How to Beat Your Competition as a Cash-Based PT

One of the biggest fears I hear from PTs wanting to open up a cash-based practice is that they’re afraid they won’t fill their schedule, AND even if they do, they’re not sure how they’ll be able to sustain that schedule long-term. Well, if you’re one of those therapists who is worried about this, you’re NOT WRONG.

With the modern world making information so accessible, patients can EASILY seek out someone who specializes in their needs. They’re not even limited by a region, since so much can be done virtually now. So, how do you compete with such a HUGE population of therapists?

You MUST build your business and brand around a specific market (a niche) so you too can stand out amongst the competition. Yes, this means that you are going to have to invest some serious time, energy, and money into making yourself an expert in something. To make yourself stand out, it is going to require that you put in some serious effort in excelling in one particular area. The cool thing about this is that as you immerse yourself in your chosen area of expertise, you will already be targeting your market and growing your brand.

The niche you choose will give you a very clear direction and purpose, and, more importantly for your business, once you have declared (and owned) your niche, it will absolutely set you apart from your competition.


Finding YOUR Niche

I like to say my niche found me. And for most people, this will be true for them as well.

For a Niche to mean something to the community, it must:

  • Fill an important need in the community.
  • Feed a passion of yours that is palpable and important to YOU.
  • It must be specific, targeted, and clear.
  • You must be able to achieve an expert level of Mastery in the knowledge and skills around it.

If you follow these four criteria when “choosing your niche,” it’s almost as if it chooses you. Following the pieces of your work that fit with your passions and feed your own happiness will continue to drive you to be the best, learn more, and immerse yourself in that community. So my very first piece of advice when picking a niche is:

Choose it for the right reasons.

Choose it because you love working in that sport, with that community, using that specific technique or skill. Whatever it is that lights a fire in you, that is where you will be most successful because it feeds you on a much deeper level than just your pocket.

Now, to take a deeper dive into this, let’s look at the four considerations each niche should have.


Fill an important need in the community.

Why is this important?

I don’t know a single physical therapist who got into the field for a reason other than to serve others. So, if you want to continue in this field and feed your drive to serve others, you must find and fill a need in the community. This is one of the only ways you will be able to nourish your love for your work and put in the hours day in and day out without burning out.

How does having a niche that fills a specific need allow you to avoid burnout?

It allows you to focus your efforts so specifically and accurately in a particular subgroup that everything becomes more efficient. Everything you put into building and growing your niche builds on itself. Whereas when people do not make an effort to grow a niche, they’re less efficient, learning a little bit about a lot of things – which does NOT separate you from your competition.

This is magnified when you take this niche and move it into a cash-based setting (let’s face it, poor insurance reimbursement makes everything less efficient, and it can be very draining).

How would someone choose a need in the community? It’s helpful to keep an eye out on trends you see in the community – immersing yourself in the community and getting a feel for what is out there and more importantly, what is missing.

Oftentimes, this will (AND should) line up with a particular passion of yours – it needs to fill a “WHY” for you. The only thing that will allow you to be the best is a drive deeper than finances.

So go live life to the fullest, spending time in the areas that truly fill your heart. When you do this, the niche opportunity will become apparent to you.

For me, my niche became dry needling. It found me because I had a patient that had failed treatment everywhere else. He had seen all the therapists and doctors I would normally have referred someone to when I got “stuck” with a patient case. Unwilling to quit on him (since my “WHY” is helping people), I found dry needling (or it found me) as an opportunity to help this patient like no one else had been able to.

As soon as I saw the possibilities with this technique, I absorbed myself in becoming the best as quickly as possible. I went through two DN certification tracks simultaneously, and through my hard work and persistence to learn, became friends with the owners of those continuing education courses (Edo Zylstra and Jan Dommerholt). These mentors in dry needling saw that I was dedicated to the work for the right reasons, immersed myself in learning everything I possibly could, and supported me in my growth in the process.

The moral of the story here is that when choosing your niche, it must fill a need in your community, but it must also fill a passion of yours that fulfills your purpose for life. When it meets these two things, the organic growth you will have in that niche is incredible.

Feed a passion of yours that is palpable and important to YOU

Why is this important?

Because if you are going to succeed at marketing yourself to the community in this niche, you MUST believe in its power and importance.

Steven Covey (author of First Things First) said it best when he said humans have an innate need to “live, love, learn, and leave a legacy.” Most physical therapists got into the field because we have an innate need to help others — that is our purpose — so when we put our efforts into work that will  “leave a legacy,” we, in turn, become personally fulfilled, which feeds us with motivation and energy to keep working on ourselves, for our patients.

In order to become true experts in a field, we must continually strive for excellence and learning in this craft/area of expertise. This, again, fills a much-needed purpose for us, which will foster growth in ourselves and spread to success in our businesses. But it is really only possible to sustain the hard work and dedication required to excel in a craft or a niche when the purpose is greater than the desired financial gain.

It must be specific, targeted, and clear

In order for a niche to “catch on,” the target market and your value to that target market must be very clearly defined. This is the only way to identify yourself as “the best” in that market.

Once you’ve defined your niche, you are going to need to immerse yourself in as many continuing education opportunities, community opportunities, and events related to it.

When I meet people in my community who have heard of me, they often say, “You’re the needler.” I never really marketed myself as “the needler.” I immersed myself so much in being an expert that the title (niche) found me. But because I worked so hard to become an expert in it, I started to stand out as specialized and different, and that is what people needed and were looking for.

Now, the niche of needling is specific, targeted, and clear based on a skill or technique.

But all niches do not have to be technique-based. A niche could be a specific athletic population or sport, a specific age range of patients, or a specific condition or injury. The most important thing about choosing this niche is that it MUST fulfill your “why.” It must fulfill your purpose, or you will not be able to excel in it.

Achieve an Expert Level of Mastery in the Knowledge and Skills Around it

Actions speak louder than words.

You are NEVER going to convince a patient (or anyone else) of your excellence in a craft through words alone. You must put the work in to actually BE EXCELLENT. When you do that, your skill and expertise in your niche will exude from the confidence you display in your words and your actions.

The only way to have this occur naturally is to put in the work. The work to become excellent can be hard on you mentally and physically at times. It requires longer hours of studying, reading, practicing, training, etc. But the nice part is that when you put this work in on the front end, the “marketing” side of yourself becomes almost effortless.

You don’t have to try to TELL people you’re an expert because they SEE it. They see it in your presence in the community, they see it through the time you spend continuing to learn and grow and even teach others. They see it in your expert skills, and they feel it in the results and difference you make in them through your expertise.

Finding your niche is not as difficult as it might sound. It starts with figuring out what your purpose or “why” is. Then allow yourself to follow and immerse yourself in the things that feed your passion and make you happy. This organically will allow you to sustain the work required to really become an expert in that area.


A physical therapist from Primal University conducting a therapy session...

Your Niche is Your Gateway to Success

If you’ve read this and you’re still not sure how to find your niche, then intentionally surround yourself with other people who are putting the work in for their own pursuit of excellence. Just like practicing with a sports team, you will “level up” just by surrounding yourself with others who are actively working to be better themselves.

This is exactly the type of clinician we tend to attract at our courses, so you’re welcome to join us for any of our courses at Primal University for inspiration. Our Primal Foundation courses teach you how to treat and train the body as a system to make you an expert on movement analysis, and our Dry Needling Masterclasses teach refinement of dry needling techniques to help you achieve mastery in dry needling.

Looking forward to seeing you there!

About the Author
Dr. JJ Thomas, DPT, MPT, CMTPT
JJ Thomas is the owner and founder of Primal Physical Therapy and Primal University, located in Bryn Mawr, PA. She is an instructor for Evidence in Motion, and lectures and speaks nationally on the topics of Dry Needling, Functional Movement Analysis, and Functional Anatomy. She has been published in IJSPT for her contribution to a commentary on dry needling and consults as a content expert for organizations such as the APTA and FSBPT. In this role, she played a large part in the addition of a CPT code for dry needling through the AMA and was on the task force that helped identify competency standards for dry needling education nationally. JJ works with US Field Hockey teams, and individuals from US Lacrosse, US Polo, USA Track and Field, NFL, NBA, PLL, MLB, and more.
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