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  • Karah Charette, PT, DPT, RYT

Why Consider Seeing a Cash-Based Physical Therapist?

By Karah Charette, PT, DPT, RYT


Picture This Scenario:


You are sitting anxiously in the waiting room as you anticipate your appointment. You are in pain and you just want to feel better. Your physical therapist gets you a little late, looking flustered as they have just sent off another patient and are now getting ready to see you. The check in conversation is quick and before you know it you are on the treatment table getting a small amount of hands on work. Then off you go to the gym with little supervision or guidance as you do the same exercises you were provided last week and told that if you “just do them every day and do not slack off” things will get better. You do not see much change, but your copay is $25 so you come back twice a week. For months. A couple months go by and you have spent almost $700 with very little results and a lot of your time used up. You feel defeated, you do not believe physical therapy works, and you seek help from other practitioners or choose to live with this pain.


A Different Scenario:


You are now greeted by a physical therapist in a calm environment. There is no patient rushing out before you and there will be no patient rushing to get in after you. Your time is protected. You have a full hour to tell your story and to get connected with your body. You have the safety of a private room, which allows your nervous system to be a little more regulated. Your therapist has the time to get curious and try new hands-on techniques without worrying about juggling another patient. Your movement practices are completely supervised by your therapist with individualized feedback and hands on corrections. The goal is to only provide you a few very specific exercises that are functional and sustainable. You only need about 4 sessions and you already start to feel better. You have spent less money and have not given away as much of your time. You are able to start seeing your therapist twice a month. After a month or two, you only need check ups from time to time. You feel happier, safer, and more pleasure in your body.


Which one of these scenarios sounds more preferable?


The first scenario is all too often the experience of a patient under an insurance model.


The second scenario is what is possible when working with a cash based physical therapist.


As a consumer, the appeal to use your insurance is understandable. You are already paying for it and you want it to support all aspects of your health. The reality of this country’s healthcare system is that insurance may very well help you with acute and emergency issues, but when it comes to true quality-of-life healthcare, insurance does not set up patients or therapists for success.


The truth about health and healing is that an extremely important factor is the state of your nervous system. You can have the smartest practitioner in the world, but if a patient is not able to regulate their nervous system in the healing process, positive results are much less likely to be seen. Rushed, crowded clinics with burnt out practitioners do not provide a safe and healing environment.


In a hyper productive capitalist society, insurance dictates how much time a therapist can spend with a patient and what they can do. This model is not patient centered but rather profit centered. The questions become: How can we get more patients in at the same time? How can we shorten appointments to fit more people in? Numbers and productivity goals trump over the quality of the patient’s experience.


Insurance also does not want you in physical therapy for very long and it does not want you working on more than one body part at a time. This results in people being discharged before they are ready and the whole body not being addressed because insurance limited the scope of what the physical therapist could do. Insurance can also delay your ability to get care right when you need it, potentially making issues worse than they needed to be.


Your health is an important investment. Perhaps your most important investment. It is unfortunate we do not have a system that supports this holistically. What this leads to is the consumer must advocate for themselves. Healthcare practitioners must also do their part to educate consumers well enough so that they understand the nuance of their options and the effect it can have on their quality of life.


This leads to the importance of understanding the real value cash based physical therapy can provide. In a cash based system, the focus and motive is providing the best quality of care to the patient. It is truly patient centered.


Not only is it patient centered, but it is also therapist centered. Remember the phrase “You cannot help others if you cannot help yourself.” Therapist burnout is real and it happens quickly. Physical therapy is demanding mentally, emotionally, and physically. Physical therapists love what they do. They just need to be able to do it in a sustainable environment.


When you choose to support a cash based physical therapist, not only are you investing in yourself, you are also investing in your physical therapist. You are helping them to support a lifestyle that allows them more freedom to take care of themselves, which is a return investment in your care.


As a physical therapist, I can speak candidly that I am a better caregiver when I have had a sufficient break between patients to meditate and regulate my own nervous system. I am a better caregiver when I have time to go to therapy. I am a better caregiver when I have time to cook a home cooked meal. I am a better caregiver when I have time to take a dance class and move my body alongside other people. I am a better caregiver when I have time to go out into my community and provide more education. I am a better caregiver when I have time to read books and listen to podcasts and take continuing education courses because I have the capacity to stay curious at the end of a work day. I am a better caregiver because I have the energy of wanting to continue to learn so that I can provide the best care I am capable of. Having a cash based practice makes this all possible.


We are entering into a time where transparency is celebrated and honest communication is understood as a foundational element of trust. I am not a corporation trying to sell a product that ultimately benefits me more than you. I am a human being who loves what I do and is genuinely trying to find a sustainable way to keep doing it while providing the absolute best care I can. Cash based physical therapy is an opportunity to solve the injustices our healthcare system has created for both the patients and the therapists. I offer this perspective of both roles because we are in relationship with each other when you choose to see a physical therapist. What affects me affects you. True healing exists in a symbiotic relationship. It is a beautiful reminder that we really are all connected and do better when our community is thriving. It is time we start viewing community health as a vital aspect of our own healing process.



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