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James Dagostino, DPT, PT
David Nishida, PT, CSCS
Gregory Kenton, PT, OCS
Ron Masterson, PT
Twin Oaks Physical Therapy
San Marcos, CA
"A 100 percent visibility fishbowl office" is how James Dagostino, DPT, describes the 1-year-old Twin Oaks Physical Therapy clinic in San Marcos, Calif., a growing community about 25 miles north of San Diego.
Dagostino, owner of Dagostino Physical Therapy in Oceanside, formed the secondary practice with fellow “founding” PTPN members Gregory Kenton, PT, Ron Masterson, PT, and David Nishida, PT, of Escondido-North County Physical Therapy in Escondido, California. “After five years of talking about it, we decided to try this venture because of the respect we have for each other, and because we were about 20 miles apart and all seeing patients in the San Marcos area,” says Dagostino. “We thought we could best serve those patients by putting together a melded practice allowing for a confluence of ideas.”
What is innovative about the venture is that, for all practical purposes, Dagostino Physical Therapy and Escondido-North County Physical Therapy are competitors. In the past, they had opportunities to build practices close to each other, but their mutual respect kept them from doing so. Instead, Dagostino says, “We had the bright idea to join forces and build a co-owned practice, something that is not usually done unless one practice buys out the other. For private practitioners to cooperate after running their own show for 20 plus years is unique.”
Also notable is that the former competitors will soon be mentors to University of Southern California (USC) doctoral students in physical therapy when Twin Oaks Physical Therapy becomes a clinical teaching site. “With 106 years of clinical experience between the four of us, our clinic can be the training ground for new practitioners,” says Dagostino. “Our concept was to build a state-of-the-art facility to attract state-of-the-art practitioners as our partners, and mentor them in the ‘best practices’ of physical therapy.” Dagostino and his partners designed the 3,600 square-foot facility with an open gym environment of 2,200 square feet with “maximum line of sight” to comply with Medicare guidelines.
The doctoral student interns will have a plethora of experiences as they do their rotations at all three clinics and benefit from the specialties of their mentors. Each student will be assessed by their clinical instructor and will be placed in the setting in which they need the most strengthening. Dagostino explains, “If their manual therapy skills are weak, students would be involved in a pull-out program with Greg Kenton. For sports therapy, they would train with David Nishida, and for head/neck/TMJ work, they would work with Ron Masterson. In addition, our partnership with California State University-San Marcos [CSUSM] provides all our students the opportunity to work in an academic sports rehabilitation environment.”
As Dagostino describes the partnership with CSUSM: “The biggest feature of the clinic is that it’s across the street from the new CSUSM campus, which will be a big part of the community, eventually making up almost half the population of San Marcos. We have a great relationship with the CSUSM athletic and health sciences departments, and they’ve contracted with us to do the consulting for their athletic training programs.” Instrumental in cementing that relationship was Nishida, a recent appointee to the advisory board of the CSUSM athletic medicine program. Nishida has been very involved with athletic medicine as a PT consultant for three high schools and Palomar College in San Marcos.
Currently, the four partners at Twin Oaks are providing all the patient care themselves, without the use of aides. “Based on our clinical experience, we’ve tried to set up a clinic that serves our patient population,” says Dagostino. “We’ve stayed with the basic, tried-and-true techniques, and have avoided bringing in all the computerized gadgetry because we feel it’s a huge cost – and often just a temporary fad.” He notes, “The open gym design is the best environment for our practice because it’s flexible, we can move equipment and desks around, and we have the space to add a pediatric or OT program. We even have a speech consultation room ready to go.”
The general PT practice offers aquatherapy, hand therapy, spine education, back-to-work programs and community consultation, says
Dagostino. “We all have extensive experience in workers’ compensation treatment, and our marketing consultant has been taking potential workers’ comp customers through the clinic.” As an advisor on the Workers’ Compensation Task Force of the California Physical Therapy Association, a chapter of the APTA, Dagostino and PTPN President & CEO Michael Weinper led the group’s recent successful lobbying efforts.
When asked what advice he has for his PTPN colleagues in their efforts to grow their businesses, Dagostino responds, “In this era of prohibitive costs of starting and expanding practices, PTs can help themselves if they support each other through cooperative efforts. This cooperation leads to the fresh flow of ideas and positions these practices as ‘the model’ to follow. And in the long run, the owners will have built a practice with real value that will attract new practitioners looking to purchase a clinic that stands above the rest.”
Contact James Dagostino at 760-941-2630 or JJDDPT@aol.com.
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