Defining Moment Striking Gold in Copper City Opening a practice, with help from mom. By Jacquie McAdam, PT, MPT | June 2015 Listen to 'Defining Moment' I grew up with a mom who was diagnosed with rheumatoid arthritis at 24. By age 40 she had undergone total joint arthroplasty on both hips and both knees. I watched her go through revisions of those original surgeries. I saw firsthand what physical therapy can do. One revision resulted from a fall in our backyard that caused the prosthesis to fracture out of the femur on the right hip replacement. I happened to be home from school that summer, following my first clinical internship, so my mom asked her orthopedic surgeon if she could do her exercises at the house, with me. He granted her request—with the qualification that if my mom did not progress sufficiently she would have to see a physical therapist (PT) in a clinical setting. Two weeks later, it was time for mom to see the surgeon. He was surprised by how far she had come. "Yeah, well, here's the deal," she responded. "If you go to a clinic for physical therapy, you go 3 times a week. If the physical therapist–to–be lives with you, you do your therapy twice a day, 7 days a week!" The surgeon and I chuckled, and she continued with her exercises at home. My mother is 1 of the toughest, most positive–thinking, most inspiring people I know. I saw from an early age how physical therapy helped her meet her movement goals, so, when people ask me why I became a physical therapist, she always is part of my answer. She made me want to earn my license and become "one of the good ones," as she puts it. My parents will tell you that I decided to become a PT when I was in the eighth grade. I never wavered in that pursuit. And I still love what I do. The job is fulfilling and fun. It's more than worth the work it took in school, and the diligence it has required to stay at the top of my game as a practitioner. I have been practicing for more than 13 years. My goal since graduating from PT school was 1 day to own my own practice. I liked the idea of being my own boss and having the ability to shape a practice in my own way. But I knew better than to attempt that straight out of school. Rather, I sought out opportunities to learn all I could in preparation for practice management and ownership. Over the course of 9 years I managed 2 separate clinics. The first clinic offered me an attractive incentive. The owner was willing to sell after I had managed the facility for a time. I was over the moon for this opportunity! As it turned out, though, when the owner was ready to sell, she wanted half a million dollars—for a clinic with no attached real estate and only a single PT (me). Equipment replacement costs would have been high, too, and I discovered that the rental agreement for the clinic space was nontransferable. I feared that I'd never be able to dig myself out of debt with this deal, so, regrettably, I had to walk away. It was, however, an excellent learning experience. My next opportunity to manage a clinic was a great experience that broadened my skill set for owning a clinic. For several years I managed a staff that included 1 full–time and 1 part–time PTs, 2 full–time physical therapist assistants (PTAs), and a full–time physical therapy aide/office assistant. I established and watched flourish a highly effective PT/PTA team approach to treatment. I was in the thick of coding, staff development, and day–to–day operations, while managing a caseload with my PTA teammate. The clinic was part of a larger company, however, which meant that I had to answer to an administrator and board of directors. That often proved challenging. There was a constant push for "numbers, numbers, numbers." I pushed back with a pointed emphasis on quality of care over quantity. I faced barriers when it came to personnel issues, as well. As department head, I was involved in hiring and firing decisions, but I never had the final say. After 8 eight years, I decided it was time to make the leap to owning my own practice. I began scouting locations. In a sparsely populated state like Montana, Butte qualifies as a city, but it's a modest–sized town by most any other measure. Finding appropriate clinic space within Butte's limited inventory proved to be an adventure. I looked at a small house—too small—that had been refurbished to accommodate a previous business. I toured a huge structure that offered far more space than I needed. I explored several buildings with crumbling and/or asbestos–laden walls that required more renovation than I possibly could have afforded. My "favorite" option was a place with basement bathrooms so small you barely could turn around when you reached the toilet! Needless to say, there was no chance for wheelchair accessibility in that place—at least not without a thick wallet and a design team. Finally, though, at my real estate agent's prompting, I visited a location that actually had hosted a physical therapy practice. The clinic had been bought out by a larger company and staff was moved to another location. This was the first place that made me feel excited the second I entered it. As luck would have it, the space had been available for more than a year and the senior living facility that held the lease was willing to negotiate. I had found a home for my new clinic. When the time came to set things up, my parents and extended family came to town. They arrived in time for Christmas. My husband, my dad, and I spent the weekend after the holiday assembling equipment. My mom and mother–in–law busied themselves cleaning cabinets and shelves, and putting things wherever I directed. They kept my 6–year–old daughter occupied, too—which was no easy feat, given that none of our activities focused on her or her toys! The final days of preparation were a blur of flying cardboard and Styrofoam. I had never had so much fun opening boxes! It was like a second Christmas. At last, on January 5 of this year, Copper City Physical Therapy opened for business. Halfway through that first day, a delivery arrived from my parents. They had sent a large peace lily with a card that read "Knock ‘em dead! We are so proud of you!" It came as a joyful affirmation from the mom whose own physical therapy journey had played a big role in setting mine in motion. Jacquie McAdam, PT, MPT, is the owner of Copper City Physical Therapy in Butte, Montana.