Over the years, I’ve had many conversations about clinic ownership and entrepreneurship in general. With the rising desire to create the life you want, the buzz of ‘passive income’, and the allure of working for yourself, it’s easy to see how starting your own venture pops up as a possibility.
Described here are reasons (mix of mine and others) that come up in exploratory entrepreneurship conversations, and factors to consider when deciding if clinic ownership is the right path for you. They’re based on my experience in opening a Physiotherapy clinic, but most of these concepts can be extrapolated to other industries.
1. “I want more flexibility”
Physiotherapists are typically tied to their jobs by space and time – they must be at a certain clinic at a certain time to see a client in order to get paid. This is changing with the advent of Telehealth but the time constraint still exists. Personally, this was one of my frustration points, something I hoped would be different after I opened my clinic.
It’s true – when things at a business are running smoothly, it can feel pretty cushy. For example, I generally don’t use an alarm clock, and allow myself to sleep until I’m not tired. Generally, I set my own schedule for meetings and that feels good. Generally, I can go on vacation when I choose.
Key word: generally.
In small business, big and small issues pop up constantly. Until recently, I would get annoyed and just ‘want things to go back to normal operations’. But here’s the thing – putting out fires and experiencing a daily rollercoaster of events and emotions IS normal operations. It’s unrealistic to expect otherwise. And when crises occur, you are at the absolutely mercy of the business, and it can feel like handcuffs. For example:
- In the early days, if a front desk staff or therapist called in sick, I would work reception (which I’m really bad at), or transfer some Physio clients into my schedule. The revenue was too fragile to forgo that income.
- At the start of the pandemic, my business partner Madison and I worked 12 hour days x 21 days in a row.
- In the middle of a personal burnout phase, our Vancouver clinic had a major flood. The last thing I wanted to do was navigate insurance, set up temporary clinics, sort through the storage locker, calm staff’s anxieties, and juggle lines of credit to support our cash flow; but we had to dig deep, work through the weekends and evenings, to ensure our business could endure
I can hear some of you saying ‘but lots of those issues probably aren’t urgent, and you’re making them out to be urgent in your mind’. FACT. I’m still learning how to tame the holy-shit response, because it’s hyperactive and I have to discern if something is a now problem, or a can-be-dealt-with-later problem. Without conscious thought, I default to GO mode, and try to deal with everything immediately.
The factor that I completely underestimated: yes, some issues require my immediate physical presence and attention – whether it’s having meetings or writing emails or typing out a new process, I’m working. But the bigger handcuff is the emotional drain. I’ve heard this from many other small business owners in their first 5 years – if you’re not working in the business or working on the business, you’re thinking about the business. In the shower, I’m thinking how to navigate an upcoming hard conversation. As I cut vegetables, I’m wondering how to make a policy fair for all staff. I’ll walk my dog, and deliberate over a big decision. I’m still working.
My partner Kolbi gets frustrated because I can be a goldfish at home. I forget the simplest tasks, or I’m constantly misplacing my wallet/phone/keys/charger/sunglasses. I’m messier than I’d like to be. He says it’s like living with a teenager. It’s not because I don’t care, rather it’s because my brain is often elsewhere. The worry train is going at full speed and I’m running to catch up.
2. “I’m tired of working for other people”
Most people don’t like to be told what to do. Makes sense.
But here’s the thing, as a business owner, you will be working for other people, full stop. Your clients, the city, your landlord, your staff. It’s indirect and it’s more ambiguous, but ultimately you’re working to satisfy others.
“But I’m always putting other people first and need to prioritize me.”
You can very well do that when you’re a biz owner, but if that’s a conscious intention – or even more dangerous, a subconscious one – that vibe WILL come across to your staff and the public, and it’s only a matter of time before your biggest problem becomes managing turnover.
Similarly…
3. “My boss does XYZ poorly, I would do it better”
It is much easier to critique a decision that someone else has already made; it is FAR more challenging to assess the situation, formulate possible choices, weigh immediate and future outcomes, and execute on your decisions.
Remember, the majority of business owners are figuring it out as we go. Even if you’re sure you would’ve handled a situation differently than your boss, no one’s leadership is perfect and if you decide to open a business, you’ll inevitably eventually be on the receiving end of that judgment at some point or another. You will make mistakes as an owner. You will fail – sometimes insignificantly, sometimes catastrophically. Your staff and others may not approve of your decisions and (spoiler alert) they’ll probably think they could’ve done it better than you.
4. “I’d make more money than I do as an employee”
It’s fairly common in the Physiotherapy industry for therapists to be paid a commission split, with around 40-50% of the revenue going to company.
Your employer may or may not discuss where their portion goes. Some costs are obvious: rent, utilities, equipment, wages.
Many costs are less obvious: training and mentoring staff, insurance, monthly bookkeeping services, leadership coaching, loan repayments, cleaning supplies (omggg the COVID cleaning supplies!), building up the emergency war chest, and alllll the account fees.
If you become a solopreneur, that’s a different story, as you won’t have organizational costs. The flip side is that you’ll likely have to do a lot more tasks yourself.
Once I reached the 5-employee mark, I realized that I needed more supports, and supports cost money. We transitioned into the phase where we weren’t a small and lean operation, but we also weren’t yet a large, volume-producing one. The middle ground is hard.
Building on the financial reasoning…
5. “I want passive income”
Ain’t that the goal! Many of us want to have sustainable, low effort income, we dream the make-money-while-you-sleep dream. But let’s be real about two things:
- This likely won’t happen for a while, and is highly conditional on your effectiveness as an owner
- IT.IS.NOT.PASSIVE. You work a lot. And when you’re not working, you’re thinking. Contemplating, weighing, waffling, worrying. Refer back to point 1.
Keep in mind, there are many ways to make passive income other than starting your own clinic: stock market investments, create an online course, purchase a rental property, or become an influencer.
Consider how soon you want passive income, because clinic ownership might be a decade+ long road to get there.
6. “I’m ready to progress in my career, this seems like the natural step”
Running a business requires a completely different skill set than being a strong therapist.
Some similarities (and how they translate to biz ownership): ability to clearly communicate your thoughts logically (sales), be likeable (HR), think on your toes (crisis management), maintain full caseload (marketing and budgeting), desire to learn (leadership evolution and filling gaps of knowledge)
Different skills required for biz ownership: ability to manage a group of people (set expectations/boundaries/navigate dynamics), ability to influence people (to get them on board with your vision), business acumen (strategy, numerical data organization and translation, excel finesse), multi-layered perspective (considering all stakeholders, not just single patient or yourself)
Consider REALISTICALLY: what are your skills, strengths, and passions? What do you NOT like? What do you think you’re good at, or want to be good at, but you’re not?
If you want to progress in your career, some other options are:
- teaching workshops using your expertise
- public speaking to non-physios
- growing a killer social media / YouTube account to monetize
- mentoring junior staff on your team
- consulting 1:1
- developing your own clinical certification; package, sell, and teach it
- become a clinic director/manager or join a larger organization
If you’re leaning toward opening a clinic, try managing a clinic first, to get a taster of the role without the risk.
Running a clinic isn’t always sexy. Sure, there are some times when it feels exciting, you get recognized, you’re asked to be on a panel, you get to travel, etc. But if your experience turns out to be anything like mine, you’ll spend the majority of the time (at least for the first 5 years) assembling furniture, developing policies, waiting on hold with Shaw, or sitting criss-cross in your fleece pyjamas on the couch tediously digging through old emails to find that one piece of information your bookkeeper needs.
7. “I see a gap in the market that I want to fill”
This was my main reason to open a clinic – at the time, there weren’t any other scoliosis physiotherapists in the lower mainland. There are opportunities and challenges to being a first:
Opportunities: first mover advantage. Your offering may be novel, exciting, and you can shape the public’s expectations. If you’re the only or best option, people will travel to see you. With a little [read: monumental] effort, your company’s impact can go a long way in an underserved population.
Challenges: if you’re paving the way in that area, you have to mix the concrete, pour the forms, wait for it to dry and hope that no one scrawls “FR+JB” while it’s setting – it’s a continuous process to figure out what your niche population needs and wants. You must find time in your already-full days to identify problems, design solutions suitable for your niche, attempt them, then iterate them, all while hoping not to disappoint people or spend too much money in the meantime. The skepticism you’ll face will take an emotional toll. You’ll spend more time than average creating awareness, providing education, connecting with others about your work.
In conclusion, business ownership is real and there are some unspoken realities that are worth surfacing for consideration. A book in my EMBA Business Ethics class talks about Defining Moments, otherwise known as right-versus-right decisions (Badaracco, 1997). It may be the right choice to open a business. It may be the right choice to stay an employee.
The book highlights a relevant quote by Philosopher Friedrich Nietzsche:
“This is my way, what is yours?”
Personally, I’ve stumbled, triumphed, learned, and lost… and I wouldn’t have it any other way.
References:
Badaracco, J.L., 1997. Defining Moments: When Managers Must Choose Between Right and Right. Boston, MA: Harvard Business Review.
Join me in the classroom of life!
Andrea Gets Schooled 
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