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What is your full name and title?
Dr. Kimberley Bell, DPT
Doctor of Physical Therapy, Specializing in Vestibular Rehabilitation
Educator, Speaker, and Laughologist
When did you graduate from PT school and where did you go?
I graduated from PT school with my Masters in Physical Therapy from University of Maryland, Baltimore in 2002.
What did you do when you first graduated?
I began practicing physical therapy at the Shock Trauma Center in Baltimore, Maryland, then returned to get my transitional DPT while working full time, graduating in 2004 with my second PT degree.
At what point did you switch jobs?
After about two years working full time with patients who experienced neurotrauma (such as traumatic brain injuries and spinal cord injuries), orthopedic trauma, soft tissue injuries and cardiopulmonary trauma, I transitioned out of the acute care and intensive care settings to pursue my first medley of part-time jobs.
Even though the Shock Trauma team rotated specialty floors every few months and always had a challenging caseload, I had begun to realize that the typical 8-5 grind of working Monday through Friday in the same setting was likely not my ultimate destination, and I began to explore other settings.
At what point did you start thinking that you’d like to go another direction?
I was also compelled to start looking into other clinical settings for health reasons. I had sustained a serious low back injury on the job at the trauma hospital when an obese patient fainted during ambulation training and landed on me (along with my OT partner who was co-treating at the time).
After a few weeks off work due to the injury, I returned to work on “light duty” and was assigned the task of writing a protocol for Rehab staff to perform deep suctioning on ventilated patients in intensive care.
I wrote the deep suctioning protocol and began to inservice all the Rehab teams within the hospital, teaching them the skill bedside and then assessing their competency with a formal guideline that I created. During that time, I discovered that I loved teaching!
But since heavy lifting was required in order to return to “full duty” as a PT in the hospital setting, I realized that I had to move on.
In 2004, I took a job in home health three days per week with the VNA of Maryland, quickly being promoted to rehab director of their multi-disciplinary team of PTs, OTs and SLPs.
I also worked two half-days per week at an outpatient sports medicine clinic with Division I athletes from Towson University in Baltimore.
My love of teaching also led me to apply for, and accept, an Adjunct Faculty position teaching in multiple courses within the Doctorate of Physical Therapy Program at University of Maryland, Baltimore (my alma mater!).
Did you try any other settings or did you immediately start to think about entrepreneurship?
It was also in 2004 that I launched my first entrepreneurial venture by opening an LLC to offer personal training, and continued to earn extra cash by officiating high school sports in Baltimore County including girls lacrosse and field hockey.
I realized that I loved the variety of settings, and each came with its own unique challenges, but I was never in any one role for so long that I got “burned out” on it.
Did you take on any other roles or try any other non-clinical pursuits while you built up your vestibular expertise?
When I decided to move to San Diego, California, I closed my personal training business, quit all three of my jobs, and ventured into the unknown.
I initially accepted three per diem positions in San Diego – two in outpatient and one in home health – and eventually had all three employers in a “salary war” for a full-time position that ultimately went to the highest bidder, a home health agency.
Incidentally, on my first day of work at the home health agency in February of 2006, my employer enrolled me in a vestibular continuing education course. I have been absolutely fascinated by vestibular rehabilitation from that day forward, and now understand why we had to take physics as a prerequisite to PT school.
After learning the basic skills of a vestibular assessment, I took on a full-time caseload and was mentored by my then-supervisor and vestibular expert, Kristen Johnson, PT, EdD, MS, NCS.
Very quickly, Dr. Johnson promoted me to be her therapy team leader, and my work became part-time clinical, part-time teaching and mentoring other staff, and part-time marketing.
Once again, the day-to-day variety was stimulating and inspiring for me, and I loved teaching physicians and colleagues about vestibular rehabilitation just as much as I loved treating patients.
At this time, I began to assess all my elderly patients with dizziness, vertigo, imbalance or unexplained repeated falls for vestibular problems, and was astonished to find that over 95% of that population had undiagnosed vestibular dysfunction.
This really fired me up due to the consequences of chronic dizziness and vertigo and fall-related injuries that I saw so many suffering with, so I was eager to take on the role of director of the Safe Strides program when Dr. Johnson moved on to teach at University of St. Augustine in San Marcos.
The standard of care within the agency at the time was to only test patients for vestibular problems who were referred with a relevant diagnosis but after much advocating, I was able to convince my team to assess ALL the home health patients for vestibular problems.
This idea represented a new standard of care that did not rely on the referring physician to identify the vestibular health problems or make an appropriate referral with a relevant diagnosis.
During my time as the Safe Strides director, I was trained as a vestibular CEU instructor by my employer, became an expert in physician marketing for vestibular rehabilitation programs, and doubled both the number of PTs on staff, as well as the number of patients seen per year.
The Safe Strides program grew 33% annually during my three years as director, for a total of 100% growth, and the revenue had doubled from $1 million to $2 million when I stepped down from my role.
I was also volunteering as the co-chair of the San Diego County Fall Prevention Task Force, in order to both raise awareness about the prevalence of undiagnosed vestibular disorders in chronic fallers, and lead the recruiting efforts for the Task Force.
The local membership in San Diego has now expanded from about 40 people when I stepped into the leadership role to hundreds of providers from all hospital systems who are now involved in this grass roots effort to prevent falls and their devastating consequences for the residents of San Diego County.
The co-chair role lead to my first appearances on radio and television, and I wound up receiving the San Diego Public Health Champion Award in 2011. I have since been featured on podcasts and ABC News in LA and Baltimore, as well as on multiple UCSD Stein Public Lectures on University of California Television (UC-TV), which now have over 500,000+ views!
I also worked briefly as an Adjunct Faculty for one semester at the University of St. Augustine in San Marcos co-teaching their “Professional Communications” course. I loved teaching, but ultimately decided that the commute was too demanding (and the traffic too heavy) to continue in that role.
It was in 2010 when I attended the first offering of the Advanced Vestibular Rehabilitation Course offered by the Neurological Specialty Section of APTA, that I realized that vestibular disorders affected people throughout the life span, and in fact was presented with a case study that told my own personal story.
I realized that I was in fact a vestibular patient myself and, even though I had been to the emergency room more than 20 times in my life with severe vertigo and vomiting, had seen multiple primary care physicians, neurologists, chiropractors, physical therapists, and ophthalmologists, no one had ever suggested that the root cause of my intermittent problems with dizziness and vertigo were in fact vestibular.
This provided an “aha” moment in realizing how under-diagnosed and underserved vestibular patients truly are in modern medicine. Just like many of the elderly fallers I had identified as vestibular patients, I realized my own case (and likely many others) had been falling through the cracks in the medical model–and would likely continue to do so unless something changed.
Due to the stress of the high pressure job as the Safe Strides Director and working long hours every week, I developed stress-related health issues and had to resign from my role on short-term disability.
I took about a year off to recover and began to explore my own case as a vestibular patient, seeking optimal health and wellness during that time. It was then that I learned a lot about taking a holistic approach to my own health issues.
When did you decide to go all-in as a vestibular PT?
I returned to the work force as a full-time travel PT in Home Health in Monterey, CA. It was a great way to get some quick cash after being on disability for a year, and it was fun to be a traveler because I was able to emotionally detach from all the problems that were evident at my workplace, knowing the role was only temporary.
While I was working as a traveler, I attended the weekly multi-disciplinary team conferences with the other PTs, OTs, SLPs, home care aides and nurses, and their nursing supervisor to review all the new cases.
I was constantly reporting significant causes of dizziness or chronic falls in the new cases I was assigned such as orthostatic hypotension, peripheral neuropathy or vestibular dysfunction, and projecting a good outcome with a high therapy threshold.
But I noticed my other PT colleagues were discharging patients early who had the same presentation, saying they told the patient to use their walker, instructed them in standing exercises at the kitchen sink, and there was nothing else they could do for the patient besides advise them to discuss their dizziness or falls with their physician.
Frankly, I felt infuriated on behalf of the patients because I knew there was more that could be done – after all, I was doing it myself, and had overseen a team of 30 PTs at my previous job who were also performing root cause assessments for these common symptoms.
The next “aha” moment came when the nursing supervisor called me into a private office after the next team conference and said, “How come all of your patients have vestibular problems, but none of the other patients we are seeing have vestibular problems?”
I replied that the other patients seen by the other PTs with the same complaints of dizziness, vertigo or chronic falls did indeed have vestibular problems, but they were being discharged early because the other PTs did not know how to assess the vestibular system. Their problems were being missed, and the root cause of their complaints was not being determined.
I stated that I was qualified and skilled to train the rest of the PTs at that home health agency in assessing and treating the vestibular system, as well as looking for root cause of the dizziness, vertigo and chronic falls, and I would be happy to do that while I was there as a traveler, in order to improve quality of care and clinical outcomes of the agency.
But the supervisor replied with, “I didn’t bring you here to train our team. I brought you here as a traveler to produce revenue and complete visits, so I need you to do that. I know you are highly skilled since we have gotten many compliments about you from patients, families and physicians already. But do not discuss your clinical findings or your treatment plan at MY case conference because you are intimidating the other PTs on our team and I can’t allow that.”
When I left that meeting, I realized that the status quo was simply not good enough – not good enough for me as a young, lifelong vestibular patient, and not good for the older adults with vestibular problems causing life-threatening injuries.
I began to write and refine my own teaching tools in my spare time and created my own training manual for instructing my colleagues in vestibular rehabilitation. I piloted my curriculum on a PT colleague in Monterey who was eager to learn about vestibular rehab, and successfully trained him to a high level of competence.
About a year later, that same colleague contacted me while he was working as a travel PT at another site in Florida and said, “I am testing all the chronic fallers and patients complaining of dizziness and vertigo for vestibular problems, and they are all positive. Am I doing something wrong?”
I smiled and replied, “Nope, you are just discovering exactly what I discovered when I started testing the same population for vestibular problems.”
He said, “This is unbelievable!” He was preaching to the choir.
At what point did you return to San Diego, and what happened next?
When I completed working as a traveler for one year, I returned home to San Diego and again took two per diem home health jobs, one under Medicare Part B and one under Medicare Part A.
Unfortunately, due to my own vestibular health issues, I was laid off from both jobs within a year due to excessive absenteeism. My bosses both said, “You are the best PT I have ever hired, but I need someone who can show up to work consistently.”
That was when, in 2014, I decided to launch a specialty private practice, with the support of my family, to rescue patients like myself with dizziness and vertigo, to teach my colleagues as a continuing education instructor, and to write and speak out as an advocate for best practices for these patients. I now only accept new patients with dizziness, vertigo, imbalance or unexplained repeated falls in my practice.
Would you consider yourself a cash-based PT, non-clinical PT, or both?
I’d say both! As my non-clinical practice of educating and training other therapists has expanded, I’ve had to make some changes to my clinical practice.
Initially, I had to make a critical decision about whether I would accept insurance or only cash, and after much research about the cost of electronic health records, billing staff and rate of denials (along with constantly changing documentation requirements), I decided to take a gamble with an all-cash practice.
My practice is designed for patients to get optimal outcomes after only two visits, so my average patient spends between $950 and $1250 on their care plan (which, on average, is two or three visits). The part-time PT I have hired has lower visit rates to allow more accessibility to our services for more people.
Considering the average patient with vertigo sees 4-5 different MDs and spends over $2,000 just to receive an adequate diagnosis, we are offering an exceptional service with a remarkably high percentage of cured vertigo patients after only two to three visits with us, and a significant cost savings for the average patient.
What makes your approach unique, and how are you able to get such stellar results?
My approach is unique because instead of focusing on one particular age group like pediatrics or geriatrics, and instead of focusing on one body system like the musculoskeletal system, I focus on one symptom.
I spend an average of 30 minutes on the phone with each patient before the visit, and I offer visits in the patient’s home or hotel room, spending about two to two and a half hours at the initial session. My follow-up visits are 60-90 minutes.
I reached this level of expertise by putting myself out there. I shadowed many expert clinicians and took a variety of continuing education courses in areas like neurology, integrative medicine, chiropractic, nutrition, gerontology, kinesiology, podiatry, cardiac nursing, ENT, primary care, vestibular rehabilitation, etc., all with the goal of finding out what each provider does to assess a “dizzy patient” who seeks out their specialty area.
I also read journal publications across multiple disciplines, not just PT, in order to review a breadth of research findings related to dizziness and vertigo.
When did you develop The Bell Method? And can you tell us a bit about that?
After shadowing countless clinicians and experts, and taking the aforementioned continuing education classes, I combined all of these evaluation skills with my own clinical experience and created a comprehensive, unique methodology called “The Bell Method.”
I have literally built an entire practice around one main symptom and now I have people travel from all over the USA and from foreign countries to consult with me on the most complex cases from around the globe.
My depth of compassion and dedication to solving each case is driven by my own experience of suffering with vertigo for over 25+ years with literally no help from the medical community except a rack of thousands of dollars of prescription drugs which didn’t even help.
My business offerings have evolved over the last four years, with the common thread always being excellent patient care for private patients.
What are some of the ways that you use your niche specialization non-clinically?
I have written over 60+ hours of CPTA-approved PT CEU courses on the subject area of my expertise, trained hundreds of PTs in my methodology, and created a CEU-accredited mentorship program for my colleagues who want to master their skills.
I also used to act as a business consultant for home health agencies and outpatient clinics to launch new vestibular rehabilitation programs, but have since abandoned business consulting due to the cost of legal fees associated with consulting contract negotiations and the staff turnover in the agencies leading to inconsistencies in agency leadership.
I offered my final live PT CEU courses in June and July of 2017; due to a new diagnosis of an auto-immune disorder with a symptom of severe fatigue, I have stopped teaching live courses and am working to convert all my well-developed, fully ripened curriculum to online courses for both the general public and eventually for my PT colleagues.
I also host a private Facebook group for PT and PTA colleagues where I post articles related to vestibular rehabilitation and Fall Prevention, called The Bell Method Study Group. I originally started this group to keep my PT CEU course graduates up-to-date with current information and resources, but now I encourage any interested professional to request to join.
My first two online courses are launched on my website and the target audience is the general public:
In addition to gradually converting my curriculum to online courses and seeing about two to three patients per week on average, I am also now a Professional Public Speaker with both volunteer guest lectures and paid speaking gigs at UCSD, Mesa, SDSU, Mira Costa, and many other locations around San Diego County.
I give an average of one lecture per month.
What is a day in the life like for you?
Most of my time is spent answering emails and phone calls from patients who are inquiring about my services, and communicating with patients on my current caseload. I have trained multiple administrative assistants to help me with emails, phone calls, checking on patients and scheduling patients but I currently do not have a receptionist.
Due to my health challenges, I still struggle with excessive absenteeism, but luckily I have job security as the CEO! I have hired and trained a per diem PT to help me keep up my caseload, and that was a good investment for sure.
What is next for you?
I currently attend two community meetings per month hosted by the San Diego County Fall Prevention Task Force in central and northern San Diego county, and I offer balance screens at community outreach events in San Diego.
Starting this spring (2018), I will be training healthcare providers to offer balance screens so that more events can be staffed throughout the county. Even though I left my post after serving a combined total of eight years as the co-chair of the task force (with a one-year break when I traveled), I remain the clinical leader and offer a lot of volunteer time to support the group.
What is your favorite part of being an entrepreneur?
Writing and creating content for my courses and blogs is my favorite part of the blended role, because I can translate what I hear and learn from my patients into teachable moments for others who have the same questions or struggles.
I also love that I can get involved with the professional community and represent a different modality of practice. I’ve been an APTA member since 1999, and have served as a representative of the San Diego district of the CPTA!
What is your least favorite part of entrepreneurship?
My least favorite part of the role is the financial uncertainty that comes with entrepreneurship and the cost of running a good business.
In addition to paying fees to credit card companies and Uncle Sam’s taxes, I also work with:
- A bookkeeper
- A CPA
- A business coach
- A website designer
- A part-time PT
- A copywriter for marketing flyers
- A graphic designer
- A videographer
- A blog, newsletter, and social media administrator assistant
- A second general general administrative assistant
- A payroll service
- A newsletter service
- An attorney for practice management issues (and a second attorney for intellectual property protection and contracts)
I have to pay six different types of taxes and insurance as a California employer and have a minimum annual corporate state tax, in addition to the costs of hosting websites and renewing web domains, printing business cards, flyers, and other promotional items, plus annual renewal fees for my APTA membership and corporate liability policy.
Since receiving my diagnosis, I’ve had many days that I had to cancel seeing my patients, and being self-employed does not come with sick leave pay. Those are “lost revenue” days, but yet everyone else on my team still needs to be paid and the bills need to be paid on time.
Where can we find your work?
I host two educational blogs on BetterBalanceInLife.com and VertigoDetective.com, along with offering a free monthly newsletter, a YouTube channel, and more. In order to keep all those marketing efforts rolling along while I am dealing with patients, I hired an administrative assistant dedicated to the blogs, newsletter and social media.
Do you have any advice for someone pursuing entrepreneurship in a niche market?
My advice is that cash-based is the way to go for people starting their own practice, but it is important to find your niche. What are you the best at? Better than anyone else? That is your niche.
If you have that fire, you can do it! But be prepared to work hard and keep asking questions until you figure it out. It is an exciting life.
Next week, for example, here’s what’s on tap:
- Seeing new patients on Monday and Friday mornings
- Four follow-up visits for my current patients
- Remaining ready to offer same-day or next-day care to a new patient who calls me in distress
- Attending a networking meeting on Tuesday morning
- Being on conference calls with my marketing and website team members on Wednesday
- Working on my websites and online course development
- Taking a legal seminar on California labor laws on Thursday offered by an attorney for my workers compensation carrier.
In between all those appointments, I will be trying to keep up with responding to incoming phone calls, text messages and emails – and in the evenings, I have been in the music studio 2-3 nights a week since July 2017 recording my first original music album!
No two days are ever the same and no two weeks are ever the same. But the freedom I feel unleashes my creativity and allows me to truly break out of the mold, making a difference one person at a time.
Could I go four miles down the street and take a job at a local medical center making a $94,000+ salary? Sure, but that would become too routine way too quickly! For me, it’s about the freedom and ability to make my own decisions to help my patients based on what they need.
Thanks for your insight, Kim!