Defining Moment Community Service Creating a clinic that literally speaks its patients' language. By Sylvestra Ramirez, PT, DPT | May 2019 Listen to 'Defining Moment' My physical therapy journey, like those of many of my peers, has featured frequent moments of adversity. Being a physical therapist (PT) requires a wide-ranging skillset. Beyond adeptly applying the knowledge and skills you learned in school, you must be an effective communicator while developing a collaborative relationship with patients and explaining procedures, modalities, and care plans. You must be meticulous in your documentation, because errors can mean no payment from the insurance company—and, conversely, strong documentation can maximize reimbursement. You must have the physical strength, too, to administer certain manual treatments, perform joint mobilizations, and effect safe transfers. Upon graduating from Rosalind Franklin University of Medicine and Science in North Chicago, Illinois, I felt well-prepared for the treatment/diagnosis/prognosis part of being a PT. I believed I had acquired and sufficiently sharpened the tools in my toolbox. But that wasn't all I wanted to do. I'd chosen this profession not only to have an impact on individual patients and clients, but also to create a societal legacy. I made the decision, therefore, to play a larger role in improving the health and wellness of the Milwaukee community via clinic ownership. Opening Physical Therapy of Milwaukee (PTM) and being an entrepreneur required a much different skillset than that of being a therapist. I needed to learn how to prepare, read, and analyze a balance sheet; draft a financial statement; and speak knowledgeably about return-on-investment. I had to develop skills to effectively market our services using today's social media platforms. I needed to instill in my team an obligation to serve each patient or client as if he or she were a member of that PTM staffer's own family. Now, imagine also being able to engage every patient or client in either English or Spanish—and recruiting a staff that is 100% bilingual. Establishing the first bilingual and bicultural physical therapy outpatient clinic in Milwaukee was a defining moment in my life. It was a roller coaster ride of excitement, anticipation, and fear of failure. But I'm proud to say that I never let any obstacle stop me. Multiple banks rejected me for a small business loan because, they noted, I had a negative net worth due to my high student loan debt. My response? I worked 2 jobs and cut out all unnecessary spending. With some family support, I ultimately was able to open PTM without incurring any additional debt. I didn't take no for an answer from insurance companies, either. From its earliest days, we at PTM have fiercely advocated for our patients to receive the care they need and deserve—at as minimal a cost to them as possible. More often than you might think, our tireless advocacy has prevailed. Our success at PTM has been a mixture of hard work, a strong dose of luck (that we've helped create), considerable out-of-the-box thinking, and ongoing dedication to listening to patients and staff and addressing their concerns. If you're thinking about jumping into entrepreneurship by opening a clinic, I'll share with you the keys to not just surviving but thriving in today's competitive marketplace. These are things that I've done and continue to do to strategically and positively impact the health of Milwaukee's Hispanic community. Be true to your beliefs. I grew up in Wisconsin—home of frigid weather, sensational cheese curds, and Kopp's frozen custard. I spent my childhood summers, however, living with family in Mexico. During those summers I perfected my Spanish and developed a firm commitment to doing whatever I could to help improve the lives of my community back home in Milwaukee. Later, as a student, I attended football games at the University of Wisconsin in subzero temperatures. I couldn't ride my bike to class for months because of all the snow. But if the climate outside my window often was hostile, my heart was warmed by my steadfast belief in my mission. I never thought about leaving the state. Milwaukee was where my Hispanic roots were, and that was where I knew my services as a PT were needed. Don't let fear hold you back. One thing I did as part of my early entrepreneurial education was network with other physical therapy clinic owners to learn the ins and outs of running a practice. I'll always remember attending a conference at which I was the only Hispanic woman in the room. I felt self-conscious that no one else looked like me or represented the community I was determined to serve. Of course I feared failure. But I promised myself in that moment not to give in to it and to instead channel my energy into working extra hard to achieve my goals for my community. The challenges of operating a business are real. They're in some ways even tougher when you are a woman and a Latina. Again and again, I've had to fight for a seat at the table. But rather than dwell on the challenges, I've looked beyond them to everything I hope to accomplish. In fact, I now mentor women from minority populations who are interested in starting a business and/or becoming a PT. I'm determined to pay forward the gift that my own mentors gave me. Service is a much more powerful motivator than fear. Never take no for an answer. A patient's health insurance may authorize 2 physical therapy visits—6 if you're lucky. In some instances, case managers refuse outright to authorize physical therapy. But always be confident that you have the knowledge, skills, and tools to help your patients meet their physical goals. No matter how challenging or complex that individual's presenting condition might be, don't give up on seeking reimbursement from insurance. In this and other difficult situations, go to a mentor or coworker, or vent to a friend for help in strategizing. Such brainstorming has helped me identify out-of-the-box solutions in many tough instances throughout my career. Establish a legacy. In addition to having an individual impact with each patient, consider the big picture. I realized early in my career that I would have to push my own boundaries daily to be a trailblazer in Milwaukee and in my profession. I've repeatedly prioritized my patients' and staff's needs over my own. If entrepreneurship is something that interests you, I encourage you to leap into it. Work from the start to break down barriers of language, access, and cost that exist within your community. As my experience attests, the trust and reputation you earn for those efforts will yield sufficient financial rewards. The greater dividend, however, will be the service you provide to those who are underserved. That will be your legacy.