don’t my employees take responsibility the way I do? What am I supposed to do with the financials my bookkeeper sends me every month? How do I lead my people without getting so frustrated I want to yell?
Those conversations felt familiar. I’d lived so many versions of the same problems.
I started coaching informally at first. Then I got more serious about it. I approached coaching the way I’d approached physical therapy. If I was going to do it, I wanted to do it well. So I got trained, earned two coaching certifications, and kept working at the craft.
By the time I sold the company, I’d been coaching owners for years.
This is what I do now.
I’ve been a PT for thirty years. Now I work with outpatient PT, OT, and SLP clinic owners. Most are running clinics doing roughly $1M to $5M, three to six years in business. Home health and outpatient therapy are different settings. The ownership problems are often the same. Too much running through one person. Growth that creates pressure instead of room. The owner solving too many problems, making too many calls, and holding too much of the business in their own head.
I understand that because I built that kind of business myself. I also know what it takes to build something better. Not perfect. Not effortless. Not the fantasy version people sell online. Better.
A business that can keep serving patients, supporting the team, and growing without depending on you for everything.
That’s the work I do with clinic owners now.
These days I read a lot, travel often, hike, and spend time with my kids and grandkids.
I’m the person I wish I’d had. Somebody who’d actually been there, who understood the clinical side and the business side, who could help me see what mattered, what didn’t, and where I was making the work harder than it needed to be.
I’m the person I wish I’d had.
If you want to talk about what’s going on in your business, set up a call with me. We’ll talk about whether we’re a fit and what working together would look like. It might be a no for either of us. That’s fine.