Starting your own practice.
By Adele Levine, PT3
For nine years, I was the most low profile physical therapist at Walter Reed National Military Medical Center. I was fully institutionalized, something we used to accuse our patients of becoming, except the one who was really never going to leave was me. I had worked there for almost my entire career. I knew my 6 a.m. bike ride to work so well that I could recognize individual cracks in the street, and I was content knowing that I was going to eat dining facility (DFAC) chicken for the rest of my life. My life would revolve around missing limbs, extremities held together by external fixators, and rabid military officers.
Then in January, I randomly came upon a Department of Navy “tracer,” that identified me as a security risk. My crime? My dual citizenship with Switzerland. At first, I had laughed about it in the human resource commander’s office. “Come on! It is Switzerland!” However, he did not think it was so funny. He had a memo already prepared for me for me to sign—with just a cursory signature, I could renounce my Swiss citizenship and then return to my lunch with my coworkers who were huddled together eating DFAC pizza and reading the latest issue of People magazine out loud.
I did not sign that memo. I know I will never live in Switzerland. I was born in the United States, and I have spent my entire life as an American. I do not even look remotely Swiss. When I travel there to visit my Swiss grandparents, everyone outside the family speaks to me in Italian. For some reason, I couldn’t bring myself to sign away my heritage.
During the days that followed—while the Navy prepared to separate me, too stunned to think about finding a new job, I spent my evenings consoling myself by going out late at night with friends—something my early morning schedule used to prevent me from doing. In the mornings, I sat on the couch, hungover and semi-paralyzed, with the want ads in my lap. One night at a Spanish bar close to my house, I drank Sol beers with a former classmate from physical therapy school. We discussed what was happening in our careers. Ronna had her own business seeing patients in their homes, with a portable treatment table and mental Rolodex of strengthening exercises that required minimal to no equipment, and she stayed busy. In addition to private pay patients, she saw many elderly people with gait and balance problems. However, she was also in the process of moving to Texas.
We agreed I would take over her clients; and in exchange, she would talk me through all the complexities of starting my own business. She promised it would be “easy.”
In the past, I had marveled at my former classmates who had gone into business for themselves—how they managed to leap into that hectic world of billing, reimbursement rules, incorporations, and employees completely baffled me. I was fine with never being my own boss, because while the rest of D.C. was busy being upwardly mobile, I had always preferred to distinguish myself by my lack of ambition.
But under Ronna’s guidance, I filled out the online forms to get a federal employer identification number, group national provider identifier, and Medicare number. I faxed a one-page form to establish my limited liability corporation—remarkably easy to do in Maryland. I applied for a business bank account, health insurance, and malpractice insurance. I was officially self-employed—although I continued to view myself as unemployed.
On seeing Ronna’s patients for the first time, I was a morose physical therapist in a tear-stained shirt. I missed my old coworkers and my old patients and the routine of my old job. I missed my bike ride and the cafeteria lady who passed me my plate of DFAC chicken—but Ronna’s patients were happy to see me. I was surprised to discover that helping elderly women walk better was not much different than helping a young combat amputee learn to walk again on prosthetic legs. It is all strength and balance, no matter with whom you are working.
I described the initial months of being self-employed—which completely intimidated me—to my old coworkers as a “free fall.” Over time, I began to see what was happening to me as not completely diving off a cliff, but letting go of one trapeze while flying toward another one.
Looking at Medicare in terms of an hourly basic rate, it pays well. I had effectively cutout the middle man. As a do-it-yourself junkie, there was some satisfaction of running my own show. Granted, there’s a lot of improvement to be made. (Like having a referral source). If I were more ambitious, I could probably double my salary. Instead I am enjoying spending one-on-one time with patients who are determined to stay independent—and the whole reason I went into physical therapy in the first place.
Adele Levine is an author and a practicing physical therapist in Silver Spring, Maryland. Her writing has appeared in the Washington Post, The Washingtonian, and Psychology Today. Her humane and humorous memoir: Run, Don’t Walk, about working as a physical therapist inside the world’s largest amputee clinic was recently published by Penguin Group. She can be reached at email@example.com.
Run, Don’t Walk by Adele Levine, Penguin, April 2014. ISBN 9781583335390 www.adelelevine.com