The Heart of an Entrepreneur
Do you want to create your own destiny? If you have a multitude of ideas, and feel that they are somewhat suppressed in your present work setting, perhaps you should consider becoming an entrepreneur. Do you have a real passion about a specific area of occupational therapy? Do you have ideas about how things might be done more effectively? You may be an entrepreneur at heart.
I am an occupational therapist with a private practice in industrial rehabilitation. Launching out on my own was a real challenge. Formerly I worked for a Veterans Administration hospital, with the security of paid leave, a retirement plan, and a paycheck every 2 weeks. However, feelings of restlessness and a need to have some flexibility and authority over my day-to-day work gradually overcame my need for security. My first step was a private home health/outpatient rehabilitation agency, where I worked for 5 years. This job offered me more flexibility with my schedule and how I performed my work, while still providing a steady salary.
My next jobs were director of occupational therapy, then director of occupational therapy services, at two other facilities. I took another step toward private practice when I contracted to provide occupational therapy services for nursing homes and small hospitals. I had a staff of four occupational therapists and six occupational therapy assistants. In this position I still had the security of contracts with the facilities that paid on a fee-for-service basis.
I had a desire to open a private occupational therapy clinic with no employees other than my husband, who would be my office manager and do the billing. The question was, how does an occupational therapist generate enough referrals to keep a private clinic going?
My thought was that I needed to provide a specialized service that was valuable and needed, and that would generate a good income. During this period I had attended three continuing education courses in functional capacity evaluations (FCEs), and I performed FCEs while working at most of my jobs. I had also written a proposal to perform FCEs in a new outpatient rehabilitation center being built in our area. When I started my own contract business, I did FCEs for several of the small hospitals and also with an outpatient rehabilitation center. I enjoyed doing them and believed that they were a great benefit to clients, physicians, and insurers.
Reimbursement for FCEs was 99% workers' compensation insurance at that time, so I decided to launch my own private clinic, specializing in FCEs. However, reason told me that there was no way an occupational therapist could make a living doing just FCEs in a town where the competition was three hospitals and a large rehabilitation center. In our area, the physicians who are not working in the hospitals or rehabilitation centers seldom refer patients to occupational therapy (even patients with upper-extremity and hand injuries are referred to physical therapy). My heart told me to go for it, I knew it would take a lot of hard work, faith, a few dozen miracles, to make it happen. My income, leave, and retirement were going to be up to me and God.
I opened Occupational Therapy Plus, Inc. dba Industrial Therapy Plus in 1998. I was not sure if I would be doing treatment and also FCEs, so I wanted to be able to use both company names if necessary. The dba (doing business as) Industrial Therapy Plus name turned out to be the one by which my company is known.
My first step was to get the additional continuing education I needed to provide the best FCEs in town. Although I had been trained in three different FCEs over the past 15 years, I did not really have confidence in any of them. I went to the Work Injury Management National Conference, where many vendors were marketing their FCEs. I needed (and found) one that was valid and reliable, that I could afford. After I had completed the training and certification on the FCE I selected, I was convinced that I had selected the best one on the market. It was practical, valid, reliable, published, and peer reviewed. I understood it and felt good about the practical methods and results.
I had enough money saved to last about a year, but no marketing funds to speak of. I rented an 800-square-foot space in an office complex that provided just enough room to do an FCE and have some counter space for paperwork. I visited one group of neurosurgeons and one group of orthopedic physicians. One of the neurosurgeons needed an FCE done on a patient who had no funding. The large hospital would not do it unless they were paid. I offered to do it pro bono. If he liked my work, he would send me more patients. If he didn't, he was under no obligation. I completed the FCE , doing the very best job I could, and hand delivered it to his office. I found out the names of all the staff in the office who were responsible for sending out referrals, and I called them occasionally to see if they had any for me. I always tried to accommodate them by timely scheduling and keeping them informed of the date the patient was scheduled, if he or failed to report, and other pertinent information.
That neurosurgical group of five physicians kept me busy for the next 2 to 3 years, and I gained many contacts with case managers and insurance companies in the process. The orthopedic group was associated with a medium-size hospital, but at that time no one at the hospital was doing FCEs. The orthopedists began to refer to me for FCEs, and they still do. I also contracted with that hospital to do their FCEs from other referral sources. Later, they asked me to do impairment ratings for their Burn Center. I looked on the Internet for courses and other information on impairment ratings, and I bought software to do them. This was a $1,500 investment. I have been performing impairment ratings for the Burn Center for the past 7 years and have been reimbursed several times over for the original cost. My belief is that if you spend money on things that will help you make a lot more money, they are worth it—and they are tax deductible if you are in private practice. But you have to do your homework to make these investments, and you have to be willing to take some risks.
Continuing education is a must. Credentials are important because you are standing on your own reputation, and not on the reputation of the facility you are working for. Work hardening and job analysis are a natural fit with FCEs, and I began to have requests from referral sources to do them. After further specialized training, I added these, plus ergonomic analysis, to my business. I found that my referrals came in cycles: I would get a lot for FCEs and then go a month or so without any. The work hardening, job analysis, and ergonomics services filled in the gaps. I added these extra services one step at a time so I wouldn't become overwhelmed. At times I have had to decide whether to turn work down or hire someone else to work for me, and my decision has been to turn work down. At this point in my career, a two-person business suits my lifestyle.
To survive in a freestanding, private clinic, you have to offer a very good service that is also effective and cost efficient. Commitment, efficiency, and timeliness are very important. Give special attention to your customers when you can. For example, hand deliver reports or work an extra client into your schedule for someone who needs it done "right away." Take the telephone calls from the case managers and insurance adjusters personally, and spend time answering their questions. Work toward gaining their credibility, trust, and respect. I know, you think this is a lot of time, and a lot of work. Well, this is the life of an entrepreneur. Think carefully about whether you are able and willing to put in this extra time. Are you still interested? If you are, here's how you start: (1) get a vision, (2) devise a plan, and (3) execute the plan.
Get a Vision
What is it about occupational therapy that you most enjoy doing? The task that you get so interested in that you forget the time? The work you would do out of choice, instead of out of need? The vision that keeps coming back to your mind, over and over again? To succeed, you must have a strong desire to do the work you have chosen.
However, keep in mind that being a successful entrepreneur requires more than passion. Before moving forward, complete an objective self-assessment. Are you great with the big picture but terrible with details? Do you count on others for assistance when you get overwhelmed with work, or do others turn to you? Are you a natural leader, or are you better at implementing others' decisions? Many self-assessment forms are available, including AOTA's Professional Development Tool1 (although this tool does not address entrepreneurship, it will help you evaluate your practice and competence skills). It is a good idea to complete several self-assessments, with different focuses, to get an idea of how your skills compare to those of successful entrepreneurs. The U.S. Small Business Administration and most Chambers of Commerce offer assessments and other information to consider before launching a small business.
Devise a Plan
Can you financially afford to make a transition from receiving a steady salary to waiting for the money from your labors to turn around? After you tally the costs for rent, utilities, telephone, and other supplies, determine how much you will need to make each month to pay the overhead expenses and still have enough income. You will most likely need someone to answer the phone, make appointments, and do the billing. Although you could do these things for yourself, you will need to spend your time generating income.
No one is born knowing how to have enough cash flow, how to pay quarterly taxes, how to get insured, how to set up a billing system, and other essentials for setting up a business. Do not assume that you will figure these things out as you go along. Learn everything you can about being an entrepreneur before you begin: attend seminars, talk to other entrepreneurs, and contact local small business organizations (see "Resources" below to get started).
Execute the Plan
Put on a conservative outfit, a pleasant smile, and a confident demeanor, and oh yes, don't forget your business cards, and go market yourself. If you are counting on physicians as referral sources and one is not available, find out who sends the referrals from his or her office. Many times the physician writes the order for therapy and doesn't specify where the nurse or referral coordinator should send it. After the referrals start, others will be generated from the first ones.
The most important referral is through word of mouth. Keep a spotless reputation. Do the best job you can—every time. Act as if each client or report is the most important. Never say anything negative about a physician or another health care professional, even if you are being prodded to do so by the client. This is a deadly sin!
After you begin to execute your plan, it will be very easy to find yourself working longer hours. If one of the reasons you want to be an entrepreneur is so that you will have more flexibility in your life—you will. However, you may find your new boss expects more out of you than the old one did. The new boss—that's you—may require you to see more clients and work longer hours. You may find your life out of balance before you realize what has happened. You need to concentrate on balancing your faith, family, health, and wealth. I heard a story once that is so true. When we are young, we have good health, but no money. When we get old, we spend all the money we made when we were young trying to get back our health. Along the same train of thought, if we spend all our time making money and put our family second, our children may not want to spend much time with us when they are grown, and our spouse may be long gone. Make a balanced lifestyle high on your goal list. The rewards are more time, money, freedom, love, and happiness.
New experiences are opening up that will give you the opportunity and freedom to choose your desired path in this profession. Take the skill and experience you have accumulated, use what you have learned, and make it work for you.
"The best way to get something done is to begin."—Anonymous
1. American Occupational Therapy Association. (2003). AOTA Professional Development Tool. Bethesda, MD: Author. Retrieved October 25, 2006, from http://www.aota.org/pdt/p1.htm
Lana Hardeman, OTR/L, CDMS, CWPE, CLCP, has a private practice in industrial rehabilitation in Augusta, Georgia. She has owned and directed three private businesses: Geriatric OT Services, Hand Rehabilitation Center, and Occupational Therapy Plus, Inc. dba Industrial Therapy Plus. She is a certified disability management specialist, and most recently became a Certified Life Care Planner. Her new business is Life Care Planning/ MSA, Inc.
A Web site devoted to starting and expanding a small business. Although some of the resources must be purchased, many are free.
America's Small Business Development Center (SBDC) Network
Small business owners and aspiring entrepreneurs can go to their local SBDCs for free, face-to-face business consulting and at-cost training on writing business plans, accessing capital, marketing, regulatory compliance, international trade, and more. The SBDCs are a partnership that includes Congress; the U.S. Small Business Association (SBA); the private sector; and the colleges, universities, and state governments that manage SBDCs across the country.
Provides resources to the federal government on compliance information, forms, and contacts.
Center for Creative Leadership
A nonprofit institution dedicated to leadership through research, training, coaching, assessing, and publishing.
The Fast Company
Management, leadership, and career advice from the magazine of the same name.
Organizational Vision, Values, and Mission
By C. Scott, D. Jaffe, & G. Tobe. Mississauga, Ontario, Canada: Crisp Publications.
United States Small Business Administration
Provides links and advice on a wide range of topics, including starting, financing, and managing a business. Provides free online courses, with options for certification in various topics.
Hardeman, L. (2007). The heart of an entrepreneur. [Electronic Version]. OT Practice, 12(1), 13–15.
©Copyright 2007. The American Occupational Therapy Association. All rights reserved.