Krista: Thanks everybody for joining us today for this webinar of entrepreneurship for the OT professional. I am really grateful for the opportunity because as occupational therapists, we do not get a lot of training about business or going out on our own.
My Personal Journey
I do not typically share a lot about my personal journey, but I do feel that it is important to share a little bit. Talking to other entrepreneurs can be very empowering and encouraging. You can think, "Gosh, I have also been thinking about starting a business." I encourage you to get to know other entrepreneurs and business owners and find out how they came to be where they are at today.
Figure 1. My journey.
Here is an overview of my journey.
- Attended Colorado State University
- Started my OT career in psych and skilled nursing.
- Worked as a rehab manager, Director of Social Services and Marketing in SNF’s.
- Loved working with clients that had dementia.
- Encouraged by the medical director to consider starting my own business.
- Worked with a neuropsychologist and began the private practice.
- Continued to work full-time for several years and built the business on the side providing treatments in clients’ homes and community settings.
- Became a Medicare provider in 2007.
- Covell Care and Rehabilitation evolved and now offers OT, PT, SLP, geriatric care management, senior fitness training, counseling, massage, contract staffing for home health, driving rehabilitation and treatment for pelvic floor dysfunction. We service 5 different counties in Colorado at this time.
- Strive to help other OT’s (and other disciplines) become business owners as well.
I attended Colorado State University, which is in Fort Collins, Colorado. I started my occupational therapy career working in inpatient psychiatric units and also in skilled nursing. I have bounced around, like so many of us, to different areas like home care, outpatient, and in all different levels of the hospital. I have typically worked with adults and older adults. I do not work with pediatrics, but once in a while, I will. No matter what population you prefer, these principles will help you as well. I worked as a rehabilitation manager for a long time and was also the director of social services and the director of marketing in a skilled nursing facility.
Sometimes, things happen that are out of our control. Perhaps, you work for a contract agency and you lose your contract, and you wish that you could still work in that facility. Or, you have lost a job or did not get hired for a job that you really wanted. These are the things that have to happen to get us where we are meant to be.
When I first graduated, the Prospective Payment System, or PPS through Medicare, had just begun. Many OTs were losing their jobs, and many OTs, that had a lot more experience than I did, were also looking for work. Since I live in Fort Collins, where CSU is, there were numerous occupational therapists around. I could not get a job as an OT to save my life. I ended up taking a position as a director of social services using my social work degree. I was disappointed that I had to do that as I wanted to work as an OT. I had to do community resourcing and had to function in a different capacity. This later helped me when working as a business owner. I never would have had that opportunity if I had gotten a job right away after school. I was then approached to be the director of marketing. I did not know what marketing was. They trained me, and thankfully, I ended up being able to pull those skills in my career and when I started a business. Little did I know that all of these things were setting me up to owning my own business.
During my time working in skilled nursing, I loved working with clients that had dementia. Our medical director picked up on that, and he told me he thought I should start my own business. He said there were people outside of the skilled nursing facility that could benefit from an OT helping them at home. At the time, I thought he was crazy, but this was where the seed was planted. At the same time, I also worked with a neuropsychologist doing home safety assessments for her clients. I had to set up a private practice as an independent contractor in order to do that. This business ended up growing from these referrals. I worked full time for several years while building this business on the side. I loved providing the assessments and treatments in the clients' homes and communities.
So, it is possible to work full time and build a business. It can be hard, but when you really love what you are doing, it is easier to manage those big-time commitments. Many of the clients that I was seeing were Medicare eligible. Thus, I became a Medicare provider in 2007. I said for a long time that Covell Care would only be an occupational therapy practice, and I have definitely eaten my words on that. We also offer physical therapy and speech therapy. These pieces were missing in the setting that we were in so I decided to add that to our business. We also added private pay entities to our business with geriatric care management for family support, senior fitness training, and counseling which sometimes can go through insurance. We also have a massage therapy component. Additionally, we help home health agencies with contract staffing. The main reason we do that is that people see us as a mobile outpatient practice. People would end up getting sick, and then they would have to start all over with a new therapy team. Initially, I did not want to own a home care agency, but what I love is being able to follow my clients. For example, I have seen some clients with ALS on an outpatient basis, off and on, for five years. Then, if they needed home care, I could continue to see them by contracting with a home care agency. We also saw a need for driving rehabilitation. You might have seen that same need in your community. We have an occupational therapist that is a certified driving rehabilitation specialist. She is able to do on-the-road driving assessments with clients. We also saw a great need for dysfunction treatments, as for incontinence. I teach classes on that as well. There are three of us that are board certified to treat that currently.
We serve five different counties in Colorado at this time. Not all of our services are in every county, but we have every service in three counties which is exciting. We are continuing to grow and help other therapists find different ways to do things. One of my goals is to have a great practice that helps clients. Another is to train other occupational therapists, like you guys, find your way into entrepreneurship or small business ownership if that is what you are interested in. When we are the best version of ourselves, we are able to help others so much more completely.
During your business's development, you may find additional needs in your community in addition to therapy that your business can meet. For example, we provide one-on-one personal training and exercise classes for older adults in their homes and senior housing communities. While we can typically charge insurance companies for therapy services, we bill clients and facilities directly for training services. It is important that referral sources, clients and facilities understand this up front.
Questions to Ask Yourself
Here are some important questions to ask yourself.
- Are you an entrepreneur?
- Can you manage to be the tradesperson (OT or OTA) and the owner of a small business?
- Is your new business actually a private practice? If not, what is it?
- How will your business make money?
These are four questions that I want you to start tossing around and see if you can come up with clear answers for all four of them. We will now take a deep dive into each.
Are You An Entrepreneur?
This is a list of eight signs from Forbes (2013). You do not have to have all of these.
- Doesn’t take no for an answer
- Competitive nature
- Enneagram Personality Test = #1 The Reformer (Principled, Purposeful, Self-Controlled, and Perfectionistic) https://www.enneagraminstitute.com/
- Think outside the box
- Strong people skills
These are consistent characteristics for people that own a business. One, you have to have passion. When you are an entrepreneur, you are going to have some hardships ahead of you. But if you are passionate about what you do, it does not necessarily always feel like work. It might still be hard, but it is not as hard when you have a really deep passion for what you are doing.
Do not take no for an answer. I was told no many times when I started a mobile outpatient practice. I was even asked if my practice was legal many times because it was different. I was told many times, "That is not going to work. You cannot do that." As occupational therapists, we are creative. I am sure you have had many administrators and rehab managers say, "That is not going to work." However, we always tend to find a way. I think OTs have a little bit of an edge even as an entrepreneur because we already know how to not take no for an answer.
Entrepreneurs tend to be competitive in nature. This may not necessarily mean that you are competitive with your OT counterparts, neighbors, or other businesses, but this is being competitive with yourself. What can you do? What can you accomplish? If you are the type of person that wakes up and loves to check things off your to-do list and see what else you can create, you probably have that competitive nature.
I encourage everyone to take the Enneagram Personality Test. It is very interesting. Oftentimes, entrepreneurs score as a type number one, which means you are a reformer. Some of those qualities include being principled, purposeful, self-controlled, and perfectionistic. While these are not always qualities that you want to have, these are the qualities that entrepreneurs simply seem to have.
Most entrepreneurs are going to be self-starters. I do not think I have ever met a business owner that is not. You have to think outside the box. If you are already thinking about starting a small business, you are thinking outside of the box. You have to handle the unpredictable because often something comes up, and you have to shift gears.
Finally, you need to have strong people skills. You will be dealing with all different kinds of people, even more so than what you are when you are doing just treatment. Remember, being an entrepreneur is neither a part-time or a full-time job, it is a lifestyle. As an entrepreneur, you have to blend things together. You do not work from 7:30 to 3:00 anymore. You may work different wacky hours. It becomes just part of our life
Tradesperson/OT or OTA
When I say an OT during this presentation, I do not want any OTAs that are on this webinar to think that they are being left out. When I say OT, I mean an OT professional. Everybody can be a small business owner. These pictures are probably resonating with you in some way.
Figure 2. Pictures of OT.
These are all pictures from my career as an OT. I have all done all different types of equipment recommendations like the middle top picture. I have also completed many therapeutic interventions that have been non-traditional, like our lady on the top right that is doing watercolors. I have completed workshops and training. The bottom, middle picture shows some contracture management techniques. I am also working on vision training in the lower left for someone that lives at home and has to spend about 10 to 12 hours a day there by herself. Your pictures may look different, but I love being able to talk to people as tradespeople. My point is that we do many things in our jobs.
As a tradesperson:
- Works for an organization/employer
- Completes therapy services
- May manage others
- Provides communication to families, clients, colleagues, and managers
- May monitor and track financial information per the employer’s request
- Completes documentation
- Attending meetings
- Meeting productivity standards
- Purchasing equipment
- Training on equipment
- May provide training for other staff members
- Other duties
We select equipment for folks, complete evaluations, document progress, etc. We may have managers that we have to answer to, and we may be a manager of a team. We may be responsible for some level of number tracking or financials, depending on our role as an occupational therapist. However, we are doing mostly client-based interventions in some way. One of the big elements is being productive. Many people want to start a business because they are so tired of the productivity standards that we are held to. It is hard not to get tired of that. All of these things probably seem very familiar to you.
As you are transitioning from a therapist to being a therapist and an entrepreneur, you are probably starting to have thoughts of, "Well, I can do this better," or, "Nobody does this in my community. " Those are typically the inklings that maybe a small business is a right path because of those thoughts. There is a reason that you are having those thoughts. You have to now learn how to be a business owner.
Role of the Small Business Owner
In addition to being the therapist, these are some of the things that you will also have to be focused on.
Small business owner:
- Is responsible for all aspects of the business-not just therapy
- Manages financials for the business
- Participates in marketing practices
- Organizes the business
- Paying bills
- Collecting money
- Ensuring quality of care
- Develops a website
- Creates brochures
- Tracks goals for the business
- Delegates tasks to staff members (if applicable)
- Adheres to rules and regulations for healthcare and business operations
- Completes billing and invoicing
- Participates in community outreach
- Accepts intake calls
- Provides follow up calls
- Tracks intake processes and referrals
- Continues to work as a tradesperson
- And many, many, many more hats!
As a small business owner, you are responsible for all aspects of the business. You have to be responsible for all these other things that may not have anything to do with therapy. You have to manage the financials, marketing and have to organize your entire business. You have to pay bills. You have to collect the money, and this is not always fun. You have to come up with systems to ensure the quality of care. You may have to develop a website or create brochures.