Running a private practice in physical therapy is a demanding and multifaceted endeavor. It goes beyond the typical responsibilities of patient care, encompassing the complexities of business management—everything from understanding zoning laws and managing business property taxes to handling staffing, inventory, and marketing. For many private practice owners, these demands are all-consuming, often taking up nearly every waking moment. This leaves little time or energy to engage in broader professional activities, such as serving on physical therapy boards. The issue of representation on these boards is particularly pressing. Recently in North Carolina, a call for new board members highlighted a striking reality: private practice owners were notably absent from the list of candidates. This absence is not due to a lack of interest or capability but rather the overwhelming demands on their time. Serving on a board requires a significant commitment—attending monthly meetings, preparing for discussions, and making decisions that impact the entire profession. For a private practice owner, whose day-to-day operations depend on their constant presence and oversight, such a commitment can seem nearly impossible. Closing down the clinic, even temporarily, could have significant financial repercussions, not to mention the impact on patient care. Yet, this lack of representation is troubling for several reasons. Private practice owners are often the most vulnerable to complaints filed against licensees. These complaints may arise from disgruntled employees or patients dissatisfied with payment policies or insurance coverage decisions—issues that are far more prevalent in private practices than in other settings. Without a voice on the board, the unique challenges and perspectives of private practice owners are not adequately considered in policy-making, potentially leading to decisions that are detrimental to their operations. Addressing this gap in representation is crucial. The current board members, who may primarily come from hospital or corporate settings, may not fully appreciate the nuances of running a private practice. They might not understand the importance of reputation management or the advanced certifications that many private practice owners pursue—such as manual therapy, dry needling, or instrument-assisted mobilization—to stay competitive and provide the highest level of care. The American Physical Therapy Association (APTA) and its Private Practice Section (PPS) offer some resources and advocacy efforts aimed at supporting private practice owners. However, these efforts can only go so far if private practice owners are not directly involved in the decision-making processes that shape the future of the profession. The challenges of running a practice—personnel management, leadership development, and maintaining a CEO mindset—are significant, but they also underscore the need for strong, experienced voices on the boards that govern our profession. The odds seem stacked against private practice owners when it comes to board representation. However, by advocating for more inclusive policies and encouraging participation, even in small ways, we can begin to bridge this gap. Ensuring that private practice owners have a seat at the table is not just about fairness; it’s about the survival and thriving of the profession as a whole. The call to action is clear: private practice owners need to find ways to engage, whether by lobbying for changes that make board participation more accessible or by supporting colleagues who can represent their interests effectively. Without this representation, the profession risks becoming disconnected from the very practitioners who are most attuned to its real-world challenges.
