The Future of Occupational Therapy is Entrepreneurship with Alyson Stover

For occupational therapists starting a private pay practice the secret to getting started is to do LESS, not more.  There's no better place than making sure your business plan is simple.  In fact, it should fit all on 1 page and contain just 5 critical elements.  

 In this interview with current AOTA President Alyson Stover we discuss why entrepreneurship is so important for occupational therapy and its future. We discuss how she got started with her own pediatric OT practice and the varied path her entrepreneurial journey took. You'll want to stick around and hear her answer to having a private practice and community access - it may just challenge your beliefs. If you'd like my help in starting or growing your OT private pay practice then check out my mentorshop program, Private Pay MBA. 

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Transcript of Video:

Doug Vestal:

I am incredibly excited to be sharing today's interview with you, which is with the amazing Alyson Stover, who is the current A OTA President. Not only that, but she is actually a private practice owner. She owns a pediatric OT clinic in Pennsylvania called Capable Kids. And in today's interview we talk all about why entrepreneurship is the future of occupational therapy. I hope you enjoy today's interview. Alyson, I am so happy that you are joining me today for this topic on entrepreneurship. And I know entrepreneurship is one of your key priorities as president of the A OTA. Can you share with us why you believe entrepreneurship is so important to the future of occupational therapy?

Alyson Stover:

Yes. So first I just want to say thank you for inviting me to have this conversation. I think it's really exciting and I just so appreciate the work that you are doing to help build the OT entrepreneur. So the reason that I think this is so important is because there's a lot of things that we have the opportunity to learn from other countries, particularly now that global communication is pretty easy. And one of the things that I look for is where are the spaces that occupational therapies known? One of the big complaints that we get over and over again with ourselves and within our profession is, well, people don't really know what occupational therapy is. They don't know when to ask for occupational therapy. They don't know that they need occupational therapy. And so I look to some of the spaces where OT is a really well-known and recognized field, and one of those places is Australia.

Alyson Stover:

And when you look at Australia and you look at sort of where and how occupational therapy is being practiced, there's largely in this private practice entrepreneur space. So where in the US you're driving across and you're seeing PT clinics or physical therapy clinic, and it has in houses occupational therapy to you don't really walk or drive past the occupational therapy clinic. But in Australia it's the opposite. All of the clinics are OT clinics and an occupational therapy clinic. And so it had really, from that inception point started me to think about, it's really the entrepreneur that builds name recognition, that understands things like branding, marketing, being relevant to the community in which it exists, needs assessments, needs assessment, analysis. And so if we are in a space where we need to increase visibility, recognition, knowledge of our profession, I really felt like the entrepreneur was something that you could really be a part of that movement regardless of where you saw yourself.

Alyson Stover:

You could be the entrepreneur, which I think the occupational therapy community is naturally, but also you could be the individual that supports or promotes the entrepreneur or can really facilitate some of the messaging of the entrepreneur where you still contributing to that movement of better recognition, better understanding of what we do, more leadership just expressed and had by ot. But you don't have to be the entrepreneur and able to do that. You can empower the entrepreneur with your practice, your knowledge, your science, your research. And so I feel that it's really that component that will elevate our profession nationally, but also everybody, regardless of where you are in your journey can be a part of that movement.

Doug Vestal:

I love that. And you said something right there that I just wanted to piggyback on and ask you a follow-up question, which is that you think OTs are natural entrepreneurs. And so could you expand on that a little bit?

Alyson Stover:

Absolutely. I have heard now a number of presentations, and I can't remember the name of the theory, but there's that theory that you don't buy a hammer, you buy something that will knock the nail into the wall for you, right? And that really, when you think about business and designing and building business, you have to think about what is it that the consumer wants to achieve? Well, that is occupational therapy. Our very first question, you sit down and we say, Hey, what is it that you'd like to do? What is it that you want to do? Where are your barriers? Where are your facilitators? What's different? And so to me, we're an entrepreneur every single day that we interact with a client. And that says to me, we all have the skill. We're all looking at what is it that the client wants to do, wants to achieve, and then we have this incredible ability to really come in at multiple different angles to provide the best result or opportunity to get to that achievement. And so ever since hearing that theory, I thought, wow, I think we all are natural

Doug Vestal:

Entrepreneurs. Yeah, I completely agree. The definition I like to use of entrepreneurship is a professional problem solver because you're just constantly having to solve problems as an entrepreneur and as an ot. In those sessions, you might not self-identify as an entrepreneur, but what you're doing in the session is actual entrepreneurship and you can be an entrepreneur working for someone else as you said, or you could be the entrepreneur who actually owns the thing. And you're interesting because you wear at least three different hats that I know of, right? You're a professor, you are the A OTA president, but you yourself are also an entrepreneur. So could you tell us a little bit about your journey, starting your own private practice, working with kids? What were some of the challenges you face and how did you overcome them?

Alyson Stover:

Yeah, another great question. I think that my journey is best described by another way that I think occupational therapy is natural for the entrepreneur journey, and that's where we are comfortable and masters of failure. So we have to try a number of techniques before the one that really works best for the client is discovered. And I would say that that's really been my entrepreneur journey. The space of just constantly seeing something that is a gap or a whole or a need is really actually what promoted me to this idea of going to law, coming back home and going to law school. So I started with the idea that as I came out of OT school, I had a knowledge and an ability to look at the way a child does things that other professionals didn't. And so when I was working in a private practice in North Carolina, I did a lot of things like IEP meetings because I was just under the assumption that people would be glad or inviting to have this knowledge like, oh, it's not that we don't want to do this for this child.

Alyson Stover:

It's that we never knew, we didn't have the lens here to share it with us. And that's where I sort of met this desire to fill the gap as I saw them. That's where I also met my first failure where I realized, no, some people aren't interested in having all the knowledge that can do certain things or facilitate certain participation. And in reality, that's where I learned that money is a big initiative behind things. And so then it was about looking at how was I filling these gaps on an individual client basis related to low cost? And that's when I discovered that every time I made myself low cost, then I said that I didn't have much value. And so it was that real intersection of knowing that I knew how to fill certain gaps, but there were actually people resistant who didn't want those gaps filled.

Alyson Stover:

And that largely finance was something that played a major role in decision making and that if I made myself financially attractive, then I also my service. So it was this explosion of contradictions that said, oh, and at that point I thought, I'm not an entrepreneur. I would never want to own my own business or anything like that. It must be a lawyer that I want to be. And so I went back to law school and it was actually there that in my journey that I started to discover, no, I'm an entrepreneur in that When I see those gaps, when I see those holes, I want to develop the way the process or the program to meet those and that if there is a larger change that emerges from that, great, but I'm not the one that's going to write the policy. I'm not the one that is going to run for office to ensure that that policy is put into action.

Alyson Stover:

I'm not a hospital administrator. That's just not places that I'm comfortable, but I am comfortable in designing the program, failing a few times, maybe 20 times, and reporting both my successes and my failures out so that there can be larger scalability to what I'm doing, but I can also learn from others who are doing similar or shared work. And so when I graduated from law school, that's when I really thought about, well, what kind of business do I want to go into? And I had a lot of failed attempts. I was going to do a really unique advocacy type of business, but then I discovered that I just was in an area where I was new to it, my husband wasn't, but I was, and no one really knew who I was, so they didn't trust me with those kind of questions or responsibilities. And so I didn't have any clients.

Alyson Stover:

And then I thought about doing some other various projects where I would collaborate with different agencies and do more of a consulting work and think about things like system change or community planning. And again, I didn't have the network, nor did I have necessarily the product to showcase my value there. And so that's when I started to think about, but what is it that I know how to do? And I know the gap is, and that's when I looked at, we had taken my daughter, she needed occupational therapy and the only place was an outpatient hospital department and incredible therapists did outstanding work. But what I saw was that my daughter who had been around disability and different abilities her entire life at four years old was very confused why she was doing her exercises next to a 97-year-old man who had had a stroke.

Alyson Stover:

And that confusion wasn't something that I could solve for her. And I also recognized that she wasn't putting forth her best effort in those spaces because she was so overwhelmed by trying to take in the environment and figure out how she fit there. That gap said, well, I've been treating children for over 10 years. I love it. I'm trusted in that space. I have some products in that space and it's a gap here. And that's what led us to open the clinic. But then on top of it, as a true entrepreneur, you never stop designing and developing. So there are programs that have emerged. We'd meet a barrier where we wanted to facilitate programming for pregnant mothers who were still using opioids in the pregnancy, but in our clinic, there wasn't any space that type of work could be represented and or reimbursed. And so we developed our nonprofit, right?

Alyson Stover:

So I think the entrepreneur journey is that it's always the journey with no endpoint. So I could talk about the incredible growth and success of the clinic over the past 11 years, but then that also makes me think about the idea that as it grew, I continued to find incredible clinical leads to run and organize and progress that success, but the entrepreneur kept looking for the gaps and the ways that I could fill those gaps. And so my journey has led to developing a nonprofit to address different types of needs that we saw and being able to apply for certain grants or treat certain individuals. It's led to consulting work, and sometimes that consulting work is just because I fall into it via discussion and then we build that program. But it's really about the idea of it's the only space that I can wear every one of my hats, and it's actually a superpower versus a really conflicting chaotic mess.

Doug Vestal:

Hey, I hope that you are enjoying this video. My course and mentorship program, private pay MBA is the fastest way to start your OT private pay practice. Whether you are starting on the side or going all in full-time, private pay MBA is the most comprehensive program available, but we all know head knowledge just isn't enough, which is why I provide so much support and accountability. Private pay MBA, you'll join group coaching calls, get access to an incredibly supportive community, and get my personalized feedback on all aspects of your practice. If you are an OT that's in the beginning stage of starting your practice, then private pay MBA is for you. And if you've already started your practice but you aren't getting the results that you want, then private pay MBA will give you the structure and tools you finally need to start attracting your ideal clients, gaining traction, and gaining that occupational choice with hundreds of students.

Doug Vestal:

The material in this course has been field tested and quite simply just works. You'll learn how to build authentic referral relationships, market yourself ethically and build a practice that you are proud of. You can check out more [email protected] slash pp mba or click on the link below this video now back to our video. And I love hearing your journey with it because I think so many people are going to be able to relate because where you are now, 11 plus years into it is very different than where you started. And many times we can overthink starting because we're trying to imagine what it's like 11 years, 20 years later. But all of these twists and turns you can't really prepare for. You have to approach it with that open mind and curiosity and problem solving, creative problem solving skillset, and then see where it goes. But I think the anticipation of where it might go will prevent a lot of people from even starting from the very beginning. So it's really refreshing to hear that just that take that you have, which is that you're constantly looking for new ways to improve stuff, and your practice 11 years from now is probably going to be very different than what it looks like today. How do you think your experience as a private practice owner has influenced your vision for the OT therapy profession?

Alyson Stover:

I think that it gives just this additional lens that we often don't hear being spoken about. Occupational therapy is a profession of people who are highly committed to our work, who are generous, who seek to give care to others, who want to be collaborators, members of a team. We're not a group of people who individually elevate ourselves or represent the quality or the very distinct value that we're bringing into a space. And by being an entrepreneur, it has allowed me to think about how we continue to address and move forward some of those very pieces that are crucial to our profession. So things like reimbursement and the struggle with reimbursement. Often we'll say things like, well just look for alternative revenue sources. And when I was in a space where I didn't own my own practice, that made sense to me. But being in that space and constantly pursuing some of those alternative revenue mechanisms and realizing that they're not always easy to find and then even harder to kind of integrate or figure out how to work with or become a part a delivery of that, it then elevates that as we look at the profession, are we looking at ways to provide resources in how individuals can pursue alternative revenue streams in a way that's more simple for the OT clinician, we carry a lot.

Alyson Stover:

We are one of those entrepreneurs that is not just the owner of our business, but also the employee of our own business. Very rarely are we not still carrying our own caseload or the consulting work that we're doing. And so I think about it as we need things to be easy, we need them to be accessible, and we also need to be frontline. So where we are not necessarily a community that speaks up regularly, the entrepreneur will. And how do we then facilitate also this movement of being able to bring those people into spotlight arenas that say, we are the leaders in this, or we've been doing this for over a hundred years. I think about things that are really catching on right now, work in the dementia world and individuals experiencing dementia is a really hot topic right now because we've seen the baby boomers really age to that generation, and we have a great number of individuals that have a diagnosis or experience of dementia, and they'll say things like adapting driving or being able to work through a bio-psychosocial approach.

Alyson Stover:

These are hot terms now that we've been integrating into our work for a hundred years. So we need to be in those spaces where we can loudly share that. But the other part of having that entrepreneur part there is that entrepreneurs know how to speak many languages. So again, the OT clinician, we speak a beautiful OT language, but it's not understood by anybody else. And so bringing that entrepreneur, engaging and inviting that entrepreneur into some of these spaces, it allows for multiple pieces of representation of occupational therapy in a powerful and meaningful way. And if I need that kind of representation, then on the flip side of it, we also need to look at how we're providing the resources so that they know how to get paid so they know how to pay employees so that they know what it looks like when you start a business and make contracts. What is type of business that an individual can start, like you said, do I have to jump right in? Can I slowly walk into the pool? And these types of questions are questions that all entrepreneurs have, but I need it to be spoken in a language that's direct to the occupational therapy professional. And then on the flip side of that, I need that occupational therapy entrepreneur to speak it loudly in the other languages they know to build our leadership. We'll only project forward with this kind of work.

Doug Vestal:

I love how you just see entrepreneurship and occupational therapy is being so expansive and so encompassing of many different skill sets. And almost like what I found supporting OTs and business is many will come out of school not really necessarily understanding how healthcare as a business works. It is not a topic that's really covered. And then they really have to dive into that when they think about credentialing, when they think about Medicare and Medicaid, when they think about really direct access laws because now they're really faced with it. There isn't someone else that's handling those problems with it. And it's really beautiful to see them get this more holistic view of how all of the pieces actually line up and work together so they can make a decision that's right for 'em. I'd love to ask you about a taboo topic within OTs, and that's around money and access.

Doug Vestal:

And there's many OTs might feel that if they went an entrepreneurial route, if they went a private practice route, that they would feel guilty that maybe some of their services wouldn't be accessible, they fear they're not going to be accessible. And this relates to your conundrum earlier, which is the other side of it is many OTs feel overworked and overburdened having to see 10, 15 clients a day. So you always have such an interesting take on these types of problems. And I would love to hear what sort of your advice is when OTs are considering private practice and access?

Alyson Stover:

Yeah, it's a great question and the way I think about it is, so before I went to law school and I was complaining about some of the things that were real barriers to my ability to deliver care and to deliver the care, I knew how to, I was actually at the beach with some friends because such do in the summer in North Carolina, as I'm sure, and my friend had just graduated from law school, and so I was telling her this story about how Medicare had created a policy or a ruling that only orthotists could be reimbursed for the fabrication of splints. But I was seeing many children that were covered by Medicaid and they had to follow the Medicare rule. And so I wasn't getting reimbursed. And everybody was just like, I would go, I would fabricate the splint, the orthotist would get reimbursed. Everybody would pat me on the back and say, wow, the dedication and commitment you have to, this is incredible, right?

Alyson Stover:

That's when my friend said, I actually think you're terrible as an occupational therapist. And I was like, no, I am literally fabulous. What do you mean? And she said, you're doing your entire profession a disservice because I don't have the skill to sit down and make a splint. And the fact that you do and that you can do it with a child and that you can do it with a child who's squirming and has no attention and doesn't even want to be there is actually really complex. And every time you do that for free, you tell the world, oh, it's not hard. And so see, when you do that, you reduce the reimbursement, you reduce the payment and the opportunity for people to place a value on your work. And when you do that, that means that your profession will continuously get paid less because every time it's evaluated what the cost or value of your services and skills are, they're going to decrease because they didn't have to pay for it here, but it's still got done.

Alyson Stover:

And then when it pays less, people can't enter your field. And if people can't enter your field, guess what? You've actually eliminated access across the nation. So really by not valuing yourself and requiring adequate payment and reimbursement for your services might take a little longer, but you're actually going to minimize access because you're going to decrease the reimbursement, which will essentially become a barrier for entry into the field. And for a while that was hard for me to understand until I started to look at some of my work in our clinic. I still carry a small caseload. We don't bill for any of the clients that I see. We can do that because we have a structure and a system in which we are able to collect the amount of money that we are owed for the high level of occupational therapy services delivered. And by prioritizing that value, it also frees up space for pro bono work to happen in really meaningful ways that are intentional for you.

Alyson Stover:

So whereas if we weren't ensuring that our out-of-pocket rates were something that substantiated the work that was happening, if we weren't collecting private insurance and requiring payment of their copay or deductible, then I wouldn't be able to give pro bono services where it's absolutely necessary and very intentional on my part because I'd be having to see more and more clients to make up for the loss of reimbursement there. So I learned from her two things. One, that by not requiring reimbursement, that's reflective of our skill level, I'll actually have the ability to decrease the access across the country because I could limit the growth of the profession. But then on the day-to-day, I learned that the balance comes when you are able to collect your value and your worth on the regular basis, then it actually opens the door for you to provide access where access would've never been provided before.

Doug Vestal:

Wow, you gave me goosebumps with that answer. And I mean, it's so refreshing to hear that, and I think it's so true. There's that old cliche, you can't pour from an empty cup. And so for you as an occupational therapist, you need rest. You need recovery, you need the ability to pay your bills, you need the ability to pay off your student loans. You need to not live paycheck to paycheck, and you need to work with clients that are going to be very fulfilling for you. And I just feel like you can make money as an ot, and that gives you the ability to do the pro bono, to do the sliding scale, but without that, without the success in another part of your life, you're going to burn out very, very quickly. And then who does that serve at the end of the day?

Alyson Stover:

And we saw that early on we saw that. So we do accept Medicaid, and early on that was sort of where I targeted. So I went into areas that had high Medicaid enrolling rates. I'd go to the preschools and do screenings there. And in Pennsylvania, Medicaid's a very low reimburser, and so I had a tremendous number of clients, but I wasn't getting reimbursed a meaningful amount. And so I was seeing easily 10, 12, 15 clients in a day. I was working five days out of the weeks from 8:00 AM to 8:30 PM and then I was catching up on paperwork and documentation on the weekends, and all of a sudden I felt resentment for the work that I was doing when we really started to reverse and we started to intentionally design programs that did have a high cost associated with them. When we started to really visit all of the daycares and pediatricians in our area, both in high income areas and in Medicaid enrolling areas, what we discovered was I could see less patients in a day, but also then I could give to those clients that I knew were not going to have access.

Alyson Stover:

They didn't even have Medicaid. I was able to service the child that essentially was living under the radar, homeless with their mother. She wasn't going to put him on any Medicaid or anything because then there would be identification that she didn't have a home for him. And by being able to see him pro bono where it didn't go on any records, we were able to get him services to really help promote his development. At the same time, we was able to regularly engage with his mother and help her to get connected with resources so that they didn't have to be homeless and essentially build up that family because we ran programming that cost maybe $1,500 out of pocket for the four week session because we did require that if you did not make three co-payments in a row that you couldn't come back until you paid off your outstanding bill. It was those things that allowed me to do the work that really actually promoted access.

Doug Vestal:

I love that. Alyson, you've been so generous with your time. I want to just ask you one last question, and that is many OTs are excited but also hesitant about starting their own private practice due to the business side. It's often not covered in OT schools. What advice would you give to those OTs who are considering taking that leap into entrepreneurship?

Alyson Stover:

That's a great question. I think that the first thing is, is to write down. So the first thing is to just do it, and you can really wade into the pool or you can dive into the deep end. Nothing says that you have to do this work all or nothing. So I would say that where you are in your own place in life, use that to analyze how you want to enter entrepreneur world. Maybe you don't work Fridays for your current facility, and so you're going to start seeing some clients on your own on Fridays, or you're going to offer to do consulting or provide a continuing education course, or you can just dive in like I did and told my husband, we quit our jobs and we just dove in. I think that is their own determination, but do it and do it now.

Alyson Stover:

So maybe you feel like you can't dive in, then wade in now. If you have any desire, then do it. Don't wait. Don't say, oh, I want this, or I think I'll get there in the next five years, or This is my 10 year goal. Do it now and do it small because you're always going to learn things. And the other thing I say is to do this every year to take out a note card and to write on it the three things that you would constitute as the biggest failures. If this happened, it would be the biggest failure or fear that I have. And then put it in an envelope and put it somewhere that you will remember to take it out in a year or maybe just six months you want to do it. It's astonishing to see that those fears never materialized, but then on top of it, B, they're not even fears of yours anymore.

Alyson Stover:

And I think it gives us this great reflective, intentional way of reminding ourselves that we can never predict what tomorrow is going to bring. And so if we let our fears of tomorrow determine what choices we're going to make, who knows what we could have missed out on? Now we also do a thing now where we will take feedback comments from the feedback box that parents give us, and we put those next to our fear cards. And so we look at it two ways now. So we look at how our fears did not materialize or that they did, and it wasn't as big of a deal as we thought it was going to be, but then we also then read those feedback comments so that we recognize, and this is all the stuff that wouldn't have happened if we didn't take those risks. And I think it's just a really great way to constantly remind yourself that the fear is never going to be more than what you receive back from the journey.

Alyson Stover:

And that the third thing I would say is there's always time. There's always space. You can always turn around. We live in this world where everybody says, well, if I do a, then I have to do a forever look. You can try it. You can try it for five weeks. You can try it for five years and decide it's not for you, or you want to take it a different way or you want to take a break from it. You always can. Nothing is this forever in stone decision. And so don't grasp onto it like this is the end grasp onto it as, oh, this is another talent I'm stopping in.

Doug Vestal:

Yeah, that's great. So do it now. Get ahold of your fear and realize that it isn't as great and celebrate your wins. And then also know that you have choices, right? So one of the great things about being an OT is that if it doesn't work out, you are still imminently employable. There are a lot of options for you which reduces that risk that we're all worried about at the end of the day. Alyson, I just want to thank you so much. This was incredible. I can't wait to share this with my audience. And thank you for everything that you're doing to support entrepreneurship and your leadership has been amazing, and I'm just really, really thankful to connect with you.

Alyson Stover:

Thank you. I enjoyed it, and I would love to talk anytime.