Choosing the Right Location and Specialty

Which came first: the location or the specialty? It’s private practice’s own version of the classic chicken-and-egg conundrum. Your location will absolutely influence who you treat and thus determine the relevancy of your specialty, and your specialty will certainly impact where you set up shop and what market you serve. Luckily, in this toss-up, there is a variable: choice. As the clinician, you have to decide what’s more important: your specialty or where you treat.  

Location, Location, Location.

Whenever I pass vacant buildings, I think: that should be a movie theater, restaurant, retail store, clinic. Very rarely do those buildings become what I think they should be. That’s because investing in commercial real estate takes much more thought and planning than my random musings. So, if you have a location in mind for your practice, make sure you do your homework. After all, location plays a huge factor in the success of your practice. As you browse for a village, town, city, or region for your clinic to call home, answer these questions:

• Are you in a direct access state?
• What are the tax implications and fees for small businesses in your state, city, and county?
• How many people live or work in the community? What are the demographics of the community? (To learn that, check out US census data or demographic data on your city’s website.) How many people do you estimate will seek your services?
• How many referral providers work in the area? How many of them routinely prescribe physical therapy?
• How many other physical therapy providers are there in the community? Is the area already saturated or can you identify a gap in services that you can fill? (The latter question can help you identify a niche or specialty.)
• How do you become a preferred provider for payers in your area? Will it be difficult?
• What is the typical reimbursement rate for providers in your area? What should you expect to write off as a result of denied reimbursements or failure to collect?

Once you’ve conducted your market research and you have a feel for the area, it’s time to start browsing real estate. You can do this alone or with the help of a leasing agent. However, “most commercial real estate brokers work for property owners and represent the owners' interests,” the APTA warns. If you want an agent who will advocate for you, try retaining the services of a tenant broker. He or she—along with a real estate attorney—will help you negotiate your contract so you get what you need in terms of lease length and landlord renovations. 

As you shop for the right spot for your practice, consider these questions:

• Is the location easily accessible by foot, car, or public transportation? Will signage be visible from nearby streets?
• If your patient population is mostly baby boomers, how accessible are the building and its restrooms? How far is the parking lot from your office?
• If you’re the first PT moving into your building, is your landlord willing to include an exclusive use clause in your lease so no competitors will crowd you out?
• If you plan to offer after-hours services, like gym memberships or Pilates, are those time frames acceptable within the terms of the lease?

One more thing to consider: How much space do you really need? Well, PT and clinic owner Jack Sparacio suggests asking yourself if you “really need...the 3,000 square foot office and [to] pay rent for space you are hoping to grow into? Or can you get your practice up and running in the 800 to 1,000 square foot office for one-third the rent?” In his opinion, growing too big for your office space is a much better problem than throwing money away for office space you’re not using. Not quite ready to nail down your own space? Sparacio offers up the following advice: “Subleasing space from other health professionals or health clubs can also be an affordable alternative.“

Specialty is Everything.

Perhaps you already know your specialty, be it sports medicine, pelvic health, or aquatic therapy. If that’s the case, skip down to the end of this section.

For those of you on the fence about specialty, you must choose your niche. Essentially, pinpoint what services you can provide that will set you apart from your potential competitors. Of course, pinpointing is easier said than done. Jeff Worrell has a few suggestions, though, in his whitepaper, “Build Your Practice by Finding Your Physical Therapy Niche.” He recommends taking “some time to jot down your experiences on a piece of paper...be as specific as possible. Look for similarities and highlight the experiences that are similar.” Also, ask yourself the following questions:

• What type of physical therapy work do I enjoy doing?
• What is the market potential for my specific area of interest?
• What type of patients do I enjoy working with?
• What experience do I have that can help me achieve success in my chosen niche?
• Are there other physical therapists who have built a successful practice in this niche?

Still drawing blanks? Try immersing yourself in several different specialties to find where your heart truly lies. You can also peruse Monster’s list of emerging PT specialties.

Once you determine your specialty, research what areas lack those services—or even better, have a growing demand for those services. When you know that, follow the steps detailed under the location section above to pinpoint the area and leasing locale best suited for you. After you open your doors (or maybe in preparation of opening your doors), check out this article for advice on marketing your specialty.

Now that we’ve sorted out the location-or-specialty scenario, can we get down to brass tacks on this whole chicken-and-egg thing? At the very least, can we make an omelet?