March 30, 2021

Growing And Scaling While Maintaining Your Lifestyle With Joseph Tatta, PT, DPT

PTO 138 | Growing And Scaling


Growing and scaling your business while maintaining your lifestyle is a challenging feat to pull off. How do you go about it, and where do you begin? Dr. Joseph Tatta, Founder of Integrative Pain Science Institute, has been through the full cycle of business ownership – start, struggle, grow, struggle, learn, implement, scale, and sell. Along the way, he recognized that he needed to do things differently if he wanted to scale and maintain his sanity. Tune in to this episode where we discuss what he did to manage the stress and maintain a lifestyle that allowed him to grow to 16 clinics in a saturated market.


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Growing And Scaling While Maintaining Your Lifestyle With Joseph Tatta, PT, DPT

My guest is Dr. Joe Tatta, the Founder of Integrative Pain Science Institute and host of a podcast called The Healing Pain Podcast. Dr. Joe, thanks for coming on. I appreciate it.

Nathan, it’s great to be here with you. Thanks for having me on.

I'm excited to bring you on because you have a great story in terms of the success you've had in owning physical therapy practices and subsequently selling them. We want to lean on your experience in terms of the ability that you had to grow and scale your practices and how to maintain a solid, comfortable lifestyle at the same time. Before we get into that, would you share with the audience a little bit about you, where you came from professionally and what got you to where you are now?

Like yourself, I'm a physical therapist. I've been practicing since 1996. I did it in the beginning of my career a short stint in inpatient rehab. I live in New York City. I worked in a practice that specialized in sports medicine and performing arts medicine. I did that for about two years, which was fun. It is an active and high-performing population. I got together with another colleague and we started our own outpatient physical therapy practice. That was in August of 2000. What was interesting thing about that practice, for those who can think back to August of 2000, it seems like yesterday to me, but it's many years now.

We were one of the first, if not, probably the first cash-based practice in New York City in Manhattan. We hear so much buzz about cash-based now and getting around the insurance system. We were one of the first practices that did that in New York City. It was interesting to set sail into waters that we knew nothing about and to see what this is going to look like, how are people going to react and respond to this, how's the market going to respond to this, what's our catchment area going to be like for this? The first six months was spent on building out the initial practice, deciding our cash-based model. We took one insurance at that time, which was Worker's Comp and everything else was 100% cash-based.

Why did you decide to go cash-based many years ago? Did you see where things were going?

My partner and I, when we got together, we both had a diverse background. We were physical therapists. We had other skills that we brought with regard to patient treatment. When I worked with dancers and performers, I got into certain types of manual care, as well as using Pilates as a form of rehabilitation. Pilates was booming at that time in the general population, hot amongst actors, performers and athletes. There was a big boom around that. In addition to our PT clinic, we had a small Pilates studio attached to it. My partner did some personal training as well. We had all these different things that came in. We said, “We have already had this cash-based training Pilates aspect.” We have the PT aspect. They feed each other in a way which is useful and beneficial, both for us as a business, as well as for our patients and clients at that time.

We saw that the quality of care out there was sub-par. There were a lot of practices in New York City at that time. We were already heading into a market that was saturated. We're moving into a saturated market, plenty of PT practices, the doctors all know the practices, how do we make ourselves stand out? The way that we did that was cash-based care. Our initial treatment sessions were an hour long. We also positioned our practice in a relatively wealthy area of New York City, which helped as well. It was a convergence of a number of factors with regard to moving toward that cash-based, but initially it was, “I want to treat the way I want to treat and to do that, I need a little bit more time than the faster pace setting we were in.”

You did grow up to a number of clinics over time. As you scaled, did you maintain the cash-based model throughout all your clinics?

There's not a direct line to the story, Nathan. It's like this jagged line. The first two clinics were cash-based. We had this model that we could replicate. We said, “Let's start to replicate this model.” We replicated it. We got to about 3/4. What we found was it was difficult to provide the same level of care. If you're an owner in the practice and you have employees who work with you, you realize that you put all your blood, sweat, tears, guts into your practice and into your treatment. With that, patients respond more positively to you. They're more likely to come back to see you, a longer treatment and refer friends and family. The whole process is easier.

We found it was a little bit more difficult to do that and asked the high price New York City cash-based fee we were asking when it wasn't “the owner.” We started to transition to an insurance model. By the end, we had sixteen clinics. We had a mix of cash and insurance. Some insurances we didn't accept. Even the insurances that we did accept oftentimes, in New York City, the market is tight with regards to medical management. They'll trim down visits in New York City quite rapidly. Once people come to the end of their insurance care, then we offer them wellness and cash-based offerings at that time. We had a mix at the end.

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Sixteen clinics, it's a ton. You had to have some growing pains along the way and some challenges. It wasn't smooth sailing. There was a zigzag pattern there. Tell us a little bit about what some of the biggest challenges were that you recognize when it came to growing and scaling up that much?

There's a memory that I have. There's a patient that I saw for a long time. He was a high-powered, successful investment banker in New York City. He had chronic low back pain so he was a frequent patient. He was sitting on the bike one day warming up before his therapy session. I can see him scanning the clinic, looking at the activity toward the front desk, in the gym area, watching all the patients walk by and all the therapists run around with charts in their hands. I came over to him, I said, “How is it going? How are you feeling today?” He stopped. He looked at me and said, “You're a little bit light on the management side.” I was like, “Interesting observation.” We had three clinics at the time. He would go to both of them. In New York City, he lived near one clinic and his work was near the other clinic. He would go back and forth. He was watching us grow and he was watching my role grow and change.

What he was saying in his own way, he probably could have been a little bit more delicate with the way he said it. He probably should have said, “You're growing. That's awesome. Keep in mind, there's a management part of every business that needs to be nurtured and cared for as much as the patient care side.” That's where, as professionals, we come out of school. We're highly skilled. We continue to nurture our skills, and then we wind up in practice and we're continuing that. We know the patient is priority one, and they are priority one. There's this whole other aspect of the business that needs time and attention for it to grow and for you to grow with it, which is what he was saying. Interestingly enough, shortly after that time, I started what I would consider rapidly backing myself out of treatment.

You recognized what he was saying right off the bat. Did you know in the back of your mind that he's right?

Yes and no. Other therapists probably, if you're at this phase of any growth, you see that, “There's a bottom line to what I do when I treat a patient. When I treat a patient, it's money in my pocket. How do I pull away from that?” There's the other part that’s like, “What's my time worth as far as growing and scaling a business?” Try to put a dollar sign on that. I recommend people, sit down and do that exercise, put the paper on the wall, step away for a week, treat your patients and then come back, look at that paper again and look at that number you put on it. My guess is you'll probably scratch it out and increase the number.

At this time, as far as patient care goes, my day would start at 7:00 AM. It probably ends at around 7:30. That was going on for a couple of years. There was a burnout factor to everything we do. After work was paperwork, management, insurance, hiring, firing, all those things come into play. My other business partner and I went out and had probably a drink or two and we were like, “If we feel we have the scalable model, let's put it to the test. For us to do that, we need to back ourselves out so we can put on a different hat and develop a different context for who we are as professionals.”

Was it that easy for you to step out or did it take some mental energy to see yourself as not the full-time treating therapist that you were for so many years?

It takes a plan because you can't just rip yourself out of the schedule. There has to be a thoughtful plan over the course of about three months. To say, “Right now, I'm treating 40 hours a week. My goal is to go down to twenty.” You can be a part-time clinician and a part-time manager. There's a caveat to that too. When you look at your schedule on a weekly basis, my recommendation is to have days where you're the manager and then days where you're the practitioner. They're two different skillsets and two different hats. If you start in the morning 7:00 to 12:00 treating patients and then you think you're going to switch right over into management mode at 1:00, it's hard.

I told the coaching client that the mental energy that it takes to switch from treating patients to the admin stuff is hard to explain. There's this mental switch. It's not like you can stop seeing patients and then go sit down at your desk immediately. Recall all the admin tasks that you have to take care of and jump right into the creative mindset of, “What do we need to do for our marketing strategies next?” They're two different thought processes. It takes some strain. It takes mental energy to switch those positions, those hats. I love your recommendation though to make a full day of admin stuff. If you can't do that, at least take a half day and take a lunch break in between. That's a perfect place to start. Plus, you recommended, give yourself a plan of a few months to gradually go down. It’s highly recommended. I had to do the same thing. You did the same thing. It's important because those tasks are diametrically different.

Our goal first was to bookend our week. We started with a Friday where Friday was no patient care. There was more management. We move to Monday, it’s management. I had Monday and Friday that were bookend with management type of activities. The middle of the week was more patient care. From there, it slowly evolved. I always kept my hand in patient care to some extent, I still do to this day. You don't need to have a schedule of 40 patients to be an effective clinician. To continue your clinical skills and development, you don't necessarily need that. Professionals, if you’re like, “I don't want to ever lose those skills.” Think about this, you went to school for seven years to be a DPT. You've already treated for a number of years. You're not going to lose them. They come back quite rapidly than if you did lose them. No fear there.

To go back into your story a little bit though, what do you think that investment banker client saw in your practice that made him say that? Did he give you some detail into the things that he saw or did that strike a chord with you because you recognize some of the management needs of your company?

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That was a point in life where we were making more money. It was exciting as far as the bank account goes, but the credits you're pulling out of your own energy and your own life is a whole other aspect to it. It’s like debiting into the bank account, but I'm constantly crediting into my personal life. You can't continue that way. If you find yourself in situations where you're exhausted, tired, extremely stressed, angry or any other challenging emotion that's arising, it probably means that something you're doing is not sustainable. Not to look at it like it's a problem, but to look at it as there's an opportunity for a solution here. If something's not sustainable, it's not going to continue.

If you continue with it, when that part of whatever you're doing goes down, it's probably going to take you or a part of your business down in some way with it. That's where we were. Nathan, investment bankers, what they do is they look at businesses and they identify what's a good business, what's not a good business for them to invest in. I wasn't so comfortable about someone analyzing my practice as they're sitting in it. At this point, I was in my late twenties. This gentleman was probably in his 40s at that point. I was like, “This guy has some experience. What can he share that I can use to help build the practice?”

Was that then the germination of, “Let's sit down, have a drink and try to figure this out.” Talking out with your partner and generate a plan. At the time, you had 3 to 4 clinics?

We had three at that point.

When I was at that stage, people would ask me, “How is business going?” I'd say, “I love treating patients. I just can't stand the business stuff. If I could get rid of that stuff, life would be so much easier.” I told a couple of them that I was close to. I was like, “I don't know if I can continue doing this for another 5, 10 years. I will be burned out for sure. It's crazy.” I recognized it was at that point where I need help. It starts with me. I didn't know where to go. Did that come internally or did you reach out? Did you find someone to help you and guide you in some of this business stuff?

I read lots and lots of books first. I took pieces of books. We started to implement that into our ongoing business plan, our monthly meetings and quarterly meetings where we got away from the office. Monthly meetings are in the office, that's fine. Quarterly is like, “Let's get away for a weekend.” Give yourself a day to detach from life, somewhere around day two, you start to feel relaxed and then you can start to brainstorm and germinate new ideas. You can come back to the clinic and put those into an action plan.

What were some of those more influential books that you followed?

Good to Great was a big one. It's funny, someone asked me this. The first one, which is an older book now and people don't talk about it anymore. It was pivotal in not only starting a business, but the scaling aspect of it was The E-Myth Revisited. I still probably should go back and read the book on some level. That book should be an eye-opener to any business owner, who you are, what the role you play and the role you need to move into. If you're not comfortable moving into that role, you have to hire people to fill that role or else essentially, what you have is a practice where you're the only employee, or maybe only the few employees. One of our goals was to grow a practice, multiple locations, which is what we did.

Like Robert Kiyosaki says, “You end up owning a job instead of owning a business.” There's a big difference between the two.

The job owns you.

The other thing that you mentioned that I want to highlight is that you started focusing on meetings. I've recognized that many owners aren't having meetings on a regular basis. If you have a partner, you'd have to have them, but with the teams on a weekly, bi-weekly basis, then on a monthly and quarterly basis and figure out, “Where are we going? What's the strategy? What are our priorities? What are our goals for the upcoming quarter or a year?” Get on the same page, that way you can gain some traction in progressing forward. I'm sure you couldn't have scaled unless you had those regular meetings.

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Monthly meetings were essential to our growth and success. At first, it started with us. It trickled down through the entire company. It’s a little bit less with the front desk reception, but with clinic managers, then clinic managers that had meetings with the clinical staff below them. We had meetings with our billing staff with regards to insurance. The biggest part is communication. Your values as a company should, in some way, connect to your business plan and should connect to all your employees that are in the company.

You talked about debiting from your life. Even though your bank account is good, there's a sacrifice there. As you continue to scale, you got up to sixteen. What did you do, maybe unintentionally, to make sure that you started protecting who you were as a person and had a lifestyle that was enjoyable while your business was continuing to grow and succeed? Many people say you’ve got to put in the time and the effort, you’ve got to put it in the blood, sweat and tears. There is a part of that when you're getting started. Some owners might hesitate on growth because they think that growth means they have to sacrifice more of themselves in order to do so when that's not necessarily the case. What did you do to maintain that lifestyle and continue to grow?

The most important part is to change your perspective around a business. When I first entered the business, the way the business runs is I'm steering the wheel. I got the wheel on my hands. I put my foot on the accelerator or the brake. I'm the one that's “running” the business. It's a challenging place to be in, because what happens is when you're the only employee, the job runs you, the business can wind up running you as well. Just because you're scaling, it doesn't mean that's going to solve your problems either. This should become almost like a game, because if you approach it in a serious way, and it's a serious topic because we're talking about people's lives and their income, their livelihoods and their families. The way you approach and create a different perspective is like, “How do I gamify this and see if I can create a business where I don't have to be there 40 hours a week?” Be playful with that. If you are entering it in a stressful way, what happens when you run through things with stress? Fist clenched and jaw clenched and shoulders tight, it becomes an unpleasant experience.

If you're entering things a little more playful, like, “How can I flexibly and malleably take what we have here, grow it and still have a connection to it?” It is important to have a connection, it's fun to work, but how do I grow this without it becoming a monster? That's a bad place to be in as well. You don't want the monster of the business to swallow you whole either. Looking at this as a little bit of a game, what could this do? It's almost like you have this speed car. It says that the car can go up to 240, but you're like, “Let me see. Let me get this baby home and see what happens.” Approaching in a different way is a healthy strategy.

One of the things I recognize is, and I don't know if it's necessarily taught or said so much, but we tend to be owned by the schedule. What I mean by that is when we're treating full-time, our schedule, we give so many hours to our patients and we expect that to get filled up. If a patient needs to come in after hours, “The patient needs me. I've got to work after hours.” At the sacrifice of our personal time and our family time and our hobby time. It might be hard to get out of that mindset to control your schedule and say, “I treat patients these hours. If patients want to see me, they need to work their schedules such that they can see me during those hours. I treat during those hours, and these other hours are sacred. Those sacred hours are my admin time, family time and hobby time.” There is a stop and end time for each of those.

Getting therapists to take control of their schedule, per se, can be a difficult thing to do when that mindset in our heads that, “I can trade my time for this amount of money and I know how productive I am. I know what the insurance company pays me on average, but my time is worth more. If I dedicate more time to the more productive endeavors that don't pay me immediately, I can do more, I can be more and I can grow this more.” Did you find that you had to do some of those types of things and work through some of that stuff mentally?

What you're starting to touch base on is a task mindset versus a strategy mindset. There's a little point in between those two that's sticky. As physical therapists, we’re highly skilled in what we do. There's also an aspect of what we do that's task-focused. Our schedule, you have a patient who comes in one every half hour, that's task-focused for the most part. Treat the patient, write the note, on to the next one. It’s task-oriented. Management, in some ways, can also be task-oriented. For example, if you're looking at your monthly billables and receivables, somewhat task-oriented as well, following up to that is a great number of concrete task-oriented process.

As you scale a practice, whether the clinic you have is growing or you're growing other clinics, that can happen both ways as you know. Your mindset should shift more towards strategy. Strategy requires large chunks of time where you're thinking about reflecting and brainstorming probably on one topic. For example, how do we make our therapists better clinicians so that our patients have a more positive experience? That's not a task. You may come up with tasks or you may delegate certain tasks down to your manager, or you may have the task yourself that you train people on. That project is more of a strategy. That takes time to develop. If you're looking at what do we need to do better with regard to marketing, there'll be tasks that come out of that. Visit ten more doctors a week, run Facebook ads, but the strategy behind that is a larger time-consuming block. I used to block things out on my schedule. I had big chunks of time and some of those quarterly meetings, we're focused on that. It was more strategy versus the actual hands-on management.

As you were talking about specific projects, but I'd imagine, at the size that you got, you started thinking about certain people that you would spend blocks of time thinking about, “How can I help? What does so-and-so need?” You need time to reflect on that. Sometimes you might have to get through a little bit of emotion, whether that's positive or negative, to get a little bit more honesty and think about what they need. Did you find yourself doing that as well?

To this day, I still think, in our type of business, you should somehow have intimate contact with the people you're managing and the roles that they have. If you've never sat at a front desk and did that job at all, I recommend that you do that before you start to manage that person, and see what the challenges are, what the obstacles are, what barriers people have to overcome and work that way. I'm not saying you have to do that for weeks at a time, but those are important. Learning every position and every aspect of those roles are important before you start to manage people. Your people will be able to tell fast that you don't know what you're talking about. Some employees may tell you that's not going to work. You have to have some legitimate reasons to come back and say, “Here's why we should try this. Here's why it potentially could work.” Remember, they're in the situation every day. They're going through the motions. They have those tasks that you're trying to optimize. They're looking to you for support and ideas.

As owners, as they start pulling out of treating and have their admin times, they underestimate the benefit or the importance of coaching their teams. I'm speaking from my personal experience, but I expected them to get it. I was notorious in my interviews when I was a younger owner. I would tell my employees for whatever position they came in, “Your job is to do whatever the business needs.” That was my scapegoat. Instead of me coming up with job descriptions, responsibilities and KPIs that were important to each position, my scapegoat was, “Do whatever is needed and do what I ask you to do.” It needs more structure than that, but then they also need more training and coaching.

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Even if you don't see yourself as a coach and think, “I don't have anything that I can provide to these people, I don't know why I would sit with them one-on-one.” You're the owner. You took on that responsibility when you opened the business. If you're looking to grow, it's imperative. They want you to talk to them on a regular basis. Tell them how they're doing, see what they're like and try to get alignment in with what they're looking to do professionally and what you're wanting for your business. We underestimate the need for that coaching of our team members.

The business that we're in is a high-touch human business from the clinical side all the way through to the administration side. We found that as well. We give job descriptions, job duties and all those types of things that belong in employee manuals. They're important. You realize, if that person doesn't feel valued in the role that they have and they don't feel valued in the larger company, a larger process of your practice, your organization, turnover will happen. In the beginning, people like that structure. They’re like, “Here's the computer system. Here's my schedule. Here are my responsibilities.” That's all clear for people. What you find fast, probably around month two, people look for, “I got this. I know where my desk is. I know what the schedule is. I know what my tasks are. Why am I here? Do you value me being here?” That only happens through relationship building and coaching, which in general, we're good at as professionals. We're good at it as therapists, but it's a different type of therapy when you're working with your employees.

As you started growing, what were some of your most important hires when it came to leadership? Who were you looking for? What positions were you looking to fill that helped you accelerate your growth? What were some of the characteristics of those leaders?

Clinic director was one of the most important, especially early on as we were growing multiple clinics. You can't be in multiple places at once. The clinic director was critical and important. That's important too, whether you have one practice or multiple practices. A clinic director is a challenging job. Over time, I started to see this is challenging because you're asking people to be excellent clinicians, usually treat their own patient caseload, be a good enough teacher that you could nurture and mentor new graduates or therapists underneath you and have some touchpoints with KPIs that you're tracking as far as the outcomes. It's the most challenging job in the whole PT practice.

Did you find that certain clinic directors did better? Whether that was in terms of certain characteristics that they had or those who were homegrown per se, people that moved up within your company. Did you have greater success with those versus hiring from outside?

The moving up is an interesting thing for me to think about. In the beginning, we would move people up based on time seniority. We wound up putting some people who were excellent therapists who've been loyal, happy in their job, who have been with us for a long time. We promoted them, sometimes willingly and sometimes a little bit unwillingly, to clinic director positions. Some of them failed. Not only did they fail, but we failed. That's probably more important. We failed by not recognizing that excellent clinician can maybe have a role in training other therapists, but the management side of it is not their thing. That's fine.

One, it can save you from losing an excellent clinician. Once you forced that a little bit and it doesn't work out, whether you pull the trigger and say that this is not working for you, or whether they pull the trigger, on some level, you’ll feel like, “This didn't work out for me. I don't feel comfortable now in my role here working in the company.” They oftentimes look for other opportunities. It's important to be conscious and deliberate about, “Here are the qualities that are required for a clinic director. Does this person have that before I put them in?” So often as a manager, especially when you have an open position, if you're just looking for a butt on a chair, that's a dangerous place to be in. When you feel desperate like, “I need to put someone in this spot, and then I can fill the position. I can move on to other things.” That's going to circle back around at some point and say, “You filled the position, but it wasn't necessarily with the right man or woman.”

A lot of times we think that we're delegating the responsibilities when we're abdicating that position and taking no responsibility whatsoever. You take care of it and if it fails, it's your fault. I love it that you shared that that is our fault if they failed many times, especially if we set them up in a position that has a job description and responsibilities. We still need to be there to check in on them and guide them and answer their questions. There's no correlation between being a great technician, a great physical therapist and being a great manager. There should be some leadership development in your company. I'm assuming, over time, you develop that as well.

Back to that patient who was observing what was going on, shortly after that time, we developed a clinical training manual. We took some of the more common diagnoses that we see in every single clinic. If you look at your diagnosis, you see 80% of what you're treating is probably spine, knee and shoulder. It’s different diagnoses, but they all have commonalities with regard to optimizing range of motion, strength. We tried to standardize that. As much as possible, it still leaves some flexibility for professionals to access their own skills and tools, worked well with regards to maintaining our quality of care, and then we had to do the same thing for our clinic directors.

There's always an opportunity for a solution to every problem. Click To Tweet

Before giving him that clinic director title, I'm assuming you took them through certain exercises, had them read certain books that you had also read. Maybe they were part of some team trainings or leading out on staff meetings and little things like that to see how they would do over time.

We'd have them shadow with other clinic directors to see what their day was. Let them chat amongst each other and compare notes about what their day is going to be like, what their week is like, what their responsibilities are, how it's different from being a regular staff therapist. A lot of time was invested in clinic directors.

What would you say then in order to maintain a healthy lifestyle, per se, in having so many clinics under your belt or growing at the scale and the acceleration rate that you were, what was one of the most important things for you to maintain a healthy lifestyle?

It’s mindfulness. People are a little bit shocked by that. Usually as professionals, we think, “If we're going to alleviate stress, we go exercise.” That's important for us as professionals, but there's a whole mindset or a cognitive/psychological process to what we're doing, working with patients and the interactions we have with staff and nurturing. If you're super excited about what you're doing, that's great. If you've got lots of different balls in the air, and you're juggling lots of different things, that's understandable, but realize you have to be intentional about what you're doing. Mindfulness is a great way to do that. It's stressful to run a practice. You have the responsibility of a lease. You have employees that are responsible that you're responsible for, that helps them care for their families. There are lots of different moving parts to it.

Somewhere along the lines, I started looking into mindfulness. It helped me with regulating stress. There are going to be stressful and challenging aspects that come up within the business. I'll give you an example. We had to move out rather rapidly out of one of our locations. In New York City, that's not an easy thing to do because real estate is tight and it's expensive. We had to move our busiest clinic within a matter of about three months to a whole other location. If I didn't have those skills to fall back on, this is where people get heated or they get lost, or you start turning to other things that are not healthy, such as drinking, eating too much, losing your mind in the internet and on your cell phone. Those things happen because you're avoiding things that are unpleasant in your current existence.

Some of those unpleasant things may be in your practice, but you can't escape them. How I can develop some psychological flexibility and mindfulness is a big part of that. I can start to be with these uncomfortable situations that I have to manage and face each day, but confront them in a way that is as effective as possible for me that doesn't wear me down over time and doesn't wear the people you're working with and the business down over time as well. When that starts to show its face, you're managing multiple people and you have to start supervising, sometimes even firing or letting people go. Knowing how to compassionately and kindly let someone go who isn't in the right position, or maybe that you're responsible for it because you didn't put them in the right position, is an important skill because your entire staff around you sees this happening. They see a wrong person in the wrong seat, that person is stressed. Usually, there's a virus that starts to infect the clinic. Everyone starts to feel stressed, you feel stressed. Learning how to handle that in a way that's compassionate is important. Mindfulness is a nice way to train all that.

Tell me a couple of things that you use to make sure that you have appropriate mindfulness.

It’s ten minutes every day.

What do you do?

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Growing And Scaling: If you find yourself in situations where you're exhausted or extremely stressed, it probably means that something you're doing is not sustainable.


It’s ten minutes, five days a week. First thing, wake up in the morning, go to the bathroom and pee and then my butt is on the meditation cushion. It’s somewhere between on the low end five minutes, on the high end twenty minutes, but most of the time, it's about ten. Think about it. I used to wake up in the morning and jot out all the things I had to do for the day. The list would follow me from Monday. I'm crossing things off. The list keeps getting bigger. We don't realize that the human mind naturally wants to solve problems. It does that through thinking. Just like your heart is beating all day long, your mind is thinking all day long. That evaluated function, that problem-solving function is useful and important, especially to a manager or a clinic owner.

It's also important to realize when you start to tell yourself, or you start to develop stories about what's happening or what could happen that aren't necessarily true. Those stories hook you and start to take you out of the present moment. That's where stress starts to develop. It's also where poor decision-making happens. It's difficult to make good decisions when your mind is chattering away in the background. It's running you in. Mindfulness, psychological flexibility and ACT, which is the other thing that I have studied and trained, teaches you that you run your mind, your mind doesn't run you. That's a different perspective because people think, “I am my mind.” The question is, if you followed every command, every instruction, every recommendation that your mind has, what would your day look like? Your mind would, in essence, run your day. Most of that is happening because of fear, stress and anxiety. Those are the three biggest. Learning to realize that, “My mind is chattering in the background. How do I notice this chatter?” Acknowledge it, see it's there and bring yourself to the present moment, say, “Here I am. What's important? What should I do?” My mind can chatter away in the background, but not adversity affects my physical or my mental health.

For so many years I've heard about these practices, the same thing, I'd recognize when I am stressed that meditation is important. Other people might use journaling, gratitude journals, prayer, all of these things to help you recognize that you are in control of your thoughts. You are also in control of your emotions. The more that you can be in a quiet, reflective state, that's when things, answers and solutions come to you. When you can stop all the chatter, you can let your mind think productively.

Perhaps more importantly, if there are instances where you feel like you're not in control of your thoughts, and you feel like your thoughts are racing, what mindfulness teaches you is that you can relate differently to those thoughts. If you're not noticing the flow of thoughts that are constantly flowing over your head, in and out of your ears at all times, they can sweep you away. It's common that when you are stressed and anxious, those thoughts increase. We use like the waterfall increases. Mindfulness teaches you, “I can let this flow over me. It's happening. I know what's happening, thoughts are coming. It may be affecting my emotions, but I don't have to necessarily act on them. They don't have to influence my behavior.”

You shared a ton of information and wisdom on growth and maintaining a successful, healthy lifestyle as you're growing. Is there anything else you might want to share as we start wrapping up?

We touched on those mindfulness aspects of health and wellbeing. Professionals see this being adopted more and more into corporations, professional athletics. One of the things that we need to be aware of as professionals is that there is a mind that our patients have as well that is chattering. Things like mindfulness, Acceptance and Commitment Therapy, which is a form of Cognitive Behavior Therapy, those skills work well for your clinicians as well to help your patients have a better patient care experience and to have better patient outcomes.

Share with the audience a little bit about ACT because I know you're training on that and you do some continuing education. It can be beneficial not only for the individual, the provider themselves, but also for their patients. Tell us a little bit about that.

Cognitive Behavioral Therapy is a family of different types of therapies. ACT, what's called Acceptance and Commitment Therapy, is one type of Cognitive Behavioral Therapy that has a ton of research, meta-analyses and randomized controlled trials supporting its use in specifically chronic pain, but also many of the lifestyle related behavior challenges that we see in practice like helping people engage with exercise and physical activity. Some professionals are into things like nutrition and health coaching. ACT, in essence, is a behavior change model. Everything that we're doing as professionals with regard to clinical care as well as our management has to do with helping people with effective behavior change.

If people wanted to learn a little bit more about ACT or what you are training on cognitive behavioral therapy, how would they be able to find that? Where can they find you?

The best place is to go to my website, that's They can find all the courses, books and resources there.

If people also want to reach out to you individually, is that the best way to do so?

They can reach out to me on the website at the or I'm always happy for anyone to email me. Email is pretty easy, it's

Thanks for your time. It was awesome to learn from you. Thank you so much for the wisdom that you shared.

Thanks, Nathan. It’s fun chatting.

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About Joe Tatta

PTO 138 | Growing And ScalingDr. Joe Tatta is a global leader in integrative pain care and an advocate for the safe and effective treatment of chronic pain. He is the Founder of the Integrative Pain Science Institute, a cutting-edge health company reinventing pain care through evidence-based treatment, research, and professional development. For 25 years he has supported people living with pain and trained practitioners to deliver more effective pain management. His research and career achievements include scalable practice models centered on lifestyle medicine, health behavior change, and digital therapeutics. He is a Doctor of Physical Therapy, a Board-Certified Nutrition Specialist, and Acceptance and Commitment Therapy trainer. Dr. Tatta is the author of two bestselling books, Radical Relief and Heal Your Pain Now, and host of The Healing Pain Podcast. Learn more by visiting

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