January 22, 2019

Build Successful Niche Practice - Check. Beat Cancer - Check.

PTO 35 | Niche PT Practice

Michele Kehrer, PT, comes to us as an owner who has been through some incredible tragedies in her life and, while overcoming those tragedies, concurrently established a thriving niche PT practice. Now she looks at life and business ownership through a different lens. Everyday is full of gratitude. Little "issues" are quickly addressed or minimized. Her priorities are quite a bit different. Now she shares her insights with us and those whom she coaches. She has definitely made the jump from success to significance, and her influence is felt around the world. In this episode, she shares her story, some of the important topics she addresses with other business owners, and the books that are playing an influential role in her leadership.


Listen to the podcast here:

Build Successful Niche Practice - Check. Beat Cancer - Check.

Wonder Woman Owns a PT Clinic! with Michele Kehrer, PT

My guest is Michele Kehrer of Chicago. She owns a clinic in downtown Chicago by the name of Balance Chicago. She is well-known for her work in vestibular physical therapy. Not only am I bringing Michele on because she's a successful niche PT business owner, but she's got an inspiring hiring personal story to share with us. One in which she has triumphed and while she has gone through those personal tragedies, she has concurrently developed an amazing thriving successful physical therapy clinic. Hopefully, her story not only inspires you but some of the successful actions that she has taken and now she coaches with other PT owners will help you think about what is most important in your life? What is the most important in your business that you should be focusing on the day-to-day? Let's get into her story. I hope you get a lot out of it. She's an incredible woman, an incredible business owner and an incredible physical therapist.


I have Michele Kehrer from Chicago joining me. I met her at PPS and she's got a great story and a great practice. I wanted to bring her on and learn a little bit about her and what makes her so successful. Thank you for joining me, Michele.

It’s my pleasure, Nathan.

Would you mind sharing with the audience a little bit about your story and what got you into physical therapy and specifically, physical therapy ownership?

I have always been the one that went through the door that was mostly unlocked. It’s a weird twist of fate of life and it began when I was five years old. I announced to my mom that I was just going to be my own boss which I'm sure made for raising a challenging child, but that wasn't my deal.

It’s the beginnings of an entrepreneur.

PTO 35 | Niche PT Practice
Niche PT Practice: When you see people grow from scary to excited, it empowers you to treat and help more people.


It was one of those things of like, “I'm going to be my own boss. I had no idea what that meant but that I knew I was going to be my own boss.” As you go through life, you just muddle through it and figure it out. In high school, I was a good runner and my path I thought was running, get a college scholarship, go ahead, get my degree in business and move on with life. I got sidetracked when I tore my Achilles tendon. It was wild. I was seventeen and I was arguably the most dramatic seventeen years old in the world. I was like, “I'm never going to walk again. My life is over.” Obviously, that's not true and I had this awesome physical therapist. She was so good and the more dramatic I was, the more she was like, “Little one, chill.”

At the same time, I had this weird marketing teacher and I made the assumption like, “He's a weird guy. I don't want to be around him. That must be all business.” There’s this woman that’s teaching me to walk and then run again and I’m like, “Who do I want to spend my life with?” That's how I diverted initially from business into physical therapy and I switched to athletic training. I had undergrad degrees in athletic training, sports medicine, and all that. It was fun working with the athletes, getting them better, and doing all that. I graduated and I started working in a physical therapy clinic in about fifteen seconds and there’s a rumble in my belly going, “You're your own boss.”

You realized that quickly that that wasn't going to work out for you as an employee.

I'm going to give it the old college try. My family doesn't get entrepreneurship for a long time. My mom thought that this was just a hobby and I was going to get over it. I tried to do that. I ended up opening up other physical therapy clinics for other people and going along that path until I realized that there was no other way. I needed to have my own practice. Before that happened, I got involved with the dizziness stuff that I'm doing now. I was working at a high school and I was managing a clinic and living my life. I had two kids go down in the same game with head injuries. The stuff they're doing around concussions is better, but this was literally ‘96 or ‘98 where nothing was being done. I was like, “I want to figure this out.” I went ahead and I was doing some research on my own of, “What are the best of the best of the things on the market and how can we send these kids back to play?”

Did you own the clinic at this time?

As you go through life, you just muddle through it and figure it out. Click To Tweet

No, not yet. I was just managing someone else's.

How many years were you practicing before you decided to jump out and do your own thing?

It was a while. I graduated in 1994 or 1995 and I opened my practice in 2006.

You spent quite a bit of time as an employee. You started getting some experience around vestibular issues and concussions for a number of years before opening up your own practice.

I tried to go down the path and I was working with my boss at the time being like, “Can I buy into your business? Can I earn into your business?” It was exciting what we were doing and then that just never came to fruition. Once I realized it was never going to come to fruition, I went back for my Doctorate in PT.

PTO 35 | Niche PT Practice
Niche PT Practice: When you are naturally optimistic, you will always find the silver lining.


While you were employed, did you start developing some niche care within that clinic?

That was the fun part. We were doing stuff that no one else was doing. We got a contract with the Department of Defense because of the stuff we were doing. We had all these fun things. I was talking to NASA about what they were doing and comparing it to what we were doing.

You weren't just an employee, you were developing a vestibular program, a dizziness program on your own as an employee before even starting off your own practice.

We were doing stuff that no one else was touching. People are doing vestibular rehab, they're doing what we were doing way back then. It's cool. The stuff that we do in my clinic is pretty much been developed. The route started back there with myself and that physical therapist and the doctors and then I've just taken and built on it. Now the protocols are all things you wouldn't see or do anywhere else.

Have you done some of the continuing education that's out there or have you mostly just learned stuff on your own over time via experience?

The best thing is how we can help and fix more people that are suffering. Click To Tweet

That's the majority of it. It was being scrappy, and we took all the principles of what we know about orthopedics and how your body feels and apply them to your vestibular system. We're like, “Can you not fix dizziness or has it not been done?” That's how we started. We're just figuring it out. Like reverse engineer your inner ear system and those are where our protocols started.

Have you created your own training or continuing education program for other physical therapists or is that something that you simply do in the house?

Physical therapy practice owners are the ones, but they'll hire me to come and I'd love to travel so I'll go to their clinic. I teach them how to evaluate, how to treat, and how to have a vestibular rehab program in their center including marketing and all that other stuff. I like doing it in their center because I've got their employees and we can create the protocols that they'll be using in their center for them. It's what we do in Chicago, but it's also unique to their facility because everyone has a little bit different layout. Some have stairs, some don't and all of that. That to me is super fun to be creative with them in developing their own program that's based on my protocols.

You went from being intrigued by these football players that got injured to studying on your own and developing your own program. You might have mixed in a little bit of continuing education here and there, but you've worked out over time to the point where you started your own company that is mostly vestibular related. Now, you develop it to a point where you're introducing that into other clinics as well. How long have you been doing that? How many years?

On and off for about five years or so. My practice has been around for almost thirteen years.

PTO 35 | Niche PT Practice
Niche PT Practice: The drama you're in right now is a temporary thing and it's only going to make you stronger than you were before.


To train another staff, is that simply a weekend? Is that three or four days?

If I go to someone else's clinic, what I put together is about two days, but they get a ton of pre-work like pre-reading to set them up for success so that we can dive right in. Like, “I don't want to have to go through anatomy and physiology. It’s boring. Read that on your own and then let's dive in and get gritty and get into how to evaluate and how to fix them.” The best thing is how can we help more people? How can we fix more people that are suffering because they're just suffering? If you've met anyone with dizziness, it's miserable.

I'm inspired not only with the work that you're doing for these people with dizziness. It's a wonderful pattern for other physical therapists who do have some specialty niches in that you develop that niche over time. As an employee, maybe you started creating and doing some of this research as a “side hustle” trying to develop your own program and whatnot to the point where you developed a program, a protocol, and then you started your own practice around that niche. Now, you've got such a well-established and well-run program that you're able to consult others and implement that same program into their clinics. For someone who's looking at a niche specialty practice, that's a great pattern to share with other people and that's why I'm so glad to have you on.

Thanks. It's so much fun. When you love something, it's easy. There's still the grind of having to create the manual and all that other stuff but the actual being in front of people and seeing how they go from like, “Dizziness is so scary,” or whatever someone's specialty is. Whether it's women's health or some other specialty, to see them grow from scary to excited to then empowered and being able to treat and help more people, that's what gets me jazzed up.

Tell me a little bit about it because you are so positive and you had some great success. There had to be a few bumps along the way when it came to business ownership. Am I wrong?

When you love something, it's easy. Click To Tweet

There's that one time. It was the craziest thing. I opened my business. I did it exactly the opposite of how you should. I opened a 3,000-square-foot facility in the middle of Chicago with two full-time employees including myself. There are three of us on payroll and zero referral sources. We just hustled and hustled. It was so good. That first year of the excitement when the phone would ring, “Do we have a patient or is it someone calling the wrong number?”

I guess one good thing about extending yourself that much is that you had to hustle to make ends meet.

The first year is like the first year of any business. You're just hustling and figuring it out and keeping the lights on and there was this whole thing that happened. I was married and that wasn't going well. I decided to exit that. Two days later, my business turned a year old and then ten days later I found out I had cancer. To say brutal is putting it mildly but the beauty of having all those three things at the same time is I could never take one of them too seriously. I get bad news about cancer and then I'd be like, “Our numbers are down. I got to go mark it.” I'd have to be focusing on the business and then my ex would do or say something ridiculous. It balances that little triangle and it helped me keep perspective on every day. I've always been naturally optimistic, so I always find the silver lining like, “Where's the rainbow in this craziest typhoon?”

What was that silver lining at the time? How did you have multiple issues going on in your life? What did you look forward to or what did you see that was coming out of that was positive?

It was cool to see my employees develop and to see my dreams come true of taking these patients that everyone was saying, “You can't help a dizzy patient. You just can't do it.” To be able to do it and get them not just a little bit better, but my people get all the way better and back to their lives. It's so good. I have this one cute patient. She was adorable. Her name was Marian. Her husband had passed, and she was sad and scared like you would expect. She was in her 70s and she was on days that she was too dizzy to take the bus. I or one of my people would drive to her house, pick her up, bring her back, treat her and then on the way home if she needed to run errands and I didn't have a patient, I would take her to the grocery store or whatever. That's the stuff like. I was like, “This is what I'm here for.” This drama I'm in right now is a temporary thing and it's only going to make it so I'm stronger than I was before. It challenged me to go, “What do I believe in and who am I and is this business thing really what I want to do?” It encouraged me to double down, triple down, or quadruple down when the path is rough.

PTO 35 | Niche PT Practice
Niche PT Practice: Some people collect stuff, but it's better to collect mentors.


What's amazing and where it comes through to me clearly is it tested your purpose and you found it as you went through that. It's a great thing not just about you, Michele, but about physical therapy in particular and being a physical therapist is that you are able to focus on other people. No matter what's going on in your personal life, you can focus on others and you can help others and you get so much joy from serving other people. It's not just your patients, it's also your employees. You see them grow and you see them get excited. You see your patients get better and there is so much joy that comes from that. Sometimes what's going on in your personal life can be put on the backburner for a little bit.

When you talk about the employees when they're growing, I remember this. One of my employees came up to me and was like, “I'm pregnant. I'm going to have a kid.” That just hit me in my heart so much. I was like, “This woman trusts that I have my path together so much so that she could rely on this as her career to have a child. Through it all, seeing people get married, buy houses, invest in their future, invest in their life. That's what we do as entrepreneurs. We create a foundation and a springboard for people to create their own amazing.

I'm assuming that the cancer resolved because you're still with us and that's great to see.

I still have to fight round two though. I went to even free of cancer for eight months and it came back. That was defeating. The first time around I was like, “Stage 2B cancer, I got this. I'm going to be bald. It’s no big deal,” but then when it became stage 4, that tested my everything.

How long did you have to deal with that?

The reason why we often don't do something is because it's scary. Click To Tweet

That was all of 2009. I was getting the diagnosis and then none of my doctors could agree on what should we do because they were like, “There's no reason you got cancer the first time. There's no reason you should have gotten cancer the second time.” The first time was very hard on my body that if they would have gone through a regular protocol, I wouldn't be talking. They had to get creative and that was just a crazy journey. It tested my resilience in being like, “Do I want to be here?” When you talk about finding your purpose and challenging your purpose and be like, “This is why I'm here.” That's when it got real.

I hate to be business-minded but what did you do with your business during that year?

Thank God, I had employees. I had an awesome office manager and I would go in and I’d be like, “Alma, what do I need to do now? What do I need to do tomorrow?” She would set it up and she's like, “I need you to do these things and this is what's coming down the pipeline.” This is how I have it handled.

Do you find that she grew a lot during that time simply by helping you through that experience?

The goal of cancer treatment and chemotherapy is to bring you to close to death as they can get you and then bring you back. Who I started was this live, vibrant, excited and scrappy to I couldn't pick my head up off the bed. There were days when it was just a struggle to even get up but if I didn't get up, we wouldn't have a company and they wouldn't get paid and that was a bigger deal to me. It was more important. That's where I had to find my real strength.

PTO 35 | Niche PT Practice
Niche PT Practice: Get your head and mindset right. Start in gratitude every single day.


Coming out of that, did you come out of it with any different goals or ideas in mind of how you were going to run your business or your life based on that experience you went through?

Quite frankly, it doesn't matter anymore. We have bad days and sometimes those bad days turn into bad months. I still have those but it's different. When someone's crabbing about something, I don't have as much time for that. I have this joke that I was telling my friend like, “I don't do superficial anymore.” I don't talk about the weather, I have an app for that. I know if it's going to rain by looking at my app. I'm going to get gritty with someone and sometimes that's off-putting because I'm like, “Let's just talk about real life. Where are you struggling?” They were like, “I just met you fifteen seconds ago.”

As a business owner, what are some of the things that maybe you put to the side or don't consider as important anymore after being through that?

It sounds a little cliché. When someone is upset with another co-worker, I’m like, “Get in a room and handle it. Be an adult.” Let's just be adults now or like, “Call your mama. Your mama can help you but I'm not going to do it.”

You went through that experience and you learned a lot. What would you tell somebody who doesn't go through those kinds of trials? What advice would you give them especially maybe the new practice owners out there? What could they get from your story?

Accountability is key, even in personal relationships. Click To Tweet

Find a mentor. Find a coach. Find someone that is bigger than you that's walked a mile in the shoes that you want to walk that you haven't walked in yet. It can be so lonely when you are a brand-new owner and even when you're a seasoned owner. You think that the problems you have are actually problems that no one else has had except for when you start talking to people. Get yourself with a network. Get yourself a team that's going to get you through those bad days that turn into bad months. Get support.

That's huge and that's one of the bases for my podcast because I have a little motto that says, “Step out, reach out, and network.” It's exactly what you're talking about. Find someone, a coach, a mentor by reaching out and have someone that can hold your hand or hold you accountable and give you some guidance or even just be a sounding board. Also, the network is important. The famous phrase, “Your net worth is your network or network is your net worth,” whatever that is. I think it's true because the people that you hang out with tend to be the type of person you become. Stepping out, reaching out and networking is infinitely valuable for the clinic owner because there's no one above you. You are your boss like you were a five-year-old little girl.

We, as owners, we are answering to the company, this entity. That's the one thing that I try to teach my employees and teach the people I work with. My responsibility is to Balance Chicago. I have to make sure Balance Chicago is healthy. When I started out, I had to make sure my patients were healthy, and my employees were healthy and now it's a bigger game as you grow. I have to make sure the entity is healthy. When you think about that mind shift, it makes the day-to-day a lot cleaner.

That's a paradigm shift that I had to go through, and I was grateful to learn from one of my coaches in the past. There's a hierarchy to your priorities and into your decision making. Number one is the company. We all work for the company. If the company's not there, none of this exists. After the company, honestly, it's the owner. The company needs to have the leader or director and that is the owner and after the company gets satisfied, then it's the owner and then the employees. Maybe you see this in some of the consulting that you do. A lot of new owners, maybe even older owners have that flipped upside down where they think, “I'm going to do what's best for my employees and then that's going to make me happy and that's going to make for a good company.” When that's not how it is.

That's the sticking point of the new person that's in business because they don't have any friends because they spent all their time at work. They're working on the business so then they look and go, “These employees that I have, they have to be my friends.” That's a dangerous little road to go down.

PTO 35 | Niche PT Practice
Niche PT Practice: In anything that you are starting, start with the end in mind.


You've been doing some coaching yourself. What are some of the things that you are noticing amongst the owners that you're talking to? Are there familiar patterns that you're seeing or constant issues that arise that they're dealing with?

People can get stuck quickly in the negative. Some people collect stuff, but I collect mentors. One of my best mentors is Jamey Schrier and he always refers to the Google world and how we can get stuck in the Google world. It’s volatile, uncertain, complicated and ambiguous. It's so easy, especially in healthcare when you're dealing with insurances and personalities and all of that. What I teach first is get your head right. Get your mindset right. Start in gratitude every single day. When you're having a bad day that turns into a bad month, be like, “I'm so grateful that I have the luxury of being able to have a bad month on my terms.”

You can take a powerful position even in bad situations.

It's easy for owners to be like, “The world is happening to me.” We can look at like, “Where is the insurance?” We've gone from PQRS to functional limitation and now we're in MIPS like, “I can't. There are so many things.” I’d be like, “No, I choose to own a company that gets to deal with these issues so it's my universe so that I'm creating is by me. I am choosing it instead of someone's doing it to me.” Instead of being a victim, you're a creator.

It's easy for us to go to the victim mindset so I love that you start off, number one, with gratitude and then number two, taking the position of, “How am I going to be the creator? How can I create my environment?” That's immensely valuable because there's a lot of negativity that swirls around us whether that's from other people or the thoughts inside our head.

That’s going to be brutal in our head. We’ve got that inner critic.

As a clinical owner, is there anything you would have done differently whether it was starting up or going through your growth processes? Is there anything you would've done differently that maybe would be good advice for other owners as well?

Yes and no. I got to now and I'm so grateful that I have now. If I could give advice to someone, maybe start with some referral sources. Maybe have a marketing plan and beyond that though, do the things that aren't sexy. Put a foundation in your business, put in processes, get an HR manual, and get an HR person to help you out. Write out what you want people to do. The other thing I work with my people that I'm coaching and especially in my organization is, “Who does what by when?” Accountability is key. Even in personal relationships like talking to my sister like, “We're going to talk tomorrow at 3:00 PM about blah, blah, blah.” Go all the way through that so it's super clear. Getting clarity is another principle that we work with our owners.

We leave so many things left unsaid unfortunately and I don't know why. Accountability can be so difficult but if it's the one thing that we reign in, it can have such a significant impact on our companies and I like what you said, who does what by when. Many times, I would find myself delegating something or asking for something without giving a deadline and without putting that timestamp on it. I'd come back and I’d ask, “Where are you at on that?” People would say, “I don't know. When do you want it by?” I’d say, “I wanted it three days ago.” They didn't understand the urgency or what timeframe I was on. I was just expecting them to read my mind. Having that accountability is necessary.

It solves so much drama. The reason why we often don't do it is it's scary. I'm going to put myself out there and say that I need your help and give you a deadline as to when to do it. I could be encroaching on your day, I could be whatever and then you could not do it and now we both are failing. You look at it from the other side of the coin of being like, “This is what I need and this is when I need it, and this is why I need it.” If you don't get it done and we get to have a deeper conversation and we get to build our relationship and make it more solid.

I love all these mindsets that you have that make you so powerful and the energy comes through it. It's amazing. Were there any books that you recommend to other owners?

I am looking at 100 books. I love to read. If you're going to break what are my top favorites, Traction like the EOS system is a good place to start putting processes and if you don't know how, it’s friendly. My other favorite is The 15 Commitments of Conscious Leadership. It's all about being a good human. It's about creating your own world and you're responsible for your own world. It's amazing.

Who’s it by?

Jim Dethmer and Diana Chapman. If you check out their website, it's Conscious.is. Specifically for physical therapy practice owners, I love Jamey Schrier’s book, The Automated Practice. It's so easy and digestible. I met him in Las Vegas at PPS and I read almost the entire thing on the plane back to Chicago. It gave me so much foundation on what to do and how to do it. The tactical things specifically around physical therapy or healthcare practice ownership that some of these other books that are out there that are fantastic, but they don't have a spin that's specific to our industry.

I had Jamey on as a previous guest, and we talked about hiring people or hiring good people, but I don't remember him sharing that book title that. That sounds new to me. I'll have to go back and check that previous episode that I had with Jamey but I'll have to check out The Automated Practice.

My favorite thing about it is it's not complicated. It's super easy to digest and you can start implementing the stuff he teaches immediately and make huge gains in your personal life and in your practice.

One other question I wanted to ask, you have a niche practice and you do mostly vestibular work. What advice would you give to other practice owners? Maybe even their current employees who want to develop a niche practice. What advice would you give to them as far as developing a niche?

First things first. Start with the end in mind. What's your ideal picture? What do you want it to be like? For me, I love education and I knew that I love treating patients but if I'm treating patients, it's me trading my time being like, “I can only help one in one.” There's a finite number of patients I can help and that to me wasn't a big enough thing for me to uproot my life and do these crazy things. To me, I wanted to get so that I can teach people to help people. Every moment I'm spending teaching, those people get to go teach one-on-one and then we can build on that. Now, we have teachers teaching teachers. You could build and develop so that you can help. When you think about a drop that goes into the lake and the ripple effect, to me, that's what I want. Someone else may not want that but that's why getting clarity on your end purpose. If you have a magic wand, pick up your pen. Your pen is your magic wand. Write it down and where is the end of the year? What do you want to do a year from now?

The idea that you're going from being successful in what you're doing in your niche to now having significance and that your reach is expanding out to other people. Your ability to help is just magnified by the teaching that you provide other practitioners.

Check your ego too because it's so ego to be able to be like, “I’m the best. I can help all these people. Help other people? It’s such a better thing.”

I love that you spent the time with us, and I love the positive energy provided. If people wanted to reach out to you whether it was for questions regarding your vestibular work or the coaching that you're doing, how would they get in touch with you, Michele?

You can email me, Michele@BalanceChicago.com. You can check out our social media. We are on Instagram and we got all these things. We're hiring so just come and work with me. That would be great too and pick up the phone. I'm so old school. I will pick up the phone and call people and that freaks people out. They are like, “What are you doing, Michele?” It’s easier to have a conversation. You can reach me at the office, (773) 525-5200.

I know you're successful but share with the audience, how many practitioners do you have? Are you still in your 3,000-foot clinic? Where are you at now?

We just expanded. We went from this clinic in Lakeview down to River North which is the heart of Chicago and if you're ever here, come visit. I love having visitors. We were in this little clinic. It's about 3,000 and we have three physical therapists, two physical therapy assistants that are part-time who love Saturdays and a chiropractor and we're growing. In my dream, when I use my magic paintbrush, my pen, I want to be twice as big.

I'm sure you'll make it. I have no doubts whatsoever. Do you take all insurances or are you simply cash based?

We take the insurances that are in good behavior.

You've been filtering.

We don’t take the ones in bad behavior and then, of course, we are happy to take cash.

A lot of people might have some more questions for you and so I hope they reach out to you. I appreciate you being on the show.

This is so much fun, Nathan. I mean it, reach out.

They should and I hope they do. Thank you, Michele.

Thanks, Nathan.

Important Links:

About Michele Kehrer, PT

PTO 35 | Niche PT Practice

Michele played a key role in developing the protocols and equipment used by the few specialists working with neurological dizziness and balance disorders today. Her success rates, contributions, and ongoing innovations to this emerging field have built her reputation throughout the medical community. As an athlete herself, Michele discovered her calling and began on her career path as a result of sustaining a serious sports-related injury in high school. After working in a variety of settings with numerous sports teams while earning her undergraduate degree, she served as athletic trainer for Highland Park High School’s LaCrosse team while simultaneously treating patients at a clinic specializing in sports and vestibular rehabilitation. Now she is the founder and owner of Balance Chicago, teaches other clinics in her techniques, and provides coaching support to multiple PT owners across the country.

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