Burnout to Balance: How one OT Built a Sustainable Practice (RTS Newsletter #6)

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From Burnout to Balance: How One Occupational Therapist Built a Sustainable Practice

For Marlene Handler, the path to entrepreneurship began with burnout. Working in an insurance-based clinic as a pelvic floor therapist, she found herself seeing up to 17 patients a day, missing time with her children, and struggling with her own health. The demanding schedule wasn't just affecting her well-being—it was compromising her ability to provide the specialized care her patients needed.

Today, Handler runs The Lifted Lotus, a successful cash-based practice in Williamsburg, Brooklyn. She sees a maximum of five clients per day and works just three days a week. Her journey from overwhelmed clinician to thriving business owner offers valuable lessons for healthcare providers considering the entrepreneurial path.

Starting with Strategy

Despite having no business background, Handler approached her venture methodically. She created a slide deck—a comprehensive Google Slides document containing everything from financial projections to brand colors. This living document helped her visualize her business and served as a roadmap for launch.

A key early decision was hiring a business coach. Though the coach had no healthcare experience, her expertise in systems and prioritization proved invaluable. "From the time I started working with her until I had my first client, everything was on target. Every goal was hit," Handler recalls.

Embracing Technology

While Handler describes herself as "not super comfortable with technology," she recognized early that the right digital tools would be crucial for creating an efficient practice. She invested in IntakeQ, a practice management platform that automates scheduling, documentation, and payments.

"The best use of my time early on was to create a system for all of my documentation and invoicing," Handler explains. "I do not want to get bogged down with all the administrative tasks." This early investment in technology—including 20-30 hours learning the software—has paid dividends in time saved and improved client experience.

Lessons for Aspiring Entrepreneurs

Handler's experience offers several key insights for healthcare providers considering independent practice:

1. Be intentional about your vision: Handler designed her practice around her desired lifestyle, prioritizing work-life balance from the start.

2. Invest in systems early: While the upfront time investment in learning new technology may feel daunting, it pays off in long-term efficiency.

3. Research your market: Handler called other practices to understand pricing, waiting lists, and service gaps in her area.

4. Focus on your niche: Understanding and serving a specific demographic—in Handler's case, postpartum clients and young women—can help establish a sustainable practice.

Most importantly, Handler emphasizes the value of being deliberate about your business model. "I was so intentional about what I wanted to create," she says. "This is the life that I want."

For healthcare providers feeling trapped in traditional practice models, Handler's story demonstrates that with careful planning, strategic use of technology, and a clear vision, it's possible to build a practice that serves both practitioners and patients better.

World of Rehab 🌐

• [Speech] A UK study reveals significant pandemic-related developmental challenges among children born during lockdowns, with one school reporting a rise in speech and language needs from 25% to 34% among pre-schoolers, while NHS England data shows over 28,000 children waiting months to years for speech therapy appointments.

• [Physical + Occupational] Starting January 2025, CMS will relax Medicare supervision requirements for physical and occupational therapy assistants from "direct" to "general" supervision, allowing supervising therapists to be available remotely rather than on-site—a change expected to save $242 million over 10 years while improving care access, particularly in rural areas.

• [General Rehab] WebPT's 2024 State of Rehab Therapy report, based on a survey of over 5,000 therapy professionals, reveals persistent industry challenges, including high burnout rates (85% of clinicians documenting at home) and declining insurance reimbursements. It also highlights opportunities in cash-pay models, advocacy efforts, and emerging technologies like AI to shape the field's future.

Indie’s Insights: The Promise of Predictive Analytics 💡

While hospitals race to implement AI for surgical outcomes, we in rehab therapy are sitting on a gold mine of untapped potential. The Cleveland Clinic's recent move to predict spine surgery outcomes got me thinking - what if we could bring this same predictive power to rehabilitation?

Let's be honest: we've all had those moments. A patient walks in, and based on experience, we make educated guesses about their likely progress, potential barriers, and optimal treatment frequency. But what if we could move beyond intuition to data-driven certainty?

The Current State: Why We Need Better Predictions

Right now, our prediction "tools" are primarily clinical experience and standardized outcome measures. While incredibly valuable, they don't capture the full complexity of rehabilitation. A patient's success depends on countless variables: age, comorbidities, social support, prior level of function, motivation, and dozens of other factors that we process subconsciously during evaluation.

The Game-Changer: Predictive Analytics in Rehab

Imagine having a tool that could:

• Predict how many sessions a patient truly needs (not just what insurance will authorize)

• Identify which patients are at high risk for poor adherence before it becomes a problem

• Suggest optimal treatment frequencies based on patient characteristics

• Flag potential barriers to progress early in the care episode

This isn't science fiction. The data already exists — we just haven't harnessed it effectively yet.

What Makes Rehab Different (And Why That's Good)

Unlike surgical outcomes, which are relatively binary (success/complication), rehabilitation offers rich, continuous data. Every session generates multiple data points about progress, adherence, and response to interventions. This complexity, which has historically been a challenge, becomes an advantage in the age of predictive analytics.

The Real Promise: Personalized Care Pathways

The goal isn't to replace clinical judgment but to enhance it. When we can predict with greater accuracy:

• Which patients need early intervention to prevent dropout?

• Who will benefit most from certain treatment approaches?

• What frequency of visits will optimize outcomes?

• Which home exercise programs have the highest adherence rates?

We can truly personalize care from day one, rather than using trial and error.

Starting Small: What We Can Do Now

While we wait for sophisticated predictive tools, we can start laying the groundwork:

• Standardize our outcomes collection

• Document modifiable factors that influence progress

• Track adherence patterns and barriers systematically

• Build datasets that capture the complexity of rehabilitation

Looking Ahead

The future of rehab therapy isn't just about predicting outcomes - it's about proactively optimizing them. When we can identify likely barriers before they arise, we can adjust our approach preemptively rather than reactively.

This isn't about replacing therapist expertise with algorithms. It's about augmenting our clinical reasoning with data-driven insights, allowing us to focus more on what matters most: meaningful patient interactions and skilled interventions.

As Nassib Chamoun from the Health Data Analytics Institute recently noted about their work with Cleveland Clinic: "We're reducing their time in the electronic health record and shifting it to focusing on personalizing care for patients. That's a more joyful way to practice for them, less burdensome, and ultimately better for the patient and their outcomes."

And isn't that exactly what we all want? A future where technology handles the heavy lifting of data analysis, freeing us to do what we do best: deliver personalized, hands-on care that changes lives.

See you in two weeks,

Eddie

P.S. Have thoughts about predictive analytics in rehab? I'd love to hear them - reply to this email!

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