Why Scaling a Clinic Is Tough—and How to Solve for It
A lot of people dive into owning a retail clinic or studio with big plans to build one location, then scale to more. But even though these are “small” businesses starting out, they demand a lot of time beyond patient or customer care. Many chiropractors, physical therapists, kinesiologists, and athletic therapists come from high-performance sports backgrounds. They can make fantastic entrepreneurs, yet it’s easy to get trapped working endless hours for limited revenue—or they build one nice clinic and then hitting two locations or jumping from two or three clinics to five or ten suddenly feels like a mountain to climb.
And for those who just want to launch a single clinic—either by buying or starting one—it can get expensive. Rent alone often takes up 8%–12% of revenue. On a 40% gross margin, that actually eats 20%–30% of gross margins. Then factor in front desk staff, software, recruiting new therapists, community involvement... and realize there are only so many motivated people who care as deeply as the owner.
We’ve done a lot of field research on this. We also own a clinic, have been part of an investment roll-up, and have opened hundreds of clinical services on behalf of other clinic and studio owners. Below are the biggest levers we’ve seen that really help companies scale.
1. Ownership
A winning move we’ve observed is giving clinic managers—or your anchor administrative, patient-facing person—some ownership or profit share. Deep trust takes time and goes both ways. One way to build that trust is to show you’re committed to caring for the key people in your business.
A Cautionary Tale
When we purchased a clinic, the clerical staff quit on Day 1 in an effort to sabotage the therapist-owner we’d just bought it from. In response, we replaced them with someone who earned a percentage of profits above a certain threshold, plus other incentives. A few years later, we discovered some therapists were doing sketchy things, and because we’d built trust with our new manager, they told us in time to proactively handle it. The lesson: there aren’t many truly capable and driven individuals to help you scale—so when you find someone special, create a solid path for them.
Learning from PT Health
The PT Health acquisition is a textbook example of what happens if you move away from ownership/profit-sharing and become more corporate. PT Health was built up, sold, and eventually struggled with profitability before being fully absorbed and then rolled into LifeMark. Meanwhile, LifeMark itself was a banner acquisition in the space and got owners excited about big valuations—but that’s a conversation for another day.
Bottom line: in our experience, owners who share upside with those they trust to help run the place see proven results.
2. Process & Systems
There’s a world of software out there to streamline billing, scheduling, patient follow-ups, and marketing. But adding too many tools can inflate your expenses without lifting sales, so it’s all about striking the right balance.
Patient Booking—The Art and the Science
Strong clinic managers know which patients are flexible and which therapists want more or fewer hours, so they can keep calendars tight. But there’s also a “cadence” to it—call-backs and follow-ups that are best done consistently.
Billing: We love JaneApp.
Phone/Process Automation: We’ve heard great things about CallHero, which some clinics use to tighten up front-desk processes. We tried it in one clinic and got good results, though we didn’t fully commit the right person to manage it.
3. Sales Processes
There are endless approaches to sales, but here’s what’s worked for us:
MD Referrals & Word of Mouth
Great sources for high-quality leads.Digital Ads
We’ve found Google Ads or Instagram offers can attract “deal chasers” rather than loyal, long-term patients—especially if your clinic runs on a higher price model. That said, bigger networks that can leverage scale and data might swear by performance marketing and SEO. We’re simply sharing our own direct experience.Community Building & Finding a Hook
Facing what felt like an impossible task of cold-calling family medical clinics, we got creative. We noticed many patients already use cannabis or CBD for pain, but cannabis retailers aren’t permitted to give detailed health advice. At the same time, family doctors rarely prescribe it due to potential risks.
Our workaround was to provide local medical clinics with a vetted list of cannabis retail stores that follow the rules and never give out unauthorized health advice—and we also position ourselves as a “canna-friendly” clinic in the area. This angle sets us apart, helps us collaborate with local retailers, and opens referral streams. It’s worked so well at one of our clinics that we’re rolling it out to our entire Align partner base.Yes, Actually Calling People
Resourcing is always a challenge, but with the right staff, a simple script, and consistent outreach, phone calls can be surprisingly profitable. We averaged $155 in gross margin value for every hour paid to a caller, and sometimes there’s even more upside down the road from people who don’t book right away but remember the friendly call later. Timing these calls around new service launches or new therapists can be especially effective.
4. Scaling by Attracting (and Keeping) Talent
When we look at scaling, we think about both square-foot capacity and calendar capacity. We can’t open 24/7, so we have to be creative about hiring models.
Common frameworks include:
Hourly: You risk paying out more overhead, and you might attract people who aren’t as proactive about building a patient base.
Percentage Split: Harder to hire for; if you don’t keep them busy, they might leave—and take their patient load with them.
Room Rental: Stable cash flow, but you risk losing bigger patient revenue potential.
So what’s the fix?
Anchor Therapist & Co-Ownership
If you’re not that anchor therapist yourself, consider giving a key clinician or manager 10–20% ownership. An anchor therapist helps drive community connections, sets hiring standards, and offers leadership among staff.Two-at-a-Time Hires with Tiered Percentages
Bringing on two hires at once on a higher percentage split that tapers down after two, four, or six months can jump-start new hires’ motivation.Ingesting a Mobile Therapist’s Patient Base
Offering a royalty-like model to an independent mobile therapist (or any practitioner) can help “buy” their book of business without a big up-front investment. If it doesn’t work out, you usually find out quickly—and your cost is limited.Build a Candidate Database
The same way you keep track of patients, keep track of quality potential hires. Over time, this list matures into a go-to resource whenever you need fresh talent.Yield Management
While scaling new therapists and keeping existing ones busy, be mindful of costs of hourly vs percentage and the sensitivities around booking new people in for one therapist vs another. Clear guidelines and communication avoids infighting while optimizing the hourly revenue per calendar hour available and per room hour available.
Final Thoughts
Scaling a clinic isn’t simple. Rent, software, staffing, marketing, and day-to-day operations can snowball if you’re not careful. But by sharing ownership or profit-sharing with key players, streamlining processes without overdoing it, focusing on high-quality referrals, and getting creative in your hiring and outreach strategies, you can set yourself up for real growth.
AlignWellness was designed to take the pain out of scaling, while acting like your navigator in the market. We don’t accept everyone, but when we do partner with owners we ensure their success. Last year we saw over 100% YoY growth with our partners vs the industry which grew only modestly. Learn more about how to build your business and net worth at AlignWellness.ca.
