Advertise on podcast: Freedom by Design

She started her practice to create freedom, but soon found herself working more than ever. Sarah shares how she transformed from an overwhelmed clinician into a true business leader by changing her mindset, building the right team, and creating systems that allowed her practice to grow. Learn the lessons every healthcare business owner needs to know before reaching burnout. This is the final episode in this launch run. If it moved you, subscribe, share it with an owner who needs to see that an intentional exit is possible, and comment with where you are in your own journey right now. Episode Breakdown: 00:00 - Opening Hook 0:20 - Guest Introduction: Sarah Pettyjohn 1:46 - The Moment She Decided to Be the Boss 29:35 - Preparing the Practice to Sell 33:28 - Why She Exited on Her Own Terms 34:54 - From Client to Coach 36:48 - Her Biggest Regret as an Owner 42:25 - Closing Thoughts If billing gaps, collections, cash flow, or revenue leaks are creating stress in your practice, schedule a conversation with Jamey here. You can learn more about Sarah's work here.

Tom DiAngelis has been in this profession for more than 40 years. He owned practices in two states, partnered with a larger regional group, served as COO, and ultimately as a company lead before retiring in 2025. This episode is for physical therapy, occupational therapy, speech-language pathology, and mental health practice owners who want the long view- someone who has been through nearly every phase a practice can go through: ownership, partnership, executive leadership, and industry leadership, and can speak to what actually mattered across all of it. If this episode gave you the perspective you needed, subscribe, share it with an owner earlier in their journey, and comment with the lesson you wish someone had told you sooner. Episode Breakdown: 00:00 - Opening Hook 1:12 - Guest Introduction: Tom DiAngelis 2:24 - 40-Plus Years of Change in Private Practice 6:11 - The Danger of Emotional Decisions 7:04 - Why Every Owner Needs Someone Who Asks the Right Questions 35:33 - Getting Clear on What You Actually Want 36:33 - The Diversification Trap 37:57 - Keeping Your Core Business the Priority 44:10 - Closing Thoughts If billing gaps, collections, cash flow, or revenue leaks are creating stress in your practice, schedule a conversation with Jamey here. You can learn more about Tom's work here.

There's a reason some practices have marketing that works, and others don't. It's not a budget. It's not luck. This episode breaks down what it actually is. Joshua Brummel is the co-founder of TherapyFlow and author of The Flow, a weekly read for over 15,000 practice owners. Before going deep into the mental health practice space, he cut his teeth in sales and marketing at places like the Chicago Tribune and Vector Marketing, so when he talks about what works, he is not guessing. TherapyFlow has helped hundreds of practices scale to multi-six and seven figures by building consistent marketing, sales processes, and operations that actually flow, and his whole philosophy is simplicity over hustle. This episode is for mental health, physical therapy, occupational therapy, and speech-language pathology practice owners who have worked with thousands of clients between them and want to know what is actually going on under the hood when marketing stops working. If this episode reframed how you think about your own marketing struggles, subscribe, share it with a mental health practice owner in your network, and comment with the tactic you have chased the most without results. Episode Breakdown: 00:00 - Opening Hook 0:31 - Guest Introduction: Joshua Brummel 1:54 - Getting Under the Hood of a Broken Marketing Strategy 2:48 - Different Revenue Stages, Different Marketing Problems 9:04 - Choosing the Right Strategy Before Scaling It 15:16 - Less Is More: Going Deeper Instead of Wider 38:07 - The Skill of Hiring the Right Marketing Help 38:36 - How to Connect With TherapyFlow 40:08 - Closing Thoughts If billing gaps, collections, cash flow, or revenue leaks are creating stress in your practice, schedule a conversation with Jamey here. You can learn more about Joshua's work here.

You don’t need to be a professional writer to create a meaningful book. You need a story, experience, and ideas worth sharing. In this episode, Jamie Dykstra, nonfiction ghostwriter and book coach, explains how healthcare practice owners can turn their knowledge into a book that builds credibility, strengthens their reputation, and creates new opportunities. Jamie shares why many successful owners never write their stories, the mindset challenges that hold them back, and how becoming an author can help you stand out in a competitive healthcare market. Whether you own a physical therapy, occupational therapy, speech therapy, or mental health practice, this conversation will help you understand the power of sharing your expertise beyond your clinic. If this episode is the nudge you needed, subscribe, share it with the practice owner in your circle who has always said "I should write a book," and comment with the one story you would tell if you finally did. Episode Breakdown: 00:00 - Opening Hook 1:01 - Guest Introduction: Jamie Dykstra 2:18 - What Actually Stops Owners From Writing Their Book 7:11 - Why Vulnerability Is the Point 11:51 - What a Book Actually Does for an Owner 14:54 - Turning Readers Into Real Opportunities 23:40 - Staying Real Without Oversharing 36:54 - Where to Find Jamie Dykstra 38:37 - Closing Thoughts If billing gaps, collections, cash flow, or revenue leaks are creating stress in your practice, schedule a conversation with Jamey here. You can learn more about Jamie's work here.

Neil Trickett built and exited his own successful physical therapy practice, then went on to build Practice Promotions, a multi-seven-figure agency that has helped hundreds, maybe thousands, of practice owners grow their patient volume. He is not a marketer who studied healthcare. He is a practice owner who became a marketer, and that difference matters. In this episode, Neil traces the entire arc of practice marketing, from cutting his teeth on direct mail postcards and printed newsletters in 2011, through the shift to websites and Google advertising, through the acceleration COVID created in digital behavior, to where AI is pushing search today. He also gets specific about what happens when an owner hires a marketing coordinator and thinks the problem is solved, versus an owner who hands over a credit card expecting marketing alone to fix a referral problem that is really a conversion or operations problem. This episode is for physical therapy, occupational therapy, speech-language pathology, and mental health practice owners trying to figure out where marketing actually fits relative to operations and conversion. Episode Breakdown: 00:00 - Opening Hook 1:08 - Guest Introduction: Neil Trickett 2:08 - 28 Years From PT to Marketing Pioneer 3:17 - "Have You Heard of This Thing Google?" 3:44 - From Postcards to Practice Promotions in 2011 4:03 - COVID as the Light Switch 6:55 - The Credit Card Question: What Marketing Alone Can't Fix 23:36 - Tracking Your Real Patient Acquisition Cost 41:28 - Your Free Marketing Ideas Kit 42:39 - Closing Thoughts If billing gaps, collections, cash flow, or revenue leaks are creating stress in your practice, schedule a conversation with Jamey here. You can learn more about Neil's work here.

Imagine walking into a maximum-security prison to teach convicted killers how to stop fighting. That's where today's guest learned what actually works, and today he's bringing it to your practice. Douglas Noll is a former trial lawyer turned peacemaker who has spent his career teaching people how to de-escalate conflict, not in boardrooms, but in maximum-security prisons and the halls of Congress. In this episode, he breaks down why almost none of us were ever actually taught how to listen, and hands over a two-word technique that calms an angry patient, a defensive employee, or a furious teenager in about 15 seconds. This episode is for physical therapy, occupational therapy, speech-language pathology, and mental health practice owners who are tired of every emotional fire in their practice ending up on their own desk, and for anyone who has ever said "calm down" to someone and watched it make things worse. If this episode changed how you'll handle the next hard conversation in your practice, subscribe, share it with someone who needs to hear it, and drop a comment with the moment that hit hardest. Episode Breakdown: 00:00 - Opening Hook 0:39 - Guest Introduction: Douglas Noll 2:38 - Why We Handle Difficult Conversations Badly 2:57 - The Real Problem: We Were Never Taught to Listen 3:39 - The Myth of Rationality 12:03 - Cognitive Empathy: The Learnable Skill 16:29 - Roleplay: Coaching an Underperforming Employee 22:03 - Why Naming Emotions Builds Trust, Not Discomfort 24:03 - The Science Behind Why This Works 27:41 - The Cost of Never Mastering This Skill 31:32 - 800 Lifers, Zero Reoffenders 32:54 - What Culture Actually Means 35:33 - Why You Should Never Say You're Sorry 40:44 - Where to Find Douglas Noll 42:21 - Closing Thoughts If billing gaps, collections, cash flow, or revenue leaks are creating stress in your practice, schedule a conversation with Jamey here. You can learn more about Douglas' work here.

Why do some practices create loyal, raving fans, while others deliver good care and still struggle to grow? Jerry Durham has spent 15 years answering that question. After owning a physical therapy practice in California and later relocating to Philadelphia, he built a company focused entirely on helping healthcare businesses create experiences that drive loyalty, retention, referrals, and growth, starting at the front desk. This episode is for physical therapy, occupational therapy, speech-language pathology, and mental health practice owners who know their clinical care is strong but cannot figure out why referrals and retention are not matching it. If this episode made you look at your own front desk differently, subscribe, share it with the person on your team who runs your front office, and comment with the one thing you are changing this week. Episode breakdown: 00:00 - Opening Hook 0:20 - Guest Introduction: Jerry Durham 1:20 - Two Old Friends and an Etch-A-Sketch Career 2:44 - Going Out of Network Before It Was Cool 4:15 - Falling in Love With the Front Desk 5:51 - From California to Philly and Back 14:57 - Why Only 10% of the People Who Need You Ever Find You 17:54 - Client, Not Patient: The Power of Words 28:14 - The Virtual Front Desk, and Why Healthcare Experience Isn't Required 32:32 - It's Marketing, Branding, Training, and Systems, All Together 40:48 - Where to Find Jerry Durham 46:28 - Closing Thoughts If billing gaps, collections, cash flow, or revenue leaks are creating stress in your practice, schedule a conversation with Jamey here. You can learn more about Jerry's work here.

Technology keeps changing. The fundamentals don't. That is the entire premise behind this conversation with Sharif Zeid, founder and CEO of Empower EMR, who has spent more than 20 years in rehab technology working with thousands of practices. This episode is for physical therapy, occupational therapy, speech-language pathology, and mental health practice owners who are evaluating new technology or AI tools and want to know the difference between a tool problem and a foundation problem before they spend the money. If this episode changed how you think about your next technology purchase, subscribe, share it with an owner mid-EMR-switch, and comment with the tool you were most tempted to believe would fix everything. Episode breakdown: 00:00 - Opening Hook 1:04 - Guest Introduction: Sharif Zeid 2:13 - What's Working and What's Broken in Rehab Tech 3:27 - Technology as Gasoline on a Fire 5:23 - Growth Amplifies Dysfunction 6:11 - The Credit Card Fantasy: "Just Solve It for Me" 7:15 - The House-Building Analogy 26:31 - The 90% Win: Why You Don't Put the Nail Gun Down 38:17 - Practicing Gratitude as a Leader 39:52 - Where to Find Sharif Zeid and Empower EMR 42:06 - Closing Thoughts If billing gaps, collections, cash flow, or revenue leaks are creating stress in your practice, schedule a conversation with Jamey here. You can learn more about Sharif's work here.

Why do smart business owners still sabotage their own financial growth? That question opens this conversation with Sean Healy, founder of Accounted4, who has spent years inside the finances of practice owners across the country. Sean's answer is not about tactics or spreadsheets. It is about behavior, specifically a concept called mental accounting and why so many owners manage their books just well enough to file taxes and nothing more. This episode is for physical therapy, occupational therapy, speech-language pathology, and mental health practice owners who feel like they are doing everything right financially and still do not feel in control of their numbers. If this episode changed how you think about your own numbers, subscribe, share it with an owner who avoids looking at their P&L, and comment with your own profit target once you know it. Episode Breakdown: [00:00] Opening Hook [0:31] Guest Introduction: Sean Healy [1:54] The gap between "good enough for taxes" and "good enough to decide" [2:48] Mental accounting and business savings [9:04] Why some owners avoid their own numbers entirely [23:07] Setting the real profit number instead of a generic target [30:24] Closing thoughts If billing gaps, collections, cash flow, or revenue leaks are creating stress in your practice, schedule a conversation with Jamey here. You can learn more about Sean's work here.

Many successful business owners achieve money, growth, and recognition but still feel stressed, exhausted, and disconnected from themselves. In this episode of Freedom by Design, Dr. Brian Paris shares his journey from building a multi-million-dollar healthcare organization to facing burnout, personal struggles, and the need for deeper self-awareness. Learn how emotional intelligence, mindfulness, better leadership, and understanding your own emotions can help you create success without sacrificing your health, relationships, and happiness. If this episode hit close to home, subscribe, share it with someone who needs permission to admit they are not okay, and leave a comment about what "trapped" actually feels like for you. Episode breakdown: 00:00 - Opening Hook 1:09 - Guest Introduction: Dr. Brian Paris 2:44 - Building a Life Around Performance 3:30 - When It All Crumbled, and the Question That Followed 4:38 - Peru, Darkness, and Rebuilding From the Ground Up 6:55 - From Fragmentation to Integration 7:22 - What "Trapped" Really Feels Like 41:14 - The Practical Tools: Naming the Feeling 41:51 - Closing Thoughts If billing gaps, collections, cash flow, or revenue leaks are creating stress in your practice, schedule a conversation with Jamey here. You can learn more about Dr. Brian's work here.

Why are so many good practices still struggling to stay full, even while they are doing great clinical work? That is the question behind this conversation with Chad Madden, who started his practice with brutal timing (opening the same week his first child was born) and went on to build a six-location physical therapy business with a recent valuation of 16 million dollars. This episode is for physical therapy, occupational therapy, speech-language pathology, and mental health practice owners who are still leaning on physician referrals as their primary growth engine and want to understand what happens when that well runs dry and how to build something more durable in its place. If this episode made you rethink your referral sources, subscribe, drop a comment about how much of your growth still depends on physician referrals, and share this with an owner who needs to hear it. Episode Breakdown: 00:00 - Opening Hook 0:27 - Guest Introduction: Chad Madden 1:32 - Starting a Practice With Brutal Timing 4:02 - Doubling the Business, Then Losing a Partner 6:16 - The Fork in the Road Toward Direct-to-Consumer Marketing 6:58 - The Moment 154 Referrals Disappeared Overnight 23:42 - Finding a Differentiator, Then Meeting Carl 47:11 - Building a Movement: The Breakthrough Event 48:46 - Closing Thoughts If billing gaps, collections, cash flow, or revenue leaks are creating stress in your practice, schedule a conversation with Jamey here. You can learn more about Chad's work here.

Is the cash-based model actually better, or are practice owners just trading one set of problems for another? That question kicks off this conversation with Karen Litzy, owner of Karen Litzy Physical Therapy and longtime host of Healthy, Wealthy, and Smart. Karen has spent years mentoring practice owners through this exact debate, and she does not land where you would expect. In this episode, you will learn why the cash-based versus insurance-based argument is often too simplistic, what patient population actually determines which model can work, and why an owner in Ohio and West Virginia is running 50 clinics on insurance with 300 happy, profitable employees while plenty of cash-based practices quietly struggle. This episode is for physical therapy, occupational therapy, speech-language pathology, and mental health practice owners who are wrestling with which business model is right for them, and for anyone hiring 1099 versus W-2 team members and trying to get the structure right. If this episode challenged how you think about your own business model, subscribe for more conversations like this one, drop a comment with which model you run and why, and share this with a practice owner who is stuck debating the same thing. Episode breakdown 00:00 – Opening Hook 00:09 – Guest Introduction: Karen Litzy 01:54 – Is Cash-Based Really the Better Model 06:36 – The Skills No One Talks About 10:56 – The Elephant in the Room: Selling Without Insurance 19:49 – What Actually Separates Winners From Losers 28:43 – Why Rest Isn't Optional for Owners 31:09 – Business Is an Inside Job 31:58 – A Perspective Shift for Owners Stuck Between Models 36:04 – Give Energy, Take Energy 36:34 – Where to Find Karen Litzy 37:27 – Closing Thoughts If billing gaps, collections, cash flow, or revenue leaks are creating stress in your practice, schedule a conversation with Jamey here. You can learn more about Karen's work here.

Most practice owners do not stay stuck because they lack knowledge. They stay stuck because they stay involved in everything far longer than they should. In this conversation, we break down what actually keeps owners in the day-to-day, why letting go feels risky even when you know it is necessary, and how control quietly turns into overload. You will hear how identity, responsibility, and habits all play a role in keeping you in the center of the business. More importantly, this episode walks through what begins to change when you step out of the role of doer and start thinking like an owner. This is where the business starts to shift from something you manage to something that can actually run. Episode breakdown 00:03:01 - The loneliness that can come with ownership 00:03:47 - How overwhelm starts to isolate the owner 00:04:14 - Why loss of control becomes such a strong fear 00:08:48 - The challenge of growing a leadership team for the first time 00:17:15 - How guilt keeps owners pulled back into the business If the pressure of ownership, control, or loneliness feels familiar in your practice, schedule a conversation with Jamey here. You can learn more about Kerri and her work at Practice Freedom U here.

Hiring help does not automatically create freedom. Many owners bring on people, delegate tasks, and still find themselves pulled back into every decision. This episode breaks down why that happens and where delegation starts to fall apart. We get into the difference between assigning tasks and truly delegating responsibility, what has to change in how you lead, and why structure matters more than effort. You will hear how unclear expectations, weak systems, and inconsistent follow-through keep owners stuck in the middle, and how to build support that actually holds. Episode breakdown 00:03:23 - Why owners can default back into doing everything as they scale 00:07:57 - The role of virtual assistants in a growing business 00:16:42 - Learning what to delegate 00:17:20 - The uncertainty around what should be handed off 00:19:13 - Why delegation can fail when expectations are unclear If delegation, time pressure, or being the bottleneck is still limiting your practice, schedule a conversation with Jamey here. You can learn more about Will and Virtual Rockstar here.

At a certain point, more demand does not create more freedom. It creates more pressure. In this episode, we break down why marketing starts to feel heavier as your practice grows, even when you are doing more of the right things. You will hear what has changed in today’s landscape, why relying on tactics alone stops working, and why consistency and trust matter more than ever. This conversation also challenges the idea that marketing is something you can turn on and off, and shows how reputation and relationships compound over time. 00:01:51 - The importance of growing a brand 00:02:19 - Why CRM visibility matters for practice owners 00:03:06 - SEO, Google, and AI search engines 00:05:08 - How marketing opportunities can grow through relationships 00:13:12 - Tracking referral activity through the CRM 00:25:00 - Dashboards, leads, emails, and the owner’s visibility into marketing numbers If your marketing, brand, or AI strategy feels scattered as the practice grows, schedule a conversation with Jamey here. You can learn more about Brent and TheraSaaS Intake & Marketing CRM here.