Robert Brown, PTA, is one of the few PTAs in the country who owns a physical therapy clinic, plus he is the first PT clinic owner that I've interviewed who purchased his practice. Wouldn't you know, just like any other PT clinic owner, he came across the same issues related to culture, staffing, growth, recruiting, and billing that any de novo clinic has experienced. You may think that since Rob purchased the clinic that some of those issues were easily overcome. You'd be wrong. Changing the culture and introducing new policies and procedures while focusing on growth ended up taking years to do, along with plenty of headaches. However, once he got rid of everybody from the team he inherited, except one, he finally turned things around and saw a great increase in business (84%!) from 2017 to 2018. Listen to the podcast to figure out what it took for Rob to overcome and succeed.
I have Robert Brown, Owner of Wasilla Physical Therapy in Wasilla, Alaska joining me on the show. This is a first because Rob is a PTA. He is a PTA that owns a PT clinic. He's expanding and he's growing. The reason I wanted to interview him is not only because he's a close associate of mine up here in Alaska but he's had some tremendous growth between 2017 and 2018. I'll let him share with you the exponential growth that he's had in revenues. I wanted to get down to the heart of it. I know his story a little bit. A lot of people share the same thing. It took him years to get through some of the issues that he had because Rob is also a first in that he bought a clinic. I don't think I've interviewed anybody on the podcast yet who bought a clinic. He did so years ago and thus, inherited a culture that he didn't like and wanted to grow, improve and expand with a bunch of people who weren't willing to do the same.
He went through years of heartache trying to train and spend money on training. People were covertly hostile. I experienced the same thing with one of my clinics and it reminded me of the mantra, “Hire slow, fire fast.” No one I've met has ever been upset about letting go of somebody too soon. In fact, it's the opposite and common refrain, “I should have let them go a lot earlier.” Sometimes when you find out the person’s the issue, you’ve got to set fear aside and cut those people off. Nonetheless, I’ll let Rob share his experience but he also had other things that he went through over the past few years to get to the point where he had such a great 2018. I figured I wanted to share his story and his experience with you all.
I've got Rob Brown, Owner of Wasilla Physical Therapy in Alaska. Thanks for joining me, Rob.
Thanks for having me.
Like with any other podcast episodes, do you mind telling us a little bit about your story and what got you to where you're at on your professional path?
I'm a PTA. I'm a little in an unusual situation. I'm not a PT and I own my own practice. I've been a PTA for years now. Prior to that, I’ve had four different degrees, two Associate's, a Bachelor's and a Master's degree. I started as a paramedic. I went straight back to school and got my Bachelor's degree in Health Promotion and Education with an emphasis in Community Health. Then I did a couple semesters in PT school in Florida. This particular school didn't mesh well with me. It was a full PT school. I dropped out of that school. I came home, I got my Master's degree in Professional Communication. Then I met my wife and she said I had one year to finish up. I called around to a bunch of different schools, I found a PTA program in North Dakota that I could finish in one year. I got my PTA degree. I came home. I started working, I was PTA for about two years and an opportunity came up for me to purchase a clinic. I didn't think that I was very qualified but the savvy owners at the time convinced me otherwise. I jumped in with both feet and I've owned this practice for six years, going on seven years now.
It was an established clinic for how long had it been prior to purchasing it?
This clinic has been open since 1990.
It’s been going on for quite some time. It had a reputation in town. It had a following. You didn't have to start anything from scratch. You're one of the few owners that I've got that have bought a clinic and not started from scratch. What were some of the difficulties that you recognized in doing that?
Mountains of debt. The owners at the time also owned the building. They not only got me to purchase the clinic, I got a loan for that and I'm paying them to buy the clinic, I'm also paying them a monthly fee to rent the space. That was tough and we have quite a large facility here. My rent at the time was $9,000 a month. That was a lot. It was fortunate that the clinic had been here for some time. As far as I know, we’re the longest operating clinic in this area. There are no other facilities open as long as we have in this particular area of Alaska. It was doing good. It had its ups and downs, it was like a rollercoaster but it wasn't great. A lot of that was due to the culture in the clinic.
Tell me about that.
One of the biggest changes that I've made over the last few years that I've owned the practice is trying to change the culture within the clinic. You go from an atmosphere of having employees that have been in practice for twenty or 30 years, trying to come to get their paycheck, do the least amount of work. They love it when they have no shows and that's not what I was looking for.
That's a plight of many owners, even if they haven't come into practice. A lot of them eventually develop these people that become like that. They're okay with no-shows and they're okay just checking in and clocking out.
That's exactly what it was.There will be no growth when you just maintain a status quo. Click To Tweet
Unfortunately, you inherited that or at least you bought that. It wasn't something of your own self-creation but it's something that you nevertheless had to deal with. That had some difficulties I'm sure.
It became very evident within the first eighteen months that something needed to change. At that time, that's when I joined the Private Practice Section of the APTA. I joined PPS and that opened a whole new world of potential of what I could do and things I can learn. While I was down there, I met lots of different consultants that with your practice, help it grow and put it on the right track. At the time I didn't even know the stuff that I needed to know. I didn't even know the right questions to ask. I decided I was going to go down and get a consultant. I probably met three or four different ones and they all talk a good talk. They all tell you what they can do.
For one reason or another, I picked a MEG, which is Brian Gallagher’s organization. He had a pretty good impression on me. What I liked about Brian was that he had one of the breakout sessions at PPS. He had one of the talks and it was good. He gave a lot of good insight, a lot of good tips that he says, “You need to do this. You need to set this up.” He gave me step-by-step directions on how to do it. He was giving it to me for free by going to that lecture that he gave. I thought, “I need to get this guy's help.” I talked to him, I hired him and I flew him all the way up from Maryland to come to Alaska. It was his first time to Alaska. He taught us some great stuff. What I'll say is there are a lot of things that were very helpful and a lot of things that I don't think were applicable for our location in the country.
This is how long into your ownership that you hired him on to consult with you?
About a year and a half to two years.
Kudos to you for stepping out and reaching out that quickly. For some guys, especially some of the more successful ones that I have on my show, it will take two or three years of struggle before they finally burn out. Before they finally decide to reach out, step out and network like I strongly suggest that we own or do. You got into it rather quickly. Was that because you heard about PPS or did you have some burnout yourself to an extent?
I didn't know what to do.
You didn't have any business experience.
I'd only been a PTA for three years and I'd never owned my own practice. I've never owned a business. I honestly didn't know how to make things better. I knew I needed someone else that had gone through all this. With Brian, he had won Practice of the Year. I thought if anyone knows how to do it, this guy knows how to do it. He did. He knew some great stuff. I flew him up for two days and he came and he lectured all my employees. From that first two days, I was able to recoup all my funds because they started billing better. It was one week, it paid for my cost to fly him all the way up here and his fee for those two days. I employed him to do more stuff and that costs a lot more money.
That one story is a testament to the return on investment you can get from proper coaching and consulting. I don't think everything that every consultant coach has to say is applicable to everybody across the board. You have to individualize it. You're going to take what fits you. Unfortunately, a lot of people will be concerned about the price tag that comes along with coaching and consulting. You and I can have the experience and I don't want to speak for you. From my experience and what I've seen from other successful people in the network that I have is that, when they put the money and the effort into using a coach or consultant properly, that return on investment is multiples.
It's a double-edge sword too and I'm going to tell you why. When I brought him on, those first two days the single-most valuable tool was teaching us how to bill correctly. Once we did that all of a sudden, my charges went up easily over 25%. That's what I mean I made that money back because we are making 25% more money. This is the downfall. I jumped on board, signed him up completely, which is a huge price tag. I flew half a dozen people to Maryland from Alaska, put them up in a hotel, train them, went through his whole program, came back and I immediately had one of my employees quit after 30 days because they didn't like it. I lost all of that money that I poured into that person, which was thousands. Slowly over the next several months, I was forcing my employees in a direction they didn't want to go.
These were the people that had been there for twenty or 30 years.
They liked their comfort zone. I didn't want to maintain the status quo because there was zero growth in it. I had to do something to derail them off the path they were going to try to push them into a growth mindset. They did not like it. Since I have taken over since 2012, I had nine employees. I have twelve employees now and I have only one that is still with me from that first day.
How did they take his two days of lectures, to begin with?
It's funny because they loved it at first. They all praised it at first.
They put on a great face.
They were like, “This is awesome. This is what we needed.” Once you start putting action to the words, they didn't mesh.
It's funny you say that. I shared this with you before, but my partner and I had a clinic where you could walk into the clinic and feel something is wrong. It wasn't warm, welcoming and inviting. It was hard for them to even acknowledge the owners. When we would train them and try to implement new programs, it’s the same thing, bright and beautiful faces, “This is great. Let's do it.” When we'd hold them accountable they'd say, “We don't like it,” or “This happened,” or come up with excuses.
Every excuse under the sun of why it doesn't work. It's not their fault. It's something else.
Unfortunately, it was the clinic director that was the poisonous part of that group. He led that group in that direction. It wasn't until we weeded out every single person in that clinic over the course of a year to a year and a half before the statistics of that clinic finally turned around. They weren't going in a good direction. There wasn't a good vibe and even the people that we thought were still good, they still had, unfortunately, the influence of that poisonous person from the past. It wasn't until we rooted it out everybody that the stats started turning around.
The ones that do the most damage is what Brian Gallagher likes to call it covertly hostile. They are not hostile to you but when you're not there, they are doing their best to sabotage your efforts. Those are the most dangerous ones. Unfortunately, the last two therapists that I had before they left, one of them I let go, the other one quit after I let the other one go, were the two most covertly hostile.
They were happy to your face, “We're all on board,” but you find out after the fact that they weren't.
They don't speak kindly about me in the community. I wished them well. They have a bigger grudge on their shoulder than I do. I don't care. I hope they have a happy life.
What would you have done differently then? Looking back on it, where you're at is in a much better place. Your culture is great, your statistics are going up. Would you have done something differently back then?When you're busy, you're not marketing as much, but then when you're slow, you're marketing a lot. Click To Tweet
Nathan, I'm not sure what I could have done because not to say it in a derogatory tone, I was ignorant. I did not know. I come into it so blindfolded. For those that are in the Lower 48, if you've ever done a polar plunge, you jump into the lake and it's shockingly cold. I jumped in with both feet. I didn't know what I was doing at first. My greatest educating tool is not only Brian, but it was PPS, Private Practice Section. I have been a loyal attender of PPS ever since 2013. There is no single greater teaching tool for a private practice owner than that conference.
They've got a ton of resources I’ve heard.
If you want to start a new practice, they have a book you can buy that tells you everything. How many parking spots do you need? It's detailed.
If you hadn't got the consultant, do you think those changes would have happened as quickly as they did? It took you years to weed out everybody honestly, but do you think it would have taken even longer or been more difficult if you hadn't had someone to help you like that?
No, it would have been much slower if I had survived. In one of the statistics, 85% to 90% of practices don't make it the first five years. It's huge. I don't know that I would have made it. As it was when that last therapist left, she gave me no warning. I was left high and dry so I was by myself treating. In Alaska, a PTA can do that if they have a therapist sign their notes once a month. I still had to have a PT come and do evaluations for me. Fortunately, I had enough ties to the community where I brought somebody in after their other job at 5:00 and they'd see two or three evaluations and I treat them during the week. Those are what I like to call the dark days.
That was 2017?
Yeah, that was early 2017. That happened and then I got a couple of travelers that were awesome. They stayed after their assignment, they signed on to stay permanently. Then they had some personal issues. I came back from hunting one week and they said they didn't want to come on Monday. They wanted to leave. I talk to them to stay in one week, then I was by myself again for about two months. Then I finally got some more therapists and slowly we have been adding more and more people. This time, I sat down with my office manager and we set down a criteria of the things that we wanted in people before we brought them on, including the travelers. We would interview travelers and I reached out to half a dozen or more travel companies. I had all of them send me their people. In the summertime, everybody wants to come to Alaska, so there is no shortage of interviews.
The one stipulation I had with all the travel companies if they wanted me to sign on with them is they had to remove any finder's fee if I hired them on permanently afterward. After they do thirteen weeks or however long, I could offer them a job and I would not have to pay the travel company any money. It's turned into like a thirteen-week interview. We got very selective on who we wanted, what kind of culture we wanted and once we did that, it was the single greatest key to the growth of the clinic. We've had 84% growth. We wanted people that had the same mindset, that had a priority of patients come first, with no drama and that was growth-oriented. I've heard a lot of woes about individuals that hire Millennials but those are the single-best resource I've had. They’ve been a lifesaver for me.
Your younger therapists, they're trainable, malleable, and they don't have any fixed ideas of how things should go.
They’re excited, they want to learn. They're right out of school, they know the most current stuff. They are a little more green so with that, their no show rate is higher. You have more cancellations because all statistics show the longer you've been a therapist, you have higher retention rates. We have that problem to deal with but they're agreeable. They come in after hours, they help out with community events. They're not asking for money every time you turn around the corner. They love being there.
What I was excited about bringing you on for is because not only do I know about some of your travails but the difference between 2017 and 2018 was so stark for you and as you said, 80% growth. It’s crazy. Were there a couple things you can attribute to? Number one is getting the right people on the bus. Was there anything else that you can attribute some of your successful actions?
My Office Manager/Marketing Director, Linda. You've met her before. She's the third person that I've put in that marketing director position and she’s hands-down done the best job.
What makes her special about that?
She's very personable and she has the idea of promoting the clinic and not herself. I've had another marketing director years ago that she was very personable but she was all about putting herself upfront, not the business upfront. I had another marketing director. He had great ideas, but he didn't implement anything. He couldn't get anything going off the ground. Linda has a combination of both. A good marketing director is important. Take your time with that one.
In her marketing director role, she also does some office manager stuff. The marketing director role, is that a part-time thing? How many hours per week does she put into that? You have the one clinic and you started a second one with someone of a similar size and you have two or three providers on staff.
There are four of us that do therapy.
I'm trying to help others that might be of a similar size and other clinics across the country. How many hours they should expect their director of marketing to spend doing that?
The busier we got, the less time she had to market. It’s like the rollercoaster. When you're busy, you're not marketing as much but then when you're slow, you're marketing a lot. I hired two more people upfront, Miguel and Alyssa to take the load off her so she could continue doing marketing. I hired more people that were her assistants and she would direct them to do our office manager stuff. She has more time to go and see the docs.
She probably sets aside ten, fifteen hours a week.
We try to do twenty but it hasn't hit that in a while because we’ve been so busy.
In a small clinic like yours, that’s not uncommon. People have to wear multiple hats. You can't have a full-time marketing director typically. That was the case when I first got started, one of my PTAs was also my marketing director. I had to set aside a few hours per week to get her off of the floor and go market. We did go through those rollercoasters.
Some of the things that we did is diversifying what we do because we no longer just offer PT. We got into OT for a while and we had an OT on staff. Then the OT ended up leaving but she brought in a lot of business. We got known through a lot of pediatric doctors that would do PT, OT. We've been looking for another OT that would be a good fit. We haven't found one yet but we also started into the massage realm. We have the PT and massage that we offer. I've got five massage therapists that are working for me. They're not all full-time. Three of them will do a day week. I’ve got two that work three days a week and then three of them work once a week.
I've heard the conversations between your massage therapists and your PTs. They collaborate on the care of the patients.
They talk to each other. They have great communication. The PT will come to the massage therapist and tell them exactly what they found on their last visit. They'll be doing two PT visits a week and one massage visit in a week, or whatever combination works for them. A lot of our massage therapy people are now referred to us for massage and their insurance company covers it. We don't have to have a PT visit at all. They come to see the massage and we’ll bill their insurance.If you can be friends with your patients, they'll keep coming back to see whether they're getting better or not. Click To Tweet
I don't think that's the case in most states in the union but I know in Alaska that’s still a benefit of some of the plans that are up here.
It's crazy. There are some insurance companies that give them 75 massage visits a year.
That's something worth looking into if you are down in the Lower 48 states is to consider do some of these plans that your patients that don’t have massage therapy benefits that you could take advantage of. It's a way of getting that patient in and patients love it. They tend to become a lot compliant when they get their massage therapy visits. Anything else that you can say, “Between 2017, 2018, this helped out in making a change?”
The real estate, I bought the building I was in. That made a huge difference because when you're paying rent or you're paying a mortgage, the mortgage is cheaper. At that time, the people that own this building also owned a building in Eagle River. They wanted me to buy their clinic in Eagle River but they were having staffing issues. I didn't want to double down on my problems at the time. I was able to convince the bank to lump both buildings into one loan. I got this building, I got the Eagle River building and the Eagle River building had two tenants: a doctor downstairs and a PT clinic upstairs. The rent from that building covered mortgage for both buildings and I made another $3,000 per month.
If that’s not on the radar of private practice owners to eventually buy their practice, then you need to be.
That is your retirement plan. Don't get into the mindset that you think you're going to sell your clinic and retire on what you made. There are some people who do it, I wouldn't count on it though. People tend to overvalue what their clinic is worth.
You're excited about PPS and what it does for you. One of the other things that I wanted to get into and share with people your experience on the Peer2Peer Network. My mantra is, “Reach out, step out and network.” That's a pathway to success that I've seen in almost every successful owner that I have. They've got to step out of treating full-time to work on their business. They've got to reach out, get some training, consulting, coaching, whatever you want to call it. They also need to network. There's a real value in the network. One of my mentors always told us, “Your net worth is equal to your network.” Tell me a little bit about your experience with peer-to-peer over the last couple of years.
It's been good. I'm not a good networker naturally. You were a lot better than I am. When it comes to networking, I first didn't know what it was. The first PPS conference I went to had a questionnaire booth where you could go and ask the people that work for PPS any questions you wanted. Everyone kept saying networking and I go to this booth and I'm like, “Why do we want to network?” I didn't get it. I get it now, there are so many connections you make. PPS was lightened enough to create a program called the Peer2Peer Network where you join it, you put all your demographics, how much you make, how many clinics you have, how many employees you have. They put you with similar individuals all throughout the country. None of you are competing with one another. You're not in the same area. You share with everybody what you have learned.
You are with owners of similar demographics and they're all across the country.
I got them in Baltimore, Pennsylvania, Iowa, Colorado, everybody has in my group one to four clinics. I've got two. That first year, I got into that. Jen, who’s from New Jersey, told us about this concussion program they've been doing in the school in their local community. That's a great idea. I came back, I immediately implemented a program with Houston High School. We have somebody that shows up to Houston High School, all their games, their football games, basketball games, wrestling, or hockey. We do the concussion training. We do all taping and bracing. The person that I had who went there, I trained him as an EMT. I send him to a course and he’s their emergency medical responder.
That’s a nice pipeline of business.
That's exactly what we did. That was strategic. Because of that Peer2Peer Network, I got that idea and I have a new practice. The second thing I learned is there's a guy that told me about real estate. After he told me the real estate thing, I came back. It took me a whole year to work the deal, but I ended up at this building and the other building. I'm making money and I'm putting money in the bank.
That's something that didn't come out of the blue. That's something you started working on because of your networking that you were doing.
People just have ideas and they show you a pathway of how to do it.
You don't have to reinvent the wheel.
You don't have to come up and everyone has to brainstorm like, “How is this going to work?” The only disadvantage to it is the demographics in different locations are so different. I'm fortunate in Alaska that in my peer-to-peer group, I have the highest reimbursement out of everybody. In New Jersey, it's awful. In Baltimore, New Jersey, and East Coast, the reimbursements are terrible. When I tell them how much I get per patient, they all start lamenting that they're not in Alaska. They didn’t know I live here.
It's almost embarrassing to say how much you make per patient.
I'm the only one that's still one patient per hour.
The value that you can get from networking makes you think outside the box. It opens you up to opportunities and makes you think differently. It's a timeless concept. It’s well-mentioned in Think and Grow Rich, the book by Napoleon Hill essentially as a mastermind group. The logic is simple. If you can get eight people working on a singular problem, you've got eight brands and you’re not relying upon yourself. How much more likely are you able to succeed when you get more people in a room to solve an issue? More than likely, one or two of them have been through it before.
When you bring up a problem, we have yet that somebody else has not already had the problem and started implementing something and we're like, “What did you do? How did you do this? We talked about EMRs. What's the best EMR? What's your best motivating tool? How do you incentivize and all that stuff?”
It's invaluable and I'm sure you can't imagine not being part of a network now.
No, I wouldn't go back. It's too valuable because anytime I’ve got a question, I shoot out an email, blankets to these people. They all know me. They feel comfortable. I've known them for years and they're like, “This is how you do it.”
Anything else that's been influential to you, whether it's been a coach or a book or anything like that you think you’ve been able to lean on?
My parents because my dad is a PT. He graduated from the Mayo Clinic in 1963. He was an old-time therapist and he would tell me business techniques. In fact, I was reading about your other episodes where interpersonal communications with the therapist, my dad told me that years ago. He goes, “If you can be friends with them, they'll keep coming back to see whether they're getting better or not.” My dad was telling me he’d always get to be friends with these people and he'd chat about their family, “How are your kids doing?” They enjoy coming, it's not drudgery anymore that they go and they get hurt or whatever.
When they're coming two or three times a week, they've got to have some positive effect of it even if it's social.
We've got people that we have a hard time discharging because this is their social life. One of the other things we've altered the clinics, we do a lot of community events and I don't know if you've heard about the tea parties we throw.
I've heard about them.
They are crazy. We had all these older widowed women who did not have social lives. They don't have friends. Linda got the idea, “Let's get them all together and let's throw a tea party.” They're dressing up like 1700 Victorian style. They're bringing this $1,000 China. The Halloween one, they turned the whole gym into a haunted house. We had three people walk up to our window without an appointment and say, “I hear you have tea parties. I want to be a patient.” That's one of the community events, the women's event is big too. We do a women's health event. I'm always worried about the fire code having too many people here. We start staggering the hours of coming a little bit later, come earlier. We’ve got everything health-oriented. We had the mobile mammogram bus from Anchorage come out so the women can get mammograms. They had blood draws. We had a doctor who's become a rock star referral for us. She comes and does cancer screenings. It's been good.
Out of curiosity, I'm assuming Linda, your Marketing Director, takes care of most of that. How much are you involved in the creation?
This is what I absolutely love about the women's event, no men allowed. I don't have to be there.
You can say the same thing about the tea party.
We do have guys that start showing up to the tea party.
You don't have to be there.
I don’t but I supply the tables. I bring all the chairs, background stuff.
Here's the great thing about it, you set it up so that it's not all dependent upon you. If it's going to work and it's going to work out well, it's dependent upon your marketing director is what it sounds like. That's where an owner needs to be.
She makes it great. I would not be able to do that if I didn't have somebody on board with the creative ideas that she does.
From a broader perspective, the more you can hear some of your activities towards females, the better. I don't want to sound sexist in that but it's known that women make most of the healthcare decisions in the household. You'll see a majority of our patients are female.
Majority of the therapists are female.
When you're looking at how to interact with the community better, you're going to get a lot of headway if you work with the decision makers. Thanks for sharing your experience, Rob. I appreciate you taking the time. I've been intrigued by your story, especially because I've known what's been going on for the past year and a half or so by talking to you here and there. I'm excited to see how well things have turned around in the past year.
It's enjoyable now. It's not what tragedy am I going to try to put out or what fire am I going to put out when I get to work.
You enjoy going to work.
It’s not bad. Everyone would love to be retired on a beach somewhere.
You're not there 40 hours a week. That's amazing. You guys are succeeding and you're not even there.
I will tell you one thing that I set up early and I've never deviated on this. I tell almost every employee I hire that I go home around 2:00 in the afternoon. If I have to work longer, I will. I let everyone know that I come in a little before 8:00 in the morning and I work straight to about 2:00 in the afternoon and then I go home. That's my day. A lot of times when I leave the clinic, I am doing stuff for the clinic. I'm not going home, I'm running errands and getting chemicals for the water because we got onsite aquatic therapy, all that stuff.
Thanks for your time. If people wanted to reach out to you and maybe ask you a little bit more about your story and whatnot, how can they get in touch with you?
Email's the best way, WasillaPT@Gmail.com. Do that and you will get in touch with me.
It's great to hear your story and I wish you the best of luck in the future.
Robert O. Brown began his career as a paramedic working for EMS services in Idaho and Louisiana. Following this, he continued his education studying public health. He received his Bachelorette in Health Promotion and Education with an emphasis in community health. His focus at this time was on presenting and creating substance abuse cessation programs. Following this, he obtained his Master’s degree from the University of Alaska Fairbanks in Professional Communication with an emphasis on organizational communication. In 2008 he ended his education career with a degree as a Physical Therapy Assistant in 2009. In 2012 he became the owner/operator of Wasilla Physical Therapy. He is also a published writer who enjoys being involved in the community in various ways, such as local school activities with his 5 kids and volunteering with his church. He enjoys playing with his kids, working in his woodshop, and doing home improvement projects.