This week on PT Breakfast Club, Jimmy McKay and Dave Kittle start with a simple patient text exchange and end up inside one of the biggest problems in physical therapy:

Expectation rarely matches reality.

Dave shares how he responds when a prospective patient asks whether his clinic is in-network or out-of-network. Instead of dodging the question or pushing the sale, he explains the difference between choosing the lowest-cost option and choosing a higher-touch model.

That opens the door to a larger conversation about why patients often disappear after visit three.

Is it really because patients do not care?

Is it because they will not do their home exercises?

Or is the experience inconsistent enough that leaving is actually a rational consumer response?

Jimmy and Dave talk about the in-network volume model, cash-pay customer acquisition costs, personal training, patient switching, the third-place concept, Equinox, Planet Fitness, Starbucks, Ironman, APTA, payment advocacy, and whether physical therapy can ever become more than a series of appointments.

The episode closes with a practical reminder: the easiest growth lever is not always finding new patients. Sometimes it is serving the people who already trust you at a much higher level.

In this episode

• How to respond when patients ask about in-network vs out-of-network care
• Why cash practices need to explain the tradeoff, not just the price
• Why visit 3 drop-off may be an experience design problem
• How inconsistent therapist switching damages trust
• What PT can learn from personal training
• Why volume-based models create predictable consequences
• The role of customer acquisition cost in patient retention
• What physical therapy can learn from Equinox and Planet Fitness
• Why community-first businesses win
• Why a package is not the same thing as a membership
• What APTA can and cannot realistically solve
• Why retention and relationship may be the most underused growth strategy

Best quote

“If you launched a video game where 70% of the people played it three times and never played again, would you blame the player? No. You’d blame the game.”