Over the past three months, Dr. Avi Zinn, PT, the owner of Druid Hills Physical Therapy, has made some big moves. He’s hired a new PT, signed on for another year of consulting, and switched his coach. He also continued to refine his processes with a new Prompt EMR and a new billing company. Thus, he has continued to grow his practice and has not had to step back into treating or be physically present in his clinic for a full day since March. Much of his hard work to establish systems and work on his business for the past couple of years is paying off for him, basically setting him to be a top-ranked PT in Atlanta, Georgia. Listen in as he shares these improvements with Nathan Shields.
This is Reality Episode 4 with Avi Zinn. We've followed Avi here in 2019. We followed you because you are a newer owner. We first got in touch because you were looking for some consulting help. If you want to hear about his story and whatnot, you can go back to the first episode. You decided to go with a consulting company. You've been with them since 2019. You have seen great growth in yourself as an owner and also in your clinic. We want to come up to speed.
In the last episode, we talked about how you got through COVID and how you're coming out. You’re optimistic about how things were going in general. Atlanta had opened up from lockdowns. You were projecting to continue to grow and bring on another PT. I’m excited for you in that regard. Bring us up to speed. What's been happening? We can talk about some of the trials that you might've had and some successes you've had as an owner over this period of time?
A lot of stuff has been going on since the last time. The biggest thing I listened back to our previous episode and I was talking about hiring on a new PT. The majority of what I was focusing on around that time was trying to figure out when the right time was to bring the new PT on because it was during COVID. It was hard to decide when things were going to feel like we're back to normal and clearly, we're not back to normal. We decided to go ahead and make the decision. Finding the right person is always challenging. It took a while, but I was able to find the right fit and we were able to get her started in the middle of September 2020.
Let’s talk about a few of the details if you don't mind. You were trying to figure out when was the “right time” to bring them on. What were some of the numbers you were looking at? What were some of the thoughts that were going through your head to make you decide to finally do it?
As a coach, you would not necessarily think I went in the perfect way. I didn't fully look at all my numbers to see that we were at a good utilization percentage or this and that. I got a sense by looking at the schedule and feeling that we were full. The world started opening up, we were getting more people wanting to come in, so it felt like we were busy and we need to hire on.
I assume you were seeing a jump up to a different level of new patient numbers or a consistent high total visit numbers.
It’s more total visits and new patients have always been about the same and that's also an indication of needing a new PT. When you get new patients but you're not getting more total visits. It’s because the PTs are discharging or too early. Some patients are falling off because we're too busy trying to get the new people when we can be focusing on the ones we have.
You got a sense that with the new number of new patients that you had, you weren't being as efficient as you could and getting them in for the 2 to 3 times per week or giving them a level of attention to the patients. Sometimes patients don't feel comfortable when the clinic is completely full. There is no table to do your exercises or they have to wait for that. You lose a little bit of patient engagement. You got some of those senses.
It was a few of those. Because of COVID, we've spaced out our clinics. We only do one patient at a time and there's not a space issue with that, but the therapist schedules were getting full. The patient engagement was more like we were letting people drop off and not having room for people and retaining them.
What were your concerns financially about bringing on someone? That's always an issue when I'm talking to newer owners. It’s like, “I've got to bring on this salary and the benefits for this PT. How is that going to impact me?” Had you worked that out or were you feeling uncomfortable?
I was feeling comfortable basing it on what it seemed like the influx of new patients and we were getting full. There were concerns with any time bringing on someone new. You’ve got to fill their schedule, spend a month or two trying to fill them up and you're still paying them. Luckily, I was able to find someone who agreed to start at part-time for the first month and then at the end of the first month, we transitioned her to full-time. What happened was even after the 1st or 2nd week, I had already asked her to increase her hours because we had enough patients. She was interested and she was happy to increase her hours.
That’s one of the benefits considering the situation that our industry is in. There are a number of PTs that are looking. I don't think that was the case in 2019. I don't know how many PTs would have been okay with starting part-time and then ramping up as they go. There’s an opportunity now for owners to bring on people slowly to build up their caseload that wasn't quite there a few years ago.
It allowed me to choose someone who I felt was a good candidate because there are a lot more people out there looking for jobs. I was able to find someone. I knew I had a little time so I didn't hire because I needed to fill a spot right away. We did get a little busy waiting to bring that person on, but I knew that I wanted to find the right person. That was what a lot of the work I was doing with the coaches. I've got my original coaching group, the Lighthouse Leaders, which is what we've been talking about most of the episodes.
Additionally, we talked about in the last episode where I hired Will Humphreys’ billing team. He also does coaching with me as well. I've got two coaches. I’ve got the coaching group and Will. A lot of what we've been focusing on is the mission, purpose, vision and values. Bringing on this new PT, I was able to make sure that she was aligned with our purpose and our vision. Making sure that she was the right fit for our team and not hiring someone because I need someone to be a PT in the clinic.
Was that a different process for you than what you've used in the past?
It was. Will helped me write some of the ads. He’s good. What did we write in the ad was about joining a team that is committed to values and purpose. Do you want to be a part of a team? Phrasing it that way. It gets better candidates because they are attracted to those specific things. I hadn't done it that way in the past.
Did you find that you got better candidates and people that were more engaged?
What’s interesting is that in March 2020, I was about to hire someone on. It didn't end up happening because of COVID and everything. Even with that candidate, she seemed like a good candidate. I was about to hire her, but it was something different when we spoke about the vision, purpose, future, growth and goals whether or not the other one wasn't the right person or not. It's hard to say it didn't happen anyways but this time, it felt different.
As you went through the hiring process, could you tell the candidates that weren't aligned or not engaged when you talked about values and whatnot? Did it help the filter system a little bit?
It made sense why I was doing that. There was one guy who clearly needed a job, which is fine. I don't blame him but all he was focusing on was specifics of like, “I want to work and I want to get paid.” Not anything more than that. That’s not what you want to say in your interview. Even though I was prompting him to talk about some of these things, he didn't align with or didn't buy into it.
If people are uncomfortable in that position when you talk about values, if their body language changes or they pay some lip service to it but you see something different in their job shadow, that tells a lot. When you put them up against the values, hold them to it and have them verbalize things related to your values, then it's almost like they self-select because they can't use the words if they're not aligned with the values. It comes across junky. You can always tell they're not comfortable. That helps a lot when you're going through that hiring phase being clear about those values and having those discussions.
You get a sense that they're authentic, sincere and it's someone that will be a good fit for your team because you can tell that they want to be a part of a team.
Not to spend too much time on this section, but it's awesome that you went through that experience. The part-time part of it is cool as well that she was coming on part-time for a couple of weeks. If it didn't work out over a 2 to 3-week period, you got some support but you're not fully committed so you have an easy out if they're not living up to what you expected.
For the reason of allowing me to ramp up with a lot less pressure.
Congratulations on the hire. Did you simply post something on Indeed and work through that?You can sense that someone is going to be a good fit for your team because you can tell that they really want to be in it. Click To Tweet
You’ve got the benefit of being in Atlanta, but you also have the benefit right now of so many PTs looking for work compared to past years. I'm sure you had so many to choose from.
The PT I hired moved from Houston. She's making a change. She and her sister wanted to both move to Atlanta.
There are a lot of PTs out there doing that.
People are moving from what's going on. You hear about a mass exodus from New York and people moving out of there. People are changing their lifestyles now because of what's going on.
I've heard about it with a client in Cheyenne. I've heard about it with some friends in Ketchikan, Alaska. People are uprooting from Chicago, New York, New Jersey, you name it, to give themselves an opportunity to reset so it's a good time to find those people.
With her moving from Houston, it was super helpful to have Will and his team as our billing company because not only has it been great having them as the billing company. The first main reason is I'm not doing the billing anymore. They do a great job. They have all their systems for keeping track of the billing, claims, deposits, EOB and all the stuff that they should be doing. They also do verification and credentialing. Since she came from out-of-state and she had only worked in a hospital system, her credentialing and all that stuff was way more robust. It was a bigger process to have to completely get her credentialed with Medicare and then all the other insurances. It was a lot of work that I’m glad that I did not have to do.
It's so beneficial to have someone do all that credentialing stuff for you because if you fill out the form wrong or check the wrong box then it can delay that credentialing process so much longer. You'd rather pay somebody to deal with those headaches. Tell us a little bit about also the consulting. You’re still with the same consulting company. You signed up again after being with them, but you're changing individual coaches. Talk to us a little bit about that.
I signed up for group membership or whatever you call it to be part of the consulting group. The year came up and it was time to decide how to move forward. The group has a new lead coach that is not a PT. He’s got a much different background. He’s a CPA and has a lot of experience with business consulting but not specifically in the PT arena. It was appealing to me to get a different perspective from someone outside of the PT realm to see what it could be like.
There's an opportunity there to get a different perspective and not work with someone who might be simply accepting of your reasonings, your thought processes and you haven't worked with him yet. Going forward, he's able to challenge you a little bit on some of those fixed ideas that you have.
It could be. The coach I had in 2019 was great, valuable and we got a lot accomplished. Having this new one to challenge me is exactly what I am looking for. To challenge me, dive into some of the financials and look at our numbers a little differently. In the first year of coaching, I had a lot to focus on other things whereas all the numbers are important. There was a lot of focus on our systems and a lot of things that were not so data-driven. This could be a cool switch with the new one.
That’s not uncommon. Will and I had at least 4 or 5 different coaches over the course of the number of years that we worked together especially if you delve into it a little bit. The CEOs that are out there that have coaches, they'll change coaches every few years to get a different voice and a different perspective. They also have strengths in different areas that you can build off of. Not to say that they're necessarily improving in the coach that they're using each time, but they're simply getting a different voice. Something that speaks to the owners or the CEO’s weaknesses a little bit more. I can see the benefit of that.
I can relate to that in two instances with the previous coach. Chris and Will in two separate occasions both talked about mission and purpose. Even though we're talking about the same thing, the way Will talks about it versus the way Chris talks about it is different. You disattach onto the language that they use differently and relate it to an experience or a construct that you have in your head. It allows you to think and approach it differently. It could be as simple as that. Hearing the same thing but hearing it differently.
As long as people are getting some coaching, that's my greatest concern. I've had coaches that were PTs and most of my coaches were not PTs or in the industry. There are people that have reached out to me to get some input and advice and some of them work with PTs and some of them don't. That’s fine, as long as you're getting some support, guidance and business training, stuff that we didn't get in physical therapy school.
As long as you're simply getting it, that's the first step and then moving on from there to make sure you have the proper systems in place. You're working on the right things at that stage in your business. We’ll have to keep track with you on how the new coach goes going forward. Tell us a little bit about what you've been working on outside of the hiring process. You've got the coach. You switched over to billing with Will as of last time we spoke. It sounds like things are going well in that regard and the other things that you've been working on.
Outside of hiring on the new PT, the billing company and we switched over to EMR so we’re still working with Prompt and they're getting better. They're developing their software and they're coming up with cool things. Every update, they have cool new features. One of the big pushes that we've been doing since Corona is social media presence. We had a little extra time but we didn't have a social media presence.
We’re posting more on Facebook, Instagram, creating blogs, video content and sending out MailChimp newsletter. One thing that we did was have the PTs make videos of introducing themselves talking about their philosophies to be put on the website and use as promotional stuff. To also send out to people so when they sign up for an appointment, schedule their first visit, it includes a video or a link to their webpage and say, “Meet your PT.” They can meet them before even getting into the clinic.
That was an idea that Jerry Durham talks about in some of his podcasts. I didn't exactly come up with that on myself. Including it in the email to introduce before people coming in. Along that same lines of social media is something that we've been talking a lot about in the coaching group, the Lighthouse Leaders, is relationship marketing. It's not the same thing as social media but in a way, a lot of our referrals have been from Google Ads and we do a lot of paid advertising.
I haven't focused so much on making relationships with people in the community. Not just doctors but also trainers, massage therapists, athletic trainers, running groups, or yoga instructor, whatever. I put that in the same category as our social media because we're reaching out to people and we're trying to be connected with more people in our community. We’re trying to widen our audience, try to figure out who our target audience is. We're a generalist orthopedic outpatient clinic. It's hard to say who our target audience is. That’s also one of the things that we have been working on. It’s the social media and trying to reach out to our community a lot more.
How often are you posting social media content? How often are you sending out newsletters via MailChimp?
We’re doing monthly newsletters. We’re posting only once a week. We should be doing more. We’re getting it off the ground. We’re trying to broaden our audience and try to figure out how to get more people to either like our page or follow us so that we can reach out to more people when we post stuff. I don't know too much about the social media stuff as far as using it for not personal stuff but as a business, how to get out there and reach your audience. We're trying to do it and see what happens.
I did a podcast with Angie McGilvrey. She's a master at it. They had a hurricane in Florida, which shut them down and it gave them an opportunity to say, “How do we want to reset our business?” Coming from someone who was not on Facebook at all, no social media presence or whatsoever decided to focus on a certain target audience and do more consistent social media posting, engagement and that stuff. They started like you. Once a week, they'd post something to a particular audience that they wanted to attract. A few years later, they've got a part-time videographer that comes in and they're spending a few hours each week. Three of them are doing different social media things. They’re posting 1 to 2 items a day. It starts where you're at. Putting someone in charge of that so it’s not you all the time and then focusing on, “Who are we speaking to? What do we want to say?”
The interesting thing is, and I don't know if you've seen this as well, but as I talked to my clients, they say, “Sometimes I post stuff on how to do certain exercises, muscles they need to be concerned about, and activities they need to avoid. I'll post something about a dog and the level of engagement goes up to 200%.” Sometimes, it's not always about them wanting to know what you know and you espousing all of your wisdom. Sometimes, it's about staying engaged and posting a picture of a nice sunset once in a while.
We haven't tried it yet but we will.
The cool thing about social media is you throw stuff out there, see what sticks, see what starts connecting, and simply start doing more of that because you find out quickly who's engaged and who's not.With the right systems and processes already in place, you don’t have to figure everything out every single time. Click To Tweet
You can see if there are 20 likes or 100 likes and go from there.
Have you had any HR hiccups that you've had to deal with? Not that you have to get into details but that things seem to be running smoothly for you.
Things have been smooth. No real issues or HR stuff. We've done HR stuff as far as developing a better employee handbook and some of the SOPs. In regards to the SOPs, our front desk has been with us since 2019. She got accepted to OT school, which she's most likely starting her program in January 2021. Before COVID, one of my PTs were transitioning to the clinical director. We put that on hold, but we're still talking about it and doing some of that stuff. Not officially but me, the front desk and the PT have been trying to develop a strong, solid SOP for the front desk so when we do get someone to fill her position, our systems are going to be much more developed and more efficient.
It should be seamless if we can hire in time that we can have her come in and even sit with the front desk for a few weeks before she leaves, that would be even better. We're working on that type of HR stuff but nothing like disciplinary things like, “Thank God, my team is great.” Part of it is luck and following the advice of the coaches and all this stuff. It’s working on your team, setting up everything in a way, meeting with your team, and making sure that everything is running smoothly and not being a micromanaging boss but also letting the team run the place and all the stuff.
The smart thing that you've done since you started was to recognize that you needed to spend time writing up systems and how things were done. That’s a grind and you're still working that at higher levels but now is when it starts bearing fruit. As you said, the team can run things and you don't have to micromanage. This is where you're working through that hiring process with your coach and Will, and establishing your mission, vision, values. It's the same filtration system for those candidates at the front desk as it was for the PT. You can have the same conversations, you can get into a flow of how that interview process goes, and also gain some experience in being able to quickly weed out those that won't be a good fit.
This is all working in your favor. The fact that you were working on SOPs for a long time. Your systems are getting into place. You've got someone who's at the front desk who thankfully gave you plenty of time, and notice as to knowing when she's going to take off so that you can start preparing well ahead of time. If the next person can come in and shadow your person to be successful and you have two people there working at the front desk for a short period or as long as you like, you're going to be set up well in that transition and hardly see a drop-off.
I hope it works as smoothly as you said. That would be great.
It all goes back to the work that you started doing a couple of years ago in putting together your systems and processes. It’s starting to bear fruit. I'm assuming where you're at, are you treating it all now? What does your weekly schedule look like?
I haven't treated since COVID, since March 15th, 2020 or whatever. I've been out of treating and I've been out billing since April or May 2020 or whatever. It’s been great because it has allowed me to focus on all these things and get some of these systems in place. Before that, I was always working on them here and there, but I've had time to sit down, write them up, get things going, get feedback from the team. Even get their advice on how we should do things and get things set in stone so we can use them efficiently.
You've been an owner for a few years. It took me 12 or 13 years to get to where you are to finally step aside and work on my business, so congratulations on that. What are the next steps for you, Avi? You've been through the process considering the mission-vision values. Part of the vision portion is setting up some goals, longer-term or even shorter-term. What are some of the things you're looking forward to in the next year or two?
I've still got plenty of work to do on the systems and everything. What I do acknowledge is that even in the year of having the coaching, I'm still not dialed into all my numbers. That's also one of the hopes of this other coach, he's got a CPA background and he might have a better sense of financials and stuff. I want to focus more on our numbers, be more data-driven. It goes back to the SOPs, but it goes almost to some of the stuff we were talking about in the last episode as far as leadership team. I've been in the process of implementing where the team reports their stats to me or to the clinic director and then the clinic director reports it to me so that we're all taking responsibility for our own numbers.
Looking at the numbers and being able to project and grow from those. I do have numbers and look at them, it’s just I don't have a strong grasp on them. Looking at the numbers of September and October 2020, October was our biggest month ever, which has 100 more visits than last month or at least. We hired our new PT. You would hope that at some point, but her schedule filled up quickly which was cool. In addition to it being the biggest month, our utilization was good for her first month.
It was at 75% utilization too. That’s a big accomplishment and that goes back to having all these systems in place so we’re not losing our patients. We’re aware of their plan of cares, cancellations, and making sure that the front desk sets them up for success by setting up their expectations before they're coming in and dialing in on all those things. Moving forward, now that those systems are at least in place, they could be refined and improved. It allows me to start looking at the numbers, projecting, and using that for some continued growth.
How many providers do you have at this time?
We've got three providers.
You’re starting to get into that phase where you start developing a leadership team. You’ve already started that process by pointing out who your next clinic director is. Considering what that leadership training process looks like in your clinic and start developing those leaders to do exactly what you said to start looking at statistics, numbers, working off of the numbers as to what to do going forward, and also tracking those numbers to see if they're meeting your goals and expectations. Developing a leadership team, getting a handle on the numbers are great things to focus on in a little bit for you as a leader. Are you considering further expansion in the course of 2021?
Yes, but it all depends on the pandemic thing. It’s hard because we have a space for more people if we didn't have to distance. In our clinic, we rearranged it so we could fit three PTs comfortably. They're all in separate areas of the clinic. That’s how we want to do it. I'm sure there are clinics that are not as distant and we can squeeze another one in, but that's how we feel comfortable with our clinics. As far as expanding, we could get another provider and fill the other hours. We're open from 7:00 to 7:00 or something like that.
For me, it's hard to make any real plans for that until some of this stuff calms down. I can see that if all of these systems continued to function and not only function how they are now but even better and improve, that growth will only be a matter of having the space, hiring the people, and getting the patients as far as growth goes big. I can't imagine it's that simple but if we have all these systems in place which we're developing, I can see how it's going to be easier each time we grow because there's going to be a process for everything that comes up and it's not going to be like, “I'm going to have to deal with everything.” We don't have to figure it out every single time. There will already be a process and it will be smooth when something comes up.
Congratulations on the new hire. Congratulations on the successful EMR and billing transition. You've gone through some great stuff and coming out of the pandemic well. We spoke about the last time, to gain more patients for this new provider, you do a lot of work with Google Ads. I assume you simply increase your Google Ad spend, revamped a couple of things and you're continuing to grow.
I will say that we are seeing more and more referrals, not necessarily from more doctors, but internal return patients, word of mouth, so that’s been cool to see also. We are playing around with the ads, boosting the budget, and all that stuff, but we are noticing that the longer we've been around, the more reviews we have. People are starting to notice us and know that we're here. People are referring their friends and family. At some point, we won't have to rely on the paid advertising and we can get patients by word of mouth and by being a part of the community.
I don't know exactly what year of ownership that is, but there is a point where your return patients start making up a significant portion of your clientele. You still have to market and get fresh blood coming in. Once you focus on starting that internal referral program and pushing patients to refer family and friends who are injured or need some help, that can be a huge boom to your new patients. It takes a few years to build up that base level, but you're starting to engage with them as well with the newsletters and the social media postings. These are people that already know, like, and love you. It’s best to tap into that number of people which could be in the hundreds and thousands over time. Tap into them and it could bear fruit.
That’s the hope. That’s what we're doing with the social media. We're trying to engage with the newsletter, people that have been into our clinical before so they've all been here. We're trying to keep in touch with them, let them know what's going on, introducing them to the new PT. We've been also creating some eBooks which have been fun. Giving out links to the eBooks. Providing value to the community and not necessarily looking for anything in return. The goal isn’t to get people to make an appointment from that newsletter, which would be great, but it's more of keeping in touch with the community. Hopefully, that will keep us on their minds. If they know someone, they'll remember to tell them that they had a good experience with us and that could create another referral.
Congratulations on the growth thus far. You're doing great especially at ownership. You’re making progress and to be where you're at is enviable for a lot of owners. Congratulations, you're making steps in the right direction.
Thanks, Nathan. It's definitely fun.
Dr. Avi Zinn has practiced physical therapy in many settings prior to opening his own clinic in Atlanta: outpatient orthopedic clinics, hospitals, rehabilitation centers, and in people’s homes. He is an expert in treating all different types of pain and injury, and in developing treatment plans that bring people back to their most functional selves as quickly as possible. Avi’s main mission in opening Druid Hills PT is to utilize the experience he has gained in the field to provide high-quality, personalized care to each and every one of his patients.
Avi has his doctorate in physical therapy from Touro College, and is a Certified Orthopedic Clinical Specialist. He lives with his wife and three children in the Toco Hills area.