This week on PT Breakfast Club, Jimmy McKay and Dave Kittle dig into a simple text exchange that opens up a much bigger conversation about physical therapy, pricing, patient expectations, and business models.

Dave shares how he responds when a prospective patient asks whether Concierge Pain Relief is in-network or out-of-network. Instead of hiding the answer or pushing the sale, he explains the difference between lowest-cost care and a higher-touch model.

That leads into the bigger issue: why do so many patients disappear after visit three?

Is it really a patient compliance problem? Or is it an experience problem?

From there, Jimmy and Dave talk about the volume model, customer acquisition cost, why PT clinics often create inconsistent experiences, and what physical therapy can learn from personal training, restaurants, Planet Fitness, Equinox, Starbucks, Ironman, and community-first businesses like Mind the Mat.

They also talk about APTA’s Payment Summit, professional associations, and why no organization can fix your clinic’s business model for you.

The big takeaway: expectation has to match reality. If it doesn’t, patients leave, members complain, and businesses get stuck blaming the wrong thing.

Chapters

00:00 — PT Breakfast Club intro
00:18 — Setting up Dave’s patient text exchange
00:59 — Prospective patient asks: in-network or out-of-network?
01:56 — Lowest cost vs fastest results
03:02 — Why some patients need in-network care
04:02 — How Dave responds when a patient chooses in-network
05:35 — Why “thank you” was the win
06:34 — Planting the seed about the in-network experience
07:20 — Why inconsistent care hurts plan-of-care completion
08:45 — Visit 3 drop-off
09:20 — Expectations vs reality
10:56 — The video game analogy for patient drop-off
11:25 — Who owns the patient experience?
14:58 — What PT can learn from personal training
15:43 — The clinician-patient batting average
17:29 — Low copay, low expectations, and patient switching
17:59 — The volume model problem
20:55 — Why in-network clinics may care less about drop-off
21:47 — Customer acquisition cost in cash PT
23:17 — What cash PT owners should say when patients balk
24:50 — McDonald’s vs the nice restaurant
25:27 — Gyms as the new third place
26:09 — Starbucks and the third-place idea
28:10 — Fitness studios outpacing traditional third places
28:22 — Nike’s gym failure and why brand is not enough
28:48 — Megan Brown and Mind the Mat
30:14 — Community is the business
30:46 — Equinox and premium member spending
32:32 — Tony’s bell curve: insurance volume vs premium boutique
33:21 — Planet Fitness vs Equinox
34:43 — Serving different audiences with different offers
35:58 — Equinox moving from $4K to $6K per member
38:41 — The three ways to grow revenue
39:47 — Ironman, executive access, and status
41:16 — Can PT become a third-place membership?
42:54 — Why a package is not a membership
44:55 — PT clinics are the anti-third-place
45:53 — Rehab 2 Perform and the space/model problem
47:11 — Lifetime Fitness and the DPT debate
47:29 — The model is eating your lunch, not the letters
47:36 — APTA Payment Summit and House of Delegates
48:36 — Payment vs reimbursement
49:19 — Will reimbursement ever meaningfully improve?
49:56 — Should new grads join APTA?
50:59 — Expectations for professional associations
51:35 — APTA is not your business model
52:05 — Short interviews and borrowing viral formats
53:14 — Parting shots: over-delivering to existing patients
54:06 — Staying close to former patients and clients
54:40 — Relationship gifts and retention
55:58 — Stop being cheap with great patients
57:10 — Expectation versus reality
57:44 — The three ways to serve and grow
58:00 — Closing