Paul Gough

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Is the Government’s Preference for Big Business Hurting Private Practice Owners?

In this new blog post, Dan Kennedy and I take a closer look at the growing influence of large corporations in the healthcare industry and the challenges facing private practices.

What does the future hold for physical therapists? Keep reading to find out, and listen to the podcast here.

By the way, have you booked your seat for Cleveland yet? Join Dan and me in Cleveland on July 8th and 9th – it’s coming up quickly, so don’t wait! Go to to book your seat!

Enjoy the episode!

P.S – Watch the full video interview on my YouTube channel here:


[Paul Gough] What does the future of PT look like? That’s what everybody wants to know. 

[Dan Kennedy] The future often looks somewhat like the past because we keep repeating business cycles and economic cycles and mistakes, you know, over and over and over again. 

I’ve been working with private practice owners since the late 1970s, more chiropractic and dental than PT, but PT as well. 

I had a very large private client physical therapy clinics in Kentucky in the mid 1980s and I was in chiropractic in the late 70s and early 80s. 

I was one of four or five, kind of leading the both the prepaid movement versus pay per visit and the cash practice movement because they stitched together. 

You can’t do one without the other. 

The problems of being the second class citizen in the care equation and being dependent on some entity someone else to hand your patients, your customers, it was a dangerous evil then. 

It’s a dangerous evil now. 

The chiropractors really never faced it because up until fairly recently. The medical community and the chiropractic community would just have nothing to do with each other. 

It actually prevented them from finding themselves in the same position that the physical therapy profession finds itself in. 

But the insurance problem was just as real. 

And, overarchingly, if you look at what has been a very slow evolution in health care and evolutions tend to become revolutions, at some point. 

They creep, and creep, and creep, and then by some reason, mechanism, means they suddenly accelerate. 

This has been a move to consolidation and big business, not small business. 

I recommended a book to you by Carol Roth called The War On Small Business. 

And it’s well worth reading. It’s not comprehensive, by the way, but it’s well worth reading because there is a determined effort, a deliberate effort for there to be big business, not small business. 

Government prefers it. Socialist government has to have it. 

And any time the government is paying a large portion of the bills, they want it because they feel like it’s easier to control. 

It’s happened in the small manufacturing business. 

It’s happening in banks. And during the Obama administration, there was a reduction of both startups on existent local community at regional banks. 

They deliberately made the regulatory environment compliance costs so high that those banks consolidated. 

And there was a lot of pressure on the family-owned bank in the community with five branches to sell because of the compliance costs for B of A, they can absorb almost anything. 

But- so there was a lot of that. Then it kind of eased up again and there were a fair number of bank start ups during the Trump years. 

And now we just had this little banking crisis, which probably hides a bigger banking crisis, and there’s a big open discussion. 

Even people who should know better, like Kevin O’Leary from Shark Tank are openly saying, “What do we need regional banks for anyway?” 

Right. Everybody. Banks digitally, which everybody does something. Everybody banks digitally. 

If we just have five big banks, we don’t have to worry about them failing. 

We have forgotten the Lehman Brothers. We don’t have to worry about them failing. 

And so why don’t we just eliminate all the small banks altogether and have like five big banks? 

That’s in health care. It’s very much in health care. 

And insurance is often intertwined with it and being used to enforce it. 

In the pharmacy industry, the independent pharmacy is fighting for their life because Aetna owns Pharmacy Benefit Management companies and I think they own a big chunk of CVS, if I’m not mistaken or it’s the other way around, but the insurers and the deliverers are becoming one and fewer and fewer of them. 

And that’s not an accident. 

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