To me, Physical Therapyworks has always been more than a business. It’s not about branding or expansion or social-media exposure, and even less about maximizing—or even making—profits. In fact, despite always having a full schedule with an active wait list, for many of our years we have worked at a loss. Since nobody- literally nobody - understands or believes how you can have a full schedule, an efficient organization, and work at a loss, I’m going to take a few paragraphs to explain. Because understanding this ties into our origin story and makes this believable. I hope it does because it’s all true.
Initially I was a “cash only” therapist, and that was only because I didn’t want to have to deal with insurance companies. Via word of mouth I quickly developed a full schedule of patients, mostly wealthy. This remained the case for many years, until my good (and somewhat bossy but certainly not affluent) friend Betty called me and in her tough Brooklyn accent told me (make that ordered me) “John, you have to take my Blue Shield Insurance!”. Because I loved Betty, and because of the beliefs I was raised with, I did just that. Word spread and next thing I knew everyone wanted me to take their insurance, and I gradually became a preferred provider with all the insurance companies. That was fine with me, as it felt good to be able to provide my services to a broader cross section of people, and it was relatively simple to bill the insurance. I was paid roughly the same amount as my cash rate, so it worked financially, and it was also a good match with my ideals or if you will, my worldview. Accepting insurance changed the way people viewed me, but that wasn't important.
Unfortunately things changed for the worse. In the coming years insurance companies decreased payment by about 40%, and the time required to deal with them tripled (at the very least). It got to the point that for quite a few years now - roughly the past ten - we have either broken even or worked at a financial loss. This is despite an excellent reputation, and as mentioned a full schedule and an active wait list.
In the meantime, the trend has been to move in the opposite direction. Most of the new clinics are cash only, and many existing clinics have transitioned from insurance to cash payment. While I have created a concierge clinic called PTWorks+, at the same time I’ve stubbornly insisted on keeping Physical Therapyworks alive and in network so that we can provide high quality PT to as wide a spectrum of the population as possible. As mentioned, this is without a diminishment of quality, and in fact I will argue that the quality of care is even better than it previously was. Why? Once again, it matches my ideals. To not only be “the best therapist” and to provide “the best therapy”, but to make “the best therapy available to one and all”. Again, we’re not so much a business. We’re more of a mission.
It hasn’t been easy to operate in this manner. I’ve become accustomed to fifteen hour days not only to accommodate patients but also to maintain the clinic (mountains of paperwork, steam cleaning the carpets, repairing the sink...) and improve the clinic (program development, and doing actual clinic build outs - that means tearing down walls and reconfiguring the clinic....), and I worked "15/7" for well over a decade. Why did I work that hard and get nothing financially in return? After many years of reflection, I think I understand the reason, and can finally tell our “origin story” in an accurate and concise manner.
I dreamed of being a physical therapist and having my own clinic since I was a teenager. Physical Therapy combines my interests and passions ranging from fitness and athletics - from typical American sports to yoga and meditation; to anatomy, physiology, biology, kinesiology and all of the pertinent branches of science; logic, philosophy, clinical reasoning and the diagnostic process; psychology; and the interactions and connections between all of the above. In Physical Therapy we treat “the whole person” and we have such a wide and varied body of knowledge and tools at our disposal. It remains fun to learn, apply, teach, and in fact play with these various components. And while of course it has been a way of helping and - with a little luck - healing others, at the same time it’s been a conduit to learn about and help myself. I’ve grown and become healthier by virtue of helping others.
In addition, the way I manage the clinic, and to a great degree the career I chose also grew and evolved from the system of values that my parents passed on to me. These values were influenced and strengthened by a childhood tragedy. My mother was most directly affected by this tragedy, and only as an adult have I begun to comprehend what it took for her to overcome this harrowing event. Here’s the story.
A 20-year-old woman and a 24-year-old man get married. They move into a working-class neighborhood on Chicago’s south side; she gets pregnant and delivers me in the 10th month of marriage. Now flash forward six months, to when Mom gets to have her first day off to herself. She drops me off at her parents’ house for babysitting, tells them she’ll be back in a few hours, and leaves.
While Mom is out, her father shoots her mother dead.
I’m told I was the sole eyewitness to my grandfather’s act of uxoricide: the killing of one’s wife. (Seems there’s no equivalent term for killing one’s husband. Maybe that’s never happened?) I remember nothing about the events of that day. Even if I did, my memories would be meaningless. When you’re six months old you have no words, no comprehension, no context. But for my mother, this trauma changed everything, inside and out. Only in midlife, looking back, have I begun to understand how shattered Mom must have been and what it took to put herself back together—and how this connects to my vision of Physical Therapyworks and how it should function.
I was 26 before I knew even the basic facts of that fateful day. In the years since I’ve learned everything I could about its aftermath and the changes it wrought in my mother, slowly assembling the whole picture in my mind. I wasn't surprised when I learned that my mother was ready to forgive her father, to tell him she still loved him--not when he was terminally ill or literally on his deathbed, based on drama or necessity -- but because she came to a place of peace via forgiveness and love. That fit her character. But how did Mom get herself there so fast?
For some people this healing process might begin with psychotherapy, but at the time of the murder we couldn’t afford to go that route. But with the anguish Mom continued to suffer in the wake of her own mother’s death, she must have been desperate for an emotional lifeline, a chance to heal herself. I think it’s fair to say that she had only one option open to her. So my mother, who previously only went to Church to placate her parents, turned to the church. She seized on the rituals and routines, the liturgy and music and language, and hung on tight. Tight enough and long enough to nurture a sense of serenity over despair, to temper darkness with light, grief with love—and to spread her newfound spiritual wealth to others. In fact, now that I think about it, my Mom has always done her best to be a Christian version of a Bodhisattva!
In those days we practically lived at church, on both weeknights and weekends. I was an altar boy. Mom went to Bible study. I went to Sunday school (where Mom was one of the teachers.) I played on the Church basketball team (we weren’t too bad!). And my life lessons continued outside of church, at home, under my mother’s tutelage. She simply and literally changed the subject from theological doctrine and the rituals of faith to focus on ethical and moral conduct. By her own example she taught me the value of giving 100% of yourself to anyone and everyone, even those who were hostile or indifferent to you, without expecting anything in return; to see things from the other person’s point of view; to be loving toward everyone no matter who they are and what they’ve done; to never be negative, never hurt anyone or anything, and always try to be a force for good. This might sound overly idealistic, and perhaps it is, but it’s the truth. It doesn’t mean that she, or I, have consistently reached this state. No, we are not saints and I know I often fall ridiculously short of this ideal. But I will say I spent many years of my life essentially acting as a blue collar martyr - both in and outside the clinic - and it’s only in the past few years, as I’ve come to understand this story - my story - that I’ve increased the focus on my own self-care and well-being.
My mother was clearly learning what it means to “heal thyself,” and she took me along on her journey. I just didn’t know the reason behind it, as she didn’t tell me about the murder until I was in my mid 20’s. Nonetheless, she taught me well; she not only “preached” but she led by example - teaching at Sunday school, volunteering at the Church, visiting nursing homes on weekends, and anonymously contributing to charities even when we didn’t have a penny in the bank. If and when she was slighted or mistreated, I would see her smile, forgive, and accept the person in the moment. I absorbed her lessons to the core, and instinctively I applied them to my own life’s work. They still drive me to this day. They’re the reasons I continue to accept insurance plans that pay me less than it costs to treat the patient. They’re the reason I haven’t told anyone - until now – about my predicament. They’re the reasons I work 12 to 16 hour days, 5 to 7 days a week, so that I can keep practicing this way and keep our doors open. Do something that’s good for everyone and bad for no one. That’s one rule I live by, courtesy of my mother.
Creating Physical Therapyworks and running it the way I do reflects the values Mom instilled in me. There have always been physical therapy clinics, of course, and excellent ones at that. But I honestly feel that here at PTW, we’ve always given our patients everything we’ve got regardless of who they are or how much we’re paid -- and I think we do it as well or better than anyone. Ultimately, it’s quite simple: I’m just doing unto others as I would have them do unto me.
So, am I the only person in this field that wants to help others? Of course not, I’m one of many. But I’ve been doing it in a way that I’m proud to say attracts referrals from top MD’s while VIP patients (and others who take the bus) continue to come back year after year--with new problems, not the same ones!-- and refer their friends and family. Even now when payment has essentially been cut in half, I continue to provide the same (or even better) quality of care I always have. You only do that sort of thing when the lessons you learned were deep, strong, and Utopian. Which I’ve become because of my mother.
But if you read the book Utopia, by Thomas More, you realize that it doesn’t always work out according to plan. I’ve learned that at times I have to ask for help. “I can’t help you if I can’t help myself”, right? We suffer together, and we thrive together. But still, I stick to the dream, the worldview, that if we treat each other with love and respect, if we forgive each other’s human weaknesses and focus on the positives, we can help each other and live together in a way that helps us all. We can share, interrelate, help each other, grow, and all be better off for it.
Twenty-four years in, the story continues, ever changing and evolving, but always sticking as close as possible to the original lessons and the dream that they inspired...
-In honor of my Mother, Patricia Ann Dravillas