No Regrets: Leaving Behind Aquatic Physical Therapy for New Waters
“The only way to do great work is to love what you do.” - Steve Jobs
It’s been almost 20 (!) years since I graduated from Ithaca College with my Doctor of Physical Therapy degree, and I feel like I’m finally exactly where I’m meant to be… even if I’m no longer working in a traditional PT position. The road to get here has been long, winding, and far from easy — but so worth it.
I found my love of aquatic therapy accidentally, having interviewed at Complete Pool & Land Therapy (in Los Angeles, CA) on a whim. We had very little aquatics training in our DPT curriculum, and I despised our pool lab — the water was cold, the aquatic center felt dark and dingy, and the focus was mainly on physics (concepts like buoyancy, viscosity and hydrostatic pressure). However, when working for Linda Huey, the owner of CPT and a pioneer in the water exercise industry, I realized that aquatic therapy can be FUN and incredibly effective — and I quickly became hooked.
Eventually I moved from LA to Santa Barbara, and I discovered a new pool to call home at Cottage Rehab Hospital. After working with mostly orthopedic patients at CPT, I found myself challenged with new diagnoses - stroke, TBI, spinal cord injury, cancer, amputation, and Parkinson’s Disease, to name a few. It was incredibly rewarding to see how the water helped patients achieve miracles — regaining their strength, independence, and a better quality of life… and I knew I wanted to spend the rest of my career working as a mermaid.
In 2014, I took over as the Lead Aquatic Therapist for an outpatient PT clinic in Santa Barbara, CA, and I perfected my craft over the next decade. I spent over 1500 hours/year in the pool working with patients, attended ATRI’s National Conference and dozens of specialized trainings, became certified as an NRPA Aquatic Facility Operator so that I could oversee our pool’s water chemistry, finished at least 4x the required number of CEUs for physical therapists, achieved my lifeguard certification (you can never be too safe!), and started teaching group fitness classes like “Hard Core Balance” and “Aqua Knees & Hips.” I had a passion for the pool and an unquenchable thirst for knowledge. I wanted to be the best aquatic therapist I could be. (I still do!)
Along the way, I recruited my (now) husband to join me, and Travis assumed the role of Aquatic Director for our therapy pool. His background in exercise science and collegiate coaching naturally led him to direct our fitness programs, like personal training and group classes, and he, too, became immersed in all things aquatics. Truthfully, our work wasn’t all sunshine and rainbows: it was exhausting, and the unrealistic expectations were causing burnout, but our passion kept us going.
In September 2023, our lives were flipped upside down when we learned our employer planned to close our therapy pool, and we would both lose our jobs. Unemployment is obviously never desirable, but the thought of being job-less in Santa Barbara was downright scary. I was told, “Don’t worry - you’re a physical therapist. You can find a job anywhere.” Sure - plenty of employers were hiring, but after 16 years in the aquatics industry, I didn’t want to leave it all behind for a hospital, home health, or clinic-based position… so I didn’t.
Over the next seven weeks, Travis and I worked full-time for our employer while frantically creating our own business in our “free” time. We worked with several advisors who helped us write a business plan, negotiate a lease, secure liability insurance, establish an LLC, create a website, learn how to use bookkeeping software, set up bank accounts, and so, so much more. The to-do list was endless, but we had a deadline — and a huge goal — in sight. Anderson Aquatics officially opened its doors on November 6, 2023.
While we definitely had a lot of support from our local community, we also had our share of skeptics. Unlike the previous therapy practice, which utilized an insurance-based medical model, we decided our business would emphasize fitness, wellness, and prevention-based programs like aquatic personal training and group classes. In fact, we didn’t even offer “aquatic physical therapy,” although this wasn’t entirely our choice. You see, the Moscone-Knox Professional Corporation Act was passed in California in 2020. It states that any occupation that requires a license to practice (like PT) must form a professional medical corporation (PC), and LLCs (like ours), partnerships, and corporations are not acceptable legal entities. Upon consulting with an attorney, we realized we would need to create a second business (something like “Santa Barbara Aquatic Physical Therapy, PC”) in order to continue working with patients — a costly and lengthy process that was simply impossible at the time. The doubters told us that without aquatic therapy, our business would fail. Fortunately, we were too distracted to listen.
Fast-forward to now, two years later, and we have absolutely no regrets. We have found our cash-based water fitness business to be extremely successful, and it doesn’t make financial sense to create a PC or offer traditional aquatic therapy. We understand that it may be frustrating to pay out of pocket for services that you’d like your health insurance to cover, but as a provider, the insurance model is not sustainable for a small business. Over the last decade, I witnessed annual cuts in reimbursement, the time/cost of claim denials and audits, and how insurance companies dictated how clinicians should practice. Operating costs are at an all-time high, the cost of living continues to rise, and yet, Medicare reimbursement for outpatient PT has actually declined over 10% since 2016. Practice owners have few options to stay in the black: treat more patients, work longer hours, rely more heavily on support staff (like therapy aides), find alternate ways of generating income, and/or tighten up the budget (who wants a raise, anyway?). It’s a recipe for disaster… and I’ve found a way to continue doing what I love while skipping the headaches and ensuring my business stays profitable.
Admittedly, after having identified as an aquatic therapist for close to two decades, I initially felt guilty and ashamed for not using my PT title in my new business. But over the past two years, I’ve accepted it, and I’ve learned a few important lessons along the way:
I love water fitness! Helping clients move better and feel better is incredibly rewarding. Water workouts are FUN and effective. I love the opportunity to be creative, teach a variety of formats, and expand my reach by leading groups (vs. strictly 1:1 sessions). As a PT, I’ve always known that I could play an important role in wellness and prevention (it was one of my favorite classes in college!), yet I’ve never had this opportunity before since these programs aren’t usually reimbursable by insurance.
I am - and I will always be - a physical therapist. It’s impossible to turn off my PT brain when teaching classes or working with private clients. My extensive understanding of biomechanics and human anatomy helps me to be a superior instructor, and my years of experience as an aquatic therapist definitely helps when working with clients with complicated medical issues.
My services are still therapeutic, regardless of what we call them! “Floating bodywork” consists of manual therapy techniques - Bad Ragaz, Aqua Stretch, joint mobilizations, soft tissue massage - techniques similar to those you would get at your chiropractor, massage therapist and your aquatic PT. “Aquatic personal training” enables me to work 1:1 with clients, crafting customized water exercise programs based on an assessment and the client’s personal goals — just like PT. I work with post-op and pre-op individuals, folks with injuries and neurological disorders, and kids with special needs. I still have my CA PT license, take more than the required number of continuing education courses each year, and use my PT skills & knowledge every day. However, I’m no longer double-booked with two (or more) patients per hour. I don’t have to supervise PTAs or unskilled therapy aides. I don’t go home after an 8+ hour day and find myself stuck with hours of charting. I don’t have to worry about prescriptions, authorizations, and progress notes. I no longer play the “insurance game” and let Medicare decide how often I can work with a client, or what body part I have to treat, or how much I should get paid for my work.
Our model has so many benefits for clients:
Improved accessibility. Back pain? Ankle sprain? Post op? Preventative care? You won’t wait forever for an appointment (another local aquatic therapy facility has a 5-month waitlist!), and you don’t need a doctor’s referral or insurance pre-authorization. I can work with you NOW.
Lower cost. Since I don’t have to account for the associated administrative time (that dreaded paperwork and billing) and expenses (like HIPAA-compliant software), or the costs of operating a second business, I can charge a much lower rate for aquatic personal training than I would if I were offering aquatic physical therapy. Meanwhile, the service that I’m providing to you is identical.
Flexibility. You decide how often you want appointments and what you want to work on. Need one visit to learn an exercise routine? Sure! Want regular sessions after surgery? OK! Long gone are the days of Medicare saying we can address just one body part per session. And since you won’t be working with a therapy aide, we can make quick changes to your treatment program whenever needed.
Better outcomes. Imagine this: you get to work 1:1 for a full hour with a Doctor of PT who has an aquatics specialty & 20 years of experience… or maybe you’re taking a water fitness class taught by this DPT, not a 16-year-old lifeguard with no formal training. Your trainer/instructor isn’t burned out and overwhelmed with managing an exhausting patient caseload, and she is very invested in you. Sound too good to be true? Previously, I was expected to oversee 75 patient visits per week. Now, I limit myself to no more than 20. Being able to stay truly present with my clients means they get better faster and don’t need as many appointments. I’m not handing them off to an assistant. I’m not multi-tasking and working with several clients at once. I can establish rapport, be creative, and use my critical thinking skills and experience to help my clients reach their goals.
It’s kind of ironic, really. Legally, the state won’t let me call my work PT, but I’m a far better PT now than I was before. After all, documentation and doctor’s referrals don’t make you a PT. Calling your service “physical therapy” doesn’t make you a PT. I love that my clients seem more invested than ever, and they’re no longer using aquatic therapy as a “free” form of personal training or massage (covered by insurance) because they feel entitled to it. Meanwhile, I’m able to shine doing what I do best — assessing, listening, teaching, and helping my community improve their quality of life.
Sometimes one door closes so another door can open… Trusting the process, following my passion, and leaning on my support system has made all the difference, and I consider myself so lucky to love what I do.
Want to work with me? Book a group fitness class online, or get in touch to schedule 1:1 personal training or body work. I can’t wait to meet you!
Breanna Anderson, PT graduated with her Masters of Physical Therapy and Doctorate of Physical Therapy from Ithaca College in 2006. She began her career in Los Angeles at Complete Pool & Land Therapy before moving to Santa Barbara as a traveling therapist at Cottage Rehab Hospital in 2008. Breanna’s areas of special interest include pediatric aquatics (for kids with special needs), pre/post natal care, orthopedics, post-op conditions, Parkinson’s, prehab & rehab for athletes, and balance training. She also has extensive experience working with individuals with chronic pain. Follow Breanna on Instagram @DrAquaFIT.
This post has been modified; original version posted in April 2024.
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