I’m talking to Craig Ferreira, the CEO and Cofounder of Survival Strategies. He told me that he's going to be talking at a conference for Survival Strategies in the near future about sales, productivity and physical therapy clinics. I thought, “That's what we've got to talk about on the podcast,” because honestly, productivity and sales are at the heart of our viability and survivability as physical therapy clinics. Since sales don’t come naturally to most physical therapists and because we tend to not talk about money as physical therapy clinic owners with our providers and staff, it's important that we find ways to broach that conversation. The beauty of Craig Ferreira is that he makes everything so simple, breaks it down so easily and you'll find as I go through the interview with him how everything seems so very natural and easy to do if we just make it simple. He says just shut up sometimes, don't talk so much. He breaks it down simply.
To tell you a little bit about Craig Ferreira, for over 30 years, Craig and his team have worked with PT professionals and have delivered services and training to over 5,000 practices throughout the US and Canada. He's created customized delivery programs aimed at exact skill building to enable owners and their staff to have the applicable knowledge and disciplined skill to ensure that they attain their goals and keep expanding. He is also of note CEO and Cofounder of Hands-On Diagnostics, the number one diagnostic testing franchise organization in the country. He is the Cofounder with Dimitrios Kostopoulos, who I interviewed in the podcast. They work together. Craig has some great simple insights and wisdom to share.
I've got with me, Craig Ferreira, the CEO and Cofounder of Survival Strategies. He's got over 30 years of experience working with thousands of practices across the US, specifically physical therapy clinics. I'm excited to bring him and talk a lot about productivity in the clinics and with your staff. First of all, thanks for joining me, Craig. I appreciate it.
Nathan, thanks for doing this.
As I do with all my guests, would you mind sharing how you got in consulting in the PT profession?
It's an interesting story. I have been in about 25 countries earlier as a young man and at that time I was trained as what's called a troubleshooter. Troubleshooting is basically going in and finding out what's going on with something that needs to be fixed or made more optimum and then going and figuring out how to do that. It was quite interesting. Out of that experience in 1985, I moved to Los Angeles and I got a phone call one day from someone that was working here in LA. They asked me to come and speak to a group of physical therapists. I'd never even heard that term before. I said, “What do they do? Sure. I'll come.”
I went and spoke at the weekend. I gave them a weekend seminar basically on communication, relationship building, managing people, a little bit on PR, a little bit on marketing, etc. When I was finished, I remember going to the owner of the business at the time and I said, “These are really good people. What are you doing here with them?” At that point, I had just sold the company. He had a little consultancy going here in LA and he said, “Why don't you team up with me and let's start helping these folks?” That's how it started.
He was the cofounder with you then in Survival Strategies.
No. This was a different company before Survival Strategies. I worked there with him as an associate for eight years and during the time I traveled all over. I was out of town two weeks out of every month for that time period, going into physical therapy practices, working directly with the folks and helping them out to basically at the time gain more referrals. That was our main focus at that time. Then that blossomed in the early ‘90s where my partner and I formed Survival Strategies. That's how it all started.
Survival Strategies is up and going. It’s strong and going strong, you've got plenty of consultants that are available to help physical therapy practice owners as well.
Trainers and consultants, we have two types. Just as an aside, we're really starting to help a lot of pediatric practices of all things.
PT, OT and speech. It's really fun.
There’s a huge demand there as well. It's a unique part of PT. I'm sure there aren’t a lot of consultants that have experience in that particular niche of physical therapy.
We've always had a few pediatric practice clients, but we never sat back. I realized that they're very different, but they always get lumped in with PT practices and they need our services, so that’s what we’re doing.Troubleshooting is basically going in and finding out what's going on with something that needs to be fixed. Click To Tweet
I'm excited to talk to you because you mentioned to me that your talk with your Survival Strategies Conference is about helping physical therapists to sell and in essence, how it’s our responsibility to be salesmen if we're going to get people to buy into our plans of care. Also in general, how to get our staff to be more productive. I know every physical therapy clinic owner wants to know the secrets and I know that you have, that's why I've got you on. Let's get into that a little bit, what have you found to help staff to essentially become more productive?
There's one basic foundation that I found that’s usually missing, that if it’s not put there, you can't really move forward. The first thing is establishing with the practice itself its financial viability model. What does that mean? In other words, how much money do we have to make here, let's say a monthly basis, not to just pay expenses? That's a mistake a lot of folks make. To pay expenses, to set aside reserves and to make profits. Once that figure is established, that needs to be carved out into the number of visits that it would take to eventually equate to that amount of money. Most people know this these days. Earlier, nobody knew anything about this.
Reimbursements were higher, maybe they had some flexibility to not know the numbers at that time. That was my experience but since then I know, all of us need to know our numbers and I went through a number of my first few years not knowing my financials and how much money it took to make a profit, so we can’t keep heads in the sand anymore, especially as things get tighter.
That's another subject, meaning that a practice owner has to really understand what position they're in. They're not just a physical therapist anymore, they're an owner, an executive, an entrepreneur, frankly. There are skills that need to be acquired to do that job and one of them has to do with finances. We'll continue here on this realm. Let's say that they find out, they trace all this back down. At this point, I'm talking about a therapist. There's a rule here. The rule is supposed to be that whatever you pay a therapist per year, they're supposed to bring you three times that money. Four or five times is ideal, but three times is the bottom line. That has to be translated into the number of visits. To increase the productivity of the therapist, what I normally find is they don't understand. A staff therapist, they don't understand.
This is supposed to be done in the hiring interview, this is where it starts. This is what I meant by the foundation. It's supposed to be that you've already figured out that from this therapist, I need 60 visits a week for the paycheck I'm giving him or her. That discussion should be in the documents that, “I'm giving you a paycheck and what you're giving me back for that paycheck is X number of visits per week.” That's the deal. Another subject you will hear is, “What if I don't have any patients?” That gets asked all the time. That just means that the practice hasn’t graded its culture or have enough internal policies for the folks to understand that they don't sit around and twiddle their thumbs when there are no patients. They need to be doing something, that's a whole other topic.
What I love about it, in general, is you were having this discussion right off the bat because it's a slap in the face if you come up to them with a quota after the fact maybe two months down the road and say, “You're not being productive. I need you to see more patients.” It's better to have it laid out on the frontend so they recognize what is good productivity and what's not.
With the existing staff, that discussion has to be carried forth as well and that's normally done with a thorough complete understanding of the practices and finances. We all want to grow. We want everybody to make some more income. I'm sure you'd agree with that. What I found out is the following, this is the number of visits that we need to be doing here. This whole topic is staff productivity. If the person doesn't know what they're supposed to produce, then I got to tell you they're going to make it up, they'll create it themselves or they'll think, “We're making $100 a visit here and I'm doing 60 visits a week and he's only paying me $2,000 a week. She's making a ton of money on my production,” not even putting into the equation the taxes and all the stuff that it takes to run a company.It's important to make sure you are value-aligned. Click To Tweet
From production forward, once the baseline has been established, it's been helping them and training them to do any anything that they need to do on cancels and no-shows and dropouts so they can keep themselves full, contact the past patients if they have some time, visiting referral sources, doing in services in the community, all the marketing stuff that they could or should be doing. Enabling them to actually make that level of production.
That's the conversation that you have in the beginning when they asked that question, “What if my numbers drop?” It’s an opportunity for you to say, “We've got some opportunities for you to get that number up.” You can even lay that out at the beginning. We have policies in which you have the opportunity to go see doctors, to call out to past patients and you'll have time to do that when you're not seeing the patient load that you're supposed to see. It just brings up another great question so that you can address all these issues ahead of time.
When you think about it, the more this is established in the beginning, everybody knows exactly what is expected, what we're doing. You're going to avoid inadvertent problems in the future. That's what's going to happen. It should be discussed that there are marketing and PR activities that all of our group members are responsible for. The person not to hire, because that needs to be known, is the one that keeps coming back in the conversation with, “You're just pushing numbers. I don't agree. It's not my job to do marketing.” It's just like, “Joe, let's talk a little bit more but this may not be the right place for you to work.”
We talked about that in the previous episodes of the podcast, how it's important to make sure you are value aligned and this is a huge part of that. What's your job as a physical therapist? It's to help people get better. Would you say you're a better physical therapist the more people you help get better? The more people you help get better, the better therapist you are and the greater influence you have. We're going to provide opportunities to help more people and push our purpose as a clinic.
Purpose needs to be brought up right at the beginning. There's no doubt about it.
Craig, what conversations and how do you come up with productivity numbers for those people who are not producers? Maybe your staff at the front desk or the people that are this other staff?
We'll get to that, but let me put one more thing. This is where you can also design bonus systems. Once you know the baseline, let's just say it's 60 visits, let's just say that's what it is. Anything above that is where you can start to get into a bonus for a therapist, as long as the baseline really covers all money, all profits, and all reserves. Let's take a look at the front desk. The front desk, the statistic that we've always had the front desk, there are several of them, but the main one is what's called percentage of arrivals. Obviously, they're responsible to make sure that the patients show up and they show up on time and all that stuff.
Let's say that you have established that their baseline is 90%. We consider that 92% is rock bottom. Let's just say it's 90% and you know that you're paying them X dollars and you want 90% arrival rate. Any person as they go above that, give them a bonus. If it's 91%, give him $50 or $25 or whatever you feel is correct. It's helping them get rewarded for going above that level. That's a bonus system that you can use at the front desk. There's a bonus system for the people in your finance department. That can be a percentage of the money that they collect that's over 90 or 120 days, which hopefully you don't have.
It's a matter of coming up with a product and its statistic that you can measure objectively and then relating that to making sure that that is in line with your financials and then fixing a subjective amount to bonus them appropriately for going above and beyond.
You used a big term there. If you don't manage objectively, you're going to be in trouble constantly because it's all subjective. That doesn't do anything. The reason I love objective measurements is that somebody comes to you and says, “I don't think the front desk is doing a good job.” You're like, “Really? Is that right?” That's a generality. Communication means nothing but as the owner that girl’s percentage of arrivals last week hit 96%. How come this person is coming to you complaining about them? Who would you investigate?
Not the front desk person.
It keeps it nice and objective. It gets out of gossip and opinion. The next one on staff productivity are games. I have found that people love games. Normally they do like, “If the clinic hits this amount this month, there's going to be this reward. If I hit this amount, there's going to be this reward or I'm going to be able to take my wife to a nice dinner this week because I went way above my baseline on my visits per week.” That makes it more exciting for the people in a group.
We've done a successful game in our clinics in Arizona. We expect all of our staff to be internal marketers in that they’re constantly asking for referrals from our current patients of friends and family members that could need physical therapy for their ailments. On a regular basis, we’ll reward the staff member in our clinics with a $20 gas gift card for getting the most referrals. It wasn't our idea, we stole it from a friend of ours, Aaron Williams over at OSR Physical Therapy. I noticed in his company and in ours that the person that consistently won didn't have to pay for gas for a year, they couldn't remember the last time they actually had to pay out of pocket for their gas. If they got us five, six, seven new patients in a month or two, that's huge.
It really benefits everybody.If you don't manage objectively, you're going to be in trouble constantly. Click To Tweet
It is really a successful game on our part.
That topic of that staff productivity, the other thing is to give recognition to those that do produce well to the other group members. Hold them up as an example. That's always a good thing.
That’s really creating a culture. When you hold those people up as examples, then you're starting to create a culture of recognizing those people that are upholding your purpose and values.
You’ve got to pay attention to those that create crosscurrents. There's no doubt about it. You’ve got someone in and you just have to have a nice heart to heart talk. If it doesn't change, then they have to be replaced. When you think about it, everybody wins if everybody's productive. It's not complicated.
We’ve used the quote over and over. I think it comes from L. Ron Hubbard and you can correct me if I'm wrong but it's, “Production is the basis of morale.” As we've considered that and as we've seen that, it's true. When we are rocking and rolling and everyone's producing well, the morale goes up and it takes care of a lot of things. Winning takes care of a lot of problems.
There's no doubt about it. I've used Mr. Hubbard's materials in all the 5,000 practices that we've worked with. It’s workable.
There's a reason it's used over thousands of practices.
Not just in this country.
I'm excited to talk about this with you because I talked about it earlier in a few episodes back with Heidi Jannenga of WebPT, but physical therapists really have to become, for lack of a better term, salespeople when it comes to getting their patients to buy into their plans of care. Patients nowadays have higher deductibles, they have higher copays and they're watching their health care dollars much more closely now that they are responsible for that purse. You really have to take advantage of the opportunity when they're there before you to essentially sell them on their plan of care and what your services can do to benefit them. If you're not willing to do that, then a whole cascade of issues can come about. They're not going to come back for their visits and not complete their plan of care.Production is the basis of morale - L. Ron Hubbard Click To Tweet
When they don't complete their plan of care, then they're not going to get better. They're going to get worse. Then it's going to become a matter of them going to their friends and family and community members to say physical therapy doesn't work. It’s just the tailspin and then it comes back to physical therapy and especially your clinic gets a bad reputation when at the very beginning it's a responsibility of physical therapists to know how to sell. That's something that we haven't had to do in the past and were uncomfortable doing. How do we cross that bridge and help physical therapists understand that they really have to take a sales approach?
The first thing that I've found over the years is that most therapists that I've ever spoken to, they actually hate sales. There's a real dislike for it. What I've always found is they don't really even understand what it is. They think it's Dale Carnegie car sales. They think it's the old school, push the person through it no matter what they say, they don't really listen, force, whatever they've experienced, they haven't sometimes experienced true sales. There's a very specific technology to sales that funny enough is extremely consistent to patient care. If a therapist could just transfer the level of care that they have when they're treating the patient to the sales process, they'd go 1,000% better because when you actually think about it, sales is really real. It's only really caring for the individual in front of you to get them onto the service that you know is going to help them. That's all it is. That means it isn't anything other than that.
I've done a lot of sales over my years. I've trained a lot of salesmen. I do understand the technology. I've trained people in several countries on sales and there is one thing that they all have in common that makes them fail, they don't know how to close. Sales is normally a process of establishing two-way communication, finding some form of a need or a problem of some sort, and finding out from the individual in front of you the importance of that situation. The importance is like, “You say your knee is hurting. How important would it be for you to fix that up?” He says, “I don't know. It's not that important.” Then you pretty much know you're not going to go anywhere there. Unless you can start to enlighten them on, “Can I discuss with you what's going to happen with your knee in the next two years if we don't fix it?” Try to bring up an understanding of, “I guess I do need to do something about this.”
I've seen over and over again that there needs to be a two-way communication. The problem or whatever it may be needs to be discussed, you have to make positive the person you're trying to sell, that you're getting them to understand the situation that they're actually in. If they don't understand it, why would they do anything about it? Like the example I gave you with the knee. They're not going to do it because you tell them to do it. Maybe some people will do that, but that's ridiculous. The funny thing is you have to listen for the close it's called and so many salespeople are like this, they talk too much.
They have to keep asking the patient, understanding the patient and drawing the patient out, “Tell me more about it. How does it feel?” “If we didn't take care of this, what may happen? Is this affecting your family by any chance?” It’s really getting into communication. That's not sales. That has nothing to do with sales. That's called communication and then you're presenting what you could do about it and then at some point the close is the close. In this case, it would be, “Joe, we've discussed your knee. We understand it. Do I understand that you think that something should be done about it?” He goes, “I do think so.” “Good. I guess I understand now that you've decided to do this.” Then you have to shut up by the way. That's the problem. That's the point that the salesmen “and the therapist,” they really have to shut up and get the question answered, “Have you decided to do this?” There's a bit of a lag and the person looks at you and says, “Yes, I have,” “Welcome to your therapy. Let's go get you scheduled. Let's get started.”
That tool I have used on anything I've ever sold to anybody, I always grant the person the ability to make a decision like, “You want to get the BMW?” “We've gone over it.” “How come you want this BMW?” “It will make me look good.” “You like the color?” “No, I don't like the color.” “Let's get the color you like, you can afford it.” “Okay, great.” “We've been through all of this. When you look at this, have you decided that you want the BMW?” Here's another part of this, maybe I'm getting too in depth here.
It is valuable that you go into these steps because I don't think enough of us know the verbiage to use. Giving us examples is huge.
Here's where you qualify if you've actually gotten the close or not. I have to tell you, it is so amazing to me. This is my own “technology” that I’ve developed over the years. Even when the person is told me they decided, “Yes, I've decided to get the BMW.” I said, “Is that a 100% decision?” It is so weird, 90% of the folks will say, “No.” Now you know two things about this person. The answer he gave you was not truthful. You don't want to go there but it wasn't, he didn't decide, but now you can find out what you've got to deal with “I have to talk to my spouse” “What are we 90%?” “Yes, I'm 90%.” “We have to run this by your spouse. Do you have your cell phone? You could give her a call. I’ll talk to her if you wish,” and you just deal with it right there. Don't let them go home. That's not going to happen.
You might lose that guy forever if they have to go home.
I don't know what the stats are, but if you don't close it right now, the stats are way too high that it's not going to happen. You got to know when to do the close. Here's the last thing that I think is the most important thing, people need to have a sequence of the sales process. Hopefully, they'll get that from somebody that knows what they're doing, but they've got to practice it. If they just get the theory, unless they're a genius, they're not going to do it. Seriously, they're not. I'll give you an example of something, I sell high ticket items. I can have a consulting package that's $30,000 to $300,000. It depends on what's happening. I was training a lot of people, these were physical therapists on how to ask for money and they couldn't ask for the money. They couldn't sit down and say, “Your program for this golf program that you've just told me you want to do is $2,500. How would you like to pay?” A majority of the people could not get the words out of their mouth. That means they just didn't practice it enough.
In our team meetings, we'll role play. Our staff members hate it, but you have to get used to using the words and addressing the situations, especially as people are truthful and set as good examples of what they're going to come up against. You have to practice it just like anything else.Everybody wins if everybody's productive. Click To Tweet
I've had staff running a group like that. What I've always said is that there's a step in education that's very important that gotten missed in some other areas of skill. The client will say, “What are you talking about?” We'll say, “I'm a professional musician as well as what I do. In music and in engineering and in medicine and any mechanical art, you always practice?” They go, “Yes, you do.” What happened to doing that in administration? Why don't we use that tool in training the front desk how to answer the telephone? Is everybody supposed to magically know how to sell or magically know how to answer the phone? No.
It's awesome that you're talking about it now as it comes to selling the patient on their plan of care that you're establishing for them, but practicing these conversations, it goes back to what we were talking about the beginning of the podcast when you're bringing on that physical therapist at the very beginning. The owner needs to practice those conversations, those interview skills and how to present the package and the bonus package and answer those questions in a real setting because going through your mind isn't the same thing, it’s actually practicing and getting your words out of your mouth.
It's an educational tool that's probably even more important than just reading the theory when you think about it.
You've provided so much valuable knowledge and insight to thousands of PT clinics across the country. Is there one thing that you can point at where you could say survival strategies really helps physical therapy clinic owners do?
Our main forte or core competency where this company started, before there was anyone else ever do any consulting in this profession, is developing professional relationships with referral sources. Sometimes that's gotten poo-pooed, as I’ve seen it now on the internet, “You don't need to do this, you don't need to do that.” Most of the time I've noticed that the people that are saying that, they don't really know what they're doing, they don't know how to do it as we do is the point. One thing, why is that still the core competency? I've seen by statistics for years and it still proven to this day, maybe you spend a little money learning how to do it.
You're out, you're doing it and we put our clients all through an internship. We don't just have people study. We make them do an internship. They develop relationships with the referral source that for a very long time up the future is going to consistently send them patients and they know how to do that with new doctors as well. The value of that is ridiculously crazy. You don't have to spend money on promotion at that point. You know you've got a relationship. You can take them and do stuff, you can take them to lunch. That's the core competency. Our second core competency is building up the practice to the point that the owner, if they want to, they can pull out but that takes us years to do.
It takes a lot of work and it takes a lot of guidance and coaching. That's what you provide.
Plus, we train the staff.
What you're talking about relationships, I think that APTA came out with a study that the physician referrals are down 50% from 2004 to 2013 or whatever the year range was. Even as I've talked to other physical therapists about it, it's not to say that you shouldn't stop gaining those relationships. In fact, it's important to maybe solidify those relationships and add on top of it. As you look at that study, you got to recognize that you still have to maintain those relationships and then maybe do a little bit more.
What we have found is you have to do many things, don’t just do doctor referrals. You need to do relationship building with referral sources. There are all kinds of referral sources, case managers, nurses, schools. It's not just doctors, anybody that can send you a patient, but you've got your patient, your family, and friends. You've got social media these days. You have marketing or promotion material. You have public speaking. You have in-services. You have staff involved in doing stuff out in the community. You have community relations. You need to do it all.
It's all about developing relationships with everyone around you. Especially those opinion leaders, if you can find those people that make the decisions or influence others in the area, getting with the coach of the local soccer club or getting on the right Facebook page of mothers who make a lot of medical decisions in the home, you name it. There are a lot of opinion leaders out there that you need to really focus on and develop relationships with.
One last little comment on the power of the relationship building, I'm not going to mention a client, but we have a particular client we've worked with him since the ‘90s. He’s in the Midwest. He's done all of our training plus the staff. They had the relationships so well built with their referral sources and even as important with all the office staff because that's what we do, we get the office staff relationships built by another person besides the owner, that when it came to the local hospital buying out all the doctors and issuing orders that you couldn't refer to this private practice, all of the staff of those hospitals they refused. They just said, “No. We've been working with this practice for fifteen years. They're incredible. “What do you mean we can't refer to them anymore?” That's where your relationship should be.
Thank you so much for sharing your insight and time. I really appreciate it. It’s something that we really have to focus on as individual practitioners and especially as owners and be the leaders of this if we want to see productivity and improve and overcome any issues that might be coming at us in the near future.
The profession is fantastic. It’s growing. We love it. Everybody does great things for people. That's the bottom line.
If people wanted to get a hold of you or reach out Survival Strategies, whichever you prefer, how would they do that?
The simplest thing is to go to the website, SurvivalStrategies.com. There’s a little video at the beginning, there's a Contact form. Look at the form, put some stuff in and we'll get back at you. There are also a ton of free articles on that site. There are also about 150 client videos if people want to know if we know what we're doing.
Hopefully, the 30 years of work in the PT profession speaks for itself, but if they really need to get some mass on that, then they can go there.
Nathan, I appreciate you letting me assist in this and if you ever want to do anything else on other topics, let me know.
You can bet that I will be reaching out to you again, Craig. I appreciate it.