The Benefits Of Creating A Specialty Practice With Susan Halbig, PT And Karen Pettine, PT Of ABQ Scoliosis And Spine Therapy

It’s wonderful to highlight a couple of PT owners who are not only past coaching clients but also young mothers who gathered the courage to partner up and create their own PT practice. Susan Halbig, PT, DPT and Karen Pettine, PT, DPT of ABQ Scoliosis and Spine Therapy in Albuquerque, NM found themselves as new mothers with a common desire to open up their own PT clinic. Not only have they been successful since then, they have provided specialized care to do so. Rather than a “take any and all patients” approach, they have “niched down” to see the exact patients they want to see and have expanded quickly because of it.

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I’ve got a couple of past coaching clients, PT owners from Albuquerque, Susan Halbig and Karen Pettine of ABQ Scoliosis and Spine Therapy . I’m excited to bring them on because they serve a particular niche of patients. They’ve got a partnership, they’re mothers, and done a lot of great work and had a lot of incredible growth over the past few years. I wanted to highlight a number of those things. Before we get into it, Karen and Susan, thank you for joining me. I appreciate it.

Thank you for having us.

Thank you. We’re really excited.

I’m excited to get into this. Tell us a little bit about your story. How did you guys get together? You’re in Albuquerque. What made you guys get together and decide to become partners in a PT clinic?

It was serendipitous. We have our first-born children eight days apart. We were both on maternity leave from our jobs as Staff Physical Therapists with one of the hospital systems here in town. We live fairly close together. We didn’t know each other at the time, but on our maternity leave, we would take walks around the park, and we connected. “You have a teeny tiny baby, so do I,” and it turns out we’re both physical therapists. We struck up a conversation and said, “We should start walking together. We’re off now. It would be nice to hang out and have someone to talk to.”

Through those conversations, we realized that we had a passion for treating scoliosis, which is our niche area of practice. That’s not super common. We took that idea and recognized there was a huge need in our state because there were very limited options for the type of treatment that we wanted to offer in our state.

We thought, “Wouldn’t it be great if we could create a clinic that would serve our community and meet those needs of these people?” It was in the moment of decision that we both were like, “Let’s do it.” We both went home that night and talked over with our families. Both of our husbands are super supportive, and they’re like, “You guys should do it. Make it happen.” That’s what started our journey.

Over the course of the next few months, we put together our business plan, rented office space, created a website, and did all those things. I remember launching the website and thinking, “If one person signs up or calls us, this is going to work. Let’s see what happens if anyone’s interested.” That same week, our first patient contacted us, and I was like, “This is going to work. We’re going to do this,” and it went from there.

How long ago was that?

That was in 2018, early 2019.

It’s only been a few years now. Where are you now? Tell us a little bit about your clinic at this point.

We’ll give a little history in terms of what room we started in and the space we started in and then continue on. When Karen and I first got that office space, it was about 300 square feet, so it was tiny. It was a closet that we shared. She would treat her patients in the morning, and then in the afternoon, we’d do a switch, and then I treat my patients.

From there, we moved to a little bit larger space, and that’s when we brought in another therapist, our first hire. We were in that space for a few years, and that was when the pandemic started. This past October 2021, we’re in a larger space. It’s about 4,000 square feet. We now have 5 physical therapists, 2 front desk staff, and 2 massage therapists on staff.

It’s incredible to see so much growth in a few years like that. Number one, congratulations. Number two, you guys have niched down. Tell me a little bit about your specialty and the patient population you treat.

Our specialty is treating scoliosis. All of the therapists on our team now have been trained and certified in the Schroth Method, which is the most well-researched method for treating scoliosis that is non-surgical. That’s something that we value as having a common language and foundation in our practice. We primarily see patients with scoliosis, as you might imagine, across all ages from as young as 2 up into the 90s, across the entire lifespan, male and female.

That is the bulk of our caseload, at least 50%, maybe a little bit higher at any given time. The other patients tend to be more general orthopedic with an emphasis on the spine. That’s our mix. Having that same shared background in training gives us a unique lens that we view all of our patients because it applies to everyone, some of these treatment principles. We can offer a very specialized and individualized approach to scoliosis treatment also.

Most owners would say, “We’ll take all comers. We’re pretty much trained coming through school as general orthopedic practitioners. We’ll see anything from the toes to the cervical spine and TMJ,” but you guys decided to focus on not only spine patients but also a particular method and treatment, the Schroth Method. That might be counterintuitive to some owners that you would niche down so much that you might be, “Limiting yourselves.” Did you ever have those kinds of thoughts as you started, Karen?

We were curious how many individuals we might be able to help and what the demand would be, but since we know 2% to 3% of the population has adolescent idiopathic scoliosis, a greater number into adulthood end up with different types of scoliosis. By doing the numbers on our population, even in our own area, I knew that we had a high number of people that would have this condition. That helped justify, “If there are that many individuals who have scoliosis, not all of them are coming to PT, but even if we got a fraction of them, that would still sustain a fairly large clinic and have a lot of room for growth.”

By doing some of the numbers, we could see the potential. Plus, we knew that this was an area that had not been served, so we felt like that would help us too. The other thing too is it’s also important to know who we don’t serve because it makes us very identifiable. If they have scoliosis and they’re looking for a non-surgical approach, they find us. They know exactly what we do and who we do it for. There’s no confusion on that end. In a way, that almost makes it easier for people to find us because there’s not a question of, “What is it exactly that you do? Who do you treat? Who’s appropriate?” It’s like, “I have scoliosis. I should see you.” It’s a direct link to us.

Susan, did you guys have any physician connections or relationships that you were planning to build off of? Was this something that you opened up, found a space, and decided on these are the types of patients that we’re going to see, and then sent that message out to physicians? Did you have any relations prior to opening up?

We did a little bit of both. Initially, I worked for five years at a hospital in Albuquerque in the pediatric clinic and had a very close relationship with the orthopedic surgeons there. They had known that I was trained in Schroth, and I was seeing a small handful of patients at Carrie Tingley for scoliosis. When I left Carrie Tingley to work with Karen exclusively, they knew that I was the only Schroth therapist there and that I was leaving.

It was nice because I had already had that connection. I know the orthotists that worked there that worked with all the kids with their bracing. I already had that in place. It was something that we could build off of to get us going initially. Quite a few patients followed me, from Carrie Tingley to ABQ Scoliosis and Spine. It was a nice cushion for us. Once we got started, we had our director of business development. He helped us with marketing and letting all the other orthopedic surgeons and pain clinics in town know that we exist. We did both.

Karen, when you open up this clinic and now that you’re into it a few years, there is also a mentality among PT owners that there’s a lot of competition around. I would assume because of your niche or specialty, you have a different view of “competition.” What would you say?

In general, as PT owners of the practice, we should be helping each other out, and there are plenty of patients to go around. I don’t feel like there’s a scarcity of people to help. I don’t have a scarcity mindset in general. Specifically for our population, there is no competition. Every Schroth-trained physical therapist in the state is under our roof. From that standpoint, there is no one else better positioned to serve this population, but even so, we value relationships with other clinics and working together. There are so many more people to help them than people who are trained and skilled as physical therapists to help them. I don’t worry about a lack of patients.

The Benefits Of Creating A Specialty Practice With Susan Halbig, PT And Karen Pettine, PT Of ABQ Scoliosis And Spine Therapy
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It’s cool because initially, people would think that as you niche down that you’re limiting the number of patients that you could see and also limiting the size of your practice. Whereas what you’re seeing is, and you guys are an example of this, you’ve niched down to a point where you know exactly who your patient population is.

If you can serve a significant number of them and get that word out, you can continue to expand because that’s 2% to 3% of the overall population. That’s a huge number of people. You are able to then expand within that group. There isn’t a lot of “competition” like other PT owners might think of other PT clinics around them. That’s cool. Go ahead and share some of your goals for the future growth of this particular niche.

Susan and I have always thought that everyone with scoliosis should have access to a physical therapist who is trained in treating that condition because it can be life-changing. We would like to reach all of the areas that don’t have that surface right now, which is quite a few. We’re in the process of refining our systems and figuring out how we can do what we want to do in a way that provides high-quality care and allows us to be efficient, effective, and profitable as a business too.

Do you know of any other Schroth-certified centers like yourself that are solely focused on scoliosis and the spine in the country?

There are a few. A lot of Schroth therapists start on an independent cash-based service. They might be in the same situation that Karen and I were in, where they have a small base, treat patients, and pay cash. There are a lot of therapists. There’s a directory that says where all of those therapists are located after they’ve been trained. There are some bigger clinics in Vancouver, nationwide, and internationally. They have these centers that are very focused on scoliosis, so it’s nice. There are a few clinics that are about 7 to 10 years ahead of us. We can see what they’ve done and use them as a model, which has been nice, but in the Southwest, we’re the only ones.

You guys started off working together, and it’s cool that you recognized some shared values and alignment simply because you were first-time mothers, children of the same age, and worked at a similar hospital facility. What do you think thus far in your partnership has made your partnership successful?

There are so many things. Bottom line, every day, Karen and I have an immense sense of gratitude for each other because we know that we couldn’t do it without the other one, considering that we have these parallel lives in our family. What’s nice is that we have an innate sense of knowing what the other one is going through because our families are so similar.

What’s nice is that we understand what we’re going through, both on the business side and on the family side. As moms, we have this natural ability to pick up the slack without even having to be told. If I feel like, “I’m slipping in this area,” Karen is immediately there to have that support so that I can take care of family stuff and vice versa. It’s been this nice unspoken way of supporting each other.

What would you say to that, Karen?

It’s been very natural. It comes naturally to each of us to find our own strengths. While we have similar values, we also have unique strengths, which make our partnership complementary so that we’re not trying to do each other’s jobs. We also are willing to step in and help them support each other.

A lot of it is not all of the decision-making rests on one person’s shoulders. That makes it much less stressful from that standpoint, too, because if there’s something that needs to be decided, we have a person to bounce ideas off of. We have someone who we know and trust who I can go, “I have this idea. We have this issue. I thought maybe this was the best course of action. What do you think?” We can share and strategize. It makes the whole process way more fun because I have a great friend to work with. We have this shared goal. It’s been just easy because Susan is so wonderful.

I know you guys. When you came to me to do some coaching, you had already had some clear delineation of responsibilities. Was that something you started that you immediately communicated with from the very beginning or understood fairly early on? Correct me if I’m wrong, but this is what I’ve seen and know about your business.

Karen, you’re more of the more financial, business-related, maybe even admin side. Whereas Susan, essentially early on, you were the clinic director and still might be in that overseeing the production of the therapy. Is that a conversation you had early on and said, “This is your lane, and this is mine,” thing?

It happened more naturally than by us recognizing what we each liked to do, what we were each good at doing, and then partially, also a necessity from different factors that played into the pandemic. At the start, I was pregnant with my son, my second kid. For some different health reasons, I couldn’t go into the office. I was on bed rest for a little while and did some different things.

That naturally meant, “I’ll take care of all the things that can be done without being in the office and treating patients. I’ll do all these things. You see patients and do those things.” We were already headed in that direction, but at that moment, that solidified that a little bit more. We realized that that worked and made sense, and we kept at it.

Another thing too is when we first opened the business, we had the mindset that we both needed to do everything because we were both trying to be, “We need to understand billing, this and that,” and we’re both doing it, but then when that natural split happened, it did make sense. We don’t need to be double-crossing and doing all of our work all the time because that makes us less efficient. It was nice that that natural split happened, and we accomplished more afterward.

What’s your communication rhythm now? Do you have to be pretty diligent in setting aside time to make sure you guys communicate, or are you doing it on the fly?

It’s both. We are mothers, and we’re mixing and crossing our world so frequently. We do have set aside time. We meet once a week for at least a couple of hours to talk everything out. On a daily basis, we’re slacking or texting each other all the time, so there’s both.

In those two-hour meetings that you have each week, I’m assuming Karen’s updating you, Susan. Susan, you’re updating Karen a little bit to some extent. Is that how that goes?

We do a debrief of all the things that we’ve done the week before, things that we’ve each been working on that we want to share, and then we spend some time talking about the vision and next steps and places we want to go. Intermixed with that, we are chasing the toddler, taking care of a newborn, and doing all those things too. It takes a couple of hours to get all that stuff, but it’s a fun time too.

Looking back, you’re only a few years into this or so. What would you have done differently starting up? Is there anything where you look back, and you’re like, “I probably should have done this. We should have figured this out?” Do you feel like things have gone fairly well in that regard?

There are always things you can look back on and say, “I would have done that better.” There’s a lot of warning that happened. I don’t think anyone has a perfect path that they would have done everything perfectly. We couldn’t say that either. Some things there were the most learning and places that were challenging for a while and places that still can be.

It’s learning and understanding insurance billing and figuring out how to get paid for the work that we’re doing. As our team has grown, we’re working on the communication of having a bigger team and staff, making sure that everyone’s on the same page and unified around the same goals, and things are communicated in a way that is efficient but effective and striking that balance. Letting go and letting other people do things has been important, too, because when we were working with you, one of the things that we were working towards was trying to get a little bit more out of direct patient care and taking ourselves off the schedule. That has made a big difference.

Part of it is a little bit of a mindset, at least for me, of feeling like if I’m not working hard every second of the day, I must be slacking, and things must not be getting done, and I could do more. It’s recognizing that maybe there’s someone else who could come in and do that job and that they can even do it better than I was doing it. That will free me up to do the things that I’m good at.

At the end of the day, the skillset that we have as Schroth therapists can apply to everyone, whether or not they have scoliosis or any spine issue.
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We’ve been fortunate to have some great hires. Our front desk office manager is amazing. She has been better at her job than I ever did when I was trying to do those things. I’m like, “We should have brought someone like that on sooner. That would have been a good move,” so things like that, but it’s all part of the process.

Both of you being mothers and two times over mothers, congratulations. I haven’t highlighted this on the show in the past, but what would you say to other women who are trying to juggle young families and considering possible PT ownership? What advice would you give them? I’ll start with you, Susan.

We’re always hesitant and be like, “Maybe I shouldn’t do this because it’s taking away from my family time.” You can get caught in this and go back and forth, and nothing happens. Karen and I went for it. We said, “We’ll figure it out as we go,” and we have. Out of necessity, we’ve had to ask the questions of not how are we going to do this, but who can we hire to help us do that. We figure it out as we go.

I would have hated putting our careers on hold because we thought we couldn’t do it. I’m glad that we went for it, and we made it happen and hit snags along the way. That’s something that you take this time, take a step back, and say, “Where are my priorities? What needs to happen first, whether family or a business?”

One thing that Karen told me that sticks with me all the time, especially when I had a higher caseload of patients, is she said, “We have a great clinic. We have amazing therapists. Our patients can have any one of our therapists treat them, but at the end of the day, I am the only mom for my kids.” That’s where I need to be able to prioritize. Whenever that happens, I run those words through my head and say, “This is what I need to do. The game plan is to get work responsibilities covered.” In summation, go for it because you can make it happen. You have to be creative.

There are so many cool ways of people doing it.

What’s also cool is you have two very supportive husbands that were like, “You guys need to go do this. I’ll help you.”

That has made a huge difference. There are some great networks of female and mother-owned businesses out there and a lot of different business models and people making things work in a lot of different ways. I would agree with Susan. Go for it. There’s a way that will work. It might not be the way that we’ve done it, but if anyone is interested, there’s a way. I’m also an eternal optimist, so I always think that.

As you’re looking forward, you have plans for growth and expansion, whether in your clinics or with your families. As someone who has seven children, there’s always room for growth. What are some of the things that you would want the readers to know about, how they should consider niche/specialty practices, and the opportunity that lays before them based on your experience? What do you think, Karen?

For us, it’s been incredibly helpful. As I mentioned, it makes us very referrable so that our people in the community know who we are and what we do. If you have a conversation with a physician, a friend, or family, you can quickly tell them, “We treat people with scoliosis, and that is what we do.” They know if someone has scoliosis, they should come to see us.

It makes it a very easy referral, as opposed to wondering who might be the best provider or what different conditions we might treat or might not treat. There’s not a lot of confusion around that. If you can make it clear, whether, “We treat CrossFit athletes. We treat tennis players,” or whoever it is that you know how to make it well-known so people can find you. That takes a lot of the work out of marketing.

What I found interesting in working with you is that 50% of your patient load is focused on scoliosis care. The other 50% is orthopedic conditions related to the spine. You also have provided in the past, and you still do, that there’s a pelvic floor component to it because that is an issue with people with scoliosis. Even though you’ve niched down quite a bit, there are offshoots of your specialty that allow you to expand almost.

At the end of the day, that skillset that we have as Schroth therapists can apply to everyone, whether or not they have scoliosis or any spine issue. There’s research coming out every day, and our body is connected in so many different ways, myofascial and vestibular. You can tie in anything. That’s where we see a lot of patients who initially come to us for scoliosis, but then they get a shoulder repair or a total knee replacement down the road, and they come right back to us because we still have that skillset.

You’re not turning those people away. That’s cool. I’ve noticed the same story. I have some friends in Florida, and I’ve interviewed Angie McGilvrey in the past. Their clinic got destroyed by a hurricane, and they had an opportunity to open it up back again. Initially, they were welcome to all comers prior to the hurricane. Now, as they were opening up again, they thought, “Let’s treat the people we want to treat.” She was a 30-year-old CrossFit athlete. She said, “That’s who we’re going to focus on.”

She and her husband decided that they were going to treat 30-year-old CrossFit athletes. They’ve noticed the same thing that as they’ve focused and niche down into a certain demographic of treatment, they now are seeing the offshoots of that. The 30-year-old CrossFit athlete has children who are athletes, and they want them to come to the same physical therapy clinic. Other athletes are hearing about how great they are, not just 30-year-olds.

They’ve grown and expanded, treating a base of patients they truly love and like treating. I know that’s not your story, but you had a demographic of patients you knew needed help and knew how to treat them and started from there. You’re not concerned about how that might be limiting. That’s an amazing part of your story that it happened naturally.

It did. To give an example of being able to provide that care for the patients that we were passionate about, we had a patient that came in. She has scoliosis. Three months later, she was pregnant. We got to treat her throughout her entire pregnancy and then postpartum. What’s cool is that we’re able to treat people through every life stage. Their scoliosis is going to behave differently through every life stage, and we get to be there for that.

Congratulations on a successful clinic. I wish you all the best in terms of your growth and expansion. Is there anything else you want to share with us before we take off, Karen?

Thank you again for what you did for us. You helped provide a lot of insight and keep us on a path. There was a lot of wisdom we gained from working with you. That was beneficial and an important part of allowing us to get from what we affectionately call our closet to our clinic space and a team of therapists.

You guys were a great team. It was easy to work with you because, with one recommendation, you guys were off to the races. You guys are doing great. Number one, congratulations on your clinic. Number two, congratulations on your successful PT ownership and motherhood responsibilities that you seem to be working well together. I appreciate how you’ve prioritized things and kept motherhood first. Congratulations.

Thank you.

Thanks. Every day is an adventure.

Thanks for your time. If people wanted to learn a little bit more about ABQ Scoliosis and Spine Therapy in Albuquerque, how would they do that?

Our website is the best place to find us, ScoliosisABQ.com. We’re on all the social media @ScoliosisABQ on Facebook and Instagram. Starting there would be the best, but they can also reach out to us directly if they want to share emails or anything. You are welcome.

Thank you so much for sharing your experience and being part of the show. I appreciate it.

Thanks. It was fun.

Thank you, Nathan.

In 2018, Susan and her husband Elliot happily welcomed their son, Milo Alexander, into their lives. Together, they all enjoy just about any outdoor activity including hiking, rock climbing, and skiing.

In 2018, Karen and her husband Dominic introduced their daughter, Talia Grace, into the world. Just like her parents, Talia is already becoming a traveler. She has visited 7 states and traveled internationally all before turning two!

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