I started out working for a busy, insurance-based outpatient practice. I was incredibly frustrated by the limitations set by insurance companies. Patients that needed care were getting denied treatment or expected to get better in just a few visits. I didn't like double booking patients. I knew I could do so much more: I wanted to hear the patient's full story; I wanted to laugh and cry with them or spend the session in whatever manner the patient needed that particular day; I wanted to pull from my clinical expertise versus treating based on which treatments were covered by insurance.

After having my son, I had a newfound interest in pelvic health. I dove headfirst into every pelvic health course. I found pelvic health incredibly fulfilling. Patients didn't just get a little better, most patients were getting completely better. I was shocked. These were life-changing things that we were treating.

It was distressing to me that there were so many people suffering from pelvic health issues in my area, but hardly any providers to treat them.

I decided I needed to open my own pelvic health practice. My community needed me. Even though I had only treated a few pelvic floor cases at my previous orthopedic job and performed about five pelvic floor exams in total prior to starting, I decided to open my practice with essentially no pelvic health experience besides taking some courses. I remember my first patient. She was coming in for stress incontinence. I stated with confidence that I could get her better. Deep down, I was terrified. I had never treated someone with leakage before. My mind was whirling. Imposter syndrome was setting in hardcore. How was I supposed to get her better? Then a patient with pelvic pain came in. Same thing. I had never treated this before, could I really do this?!

However, my patients were desperate to find someone to help them. I knew that doing my absolute best was going to be better than the alternative: nothing. I had to pull from my ortho based experiences and incorporate everything I had learned from the pelvic health courses. I had no mentors. By some miracle, patients were getting better. My confidence began to increase. I started to recognize patterns and figure out which treatments really were most effective for which diagnoses.

I knew when I first opened that I did not want to partner with insurance companies. I wanted to truly help my patients in whatever way I felt best. I enjoyed treating in an unconventional but totally functional fashion. If a patient had leakage while playing volleyball, I would set up a volleyball net in the grass and train movement patterns until the patient no longer leaked. I liked having patients lift heavy weights and max out during sessions. This wasn't the way I could practice when I was double booked at an insurance-based practice.

At first, when I opened, it was crickets. I had a few friends that booked sessions with me, but that was about it. For about three months, nobody called. I was marketing like crazy to doctors but still no referrals.

My area is heavily insurance driven. This was the first cash practice in my area of the state (at least that I knew of) besides a few small, mobile practices. I had doors slammed in my face by doctors who thought it was evil that I was not taking insurance. Potential leads just horrified on the phone that I did not take their insurance. I wasn't sure if it was going to work and in one weak moment almost switched to the dark side and started to take insurance. Then, all of a sudden, about three months in, I started to get a few phone calls, then more, then it snowballed. Most of my leads were from direct patient marketing–workshops and organic Facebook marketing.