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How to start a small solo PT practice
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How to start a small solo PT practice - March 23, 2005 6:48:00 AM
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Diane
Posts: 1507
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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Randy asked me in the PT Salaries thread in another forum how this worked.
[URL=http://www.rehabedge.com/cgi-bin/ultimatebb.cgi?ubb=get_topic;f=10;t=000077;p=1]PT Salaries[/URL]
[QUOTE]I've been wanting a marketing/business section on this forum. Why don't you and FLA and any other therapists, maybe the chiro's also, share with us your experience, ideas and routine. I think a lot of therapists would like to practice like you do, but just haven't really been exposed to it as a practical idea. How do you market, bill, do you have staff, do you answer to anybody, overhead, etc.[/QUOTE]I see Nicole opened a thread that is for marketing all varieties of practice, but my understanding is that some of you would like your own little dream solo practice. So I will address this in ths thread, and Holly and others who have 'stopped the madness', can add their thoughts too..
I'll leave out the first couple decades of practice. It was good practice, that's all. I went to manual therapy courses and studied, got myself to a place that I thought was adequate first. I was in absolutely no hurry, took my time, way more than most people would probably. I must give Loren Rex DO at the URSA school credit for providing a model of what a solo manual therapy practice could look like. It is essentially the one I adopted.
Here are the steps:
1.Psychological preparedness
includes:
a)be confident with your hands as palpatory and treatment devices. You'll be dealing with peoples' persistant pain mostly. Focus on how to help alleviate that and your practice will grow naturally.
b)learn to spot red flags and refer them to a medical person
c)be fed up with your working life to the point of wanting to change it completely.
d)enjoy learning. Be perpetually discontent with what you know. Strive in all ways to be better as you grow/age. There will be just you, no co-workers to consult, so have a clue and get a grip.
2. Find a location you like and find a room to rent. It doesn't have to be around MDs. It can be anywhere. I picked my own neighbourhood because I saw that it had no other PTs in it, besides I wanted to walk to work. It's a retail neighbourhood, had a couple chiros, many hairdressers, some MDs, some dentists, and several well-established massage therapists, a naturopath, a yoga studio, and now a PT. All these people know me and I know them, lots of them have referred people, lots of them (including the MDs) have come for treatment.
My first "clinic" was a secondfloor office space. It had no amenities, not even parking. It was just me and my table. Very low profile. I moved to a nicer hole in the wall a few blocks up 4 years later, then to a much nicer, more permanent space with an elevator etc., 4 years after that. Patience. When your practice is humble and you affix yourself to your patients' successful rehab instead of your "job" and keep the same phone number, you can move your table to a new address in the same neighbourhood without losing your base.
3. Become direct access somehow. The whole point is that you want to be accessible to people, not have them need to go through hoops to get to you.
4. Get your place chosen and a phone number for it. Sign a lease or go month to month. Go get a line of credit to pay bills with for awhile. Don't be scared. Get a sign out front. You'll feel like such an adult. I made sure I wouldn't starve by lining up a locum two days a week at a busy practice for a few months. I needn't have bothered.. my "practice" paid for itself the first month it was open. However the stress level was much lower and I was able to seem more relaxed and confident by having no financial worries at all. It took about 4 months before I was actually making enough to live on. I must say, seeing fewer patients for more money was very self-reinforcing. It began to dawn on me what a serf I had been in my prior PT existance.
5. Marketing: Simply let people know you are around. You don't have to be razzledazzle to get attention. I gritted my teeth and visited MDs..once. I didn't want to, but the first patients had to come fom somewhere. Lots of people came from referrals from friends. Some people saw the sign and came to check me out. I realized that each happy patient was a direct marketing tool. I never hassled anyone for referrals. I waited patiently, and they trickled in. It grew by itself. I was fully booked all the time by my second year.
6. Getting paid: I stopped being an insurance collector on behalf on my patients finally. Other PTs like me were cash only long before I had the nerve to be, and they did OK. Takeaway point: You'll not only survive, you will thrive. Work for your patients, not as a cog in a wheel that only benefits the CEOs of insurance companies.
I'll happily answer any questions.
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Re: How to start a small solo PT practice - March 23, 2005 10:58:00 AM
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hmgross
Posts: 292
Joined: February 28, 2003
From: Minnesota
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Well said, Diane. I had similar experiences in all the above. The only difference (big one at that) is item 6. I am not at that point yet, and where I live, I am not sure I will be able to get away from insurance billing. I've only been at this for 6 months and I am learning every day how to be more efficient, less of a workaholic and have fun! I know I could never go back to working for someone else.
I do very little advertising or marketing. Word of mouth has been working quite well. In the next few days, I will try to write some of my "pointers" for starting up a solo practice. It never hurts to get a few different angles, and I hope other practice owners on the forum will do the same.
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Holly Gross PT
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Re: How to start a small solo PT practice - March 23, 2005 11:28:00 AM
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jma
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From: NY
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Thank you for sharing your ideas. Hope to incorporate them one day should I decide to follow my own path to work solo.
JMA
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Re: How to start a small solo PT practice - March 23, 2005 12:13:00 PM
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Diane
Posts: 1507
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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Holly,
Congratulations!
[QUOTE]I am not at that point yet, and where I live, I am not sure I will be able to get away from insurance billing. I've only been at this for 6 months [/QUOTE]It's perfectly fine to bide your time and wait til your personal coast is clear. No rush. Took me years to get out of that loop.
Meanwhile you can build and polish your professional reputation, which will come in handy when you decide to fire your insurance 'masters'. Your patient base will remain loyal (you've given them their freedom and quality of life back after all..) They might not need to see you, which is a good thing, instead they'll send you referrals. I've had people come in that were told about me from their hairdresser, yoga teacher, massage therapist, someone sitting near to them in a coffee shop, on a bus, standing waiting in a line.. total strangers to each other. It's quite amazing really. If you do a good job your schedule will remain quite full. And you will have loads more time, not having to be on the phone chasing after crumbs.
Good luck JMA.
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Re: How to start a small solo PT practice - March 23, 2005 12:22:00 PM
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jma
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From: NY
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If your solo practice continues to be very successful, then perhaps you can write about it one day in a book to share with everyone. I'm sure you can expand on it much more. We hear about success stories in other fields but not in PT.
JMA
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Re: How to start a small solo PT practice - March 23, 2005 1:27:00 PM
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wjPT
Posts: 33
Joined: October 11, 2004
From: San Diego, CA
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Diane,
I see that you practice in Canada. Do you know if it will be any different or more difficult to move to a cash based system in the U.S. I am very interested in owning my own practice after a few years of experience and it is great to see PTs have success with this form of payment.
warren
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Re: How to start a small solo PT practice - March 23, 2005 5:18:00 PM
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Diane
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From: Vancouver, B.C., Canada
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Warren, I think it's important to have direct access first. Everything rolls from there. I know direct access PTs exist in lots of states. I've met lots, and they lurk here, I'm sure. They are raising families on their solo practices! Perhaps they would like to post about their experiences.
They are cash based, and built their practices from the ground up like I did. They were/are successful. I think 100K was thrown around as the usual amount people make, whether they work solo for cash or have a big operation with lots of overhead. If the amount you take home is around the same, who needs the headaches?
Having said that, why not work your solo practice for insurance like Holly is doing and fire them later after you've got enough of a base? It's slower to get launched if you start out cash only, but the advantage is that whoever you do see will be trained from day one to pay cash, and all the people they send you will know they have to pay cash, and will be prepared. No ugly surprises. And they can always go collect for themselves.
I have no real idea of the speed with which growth might occur. The pattern people describe is that things grow in spurts; you get a flurry of a few busy weeks, it dies away, then another spurt comes along a bit bigger/longer than the old spurt was. Sort of like the tide coming in. You learn the pattern of your practice as it evolves. The main thing is to have backup plans in place to help you feel secure, like training wheels, then ignore them and just practice. You know they're there but don't use them unless you are really up against a crunch.
JMA, I'll think about what you said.
:)
Diane
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Re: How to start a small solo PT practice - March 23, 2005 7:30:00 PM
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wjPT
Posts: 33
Joined: October 11, 2004
From: San Diego, CA
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Diane,
Thanks for the detailed reply. I definetly would like to have a practice in the future without all of the headaches of 3rd party payers. I hope other PTs out there can continue to provide services in this manner, which may help to foster the value of physical therapy to potential clients.
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Re: How to start a small solo PT practice - March 31, 2005 5:30:00 AM
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hmgross
Posts: 292
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From: Minnesota
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Diane, if you write that book, put me down for an order! If I had to think of a single bit of advice, it would be GET A MENTOR! Talk to someone in a similar setting and ask questions. I am so fortunate to be able to do that. Well put about how growth occurs, the tide analogy is quite fitting. (I am at low tide right know, as if you couldn't tell by all my posting lately). The thing is, I don't sweat it too much because I know from previous experience around here that certain times of the year are slower. We are experiencing our "snow melt" FINALLY, and I am getting more cancellations. People are so happy to be outside, doing yard work, walking, etc. I will probably be seeing those "yard work" people in a couple weeks. ;)
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Holly Gross PT
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Re: How to start a small solo PT practice - March 31, 2005 10:04:00 AM
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Diane
Posts: 1507
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From: Vancouver, B.C., Canada
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Holly, I'm sure you could write the same book. My slowish months were Jan and Feb.. March took off and I was overbooked. April shows no sign of slowing down.
Meanwhile, about the topic, maybe our moderators would be willing to start a little forum here where all the threads on private solo practice could be kept together in one place. Any questions or consult could happen there.. What do you think Holly? Others? Would anyone like to see something like that?
Before you can solo, of course, first you have to have legal direct access. So put your collective foot down people. It's high time.
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Re: How to start a small solo PT practice - March 31, 2005 10:20:00 AM
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JLS_PT_OCS
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From: USA
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I will second Holly in that I would DEFINITELY be interested in a book like that.
Maybe bring several different PTs from disparate settings and niche practices together and write different chapters.
Anyone talked to APTA's private practice section or maybe the Canuck version of that for further ideas?
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: How to start a small solo PT practice - March 31, 2005 10:55:00 AM
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hmgross
Posts: 292
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From: Minnesota
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Jason, the PPS publishes a book: "Private Practice Physical Therapy: The How-To-Manual" which includes a chapter on "How I Went into Private Practice", one therapist contribution per decade, starting in 1950's (can you imagine that)! The stories were good, but sort of brief. Anyone considering private practice should get this book; I can tell alot of work went into it. I also belong to the section and would like to see more resourses on the web site.
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Holly Gross PT
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Re: How to start a small solo PT practice - March 31, 2005 11:27:00 AM
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SJBird55
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From: Michigan
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Peter Kovacek has the 3 books (Strategic Marketing, Legal Issues, Defining Your Business)he editored for purchase through APTA. You can also gain CEUs from them. Starting and Managing Your Own Physical Therapy Practice by Samual H. Esterson. A generic book that has great ideas with a corporate perspective - Good to Great by Jim Collins along with The 8th Habit from Effectiveness to Greatness by Stephen Covey. And then of course, the Bible...
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Re: How to start a small solo PT practice - March 31, 2005 6:40:00 PM
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eam
Posts: 292
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From: New York, NY 10028
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Diane-
Glad you started this thread! I find it enlightening, to say the least, to learn and understand how other PT's started and continue to THRIVE today. I work in a non-insurance based practice. And it is clear that if you establish a good client base with well established results then that is one of the keys to success. Also, as you mentioned, constantly being kept up to date on the latest research (which, sadly, is a rarity among most PT's today) and to continue to have a thirst for learning, no matter how long you have practiced will translate into good therapy, in my mind. Keep it up! As Holly mentioned, having a mentor is key. The APTA did have a mentoring program ( I think it still does) but I don't know how extensive it is.
Erica
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Re: How to start a small solo PT practice - April 1, 2005 1:48:00 AM
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Sebastian Asselbergs
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From: Barrie, Canada
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You're a good torch carrier, Diane! Thanks. Your list illustrates the most important aspects of going private and small. My story is about a small duo-clinic that started out as a trio...
Two young PTs right out of school in 1998 (one of them was a student in my clinic and later did a locum here) decided they wanted to start their own clinic. I got involved for my experience. They scoped out a location in a rapidly developing retail/commercial/manufacturing area, close to a 11000 home residential development. Got a line of credit, 2300 sq feet in a stripmall, built the inside themselves (ourselves - I put up the 12 foot drywall sheets - solo) and saved big $$ in leaseholds. Made one page flyers for residential delivery - by 3 12 year olds for $60 total labour. Developed a paper package for the human resources and health and safety departments for the surrounding businesses; they wrote to all the doctors and visited their offices to deliver their referral pads (although we are direct access), and opened with local member of parliament and the mayor opening the clinic (they love it - great photo-op and free publicity for us, other than the snacks and drinks!).
We had a decent equipment lease although I feel the two young ones were too focussed on the modalities and exercise equipment - I did manage to convince them to build three treatment offices of 14 by 16 with good warm carpet and paint colours, big bookcase, easy art and comfy table - all with a bit of daylight.
After one year, they bought my share and we split - all happily. One of them was friends with a couple of MDs - orthopod, peds, family doc - who started a medical building in a university city. They invited him to run a PT clinic out of their building. He took it and is doing really well with the in house referrals he's getting. He IS completely independent and is the sole owner of the practice. That is an easy way to start your own business, but it ties you in with the referral sources, which can influence the style of your work.
The other one is still in his clinic here and enjoying his solo-practitioner life.
Right out of university.
And to quote Diane: "Get direct access".
And that concludes my April 1st morning ramble.
PS: Did you hear about the failed marshmallow crop due to flash freeze?
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Mundi vult decipi
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Re: How to start a small solo PT practice - April 1, 2005 11:14:00 AM
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srcase
Posts: 551
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From: Michigan
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I am very interested in this thread, as I have been hit upside the head by a managed care 2x4 this week. All I can say is: HMO's stink. And working with the referral coordinators at the PCP offices comes in a close second. Did I go to school for 7 years to shuffle paperwork and know the in's and out's of insurance guidelines? I don't think so.
I would love to start a cash-based practice, but we don't even have direct access here in Michigan yet. So, till then, I will continue trudging up the managed care mountain, or should I say "pile of s***". Thanks for letting me vent.
Sarah
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Re: How to start a small solo PT practice - April 1, 2005 12:21:00 PM
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Diane
Posts: 1507
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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Vent away Sarah.
Ask yourself who benefits by keeping PT in your state in chains. Ask yourself who does it serve to force you to remain a cog in a wheel instead of being free to do what I assume all Americans want to do, have liberty and persue happiness.
Get mad and get involved in your branch of whoever is your lisencing or professional body and get active. No one will roll legislation over for you until you ask them. Sometimes repeatedly. Sometimes insistantly. Through an organized voice. Get busy. Times a-wasting and people are a-hurting and the baby-boom is a-aging.
Most of the educated baby boom don't want to be forced to see insurance practitioners. They want good attentive treatment and are willing to pay cash, but they don't want to go to so-called alt med people who offer strange belief systems along with their physical treatment. They want someone like US! Go for it. You can't lose!
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Re: How to start a small solo PT practice - April 1, 2005 12:37:00 PM
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FLAOrthoPT
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From: West Palm Beach
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I am only skimming this topic, because I am too busy to breathe these days! But...my 2 cents...location location location. I am fortunate enough to be in a direct access state, with wealthy population, willing to be treated like VIP, expecting to be treated like VIP, and willing to pay for this. I started off looking for a solo practice inside a gym, but ended up seeing people at their homes for cash. I meet them at some of the gyms I belong to if need be, but typically at their homes. I have little to no overhead, incorporated myself to reduce liability, and write off a lot of driving etc. I on average work 5 hours a day all one on one my own patients, no referrals, no prescription, etc. I have no headache, have great sense of accomplishment, vacation when I feel like it, and work 7 days a week if I feel like it. It is PT in the most pure form I feel.
I initially started with a mailer to very direct specific neighborhoods and demographics, and you do good work, word of mouth, and you have a steady client base.
MY one question for states without direct access, is it madatory that these clients are patients, or can they be clients? I mean why do LMT and ATC, and personal trainers who may all be trying to see the same person for the same reason not worry about direct acces b/c they call them clients...are we forced legally to call them patients? Just curious and I know someone out there has the answer...all I know is when I was in VA (a "fake" direct access state) I was unable to work with my golf performance program b/c my company was afraid that even though I was not seeing them as patients, we'ds till have to get a referral b/c they are always patients b/c of my degree? Not sure of the answer..
But work less, earn literally 2 1/2 times more, and be stress free, and see results...what a way to go, you couldn't get me back in corporate america...
Good luck to all in pursuit of bigger things-
Ben Galin, MPT, OCS
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Re: How to start a small solo PT practice - April 1, 2005 6:59:00 PM
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Randy Dixon
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Joined: August 6, 2004
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I've wondered the same thing Ben (first time I've seen the name) asks. If you are doing things other than physical therapy evaluation do you need a prescription to do things unlicensed people do?
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Re: How to start a small solo PT practice - April 2, 2005 7:34:00 AM
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Diane
Posts: 1507
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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It shouldn't be call a 'lisence' should it? Maybe it is more accurate to call it a 'restriction'..
Loved your stories, Sebastian, Ben. Keep them coming.
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