Continuing where they left off in their last discussion, Nathan Shields sits down once again with Avi Zinn, DPT of the Druid Hills Physical Therapy in Atlanta, Georgia. Despite being a new PT owner, he already made some big changes in the last episode – changing his EMR, outsourcing his billing, changing his business coach, and was expecting his front desk to change in the near future. In this episode, they discuss the effect of those changes and how he started 2021 with a bang using a roadmap for continued growth and expansion. He's made some great decisions along the way and is headed for even greater success. Moreover, Avi also shares some strategies he follows when hiring new PTs, particularly with how online ads work in the recruitment process. 

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Reality Episode #5 - Making Great Progress As A New(er) PT Owner With Avi Zinn, DPT

We're doing Reality Episode #5 with Dr. Avi Zinn, a physical therapist and Owner of Druid Hills PT in Atlanta. Avi, it's been a while since we started this up. 

I was looking back. We started around November of 2019. 

We're going into a few years of following your progress. You've made some awesome progress. Congratulations, by the way, especially for a young physical therapy owner like yourself. 

Thank you. 

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Where we left last time is you had made some changes. You were in the beginning phases of making a number of changes. Number one, your front desk was about to leave. Number two, you had switched over to Prompt EMR. Number three, you’ve switched your billing company. Number four, with your consulting company, you got a new coach to work with you one-on-one. You had a lot of changes. We want to follow up on that stuff and more if that's okay during the show. Start with something that's been most dramatic for you. 

First of all, thanks for having me back. I love doing this, always. Last time, we were talking about my front desk. That's been the biggest change for us for a lot of good reasons. Our front desk, she was leaving to go to OT school. We were looking for a new patient care coordinator. We were trying to get her started before our previous one was leaving so we can do some training. 

You had some overlap and support there as they're training. 

It worked out that way. We got on our new patient care coordinator to start. She started in December 2020 with enough time to overlap for about a month. She got some good training. That was great to see how she eased herself into our office. 

What were some of the things that you were looking for in your next front desk person? Did it vary much from your new one or were there certain character traits you were looking for? Are there certain things during the interview process that you tried to vet out? 

One of the main things that I was looking for was someone with good organizational skills. Someone who was able to follow our workflows and be able to take the stuff and efficiently do whatever needed to be done. There are so many different tasks to do at the front desk.  

You want someone at the front desk who's so high tone, great attitude, willing to go the extra mile, caring about every patient that comes in. If it's a female, you almost want that motherly type. 

Take care of the clinic and the patients. Make sure everyone gets the appointments they need. Let them know that, "We'll get you on the schedule. Don't worry. We'll make sure you get your visits." We got her on. That was a good transition because of all the extra training. What was also cool at that same time was I was focusing on the SOP and figuring out what we can do to improve on what we've already built with our previous. Part of it was using some of Prompt's reporting. The EMR software that we switched over to have some awesome reporting. They have this plan of care compliance report, which you can pull up the next week's list of patients. 

It shows exactly who is scheduled and who's not scheduled, if they're supposed to be scheduled two times a week or one time a week, whatever it is. That has been so helpful because we're able to get that report on Monday morning. By Tuesday, maybe Wednesday, we'll already know what our schedule is looking for the next week because we've already called and scheduled all of our patients. By Wednesday, we're looking at next week. We see it's full and that's good or we have a bunch of spots open. "Let's boost the ads." That's been helpful. That's been cool. 

For those people who are reading, SOP is Standard Operating Procedures or your policy and procedures. There’s some huge value that you went through your policy and procedures during this training to shore it up. 

We did. We created our patient journey. It was every step from the first call until they see the physical therapist. We created that. When our new front desk came on, we trained her with that patient journey. It was like, "Step one, this is what happens when they call. Step two, you follow up with this. Step three, you do it." That was something that was cool. With that, all of a sudden, we started seeing that by managing the expectations of the patients and explaining everything with that workflow of patient journey, our patients were coming in prepared to do their physical therapy. They were already bought in. The PTs were telling them, "You get to come in twice a week for six weeks." They were coming straight up to the front after their visit and scheduling out all their appointments. 

We're seeing that because we're managing the expectations. We're setting up our patients for success. We're seeing in our cancellation rates. We're lower than we've ever been. Last time, we were at 5%. We've never been that low before. I attribute that to our front desk managing our expectations and getting our patients. The PTs are doing a great job with everything they do. Taking away some of that pressure to get them to buy in on that first visit by explaining everything to them beforehand has been wide. The front desk has been so successful and integral. 

 

First of all, congratulations on a 95% arrival rate. Secondly, it sounds like you've given some of the responsibility for the compliance to the front desk by what they're saying before they even come in for the first visit. On their phone calls, as they're talking to patients, they're telling them what to expect, what it's going to look like, and what successful physical therapy looks like. You have conversations like that. 

I was listening to Jerry Durham's show. He talks about front desk stuff a lot. One little thing he said on one of his shows was often, no one asks for the patient who's calling to talk about their story. It's always like, "Let's get this information so we can put you in our chart. Let's get this so we can set you up." It's never like, "Why don't you tell me a little bit about yourself and what's going on so we can learn more about you, we can know what to do to best get you to where you want to go?" That has been another part of the success. It was a different approach to talking to our patients when they're calling, show them that we do care about them, and try to get them in. When they come, they already trust us because they know we've talked to them and ask them about them. They're coming in ready to do whatever we tell them that is going to be best for them. 

You've changed the mindset at the front desk and with your providers as well to say, “It's not all about what we need.” When they call, it's not just about, "What's your name? What's your date of birth? What's your insurance?" Instead of going down that checklist, one of the questions that may be if not one of the first questions is, "Tell me what's going on. Your back hurts you. Why is that hard for you? What can't you do because of that?" Are those the conversations your front desk is having at the beginning? 

That's exactly what she's doing. That is part of the reason that we're having a high arrival rate. From the beginning, they're calling us, they see that we care. We do care. Every place cares, but when it's trying to schedule, it's all just about numbers and trying to fill the schedule, it's a different mindset or approach when you let the patient know that you are caring about them. It shows. 

It goes back to a conversation that I had with the guys at Keet Health on an episode. They stress the customer experience as well. I did a show with Jerry years ago when we did our first one about the customer experience. One of the exercises is to map out the life cycle of a single patient and all of their touchpoints with you at the clinic from your website or the first call to their first visit, confirmation calls, follow-up visits, discharge then to billing and collections. Map that out and how we can improve and more fully live out our core values at each of those touchpoints. When you do that, it forces you to think differently instead of, “What do we need?” but rather, at each of those touchpoints, “What does the patient need and how can we help them have a better experience with us?” 

The guys at Keet Health swore and they said, "If you can improve that customer experience, you will triple your marketing efforts." You see that based on your improved arrival rate, your average frequency of visits, frequency per week of individual patients coming in improves, and full compliance to the complete plan of care significantly improves. They're not dropping off after the 3rd, 4th, and 5th visits. They're staying with you for longer periods of time and thus seeing results. That first domino is how we can do this differently to show that we care more in order to get their buy-in. 

Everything you said is what we're experiencing. There are plenty more that we can do to enhance the patient experience. From the few things that we have worked on, we're seeing huge improvements and success. They're all around from us and for our patients too. If we're getting them in twice a week or completed plan of care, that means they're getting better. If they're completing their plan of care, that means they've completed their physical therapy. Hopefully, that means that they're back to doing whatever they wanted to do in the first place. 

That also goes to your point where you are getting results and this is where it triples your marketing efforts. At this point and at this stage of your ownership, you're a few years in. You're starting to see some of those return patients or they're referring family and friends. When you treat people right, they're going to start referring other people or trust you enough to come back yourself. 

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We are starting to see that. Interestingly enough, historically, a lot of our referrals have been from the direct-to-consumer Google Ads. 

You were solely built on that for the past few years. 

From the beginning when I first started, we got some good ads going and they were working. I never had to do too much relationship marketing with some of the other doctors in the community. Not that I didn't try, but we found that this was so much more successful. That's the way it worked for us. As we got busier, we had to turn down the ads because we don't have room for everyone that's calling. We're looking to hire because we're so busy. What was interesting is that we've turned the ads off but we're still getting as many people calling. We're seeing that it's return patients. We're getting people who have come back every year. Every year, there's something new. This is their PT place. Whenever something comes up, they come in. We're seeing our patients who are coming in, we ask them who referred them. We're getting a higher percentage of people coming in from their referrals from past patients. We are seeing that, which is cool. 

Is that something that you set up internally or your providers coached or instructed on how to ask for referrals? 

No. I started to try to implement that at some point. It was right before Corona. It was something that we didn't implement. The plan at some point is to build that in. One of the things from the Lighthouse Leader Group, Jamey Schrier group, which you put out a show with him, they do this QA. On the fifth visit or something you have, you do, not a re-eval but a quick check-in. Are you progressing well? The whole reason for that question is if they're doing well to then take it to the next step of, "You're making great progress. Do you have any friends or family that you know that could benefit from our services? We do want to help people." It's a good opportunity to take advantage when people are seeing good progress to use that, to ask for them to send their friends. 

That was a really successful action for us. It's something that PTs shy away from because they don't want to feel salesy. If you're trying to fulfill your purpose as a physical therapist, you want to help as many people as you possibly can. To make it easier or easiest in the conversation like that is when they're speaking positively and glowingly about your practice, how much they love coming to work or about their condition in general. "I made some great progress. I can do this well." 

That's number one. Make sure you tell your doctors. If you have a ready-made template to have the patient, write a note and you can fax it off to the doctor. That can be a successful action. Number two, you can simply say, "That's awesome. Do you know anyone else that's having issues so we can help them like we're helping you?" It's a quick and easy way to ask for referrals but it's also a way for you to solidify. "You are getting better. We can do this for a lot more people." Hopefully, that cements it in their heads. 

You said something that I've been realizing lately. It the mindset of what you said about PTs have a hard time because they feel salesy when they're trying to convince people to send their friends. Our true purpose is to help as many people as possible. Once we recognize that's what we're here for and that's why we became PTs in the first place is to help people. I don't know who said it, but I heard someone talk about making a sale. As a PT, we're doing it all the time. We're trying to educate our patients. We're trying to get them to comply with our plan of care. We're trying to sell them all the time. We are almost salespeople by nature of trying to get them to complete their plan of care. Realizing that and switching the mindset of it's not trying to make a sale, but we're trying to do it because we're trying to help them. 

Speaking of plans of care, your usage of Prompt EMR and some of the reports they provide. You are amazing compared to the other EMRs like business management reports. Prompt does a great job at that. 

I've been surprised that they keep developing their software and everything they put out. As far as the business management side, they're doing great stuff. 

That procedure used to be 1, 1.5-hour long procedure for us weekly. We called it the weekly walkthrough. We weekly walk through each physical file on the active patient file shelf with our fingers and walking it through with the front desk, saying, "Where's this person? What are they doing? Are they scheduled? How are they doing? Are they coming back?" That was a weekly thing that we had to do every week. For you to simply be able to pull that up and save all that time, you're not even involved at that point. They are expected to pull it up and do the work. 

 

It's automatic. The front desk pulls it up on Prompt. It’s two seconds to pull it up and then she shares it as a shared Google file through Google Drive, which is also amazing. Google Drive, in general, is so cool. It's shared to all the PTs and then they make a note on each one like, "That person was dropping down to once a week, make sure to call them,” or “This person is discharging this week." It happens so quickly. 

Have you been overall happy with Prompt? 

I'm happy. The part that I'm not so involved with is the actual documentation because I have not been treating since before COVID, although I jumped back into treatment. We've been busy. Our schedule is full. I'm trying to hire someone. We're also saying to our patients, "We want you to commit to twice a week." If we don't have room on the schedule, I feel like a little hypocritical not letting them have those twice a week visits. It was important for me to jump back in to allow our patients to get on the schedule. I did one note on Prompt for it on the documentation side of things. I hadn't spent too much time doing the documentation but overall, we're happy with Prompt. They're great. They continue to develop their software. I still think that they're going to be the best, if not, getting close already. 

They're making so many changes, not knowing exactly what's happening on the documentation side and on the billing side. From what I hear, there's room for growth there. It's good to hear that they are receptive and they're trying to be reactive as possible to make changes on the fly and keep things up-to-date. 

That's also one of the cool things that I like about using them. They're a young company. We have been working with them in their early stages. Some of the suggestions we give to them, they listen to us. Hopefully, as they grow, they'll continue to listen to people. Early on, some of the suggestions we make, they implement it and put into their software. It's cool to be a part of that also. 

Has the billing been going okay with Prompt as well? You made some changes with similar timing. That can be a big upset to have an EMR change and a billing company change about the same time. How did that all work out? 

Everything worked out well. They're starting any new software or new company. It took some time for things to work well together. It was new, not only for us but also a new software for the billing company. Everyone had to figure it all out. That was from the beginning. We had a meeting with the billing company and Prompt talking about if we're going to make this work. The billing company had a list of things that they needed Prompt to change, modify, or add into their software in order for them to be successful. We prioritized a certain number of things. They've hit upon all of the main things at this point. There are more things that the billing company wants them to implement. For the most part, they've been able to take suggestions on the billing side as well and change them in Prompt. Things have been going well. 

Prior to this, so the audience knows, you were doing the billing yourself and then you finally switched over to a billing company. 

I stopped doing the billing when we started Back in the Black, the billing company. It was May 2020 or June 2020 in the early stages of Corona. I don't even know how I did the billing when I was doing it. 

I'm assuming your collections might have improved since then, but at least it freed up your time. 

It freed up my time. I know for a fact collection was for the denials. I know that I was writing things off back then when I was doing it. I didn't have time to follow up or know the best way to follow up, resubmit, and change a modifier. I was not doing that stuff. The fact that I don't have to do that, I don't have to worry about it. I have a company that's not only doing my billing for me but also bringing in higher collections. It's so worth it right away. The loss that I was writing off is more than enough worth it to pay a billing company to do it. 

We might have discussed this at the last episode, but since we brought it up, what made you decide to go to a billing company instead of keeping in-house and train your own person or bring on someone with experience? 

The biggest reason was that it was COVID. It was too hard to think about bringing someone in and training at that time. It was that. The other thing was because the company is Will Humphreys. You recommended it. I asked you about him. He was starting his billing company. I felt like I already could trust that they were going to do a good job whereas if I was going to have to hire someone and train them. If I was to be the one to train someone, I wasn't the best biller person. How would I even train someone to do the best billing practices? If I was going off of knowing that someone had previous billing experience, I didn't feel like it was, at that time, the right time to hire someone in-house. It made more sense to outsource it. 

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The other change that you made was to stay with the same consulting company but have a different one-on-one coach. What have you been doing differently than the previous coach? 

That's been cool. One of the reasons that I switched was I wanted to get a different coach. I hadn't been in a year. It was interesting to see what other coaches had to offer. The coach that I started working with was not a PT himself. I found that intriguing to work with someone who's a CPA. He's been a business consultant. I found that interesting to see what we can do. A lot of what we focused on in the beginning was the mission, values and purpose. Some of the stuff that I had already worked on with my previous coach is to fine-tune that a little bit. It was the end of 2020. We worked on a budget for 2021. That was something I had never done before. It was a cool practice but it was also super helpful. 

2020 was a different year than anything ever before. We had to look at 2019. I use that as a template to grow. We worked backwards because it was still Corona. We're trying to get a sense of how much space we have to grow in the practice with maintaining the distancing. We came up with an idea of how much we could use in our office and then worked backwards from there. We ended up choosing our 2021 budget as we were going to use a 30% increase from some of our best months of 2019. That was a cool exercise to do. I'd never done it before, but I was able to see the whole year in advance to say, "If we want a 30% increase, we need this many visits for this month and this month. We need to ramp up." 

We were able to dial in all the numbers and look at, "We need all these stats to work out this way." From there, we were able to break it down into quarters and that helped. It was a big mindset shift, understanding how projecting and planning works. “If I look at this quarter, in order to hit our goals, we need to hit this.” I have a better sense of what we need to make sure to do. If next quarter, we need to get to this number, I need to hire and start looking for someone to hire. I need to make sure that these numbers are hitting the goals. It was cool for me to do that because I hadn't done that before. 

How did you land on the 30% increase? Is that something that you had decided upon? 

The way we work backward was we chose a number that we felt comfortable as far as how many people we could fit into the space because of Corona and the capacity of our clinic. 

We never had a chance to do that. Your coach tends to be a numbers guy. He's an accountant by trade. If people who are reading would want to do something like this, by all means, get together with your CPA, have that relationship with your CPA, and you're communicating with him regularly, maybe you can ask for a sit-down and talk about the upcoming budget for 2021. It's easy for them knowing QuickBooks to input the numbers, bring it all up, how that affects the expenses, or a bookkeeper might have that same capability. 

To look at your 2021 goals and how that is going to affect us financially. If we want to get these goals, what does that look like? How does that change things? How are we going to hire? It's so important that a lot of times, as we look at our goals, we look at those goals and set them aside, but not seeing how they compare, what effect they're going to have on our financials, and when we'll need to hire. It's cool that you married the two together with this meeting. 

It was cool. The last thing you said when we need to hire was one of the things that first stood out to me. We needed to ramp up in quarter 2 or 3. We needed these many more visits based on our projection. We need to hire. I realized it's February 2021. We're planning on hiring by June 2021 because we need to get these numbers for the budget. I need to start looking so that we're ready to hit our number. I was able to use that and see, “This is when we need to do this. This is why we need to do that based on the numbers.” 

You have some real guideposts to say, "When we hit this number, these actions need to fall into place." That's what it sounds like. You're at that point. 

That's how it feels. We'll see if we stick to it and how it goes, but it's a great place to start for me based on the fact that I've never done it before and then allowing me to try to plan and grow. It's been great. 

I love that you looked at it for the whole year annually and then broke it down into quarterly pushes. We're coming towards the end of the first quarter. I assume you're on track. 

We are on track. We're trying to hire. I wanted to get more into the numbers. Our arrival rate is great. Our utilization is great. February 2021 was our highest number of visits that we've ever had in a month. Thank you very much. In March 2021, we're already 100 more than February 2021. First of all, March has 23 workdays versus 20 workdays in February. It's a little bit of a difference. It's also just been because of all the different things that we've implemented being able to look at the numbers, also with using Prompt and being able to make sure the plan of care compliance report is keeping our schedules full. We're on track with that budget as far as where we should be, if not more. 

The things that have worked out so well for you are that you have focused on numbers to guide you instead of feelings. When you look at your front desk and you're like, "I know this person is going to be gone in January 2021 so we need to start the hiring process late October 2020 or early November 2020 so that we have someone in here by December 2020 to overlap and train." That allowed the front desk person to not only train but also review the policy and procedures, make sure they're up to speed, appropriate and that they're following them. 

 

The same thing with your EMR. You're using it to track your numbers, your statistics, see the growth, and the business but also to see who's falling out and how we can recapture them. It’s the same thing with your bill where you're looking at that. Number one, you hired a great billing company because they provide you reports and communication. I know that because I know Will. They provide great reports and great communication to you. You outsource it knowing that someone else is going to be able to care for it better than you could since you're not the billing expert. 

You leaned on your coach. You returned back to the financial numbers. Looking at your overall story, you’ve reached forward and received help in terms of finding an EMR that can help you better manage, finding a biller that's outsourced that knows more than you do, finding a coach to help you see your weak spots, help you shore those up, marry those things together, and also using Google Ads to your advantage to grow your practice. You've outsourced a lot of things to your advantage. They've all paid off. 

It's funny that you say that using the numbers. The last few times that we've spoken, you've asked me questions where my answer is a coach wouldn't love the reasons of why I chose this. It sometimes was based on feelings and not the numbers. Once I've had a better grasp of the numbers like I have, I can tell you that when I make those decisions, they feel so much more sure of that decision. Before, I'm like, "This feels right. I think it will be good." Thank God most of the time, it's turned out that way. This time with the numbers, I'm making these decisions and I know this is the right thing to do based on the numbers. 

You’ve got some growth and expansion goals. The next step is to bring on another PT. Are you looking at another PT after that? Do you have a space for that or will you have to be looking for another space or a bigger space? 

We've done this distancing thing for a long time that we feel like comfort-wise, we can fit more than we were comfortable several months ago. We can hire another PT. We're looking to hire now. We could even hire another one after that in this space. It's also interesting that I've been talking to my landlord. I don't know that it's going to work out like we originally talked about. There was an opportunity to take over the middle floor so we would be able to double our space. It was possible that we could have expanded in our own building. 

I think it's not going to work out. He's selling one of his companies. They're going to maintain that middle floor. It's not going to be available for me anymore. It would have been great to be able to know that I could expand and not have to move or get a second location, but either way, we're looking at our space and we're realizing that we can fit a little bit more than we thought we could go earlier on in Corona when we're all being cautious. More and more people are getting vaccinated. People are comfortable. We realize we can do a little bit more with the space that we have. 

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Maybe a lot of people reading have this question. What is your tipping point for hiring the next full-time PT? Is it a certain number that you have to hit that you know the numbers? How do you figure it out? 

To answer your question, at the end of 2020 around the holidays, our numbers started dropping a little bit. At the beginning of the year 2021, we were having cancellations and no one was calling. It was just the beginning of the year. Deductibles were resetting. It was still Corona. All of a sudden, we had a time where we've been jam-packed. I didn't even have that much time to see we're at 85% capacity, 90% capacity, and 95% capacity. I didn't even have to look at the numbers. It was because we didn't have room to fit anyone on the schedule. I knew that it was time to hire. Also, moving forward, the number that we're trying to base it on is 85% or 90% utilization capacity for more than a few weeks. We know that's not just a 1 or 2-week thing. That's a trend that's going to stick around us. We’ve got to bring people on. 

When you can be an 85% to 95% efficiency with your schedule and then your front desk is complaining, "I don't have anywhere to put these patients," then that's a good sign that it's time to start up the interview process. I say interview process because from our perspective, you always have an ad out for a PT. You're always collecting resumes. We're always "hiring." For us, it would mean, "We're going to get serious and interview these people." Not knowing how you do things, it's like, "Let's start ramping up. Let's start that cycle of action." 

I will say that I learned from Will because I do coaching with him as well. I don't think it's his term, but stacking the bench. I learned from him to always be looking. I've had ads running. It is time to start being serious about it, but it is something that I've at least been entertaining or trying a little bit with keeping that bench stack. When it's time to hire, we'll have a few people that we can get in touch with. 

You can start calling those people that you have on resumes. You don't have to create the ad and post it on Indeed, which might delay you a few days if you're trying to wordsmith the ad correctly. We've got an ad that works. It's up and it's going. You've got some resumes already. Maybe you boost the Indeed payment to get more views on it. That's great that you're not starting from scratch. 

We've already dialed in a lot of our ad contains a lot of our purpose, vision, mission and values. A job to treat patients, benefits, and salaries. He was wanting to be a part of a team. He liked that we were a company that stuck to our values. He said all the things that I wanted someone to say. He's a new grad so I don't know if we're going to move forward with him or not. I have to make that decision. We've hired a new grad in the past. We were thinking it would be better to have someone with little experience if it's the right person. We're not against hiring new grads. We'll see, but he spoke about all the right things. 

You looked at your team and said, "What could we need? What could we do to round out this team of providers where it could be shored up?" You know what you're looking for, which is cool. 

It's been different this time with the interview process because of being a little bit more in tune with what you said, knowing what we need, what our team might be lacking, or what everyone could benefit from if we bring someone else in. It makes us a stronger team altogether. 

What's super exciting about you bringing somebody on is you're already 95% efficiency, utilization capacity, whatever word you want to use but your Google Ad spend has been lower. You bring that person on. If you want to fill up their schedule, you've got to boost your Google Ad spend. 

That's how it worked with our last hire. We filled her schedule quickly with the ads. We have to pay for that, but it's a way to fill up the schedule and do it faster than the normal potentially. We'll see if that works that way. We lowered our ads. They're at a minimum. We're still totally full. Whenever we do hire, that's the plan. We're going to ramp up those ads, turn the budget to however much and see what happens. 

When you bring someone new like that on, do you have a conversation with them that maybe they're going to shadow somebody until their schedule gets full or we're going to do what we can to get you busy? Do you also expect them to do some work on their end to market and build up their schedule? 

To the last point, no. That's something that I haven't had with any of the providers about having them be accountable to fill up their schedule. That was a conversation I had with the team when we had this 6 to 8-week dip of us being at 80% towards the end of the year and in the beginning of the year. We had a conversation about accountability versus responsibility. No one is accountable to fill up their schedule, bring in new patients as much. That would be great but the way we have things set up, I use the ads. The way it's always been. 

I'm the one who brings in the patients with the ads, but everyone is still responsible to make sure that their schedule is full. We did have a meeting. Let's talk about when we do see a dip in the schedule. Let's have a plan for knowing. It looks like we're going down in numbers. Let's make sure we have a plan to make sure that this doesn't happen like it just did so that way we can get to it earlier on. That was to the last point, which was interesting about accountability versus responsibility. 

Everybody on your team should be marketing in some way or another where you're spending money on Google Ads. Their responsibility is to get patient compliance and ask for referrals. If they have some downtime during a slower season to make calls to past patients and follow up on them, they have some responsibility towards that as well. 

You asked when hiring on, is there an expectation when their schedule is filling up of what they should be doing? I'm glad you asked that because no, I don't have that. I know that I need to work on that. One of the things was you ask, “Are they supposed to shadow other PTs?” That's a great thing to do, especially if it's a new grad because that could be a perfect opportunity for them to get a little bit of that extra mentoring and shadowing early on. That would be a way to be more comfortable with hiring someone who has a little less experience knowing that they're going to start and they're going to have time to do that mentoring in the early stages. That can make up for their lack of experience. 

It's something that I don't think we felt we were honing in on or got good at until towards the end of our ownership, that hiring training process for all positions. We started getting good at it, but it wasn't towards the latter parts of our leadership development as leaders ourselves, where we focused on what does the training look like for every new employee as they come on in each different position. There was some general stuff like, "We're going to go over the employee handbook. We're going to cover these principles and what you're responsible for. We would break down into specific responsibilities. As a front desk, you're responsible for these stats and this is how we can train you. For a PT, this is what you're responsible for, these stats. This is how we're going to train you." I can see that maybe as a potential growth avenue for you is setting up. How do you establish a successful physical therapy on their post? What does it take? How long does it take? Is there a checklist of things that they need? 

The truth is I did that for the last one. We created a little bit of an onboarding process of 1, 2, 3 weeks in 30 to 90 days. It was more of training them. We started. I have a lot more room to start enhancing that and focusing on that. 

Are you starting to establish a leadership team as well, or is it just you at the top? 

That's another thing that I've been working on is I'm trying to. I've been doing this for a while. I had talked to this one PT right before the beginning of 2020 before the pandemic hit. We put that on hold. We've been talking about developing that role. It's been interesting with her because she's been affected by COVID with her kids. Her kids have been remote learning this whole time. She said to drop her hours. It's been interesting talking about the leadership role. We're going to make her clinic director. She might not have enough time to do it. She had to drop her hours. It wasn't her fault or anything. 

What's been cool is that we've been discussing changing that role a little bit. Maybe she traditionally has a clinic director do all these things. When we started doing these leadership meetings every week with her, when we talked about, "Let's look it up. Here's a list of all the things I would want a clinic director to do. Why don't you look through this list? Choose all of the high-energy things that you would want to do. Maybe we can build a role based on those few things. That way, it's not a clinic director in the traditional sense, but at least it gives you some more leadership opportunities to do." With the time that you have and the hours, you can still treat but also take on some leadership things. It's been cool to be flexible, tend to pivot with what we're working with and try to develop that leadership team. 

I see that's where your path is next as you're starting to develop these policies and procedures or shore them up that you've done over the last little bit. You're starting to establish some goals. The next thing on your plate seems to be, from my perspective, the development of the leadership team, some of the day-to-day management, operations, and even some of the higher-level things can be taken off your plate. Thanks for updating us on everything. It's cool to see how things are progressing for you. You've got a golden touch. I don't know what it is you being in Atlanta. You have access to a ton of great people and a population that is receptive to Google Ads. You're doing some amazing stuff especially years out in ownership. You're already successful. We'll stay in touch for sure. 

 

Thank you, Nathan. I appreciate hearing that too. Sometimes I don't know where I should be compared to few years in, whatever it is. It feels like we're growing in a good way as far as what our reputation is. That's been the biggest thing. Clearly, the clinic is full. People do like coming to our place and we have a great reputation around town. That's been reassuring to know that people are valuing our service. 

You're going to see that jump in return patients here in the next few years, people that are referring family and friends such that your return patients are going to be 50% to 60% of your patient population. Simply by adding the physician relationships that you develop over time and your continued work with Google Ads, turning on that faucet, turning it down, turning it up as you need it will allow you to continue to grow. It's great to get in touch with you again. Keep us updated. Is there anything else you want to share, Avi? 

We went through a lot. Hopefully, we'll do this again in a few more months. I'll give you an update. I love doing these updates. I always try to go over from the last episode. It's fun to be able to look at my progress or what I've gone through. These are so fun to do because of that. It lets me see where I've been and where I'm going. 

Congratulations and keep it up. We look forward to talking again. 

Thanks a lot, Nathan. 

Important links: 

• Druid Hills PT 
• Prompt EMR 
• Jerry Durham 
• Keet Health – Past episode 
• Jerry Durham – Past episode 
• Google Ads 
• Jamey Schrier – Past episode 
• Back in the Black 

About Avi Zinn

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The COVID-19 pandemic has pushed every one of us to adapt to this new normal and marketing strategies are no exception. In this episode, Nathan Shields interviews his long-time friend, Neil Trickett, who talks about how marketing strategies can be optimized in the post-COVID world. The CEO of Practice Promotions, Neil is a marketing expert who has worked for over 900 PT clinics across the US and Canada. Neil and Nathan take some time to discuss online visibility, SEO, web content, and other elements that PT owners should pay attention to in order to keep their funnels busy. Stick around to the end as he shares his personal new normal strategies and what should owners be really focused on. 

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Listen to the podcast here:

Optimal Digital Marketing Strategies Post-COVID With Neil Trickett, PT Of Practice Promotions

Our guest is a long-time friend, Neil Trickett, CEO of Practice Promotions. Thanks for coming on again. I appreciate it. 

Thanks, Nathan. It’s always a pleasure. 

It’s been a couple of years since we last spoke and a lot has changed, but I’m glad to bring you back. I’m excited. If people are interested in learning more about Neil’s history. He is a prior PT owner that has transitioned into marketing with Practice Promotions. They do a wide range of things, especially digital marketing, newsletters, websites, you name it. They cover the basics. Now, especially where Neil sits, a lot has changed with marketing compared to pre-COVID-19. I decided to bring you on because you have a real pulse on the industry. You work with hundreds of clinics across the country. You’ve seen how people have had to pivot and change, firsthand and what is working now compared to what was working back then. I’m excited to get your insight. Let’s get into it a little bit right off the bat. What’s it like for PT practices out there now? 

Much has changed here and we’re working with over 900 PT clinics across the US and Canada. It’s interesting to have a pulse on what’s happening in different states, in different parts of Canada with lockdowns, partial openings and all this stuff that has been a challenge for many practice owners out there. It’s interesting to see what is working now for practices and how people have evolved and changed their marketing and practice. What’s interesting is a lot of the things that we were doing before that were helping clinic owners to focus on, which is going more direct to the consumer, that has become more of the way of life now. We see practices across the board. They’re getting busier now. As vaccinations are becoming more used, things are starting to relax a little bit. 

When you open up your clinic, you're no longer a PT, you're an entrepreneur. Click To Tweet

People are starting to reach back for services. We see practices overall get busier, especially in March 2021. Some clients were at max capacity with space restrictions, less staff, things like that, or maybe they had done some layoffs in 2020. They have leaned down their staff. Now, they got this ramping back up and they’re busy, which is a great thing. By survey, we are seeing that more physicians are referring it to clinics, which is great. More past patients are coming back in for care. That’s a great thing that’s working out for practices. Things are starting to get busier and busier. 

I know you’re pushing it, so it’s not the case, but do you see some owners who were reliant on physician referrals leaning back towards that and pulling back their marketing away from other aspects because you wouldn’t recommend that? Is that a tendency, whether it’s because that’s what they like to do or because they’re going into a slower season? 

I can’t speak for practice owners that are not our clients or not working with us. The ones that are working with us are seeing going that route of going more direct to the consumer and working with their customer list and how valuable that has been. What’s fascinating is that quite a lot of our clients and practice owners that we work with from 2020 had their best year ever, which is shocking to say this was the worst business disaster that we probably have gone through in modern times. What we looked at, what we saw was that the practices were very heavy on physician referrals. Maybe more than 60% of new patients that were coming in were from doctor referrals. 

They were very busy, happy and complacent that referrals dried up when that crisis happened. If they didn’t pivot fast enough to go out into their online community, working with their past patients and customer lists, they’ve struggled. There’s a lot of people in our community that need our help and they focused on that online marketing aspect and then also leveraging their customer lists. They had some of their best months ever. We’ve seen them continue on that trend and wanting to do even more and more. They realized that there’s a lot of potentials there. I’ve seen in conversations with prospective clients that they are saying, “We’re busy now. We don’t need to do anything because our physician referrals are taking back up.” They were waiting, but they don’t realize that it puts all your eggs in one basket and that’s not what you want to do from a business perspective.  

I had an interview where we talked about the four different buckets of marketing. There are your physician referrals, current patients who could refer family and friends, past patients who can return and/or refer family and friends. Then there’s direct-to-consumer, the community around you. What COVID forced us to do is pull away from that main bucket, which was physician referrals. Ninety percent of the owners out there were focused on those physician referrals. That was their bread butter to the point where they weren’t even looking at the other three buckets, unfortunately. It forced them to look at the other buckets. 

I even have a client who, through the pandemic, survived because of Facebook Ads. All his referrals came from Facebook Ads. He grew during the course of the pandemic because of Facebook Ads. Now that he’s sprinkling back in physician referrals, if his Facebook Ads wane for a week or two, he’s getting some physician referrals that are coming back on. If owners can leverage those things, if they can put appropriate money, time, energy into each bucket, they’re going to see the maximum capacity of their clinics. 

Physician marketing is an important aspect of your practice, but where many people fall into a trap as they didn’t work as hard on those other buckets. Sometimes it’s outside of your comfort zone. For a lot of practice owners, it’s comfortable. You know how to work in physician relationships and that you need to get referrals from physicians. Even if in your direct access state, it’s pseudo direct access where you still need to get a physician’s referral for an insurance contract. It’s still much better to have that person come in from finding you on Google, coming to the clinic, “We can do a free screen for you. This is going on. Let me coordinate with your doctor. Let me have my front desk reach out and recommend this. You may have to go in for a visit.” You’ve already created that great experience for them. They’re more likely to go ahead with their care at your clinic rather than purely waiting on the doctor. 

I did a Facebook Live event in our Facebook group, The Physical Therapy Owners Club, with Vinod Somareddy. He shared the successful actions he’s had with Google Ads and brought on his Google Ad agency to the Facebook Live event. What came to my mind was how a new PT owner approaches a billing meeting. We don’t know the first thing about billing, and we don’t know how to hold them accountable, and we don’t know what the metrics are. 

 

You take an owner like that, then similarly go into a Google Ad meeting, Facebook Ad, or whatever agency is doing those ads for you. It’s the same questions like, “I don’t know what I’m looking at. What are the questions I should ask? How should I hold them accountable? What should I be looking for? Is this successful or not?” They could tell you all kinds of numbers and throw stuff at you. If it doesn’t get to more new patients, then you’re like, “I’m not sure if I’m spending my money correctly.” I like what you said there that they know they need to do it, but they don’t quite know-how and to assess the ROI. 

One of the most important hats for a business owner, and let’s face it, when you open up your clinic, you’re no longer a PT. You’re an entrepreneur. Sometimes people don’t realize how much of an entrepreneur they should be. They get comfortable treating patients going, “I have a couple of therapists working with me.” The minute you open that door, you’re a business owner. You have to think that way. For a business owner, especially a CEO, one of your main functions is promotion and marketing, but you’re not doing it all. 

You’re making sure it’s coordinating, happening, and you’re getting ROI. As you get bigger, you might have a marketing director or even a marketing team that’s helping you out in the clinic, and you need to have a good pulse for them. What’s the rhythm going on with your marketing. If you do not own that hat as a CEO, as an owner of your practice, that’s when you get into trouble. It’s an important aspect of being a business owner to focus on what is your marketing strategy and actions. 

What are some of those tips that you could share? What are some of the new normal marketing strategies? What does that look like? What should owners be focused on? 

We’ve put the strategy together called The Ultimate PT Marketing Funnel. We’ve been doing this for years. It’s based on research. This is what was working well before COVID. If you were starting to transition from that model of more reliant on physician roles to more direct-to-consumer and working with your customers, you’re going to be much more successful. In this strategy, the first most important layer is building a large online presence. You have to be discoverable online in your local community. You need to be everywhere there, especially from a Google perspective, from local search, through Facebook and social media. One of the key things there is to make sure that you’re focusing on search engine optimization. There are a lot of things that can be done there and you can work with different groups to help you with that. That makes sure that your clinic is going to get in front of more people when they’re doing searches for help. 

You want to have a nice clean website. You want to have one that might not focus so much on how amazing your clinic is but what you provide the patients. It’s not so much about you and the letters behind your name, but more about the patients. That’s what we learned from past marketing interviews we’ve done here on the show. I also remember an interview I did with Angie McGilvrey. She’s been strong with her social media presence. 

They’re posting 3 or 4 times a day. They’ve got a video person that comes in a couple of times a week which takes videos and posts all over Instagram. She quoted Gary Vaynerchuk. He said, “If you’re not on Facebook, you simply don’t exist as a business nowadays.” That works for certain demographics. She highlighted that. If you’re talking to anyone above 35 years old, a lot of them are going to be on Facebook. A lot of the decision-makers are on Facebook. If you want to have more connection with the younger crowd, then you’re going to be on Instagram, possibly. 

We’ve definitely seen that. We worked with all kinds of clinics, from pediatric to geriatric to super sports athletes and recovery clinics. You got to know your audience. Where does your audience mostly reside? For some of our clients, we’ve got some phenomenal clinics that are amazing at promoting themselves. They do a ton of video work. They’re all over Instagram. They’re able to build that up. One thing to realize is that there’s no one media that is king over everything else. You have to realize that there are behaviors of patients when they are going to come to you. First off, you’re mostly an unknown. People don’t know what you’re going to do to help them. If you went to someone on the street and you said, “If you’ve got a back problem, who are you going to go see?” 

Are they going to say PT? Most likely going to say chiropractic or maybe their doctor. First off, you got to be able to get in front of them. They’re usually out there searching, not just for, “Physical therapy near me.” Those are people who are looking for that service. You want to be in front of those people, but the majority of people searching for, “How can I help my back pain? I think I tore my knee.” Can you get found in those searches? That can get you in a much wider audience in front of people who are never even thinking of PT as the solution to that problem that they’re having. Now, you have that opportunity. That comes down to the SEO Trinity. SEO is Search Engine Optimization. That means you can get ranked higher better in Google. Also, Bing and Yahoo, still out there. Don’t forget those. A lot of seniors are on Bing because of Microsoft Edge and Explore. That’s the default browser. 

They don’t know how to change it. 

You have to be discoverable online in your local community. You need to be everywhere, especially on Google. Click To Tweet

While Google is still the king of the hill, we can’t forget Bing in all those guys over there. With the SEO Trinity, what that comes down to is to rank better and get your clinic more found. You need to work within your website, and the content and the copy in there that works with the different keywords like physical therapy. Back pain, sciatica and all these things are keywords. The important part there is, “What’s going on with your website? How optimized is that?” The other part of that Trinity is Google My Business. You are a local business. Google My Business is the key to getting your information out there. That’s where Google reviews reside, questions and answers reside, your hours and operation. You can do appointment requests through there. 

A lot of people miss the part of putting a lot of great photos in Google My Business. Think about when you look at a restaurant, and you’re looking on Google My Business, you look at the menu and the food. Does the place look nice? That’s a great thing to use for Google My Business. Do you have the same thing happening with your clinic? Have you put a lot of great visuals in Google My Business to get people to go, “That looks like a nice place. They look professional and hands-on with people?” That’s the second aspect. 

The third aspect is called listings. Listings are how your business information address, phone number, what you specialize in all these data points. How is that on hundreds of different directories? When you go on Apple Maps, how does Apple Maps know your business information? When you go on Waze, how does it know your business information? How does your car navigation know your business information? All that comes from these online directories. The more your business information is out there on the internet, on these different directories, Google crawls those and finds your information and then ranks you higher. That makes the third aspect of that SEO Trinity. 

Do you find that a lot of clinics aren’t doing this? 

It takes constant work. 

For those owners who say they have an SEO company that’s doing this for them when you look at that, are they covering all three bases? 

Usually, not. They might be focusing on one aspect. The thing to realize is that it’s never done. It’s a constant battle for the top. You always have to be working on it. You always have to be tweaking, changing, and optimizing things and looking at what’s working or what’s not working. We’re doing it constantly for our clients’ online work there. 

Case in point on that Facebook Live event with Vinod, his agency showed that in February 2021, they made 1,100 changes surrounding Vinod’s website and Google Ads to optimize them. That’s not just one time. That’s ongoing. They said they average 900 changes a month for most companies, which blew my mind. It’s not like a tweak here and there once a week. It’s ongoing. 

There are thousands and thousands of directories online. It’s about getting all kinds of information from your clinic on those different directories that link back to your website. That helps build relevance for sure with the way Google looks at your business. 

Making sure that your online presence is there, Google Ads and Facebook Ads, what do you see with those? 

What I always recommend for people is that what we see statistically is that the person that will take the most action, meaning they’re going to call your clinic or are they going to fill out a request appointment form on your website comes from an organic search. Meaning that you rank naturally in what’s called the 3-Pack, which is that part right under the maps then also the top ten. It comes down to the more spots that you can control on Google and page one, the more authority people think you have. 

If you see a business and it has 2 or 3 spots on Google, you think, “That must be the best one. Let me click on that. Let me call that one.” It’s critical that you get your SEO Search Engine Optimization cooking first and then start to spend money on Google Ads because then you can command even more of page one of Google with Google Ads. What’s interesting with Google Ads is that it drives those other behaviors. I know you probably realize this when you do it next time, but when you search for something, and you see their ad pop up, you’re not so likely to click on the ad. You’re more likely to click on the organic underneath. 

Scroll past the ads, find the first organic one. 

If you see RISE PT on an ad, but you see RISE PT below it organic, the tendency is you will click on the organic. It is good to do Google Ads because it drives better SEO behavior of people coming to your website. The bottom line is to make sure you get a good website going, get your SEO in place first, and then start to invest in Google Ads. 

Many people focused on that moving to direct-to-consumer during the course of the pandemic. I think a lot of people had a lot of success going back to their past patient lists, which they probably hadn’t cultivated much in the past. Those who are successful are and that’s why WebPT came out with reach and stuff. They focused on getting back to those patients that already know, like and trust them. 

It’s your lowest hanging fruit. The most successful businesses in the world cultivate their customer lists. If you think of Starbucks, how many times do you go back to Starbucks in a week? Think about it with yourself. It’s been a fascinating journey of these last many years of building Practice Promotions and talking to thousands of practice owners. I always ask, “What are you doing to market to your past patients?” They giggle because they know they should be doing more like, “I know it should be doing more, but we do some emails. We do an email newsletter or maybe a birthday card.” That’s typically the extent of it but what they don’t realize is that it costs you 4 to 10 times more to get a new patient in the door than just to get a returning patient. Your ROI is the cheapest thing you can do to get a returning patient. They know you and love you. What most patients don’t want to do is come back to PT. You only go back to PT if you need to. 

You don’t want to go to PT if you don’t have to. 

When I was treating patients, it was, “Mrs. Jones, it’s good to see you again. Your knee pain has flared up. How long has that been going on?” “Six months.” “Why didn’t you come back in sooner?” “I thought it would go away,” or whatever the usual is with that. If you don’t frequently communicate across many media channels to get in front of as many eyeballs as possible, then you can’t capitalize on your list. When you do, you can build your practice up. Where I love to see clinics get to is 50% or more of their current caseload is returning or referred patients. That’s unconditional power. 

That was something that we frequently did especially as we went into our “slow seasons” and we were actively working against that mindset and being reasonable with a slow season altogether. One of our successful actions was to callback past patients. Getting providers on the phone, “If a patient canceled, you’ve got a free hour. Let’s look back at patients that came in six months ago or were discharged six months ago. Give them a call and see how they’re doing. Not only see how they’re doing, how are their family and friends doing as well?” Because they could refer family and friends in as well. Surprisingly, a lot of patients would call back, and they’re like, “I’m doing fine. I appreciate that you guys took the time to call me, and I hope you guys are doing well.” They’ll leave notes like that. It was good to build that relationship further more than just a cold email. It was very personal and that was a successful action of ours. 

We did that in our practice. What we did is we had our patient list of a few thousand plus people and every quarter we would call them. We broke that down into, “We’ve got to get to a third of that list this month.” We break that down. We’re going to have the techs reach out and they got many calls they need to do a day. It’s like, “Just checking in. How are you doing? Are you doing your home exercise program? Do you need me to resend that to you? How’s your knee feeling?” It’s like, “It’s bothering me again.” “Do you want to have your therapist con connect with you on that?” 

“I do a free consult on the phone or come in for fifteen minutes.” 

There are many ways to reconnect. One of the things that you need to go into it is that, “I need to cultivate my customer list as best as I can. How can I develop raving fans that send their friends and family who want to come back know that I’m the expert to turn to when something’s happening?” I’d rather have them call me like, “I think I might’ve tweaked my knee. Do you think I should come to and see you again?” I’m like, “Absolutely. Let’s check it out really quick.” That’s the kind of conversation you want to have. To get in front of those people, you have to realize that people are across all kinds of media. Back in the old days, we used to be able to put a TV ad up because you get in front of about 30% of the people. Now, you might get in front of 2% of the people on that channel. 

You need to be leveraging newsletters and personalized emails going out. You need to be in social media engaging with that customer list, text messaging, phone calls, callbacks programs and direct mail works well nowadays. Even more so now than it was many years ago. Do you ever see that meme? It’s from AOL. It was back when you, “I’ve got an email.” You get so excited and you’ve gone through your mailbox. You’re like, “I got all this junk mail.” Nowadays, it’s like, “I got a letter. I’m so sick of my email inbox.” Direct mail works much better now than it ever did. The bottom line is with your customer list, you’re trying to get in front of as many people as you can. If you rely on emails, you might get in front of 30%, 40%, maybe 50% of your list consistently. You’re missing over half of the people that you’re trying to reach. How can you reach more people? You’ve got to be on different media to do that. 

I talked about the four buckets and making sure you have time, money, and energy, and all four. It takes so much more energy now for owners. It was so much easier to drop something off of the physician and expect the referrals to come in. To stay afloat and survive in the way things are with economies, and competition around you, if you’re not doing it, the large corporate brands are, and the physician-owned PT practices are. If you’re going to stay above water, you need to focus on spreading yourself out across these different buckets and make sure you have the money and energy to do so. 

I always have a stat on this, but from up until 2012, there were about 25% of physicians who worked for a hospital network and that, in 2018, skyrocketed to 45% of physicians who worked for networks. I can’t even imagine what that is now. Here’s the deal moving forward. It is a different ball game. If you’ve been in PT for as many years as I have, it’s different than when you first started. You have to be in that mentality of a business owner. You cannot treat full-time if you’re beyond yourself in the clinic. If you have additional therapists that are working for you, you have to have time in your day to be a business owner and function that way. 

Marketing is one of those critical components that you need to be on every single week looking at because acquisitions have skyrocketed. There’s a lot of buying out of clinics. There are bigger groups coming into your area where they will be coming into your area. Hospital networks are gobbling up places around them too. There are lot more challenges coming up. There are also a lot more opportunities. If you know what you need to do and you know that you need to learn about that a little bit more, you can take those opportunities and grow your business with your goal is to be as profitable as you can with the clinic that you have, or if you have aspirations of additional locations, knowing how to market is going to help me get there. 

I’d like to say that your business’ love language is quality time. Your business needs quality time. That’s not like in between patients, after hours or on weekends. It needs quality, consistent blocks of your energy and time to be successful and achieve the goals that you want to achieve. Otherwise, it’s going to lead to your burnout and lack of fulfillment. I’m sure you probably still stumped a lot of owners when you say, “What’s your budget for this?” Is that like, “Deer in the headlights, I don’t know,” still? 

I like the State of PT that WebPT does every year because they survey quite a few thousand practices. You get some good information out of that. It’s always fascinating to me when they ask, “What’s your marketing budget? What are you spending on a marketing budget?” Across the board, up until probably a multimillion-dollar or a $5 million practice, the average was less than 1.5% of what you made that you spend out on marketing. The small business association average across all industries is 11%. In total healthcare, it’s about 8%. When you say, “What’s my budget going to be for this?” You have to look at, “What’s my gross income? What are my goals? Where do I need to be in my clinic to maximize the space? If I hired more therapists, could I maximize and be as profitable as you can be?” 

You work backward from that. “What is the number of patient visits I need to be doing? How many new patients do I need to generate on a weekly basis or monthly basis for making that all happen? What’s my revenue going to be?” If you’ve been spending 1% or 2%, try to go to 5%, what happens? If you’re spending it right, if you have a good strategy, you’re going to get tenfold on your money. It’s fascinating that in PT, we spent very little in terms of marketing compared to many other industries. 

Especially if you don’t have the time and also if you don’t have the know-how, you’re going to spend that money and not know how to track it. I’m sure you would recommend if someone’s going to have a marketing strategy or alter a marketing strategy or want to assess their current marketing strategy, they need to, know what track, what statistics they’re tracking and then see what that impact is when they spend extra dollars in different buckets. 

 

Sometimes you go into it thinking, “This is going to be so complicated.” You can go down that rabbit hole if you want to. The reality is you need to be tracking, “What’s my general marketing expenditure here. What’s my number of new patients? What’s my number of returning patients coming in here? Let me look at when my marketing is arriving, doing things, and try to correlate that with your increase in new patients?” You can see what’s working and what’s not. It doesn’t have to be super complicated. As you grow, you will need to get more complex in your marketing statistics, but to start off with, or if you’ve been not putting a pedal to the metal with that, you don’t have to go crazy with trying to analyze a whole bunch of stats. 

What I’ve seen is owners get a little bit gun shy with Google and Facebook Ads because the expense is greater than what they’re used to or extraordinary is what they think. That’s because they’ve spent $100 to $200 for a doctor’s lunch here and there. That’s about the extent of it. Now, they’re looking at spending $1,000, $2,000, $3,000 a month on digital ads. Talk us through that because a lot of owners aren’t seeing immediate results from that. The general idea is that it’s going to take 2 to 3 months to gain some traction. 

It comes back to this whole strategy. There’s a lot of shiny objects out there. “We’ll do your Facebook Ads and you’ll be getting guaranteed 30 new patients a month.” That’s for some. For most, what happens is if you don’t have a very good website or a good organic SEO, it comes back to people’s behaviors. They might see you on Facebook. They might see the ad and be interested, but they’re going to go check out your online reviews first. They’re going to look at your website, second. They’re going to might call. They then might fill out a form. They might see that ad again on Facebook and then do something with it. First and foremost, before you go spending a boatload of money on Facebook Ads or Google Ads, you have to have other core things in place. 

That’s the best place to start with your money is. “What are you doing to your customer list? What is your SEO presence? What is your online brand presence? Can you make improvements there?” You will then start to see results from that and then, “I’ve got to get a good solid foundation, let me tack on some of the more technical things like Google Ads or Facebook ads.” Those things will work even better than if you went at it without looking at those fundamental things in place. 

I love that recommendation as a step-by-step program because that is the trend or the shiny object is to jump in on Google Ads and Facebook Ads. Whether you’re struggling or whether you’re feeling rather comfortable and want to make more progress than you are right now, let’s maximize what you’re doing with current patients, past patients and physician referrals. If you’re getting 60%, 70% are returning patients and friends and family referrals, and then the last few are physician referrals, that’s great. Maybe that’s when you can start capitalizing on a Google Ad. 

Look at that customer list first, see what you’re doing there and invest your time there first. For the current patients, you can ask for referrals and free screening offers workshops that might invite friends and family to their online reviews like, “Here’s a statistic for you, 89% of people consider a review that’s three months or older irrelevant.” If you haven’t a Google review in 3 or 6 months, that’s hurting how people perceive you online. The most important thing to be doing with your online reviews is not necessarily leaving it to an automated system to do. That’s important to have as a backup, but you should be training your team internally, your therapist, and the front desk to be asking for online reviews because that is the best time. 

It’s all about timing. You want that person who’s having an amazing transformation. Their pain is almost gone and they were happy. That’s the time to ask for a review, and then you have the mechanisms for them to be able to leave that review. Ultimately, it comes back to ask that patient, “What can you do before and what can you do now?” They’re going to leave this amazing transformational review that will convince others. It’s a simple action but often overlooked and a great place to start. 

I like that you said that it has to be recent as well. People are going to disregard those. Especially a year old. I didn’t know three months was too old, but if you’re looking at past reviews that aren’t recent, you’re like, “Maybe they were back in the day. Maybe they’re not so good now.” That’s my first thought. 

If you went to a restaurant and the last review was 6 or 9 months ago, you’d be like, “Are they still in business? Did something happen? Are they not good anymore?” 

“Is the chef still there? I don’t know.” Those are good questions to ask. Asking that routinely and I love that you share those things because those are all bang for your buck. You get so much return. To make a phone call costs time. Whereas the Google Ads and Facebook Ads spend is going to be money out of your pocket. Why don’t you maximize what’s cheapest first? Once you know that you’ve maximized that, then move on. 

Our most successful clients are the ones that have a good pulse on their marketing internally because they will be taking a lot of videos, pictures and asking for those reviews. They know that they need to market to their past patients and then we’re coming in with the technical aspects. We know how to craft the website, SEO, digital marketing, digital newsletters, email campaigns and all that to support that. We can then work closely with them and get the absolute best results because you have to customize it to your brand, “What was your clinic all about? What are you portraying out there?” 

It’s almost like plugging a few holes in your bucket before you start adding more water into it. 

The worst thing that we get sometimes is a practice that comes on board and it’s like, “I’m paying you. You guys do everything.” That is the wrong mentality. It’s like, “How can you leverage consultants and professionals around you to enhance what you’re doing?” That’s a better mentality to have. 

Do you see that as you’re taking off the items, going to your current and past patient list, doing Google reviews, better SEO on your websites and direct-to-consumers? That’s what people are doing now to be successful. It’s going to get more and more so going forward, I assume. 

It’s going to accelerate more and more as we go forward into the future. People expect it now. If you’re not everywhere online, if you’re not super active in social media, if you’re not pumping out tons of video and pictures, then they’re going to look at the practice that is. 

Even if the doctor says, “I want you to go to so-and-so physical therapy practice.” What’s the first thing you’re going to do when you sit in the car? You’re going to look them up. You’re going to see what their website looks like and what their presence is like. 

The practice now in physicians is, “I want you to go to PT. Here’s a list. You do your own research on who you want to choose.” There are doctors that say, “You have to go to my clinic,” and we know that. For the ones that do refer out, they are giving them a list because they don’t want to be like, “I do recommend these places. They get amazing results, but I have to give you this list.” The patient’s going to do their due diligence. 

Anything else you want to share? You shared a ton already. I love what you’ve talked about so far and showing up what’s happening within your practices and then moving on to the digital space. What more can you add? 

We covered so much here. My purpose is to help practices succeed in improving more people’s lives. That’s what we’re about at Practice Promotions. We have great advocates there at the APTA level, the government level. It comes down as individual practices. If we work better to educate the public in how we can help them solve musculoskeletal neurological problems and empower each one of those clinics to be more successful at reaching the community, that’s going to raise the ship. That’s a huge focus for us. 

I would come back again. The thing that we try to portray to our clients and help practice owners understand is that you can definitely be in charge of your marketing. You can be empowered in your marketing, learn more about marketing. It’s a critical hat as a practice owner. You have to look when you’re working with different consultants out there, “Are they going to help you build the right strategy? Do they have the right systems processes to help you get there? Do they have the specialists that are going to be able to advise you and help you get the results that you need?” That’s a critical focus for us. 

It’s cool that you systematize things so well and you’re not just some guy working on his own, “Let’s try this, that, and the other thing, and see what works for you guys.” You are coming from a physical therapy background yourself, knowing and talk to hundreds of thousands of owners over the years. You know what can work best for physical therapists. 

It’s been a fun journey for me being a PT, working in lots of different types of facilities and outpatient. I had a real passion for manual therapy. I went for a while to the Canadian College of Osteopathy that was a passion of mine there. I did teach CEUs and did some teaching at a university for PTAs. I got into my practicing and learning how to then be a business owner. Lots of training around that, getting better practice and then going through the process of selling your clinic. 

Focus on SEO but just make sure that your clinic is going to be in front of people when they're doing searches for help. Click To Tweet

That was quite an experience, then starting Practice Promotions many years ago, which is my wife, Amy and I. Now, we’ve been able to build that up to 75 employees and learning about being a business leader at that level. We always continue to grow and marketing at this level, marketing Practice Promotions to clients and learning a lot as we do that too. You can never stop learning. That’s an important part of your skillset as being a practice owner. 

It’s cool to know your story and where you come from, but it’s equally cool to see how you, over the past many years, have changed your marketing company. You have gone into the digital. You’ve had to learn so much yourself to be in charge of that but to hire people that are even smarter than you to do some of those things. It’s not just the newsletter here or there anymore. It’s a lot more than that. You have it all. 

Many years ago, we started off with print and direct mail and newsletters. Now, we send out over five million newsletters for practices over the year. We have a big impact there in their communities. Many years ago, we started to do websites. We wanted to do them a particular way. One thing that’s always been a guiding light for us is focusing on the results. It’s not just putting something together that looks fancy. It’s always looking at what’s converting better. Now we have lots of great data to look through and continue to focus and improve with that. The digital marketing that helps you rank better in Google, Google Ads, and all these things comes back to like a full all in one marketing solution for clinics. 

If people wanted to reach you, how would they do that? 

We’ve got tons of resources and free information for you, and video training. Go to PracticePromotions.net. You can learn a lot there, tips and strategies to help your practice. You can also get in touch with us there to scheduling a consult, a great way to get introduced to our strategy and our systems and talk about our specialists. We have different plans to help all kinds of clinics. We help everybody from small start-up clinics all the way through 80-plus location clinics. 

If they have some questions, then you schedule a consult? 

Yes. Get right on a consult call with one of our specialists. 

Thank you so much for taking the time. 

It was great to be on, Nathan. It’s a pleasure as always. 

Have a great day. 

You too. 

Important links: 

• Neil Trickett - Previous episode 
• Practice Promotions 
• Interview - The Basics Of Marketing - The Buckets, Budgets And More With Steve Line, PT episode 
• The Physical Therapy Owners Club - Facebook Group 
• Vinod Somareddy - Previous episode 
• The Ultimate PT Marketing Funnel 
• Angie McGilvrey - Previous episode 
• Google My Business 

About Neil Trickett, PT - CEO, Practice Promotions

Neil is a physical therapist, former private practice owner of 8 years, and CEO of Practice Promotions, the leader in marketing strategy, digital marketing, websites, and print marketing for the PT industry. With 20 years of real-world experience, Neil has helped over a thousand PT clinic locations across the US and Canada, implement the right marketing strategies and systems to exponentially grow their new patient numbers.

Neil and his wife, Amy co-owned their successful physical therapy practice in Boynton Beach, FL for 8 years, developing marketing strategies and systems along the way. He has dedicated his career to helping elevate the profession of physical therapy in the public, by empowering rehabilitation practices to successfully market themselves to their local communities.
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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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Listen to the podcast here:

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.

Go and set sail into waters you may know nothing about. Click To Tweet

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?

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.

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.

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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?

 

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 IntegrativePainScienceInstitute.com. 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 IntegrativePainScienceInstitute.com or I'm always happy for anyone to email me. Email is pretty easy, it's Joe@IntegrativePainScienceInstitute.com.

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.

Important links:

• The Healing Pain Podcast
• Good to Great
• The E-Myth Revisited 
• IntegrativePainScienceInstitute.com
• Joe@IntegrativePainScienceInstitute.com

About Joe Tatta

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"How are you showing up in the world?" is always a central question in marketing. For Jamey Schrier, PT, driving referrals is an essential first step in building up your business authority and reputation. Joining Nathan Shields once more, he talks about the best way to present yourself to referral sources, patients, and communities, which is an essential part of your marketing message. Nathan also discusses how to be clear with your goals, choosing the proper target market, and how to come across the public in the most engaging ways. He also explains why it is important to focus on delivering tangible solutions than mere therapeutic methods, making your PT practice more than just what is happening within your clinic. 

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Listen to the podcast here:

Driving Referrals to Your Clinic With Jamey Schrier, PT 

I've got multiple-time guests coming back to be on the show. Jamey Schrier, I appreciate you coming back.  

I appreciate you having me, Nathan. 

Thanks for coming on. We've been talking about a bunch of different topics and trying to figure out what the connection was. We want to talk about how we make more connection with the audience. How do we provide them what they need? How do we prepare our messaging so that they want what we're giving? Maybe I'm not saying it the right way because we were thrown a lot of things out there. First of all, let me say, if you haven't heard my show with Jamey in the past, go back to those. I've had you on what 2 or 3 times now.  

I think so, at least 2, perhaps 3.  

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Jamey has got a great personal story. If you can find his first show from our first year of doing shows in 2019, go back and listen to it and what drove him to become a coach and consultant now for PT owners. Make sure you go back and read those because he's got some great wisdom to share and great value for you. We want to talk about how to connect. Where do you want to start this off, Jamey? I don't have a certain direction I'm going with this because we can provide some great value with simply the discussion, but where do you want to start here?  

Let's start by grabbing people's attention. What we're going to do is talk about driving referrals to your business. That's the essence of what we're going to discuss because a lot of this comes down to how do we connect. How do we bring in referrals to our business starting with understanding how to connect with the people that we want to come into our business? We're all caring and compassionate people that went out on our own to start a business. I've never met a business owner that wasn't busy, overwhelmed, and stressed in doing that but yet, we all have this challenge of getting consistent referrals in our business that of course convert into new patients or new clients. What we were talking about before is we’re discussing where's the real problem here.  

Not necessarily the tactical thing, which I can certainly provide some tactics, some tools and some tips, but where is the problem in doing it and what can typically be done? That's an area I've spent a lot of time and personally being a former private practice owner for years and now the Founder and CEO of Practice Freedom U, this is what we discussed. This is what we live for and this is what we do every single day. It’s providing this business knowledge to help people grow and flourish knowing that we haven't been taught this, we're out there, and there's a million clinical courses to help you treat your back better. This stuff is a little rarer. Where would you like me to begin? I can go in any direction you like.  

We can talk about driving referrals and start with where you were with your workshops. Most people are going to go once they get a referral for XYZ Physical Therapy and sit in their car with that prescription, they're going to Google XYZ Physical Therapy and see your website or they're going to say, “My back hurts. How am I going to get over my back?” Let's start with the webpage because a lot of people nowadays are going to see your presence online. As your experience with what you shared with me, 99% of those physical therapy websites is hard to tell exactly what they can do for me, the patient. They're focused on saying, “We've got this certification, we do this service, we do that service. We do this kind of thing.” The messages seem to be off, they're highlighting themselves, and not highlighting the result or the product that they're producing.  

If we take a 30,000-foot view here before we dive into the ground level and get into the weeds a little bit, the 30,000-foot view is marketing is all about how you show up in the world. That's what marketing is. How do you and your company show up in the world? It could be your personal brand, but even your personal brand is still about you, your practice, and how are you showing up in the world. How do other people see you? When you look at it from that perspective, you want to consciously and intentionally show up in the world the way you want to show up in the world because if not, other people will pigeonhole you and stereotype you that, “You're a physical therapist, you’re good at doing some stretches,” but we're the ones that take care of people with back problems. We're the ones that take care of this.  

 

That has happened to physical therapists for 50, 60, 70 years. The reason is because we are not communicating clearly and effectively how we want to show up in the world. It's confusing. We have a great saying at Practice Freedom U and it says, “Confused people, don't…” What it means is any time there is confusion, you are going to have someone that does not make a decision or if it's your staff is confused, they’re unproductive. If there's someone out there in the world that's thinking, “I have a back problem. Who should I go see?” If your message is confusing and it's not clear on whether or not you can help me, then I'll go somewhere else. I'll go to someone else that's speaking a louder message, a clear message, or maybe a message that's showing up either on the website.  

That's one of the big things from a higher-level perspective which as owners, we have to take that perspective first. We never want to dive in first. We have to look at it from that perspective first so we could make sure we're moving in the direction that we want. That's number one, marketing equals how we show up in the world because if you don't, someone else will have a plan for you and start to dictate how you show up in the world.  

How do you help someone get clarity on their message? That can be a difficult one. I know for Will and I with our practice, it took some work talking it out. We had to get back to what was our purpose and get clear on what were our values. Start there before we can start talking about what we can offer to the world, how we present to the world, and that it derives from that. That's where we came from. What do you recommend?  

Nathan, that's not fun. I don't want to do that. Read books, you start with that, that’s not fun and yet here you are saying, “Do you know what we do in our program? We start with a mission, vision values.” Do you know where Donald Miller, Michael Hyatt, Tony Robbins’ people and others start? A mission, vision, values. Now, you might call it something unique. You might wrap it up in a different bow, but that's where you have to start. You have to start with, “What are you about?” Before you communicate that out in the world, you have to ask yourself. I'm going to be very honest with everybody. The world does not need another physical therapy practice. We will survive without you. However, the world needs you. We want to make sure that you are bringing something that’s impactful and important.  

You have the ability to do that but I don't want you to show up as someone else. Be unique and communicate at least to yourself, “What is your practice about? Your vision or your mission? What are you about? Where are you going? What are you trying to do? What impact are you trying to make in the world? What impact are you making in your community? Why did you get into physical therapy? Why did you open up your practice?” These are the questions that make you think. I get that most of us are impatient and we want this now but these questions are going to come up again and again as you start marketing, building your referral sources, building your presence online, and doing the other things that we do to drive referrals. We have to start there for sure.  

If you don't get clear in what you're about, then other people will just tell you what you're about.   Click To Tweet

I've had marketing people on in the past and they say, “If you can improve the customer experience and create a culture, that can improve your marketing efforts three times.” That's where this starts from. When you're clear on your message, your purpose, mission, vision, values and all those things, then that drives the culture of the business and then you start developing something that people can get behind and people can buy into. Remember, when people buy, they never buy logically, they buy on emotion. If you can translate that into your message, that means the connection becomes greater. It's hard for me to work with PT owners because many of them don't have a clear purpose. I don't know if you've had the same experience, but that's where we'll start. As I'm working with clients, it’s okay, let's get clear on this and their purpose. You've probably seen this as I have. We're going to be the best physical therapy that provides hands-on treatment and a one-on-one approach.  

I was yawning when you said that. “We're going to be the commitment to excellence and the best therapist place.” That was mine. I got it from the Oakland Raiders back in the day.  

No surprise that we're a commoditized entity at this point because we all say the same thing. Physical Therapy is not your purpose and not your why. Physical Therapy ends up being the vehicle through which you've lived out that purpose. You could be a roofer and live out that purpose as long as you're clear on that purpose, what it's doing for the community and those around you. It's important to get that clear in and that then drives the marketing and can improve referrals because people buy into that culture. They buy into what you're doing so much more than the services you provided.  

The way your prospect, your client and your patient are going to look at it as they have a problem and they want a result. What you're providing as a therapy provider is the solution to that. You're the bridge. There are lots of solutions. As you said, Physical Therapy has been considered a commodity which means Physical Therapies are Physical Therapy. We're grouped into “it's all the same.” It doesn't matter. It's interesting if you ask any physical therapist that they would not say that at all but if you ask other outsiders, they may say that. That goes back to my point that if you don't get clear in what you're about then other people will tell you what you're about.  

To your point, if you provide a better customer experience or customer journey as it’s often called, it comes from the Hero's Journey, that is critical in how you can generate referrals. What you have to understand before that, after the vision, after the mission, after you divide those values and this principles in which you live by, what you understand, and what your business is about, the next most important step is understanding your audience. That means you have to first of all, figure out who is your audience. Let me tell you a quick story. We have something called the Velvet Rope Policy. Imagine this. If COVID is over, you go down to Miami, you're walking along, and you see this club. You hear the music on and you see this Velvet Rope. What's the first thing that you think when you see the Velvet Rope and there are people on the other side of that? What do you think, Nathan?  

There have got to be some special people in there.  

There are special people on the other side of that rope. They’re VIPs. You're thinking, “They must be important people.” You might also be thinking, “Am I one of those very important people? Am I VIP?” Here's what happens. Here's the psychology behind the Velvet Rope. The Velvet Rope is the target audience of that club. These are the celebrities, the big people, the big spenders, and the people that will attract other people to the club. That's their audience, but here's the mistake that people make in our businesses. We're not clear on our target audience.  

One of the things that we discussed in our Practice Transformation Workshop that came up is, “I'm afraid of becoming too niche.” “I can help many people and they go wide.” They say, “I can do this.” When you do that, nobody knows exactly, can you help them? By having that Velvet Rope and by being very clear, not only do you dial in your message to your ideal audience but other people go into that club too. Not just the VIPs. Most of the club is not made up of the VIPs. Most of the club are the regular people outside. The false misnomer, the myth that is happening is that if you spend your time focusing on your niche audience, your target audience then you're not going to attract other people and the opposite is true. 

I have a couple of examples. One is Amazon. When Amazon first started, what did they sell? They sold books. They did not start with selling 42 billion items as they do now. They focused on books. They dialed in their messaging. They dialed in their operations. They dialed all of that in. Once that was dialed in, they started to expand what they offered. That's a perfect example of a niche. Another example that came up in our conversation is Lululemon. It came up funny and someone brought it up. I bought a pair recently of ABC pants. Have you ever heard of ABC pants? 

 

I've got a couple of them.  

People were cracking up because what does ABC stand for?  

Anti-Ball Crusher.  

A couple of friends of mine were wearing them. They played golf with them. They went out to dinner with them. They hung out with them. A lot of times, all on the same day, they never changed. I'm like, “That's cool to complete in their stretching.” Do you think I'm Lululemon's target ideal customer? Heck, no. I'm the furthest from them but it doesn't matter. I understand who their customer is. My wife wears some of that stuff but I still paid them money to purchase something. When they do an ad specifically on the ABC pants, that ad is going to be reaching their particular audience, which is you and me, basically your 30, 35-year-old to 60-year-old male. That's who they're going to target. One of the things that we have to do right from the get-go and after where we established our vision, mission and values is to dial in our audience.  

When you dial in your target audience, you're clear on their fears, worries, wants, needs and frustrations. When you are clear on that, that becomes gold because that's the messaging that you will use. You can use it in workshops. You can use it when you speak to referral sources that I know seems to be a dying focus with people and our profession. We are specialists. People are referred to a specialist. That’s a fact. What we're talking about a lot of is that messaging online. "What is our website's message? What are we putting out there if you're using social media, Facebook or whatever? I don't think you need to be an expert at being a social media person. As you've mentioned, you've had a lot of other internet marketers or internet people on. There are talented people that can help you do it. Our job is to understand our audience and be able to speak clearly in our messaging to our audience no matter what medium it's in. You hire someone that can help you put all the tactical stuff together in order to do that. That's the next step, Nathan, that we need to begin before diving into all the other stuff.  

I had a bad experience with a website designer that I was sharing with you prior to our conversation and as I was discussing that experience with my coach, it led back to the fact that I wasn't clear on my message. They're lost in the woods as to what to design for me because my message wasn't clear and the same can be said for the physical therapy teams. If they're not clear with their message and who that specific avatar is, get it down to, “Is it a man or a woman? How old are they? What are their cares and concerns? What are their family and community look like?” All those things. Get detailed so that you can speak to that. As you said, the fear comes up then what about everyone else.  

As you said, I don't know how many times I've seen it. My friend, Angie McGilvrey down in Florida had the hurricane come through. They had to start all over again. They decided, “We're going to do it this way.” They are going to focus on social media, but their focus was going to be on 30-year-old female CrossFit athletes. That's their avatar. They’re busier than they've ever been before now because they treat those CrossFit athletes well. CrossFit athletes have families. They have friends who are CrossFit athletes. You and I both know if I have a rotator cuff issue, I want to get my rehab from the guy that works with the Major League Baseball operations. I want the specialists. I want the guy who's known for being good with the athlete rotator cuffs. I'm nowhere near an athlete and I'm not going to throw a ball more than 50 miles an hour but I want that dude. As your niche, you aren't limiting yourself. You're saying, “Here's where we focus.” You can also be part of the group. We're still going to take you that it allows you then to focus on your messaging.  

The more information you know about your audience, the more you'll be able to connect with them. Click To Tweet

This is an example that will hit home. Surgeons have done this. Everywhere across the country, if you look at multiple places that do, let's say orthopedic surgery, what you will see on their site, you will see very clearly the surgeon and the specialty, the back guy, the knee woman, the ankle specialists or the shoulder specialists. What they realized is that people are referred to a specialist. Nobody wants to see, “I have a back problem. Can I see the generalists? I want to see the generalist, not the specialist in shoulders.” Here's what you don't see, “I have a good friend, Dr. Goldsmith. He’s a great guy on the site. He's the back guy. What's interesting is he tells me that 60% or 70% of his patients are not back problems.  

I said, “You're the back guy.” He goes, “Yes but they call me for everything.” As you said, they refer their friend, neighbor, kids, and their spouses. As a business owner, it hits me. I'm like, “That's brilliant.” In the workshop, I was telling you, we had one of the participants and they’re pediatric therapists. We went on the site and there was a picture of a child on the site. There was nothing verbally saying what their niche was. There was just a picture of a kid and they had all of the different diagnoses and all the different treatment techniques. It was way too much information but it never answered the question, “Can you help me with my problem?” It became confusing and she's been doing this a long time.  

She was like, “I never realized that.” I was like, “How much time have you spent getting clear on who your audience is and what your message is? What do you want them to know that is important to them, not you? What's important to us is our certifications. What's important to us is how much information we know. We want to throw up on people of how many years we've been doing and how many certifications.” That's fine. Do that at your next conference with your other colleagues. You can show off all that stuff. Your audience doesn't care. The person that has back pain wants to know, “if you help them with their back pain so they can go back to playing basketball.” If the answer is, yes, they come to you. If the answer is no, they don't. Either way is fine. When the answer is, “I'm not sure,” then you are potentially losing, who knows how many potential referrals. It's not a financial thing. You're losing the ability to help somebody, which is what we do, which is why we do all this.  

They may go somewhere else and maybe not get the help or they may go nowhere and try to look for the magic pill even though you could help them so well but they don't know that. They don't know what you know. If you do those first two steps, that mission, vision values, and start getting clear on your audience, start diving in like you said, “Tell me everything about them. Where do they live? How much they make? What do they like? Do they have a dog or do they have a cat? Are they married or are they not? What kind of car do they drive?” The more information you know about them, the more you'll be able to connect with them. That's what this game is about. That's where the art of marketing comes in. It's the ability to connect with people. You have to start there. If you start there and find a good reputable person, let's say your website or other digital things, you are going to be much more successful at generating referrals consistently because you know how to connect with your audience. That's the part that's missed. We take a bunch of money that we don't have. We give it to somebody in the hopes that they're going to do all of this work.  

The expectation is, “I give money, they give me a bunch of referrals.” What they're saying is, “Yes, I can help you get referrals but I can't answer all these questions.” Hopefully, they can do what they promised to do which is the links, connections, put the images up and all the stuff up. That messaging I've spent tens of thousands of dollars. I won't call it a waste. I will call it a lesson. It was an expensive lesson I had. I went to school. I paid $50,000. I got an F but I learned. I learned that there were some things that this person in this company did that I wish I knew but a lot of it was. I wasn't being clear in what exactly I wanted. That was the problem because I wasn't clear. That's on me and that's on every single owner. We have to start focusing on that which of course begs the question we've talked about in the past, which is, “I'm busy. I don't have time. I'm dealing with all the stuff.” I'm like, “There's the real issue. What do you focus on and how do you carve out time?” That could certainly be for another time management topic. 

That’s completely another episode. As you're talking about that, I remember I had Aaron LeBauer on. If you don't know Aaron, he has his own cash-based or out-of-network private practice and is successful at coaching others in setting up their own cash-based private practices. Interestingly, in his practice, they don't bring up the words physical therapy. They talk about what they can do for their patients. They have an ala carte menu. Part of what we can provide you is physical therapy. That's one of the menu items. That's interesting because I brought him on to talk about how to market an out-of-network owner to ask someone to pay cash when they could go down the street and have their insurance pay for it all. That's a higher level of marketing acumen that you've got to attain to get people to pay cash for something that could be for free.  

Yes and no, Nathan, so give me a chance to respond.  

I was going to say, it's interesting though that his focus wasn't physical therapy. That's not what we provide. It's a service that we offer but that's not what we do per se. What we do is we live out our purpose, providing you a pain-free lifestyle, getting you back to the functional activities you want to do, helping you enjoy your family, your friends, and your neighbors, and helping you play with your dog. That's what we do. Physical therapy happens to be a vehicle.  

Stephen Covey in his book, The 7 Habits of Highly Effective People said, “Begin with the end in mind.” It’s one of his famous sayings, and everyone grabs and uses it like me. What does that mean? In this case, the end is the outcome and what people want. They are coming to you with a problem, pain, a disability, balance issues, and their kid not able to play a sport. What they want is the outcome. Clear as day. That's what they want and that's what you want when you do the same thing. You want the outcome. What is not as important is the part where we spent our whole life, which is learning the solution from the problem that they have to the pain. That's not where the conversation begins. Is it important that they understand? Yes, perhaps. It all depends if they have those questions.  

A lot of times, they don't ask every little thing that you're going to do. They connect with you, build rapport, trust you and say, “This is the place for me.” Sometimes, they want to know so exactly what the process is. You can share that with them, but what has to be clear first is, can you help them solve their problem? That's the biggest problem. I know Aaron, I've been on his show. He is smart and he understands the fact that the less you can talk about the widget of how you help somebody. A widget can be a product or a service. We're going to talk about the widget service, the dry needling widget service, the myofascial release widget service, the exercise widget service, and the pool therapy widget service. These are solutions to help people get what they want.  

People don't care about that initially. They may or may not care eventually. What they care about is, “I’m in pain. Are you going to help me get here? If so, what do I do? How do I get with you?” We have to be clear on that. As an owner, potential director, manager of your business, and as a clinician, it is very confusing in our heads that that's how our people are thinking. We need to make sure that when we're looking at marketing and our business that we step out to that 30,000-foot view and make sure we put this marketing hat on to start looking at our business from their perspective. From the perspective of our avatar of our ideal client. When you do, things will start to become so much clear and you will start to be able to get more people coming to you because they will understand the question. Can Nathan helped me get what I want? You said something about cash-based. Can we operate out of network? I’d love to dive into that. 

To add on there in my conversation with Aaron and also to what you're saying is one of his first questions in that initial evaluation goes back to imagine six weeks from now and completed your physical therapy, what would have happened? What does your life look like to say that this interaction with us and what we're doing to help you with your shoulder, back or knee has been a success? What does that look like? Starting with the end in mind, he takes that so far as to put it in part of his initial evaluation process and to get compliance, to get buy-in to say, “I can help you do that.” On subsequent follow-up visits is that's what they're going to allude to. 

Remember on our first visit, you said at the end of our treatment, we want to get here. How much closer are we? This is what we needed to get there. It's less, so much about mini me, my OCS, ECS, CSCS and CSS. No one cares about all the letters but it's what can you do to help me get to that goal. He takes it not from his marketing and getting that message clear then putting it into his first initial visit with that patient is, “Tell me, what are you here for? What do we need to get to in order for this to be successful?” Keeps compliance that way. 

You don't need many relationships to blow away your numbers. Click To Tweet

There are three ways to get referrals in your business to step out of the fray. You can get referrals online. We know about that through your website and different social channels. You get referrals through referral sources. It does not necessarily mean just doctors. There are lots of other people that have influence over your audience. When you're clear on your audience, you'll know who those people are. The third way to get referrals is one of the ways that we love to get referrals which is word of mouth. It happens when you're delivering an amazing experience to people, and we want the experience to be consistent and to happen regardless of who they are when they come in.  

That’s what you're talking about with what Aaron was saying. When you start focusing on the experience, it starts when they call your office, they come in, and go through the evaluation. You're always looking at the experience that you're delivering from their point of view. We can go into lots of detail about how to do that and all the different touchpoints of that experience, leading up to the discharge and then the experience after the discharge. That increases the ability for one patient to turn into multiple patients by referring others and shouting on the mountaintops how great you are. To the one point about beginning with the end in mind and the evaluation is a funny story. I had a mentor for many years, Dan Sullivan, strategic coach.  

It’s a great book he put out. Who Not How is crazy awesome.  

One of the most powerful things that he always talked about is delegating and the Who Not How. One of his biggest things that he developed was something called the R-Factor Question. It's called the Relationship Question. The Relationship Question says, “If we were sitting here blank time from now and we were going to look back on now, what would have to happen personally, professionally, depending on who you're talking to for you to feel good about your experience or do you feel happy?” Once you see that, you realize that there are lots of ways to take that question to that perspective and use it throughout your thing.  

Aaron is using that question, “If we're sitting here eight weeks from now, what would have to happen for you to feel good about your progress here?” You're taking people into the future and into the possibility of what is going to have you feel good. That's some tactics and strategies of how to connect with people build rapport. When you do that, you reduce cancellations. The key is driving the referrals to begin with. That happens in 1 of those 3 areas through a referral, an internal referral or word of mouth. Putting out there in that digital world and allow people to come to you and come to your website.  

It's more important than it has been in the past. We saw that with the pandemic where we couldn't visit doctor's offices, and there was no way to connect with our community unless we did use other avenues to get to them. It's important that we're clear on that message so we can connect with our community directly and have more of that connection without relying specifically on the physicians all the time.  

You and I talked about this. I want to caution people not to jump ship and say, “It's not where the doctor is at. It's all online. We’ve got to go online. We’ve got to get the people online.” People are referred to a specialist. People ask their friends. I have this thing called Listserv in our community. We have a community of 400 houses. Every day, there is someone saying, “Does anyone have a recommendation for blank?” Many times a week, it's always something health-related. What's amazing is multiple people then provide the solution or provide the answer like, “You’ve got to see my person.” Sometimes they're so adamant about their person. They're like, “You’re going to go see them? I'll give you their information. I'll call them for you. I'll help you set up an appointment.” These are your raving fans. This is how people are referred to a specialist.  

Now, they may then go online to do it or the reverse will happen. They're online in your Facebook Ad or social media post comes up and they go, “Whatever,” then the person mentions that and you're like, “I've heard of them.” They don't know where, but they saw you out in the universe and their world. Most of us are within a community, we're not trying to promote ourselves nationally. We're in a community where it's easier for you to do that because it's a confined area. I want to caution people not to stop building relationships with referral sources, with referral partners.  

Here's a tip on that. I want you to look at your referral relationships. People that have an influence over your audience, you have to identify your audience before we’ve spoken about that and I want you to look at them as they're your client and your patient. I want you to start looking at the referral partner as they're your target audience, not who they're referring, they are. What would you want to know about them? Would you show up? I have a blog that talks about one-night stands. You’re going to love it. It talks about we treat a lot of our referral sources like one-night stands. It's a one-way relationship and we want to get what we want where we want to call them up. “I'd like to meet with you because I want you to send me some referrals. Can you do that please?” That's not a relationship.  

To your point, COVID said, “We can't visit doctors anymore.” I'm glad that happened because we have to wake up. People have been asleep at the wheel and not woken up to the fact that it's about relationships, and it's always been. If you start to focus on these doctors, try to create a relationship, truly try to be interested in them, see how you might collaborate, and serve them better which ends up meaning helping them somehow with your expertise and your solution to their clients and patients. That mindset shift will help you develop key relationships.  

For most practice owners, let's say $500,000 or $1.5 million in revenue, you don't need many relationships to blow away your numbers. Get a handful of people. Get five good relationships sending you a couple of people a week. That's 50 new patients a month. Most likely you would blow away your numbers beyond belief. Your next problem would be hiring therapists to see everybody or getting a bigger space, which isn't a problem because there's plenty of space out there available. That mindset shifts of looking at them the same way you would look at your patient. You want to have two avatars. You want to have a referral source avatar and a patient avatar. Start there.  

I love that because you never try to think about who your perfect referral source is or what your message should be, what do they want to know and who is seeing your perfect avatar patient? That's a good mindset shift as you're considering your marketing strategies because those guys and girls that I know that did fairly well through the pandemic got through it okay. The people that they had the doctor's cell phone numbers because they had developed that relationship over time. They didn't have to rely on going into the office and dropping off candy. They had got the relationship with the physician to the point where they could say, “How are you guys doing? Do you need anything from us? We're still open. FYI.” They could market to them directly because they had taken the time to develop relationships with these people.  

Unlike a one-night stand, when you develop a real relationship, it can withstand things like this. It can withstand competitors. People are trying to move in a little bit. It can withstand a lot of things. It comes back to why haven't we looked at it that way? Our perspective with doctors is they have served one purpose and that purpose is to feed me, people. If they don't, there's something wrong with them. This is a systemic problem that we need to shift the way we think about this. That could be the greatest collaborators with us. If we step up our game and start to look at it as how we can work together, how can I provide a service and help to you? That means increasing our own communication skills, ability to connect, and build rapport.  

These are things we haven't been specifically taught in that we have to learn. When you do, there's not a lack of people that need us. What was the latest AVTA number? Eight percent of the population comes to physical therapy but 150 million need or could benefit from physical therapy. Where's the other 92%? It's not because we're not good at what we do and you're not knowledgeable enough or smart enough. It's because we are not spending time educating and learning how to connect with them with their wants and their needs. When we start to do that, there is plenty for everyone.  

 

It's sad to know about physical therapists who worry about the competitor within a couple of mile radius. It's understandable to know what they're doing because it feels like with a mindset of scarcity, then we're all fighting over that 8%. Whereas if we improved our message and got that out to the community, we could be playing in a much bigger pool that is 92% of 150 million and not fighting “over the 8%” that are getting the therapy that they need. There's so much more to be had if we got clear on our message and focused on those people who need it.  

The shameful part of it is a lot of these people that you're referring to are very smart, talented people that are providing in a very small way and amazing services. They don't look at it as a business. More importantly, they don't look at themselves as an owner or as the CEO. As the CEO, your job is to 100% focus on not only where the company is going but servicing your customer. You have at least two customers. You have the patient that comes in and you have the people that refer patients that come in. If you spent a little bit of time and did some basic stuff, you can't get any less people connecting with people, building rapport, and showing them value.  

You can only go up. That's what we've seen with our program and with our clients. I'm sure you've seen the same thing. This is why we do this. My mission is to help every single practice owner and practice that wants to build and grow to do it because we have an endless number of people who need our services. It's not because our high is only ten people. That would be a problem. It's a blue ocean out there. It's endless. We do such great work. We need to have a little B-School for the practice owners. We need to get a little business education with the practice owners and that's what we try to provide and help them in.  

We’re going on for a while now and I appreciate you taking the time. We could go on for more. We had many tangents if we could have gone down there. If people want to get in touch with you, Jamey, how do they do that?  

If you want to get in touch with me, go to PracticeFreedomU.com. You can check us out. Also on there, you can download my book, The Practice Freedom Method: The Practice Guide to Work Less, Earn More, and Live Your Passion. It’s not a bad three things to do. It's about my experiences as a practice owner and all the trials, tribulations, and disasters I've had but I was able to figure out a path and now trying to impart some knowledge to help some others.  

Thanks again for taking the time. I appreciate it as always.  

It’s my pleasure. I appreciate you and what you're doing, Nathan. 

Thanks, Jamey.  

Important links:

• Practice Freedom U 
• Jamey Schrier – previous episode 
• First show – Jamey Schrier’s previous episode 
• Aaron LeBauer – previous episode 
• The 7 Habits of Highly Effective People 
• Who Not How 
• The Practice Freedom Method: The Practice Guide to Work Less, Earn More, and Live Your Passion - Amazon 
• Practice Transformation Workshop 

About Jamey Schrier

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The importance of the front desk, and the experience that patients have there, can never be overestimated. Stacey Fitzsimmons of Account Matters, Inc. has witnessed this time and again through her work with PT clinics across the country. Considering that the patient's assessment of your clinic (and not the therapy you provide) could hinge on those interactions, you have to make sure that the person at the front desk fits the bill and gets properly trained. Having a natural people-person and problem-solver and someone who is positive, encouraging, and straightforward is essential. Far more than we give them credit for, they have a direct connection to the revenues of your company. Now the question remains, are they more important than the PT's in the back? It's worth considering. Follow today's episode as Stacey sits down with Nathan Shields to tell you.

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Listen to the podcast here:

You Could Be Losing $100k's! Tips For Creating An Amazing Front Desk With Stacey Fitzsimmons

I have Stacey Fitzsimmons of Account Matters. She's been in the physical therapy space for decades. Thanks for coming on and joining us. I appreciate it. We're going to talk about some important stuff.

You're welcome. Thank you for having me. It's a pleasure to be here.

Tell us a little bit about you and Account Matters, what you have done in the physical therapy space here in the last couple of decades and what you're working on. What's gotten you to this point as we're speaking?

Account Matters has been around for a few decades. The original founder of this company is my partner, Diane McCutcheon. She has been in this business for more than two decades. I came on board in 2003 in a consulting manner specific to the PT/OT world. That's what Diane's background was and me coming on board with her, I followed suit. The difference between some other owners out there of billing companies and me personally, is I went into a physical therapy clinic and got hired and I've done every one of the jobs at the front desk, the billing and collecting. The only thing I haven't done myself is the actual treatment because I'm not a physical therapist. Everything that I've learned when I was on the job and then everything I've listened to from people through the years of consulting was how I formed my billing company, Account Matters.

I tried to take all of the complaints of what people hated. I didn't want to do that in my billing company because I keep hearing people complain. That's how we formed ourselves. Going back to the 2003 time, we were forming ourselves of not just a consulting company, but let's open up and give this industry what they need and that's all admin support. Front desk right through your collections getting your money in. That's what we did in this business is we started the billing company. We started adding on, we started training programs and it was all geared towards the front desk and billing department. We offer all of those services here at our company that we can certainly do for people but we took it one step further where if you don't want to outsource your billing and front desk, you don't have to.

We do have trained professionals here that will teach the right person on your side in your practice. For some of those things is I've always tried to set myself a little bit different. There's certainly a ton of billing companies out there. There are a lot of good ones as well as bad. I like to be a little different. I like to try to capture things that I'm not your typical billing company that only knows how to bill, push your payments and collect. I do understand the entire private practice section for physical and occupational therapy.

You initially started off as business consultants and have worked your way over to the billing side a little bit more, from what I remember. When you talk about the billing cycle, you're talking not just about the billing department, but you included the front desk in that. That's a misunderstanding that some physical therapy owners have is not recognizing how much the front desk impacts your collections.

That's where my passion comes in. I was in a lot of pain and couldn't walk. I couldn't work because I was always in pain. I went to a physical therapist. For the reason you become a physical therapist, I didn't become a therapist, but I can appreciate the gift that therapists have to get people pain-free and live their lives. I also understand that you went to school to do that. That's your gift. I don't have that gift. I don't want to touch a human in pain. My gift is business and figuring out how to make sure that what you're doing is going to get reimbursed. A physical therapist by nature, you will do anything for anyone. You love helping people or you wouldn't be in this business.

The only way you're going to continue seeing people is if your doors are open. Click To Tweet

If you have a private practice, it's hard for a therapist to remove the heart. It's hard for them to say, “I'm going to treat Stacey because I know she can't walk and I don't care if I get paid,” which I understand from a therapist. That's your heart. That's you saying, “I need to get Stacey better.” I look at it from you're valued and you won't be able to keep your doors open if you keep doing this for people. I understand it, not from you just have big hearts that you want to help. I'm taking it more like you do, but you should get paid for it because the only way you're going to continue seeing people is if your doors are open.

Is that how you train your front desk people and your billing people? Not to necessarily remove the heart, but training them from a perspective of, “We provide a valuable service and we deserve to get paid as much as possible for the service that we provide. That is your responsibility to ensure that the collections come through at 100% so that we can be reimbursed adequately, if not more so, for the services that we provide,” right?

Absolutely. The part where we're working with the front desk and why I keep bringing your front desk person is because, in my opinion, your front desk person is the most valuable person that you have working in private practice. The reason is they’re the first person to answer the first phone call from a patient. Nathan, you might be the best therapist on the planet. If I'm hurt and I'm calling your clinic, I'm not going to talk to you. I'm going to talk to your front desk person. If she or he is rude, they don't pick up the phone, they give me non-complete answers, I don’t know’s, I will most likely pick up the phone and go to the next person on my list. It makes good sense to bridge the gap between your therapists, therapy owners and the front desk that is typically, “We just need someone to sit in that seat.” It's a lot more than sitting someone in the seat.

If you have the right people, you, as the therapist, with your heart of gold, don't have to answer your patients about their bills and what's going on because you have people to take that hit for you. That’s where it's very important to get the right people at your front desk in your billing department. Those are the people that you, as the therapist, “I don't know what's going on with you. I don't do billing. Go see Stacey in the billing department. She can tell you what you need.” It takes you right out of the equation and it will help your practice to be viable and profitable versus I want to help someone because you are helping them but you should get paid for it.

A good front desk person is like gold. They can set the tone of the clinic. They are the customer service arm of your organization if you will. As you said, you could provide the best therapy on the planet but if they get a bad interaction with that front desk person, either coming in or going out, they're going to remember that more so than the care that you provided. They'll find somewhere else.

Back when we were doing the consulting, we used to travel around the country and we would assess a private practice. What our findings are. We would go through everything down to when I walked through your front door, is it clean? Some places are dirty and messy when you walk in and me as a patient coming in here, “This is dirty. I don't want to be laying on this equipment.” It's very important to think beyond, “I have the absolute best therapist in the world.” It's almost where I can appreciate it if you're going to open a practice, the first thing on your mind is getting therapists in there but it should be getting your admin staff and then adding the therapist. The therapist already knows what they're doing. They need a bench, a table and equipment. It's about your admin staff.

How do you find, recruit or hire the right person for the front desk? What are you looking for? How do you train owners to find the right person?

I like to find and ask people certain questions about where they came from. I don't care if someone came from the local coffee shop and they're coming in here applying for a job to be my biller. I want to know, at that coffee shop, give me one of your worst days where every time you turned around, there was a problem, and tell me what you did to fix the problems. I want to know what you did at your last job. What was the perfect job you had? Tell me the one thing that you did to make a difference in the company you worked for. I'm usually the one to ask not so much specific questions about the job you're trying to hire them for, but I want to know what you do in your jobs. If you’re a hard-working person, it doesn't matter what your job was. If you're a cashier, be the best cashier out there. If you're a therapist, be the best therapist. I'm always looking for the person to be the best of what they are. Not everybody has the education to be a therapist or a doctor. Some are truck drivers, and they're the best truck drivers out there.

 

What you're trying to key in on is to get the best front desk person. When they come into the interview unless it's COVID time and you have a mask on, are they smiling? Do they smile at you? If your patients are coming in, they're not coming in because they feel great. They're coming in because they don't feel good. Is someone going to greet them with a smile? “Hi, Stacey. It’s nice to see you. Hold on. We'll be right with you.” In the interview, how did they dress? They knew they were coming to an interview. Were they sloppy? Because they'll do that at your front desk. Again, we're not looking for models. We're looking for a clean-cut, for someone that can speak clearly, someone that can smile, make people feel happy, warm and welcomed. Typically, what I look for when I'm going for new candidates, it's not so much, “Do you have a degree and what's your experience?” It’s, “What can you bring to us? If we give you the right tools, will you learn and be able to do this job?”

It’s maybe more at the front desk than from physical therapists, but we often talk about soft skills. Skills that have to do with personal interaction, feeling other people out, and becoming a problem solver because we can teach the technical skills like how to call, verify insurance, how to collect the copay, here's the paperwork you need to fill out and here's how you do the EMR. Those are all hard technical skills. We can teach you that stuff, but you want someone who's inherently what we like to call high tone. Someone who is naturally happy and excitable. They don't have to rev themselves up to interact with individuals on a regular basis. They want to interact with people and get to know them.

They ask more questions. They’re involved. They know, just like the therapists know, all about the dog, the kid that's sick, and the husband that's hurting as well. They ask those questions. We like to look for people who are in a high tone. I liked the questions that you brought up about people's past experiences because it sounds like you're trying to figure out, number one, were they high producers in their previous jobs? Were they also problem solvers? There's so much that comes out of nowhere at the front desk that if those people are going to be productive, they've got to be able to solve their own problems with the best knowledge that they have without coming back to talk to the owner every day or every second about, “I've got this. What about that?”

In any private practice that I've been in, they are busy. You've got people coming, do they have a copay? We've got people leaving, do you want to schedule an appointment? We've got referrals and OCS we need to get because this one is coming in tomorrow. “We can't schedule an eval for the first visit because this therapist doesn't like that.” They are answering phones so you don't want to hire someone walking through the door, dragging the feet, and sloppy dressed. You’re like, “What's your five-year plan?” “I just want to have a good job.” You're not looking to better yourself. I always say, “I like the people that don't try to be better than anyone else. I like the people that try to be better than they were the day before.”

You want that energy, but again, you don't want someone coming and telling you their whole life story because that's what they're going to do when your patients come in. You don't like your patients listening to me saying, “I know. I felt awful and this is happening because.” They don't feel good. You want someone at your front desk, “How are you doing? It’s a great day. It's sunny out.” It's really important. You're looking for an ambassador of your company. You're looking for a professional person that you can train on the hard stuff like, “Here's a book. This is how you build. This is how you do that.” You're looking for more than that. You're looking for someone that's going to fit in and make your patients feel like, “I'm so glad I came here. Stacey was so nice when I walked in the door. She couldn't have made it any easier to do my paperwork.” That's what you're looking for.

Many people that are reading might be thinking, “I don't have that person,” or they're thinking, “I've had a lot of turnovers and I can't retain the people that I'm wanting.” What are your recommendations for such a position that can be a high turnover position?

We do have a turnover guide. It's a free download that everyone, if nothing else, get your free Turnover Guide. It's a Bit.ly/turnoverguide. Hopefully, you can read some things that will help you out right off the bat. It's not science. Sometimes, people leave for reasons we can't predict or out of the blue, your best person found the dream job down the street. That's always a tough one to swallow. If you don't give the right person the right tools to succeed, they're going to leave because if you find the right person and you stick them at the front desk to figure it out, they're looking for guidance, a leader, and they will leave you.

Once you do find the right person or if you're reading and you think, “I know that I have the right person. She just doesn't know what she's doing.” It's up to the owners. It's up to you to get out there and find the tools to give to them. We have all kinds of training programs here at Account Matters that we work with a lot of clients on basic data entry. How do you put a person complete into the software? What is it that you're looking for? How do you call and check on benefits? They should be done before you have the patient in for their email. If you hire the right person and they don't know any of this, you're going to lose a lot of money. They're set up to fail. If it's the right person, failure is not an option. They will leave and find a job with a leader that will give them the right tools.

The right people want to know their scorecard and what does a successful front desk person looks like. If you can't tell them, “Your job is to produce blank.” Most front desk it is, “Your job is to fill the schedules.” There might be some other iterations of that, but it’s essentially, “Keep the schedule full.” That's their job. If they can't tell you that, then you haven't trained them on their basic purpose and product. Their job is not necessarily to collect all the copays. That's a vital part of their job but their main job is to keep the schedule full. Number one, they need to know stuff like that. They need to know the statistics that you're going to judge them by. That's what I meant by the scorecard. Are they collecting 100% of the copays on the patients that are coming in? There should be benchmarks.

Your front desk person is the most valuable person that you have working in private practice. Click To Tweet

Right off the bat, “You're coming with us. In your first week, you won't be very fast. The second week, we want you to go from 5 new patients in the system to 10 new patients.” You know your businesses. If no one has a benchmark, they're going to do whatever they want. I've certainly learned my lessons in business as the years go by, “I gave them an open-ended window, how come they didn't do more?” I gave them an open-ended window and they did what they wanted. It's all about setting benchmarks in what is best for the company, not the individual people.

Are there certain benchmarks that you think are more important than others?

I do, especially when it comes to scheduling. The number one benchmark is to make sure that every new patient gets in your schedule within 24 to 48 hours. If they call on a Friday, it will be Monday. Because people are usually leaving a doctor’s office with like, “Go see a PT.” It's top of mind, “I'm hurting. I'm in pain. I can't walk. I'm going to call now.” “I can't get you in for two weeks.” You all know PT places are everywhere. They're going to call someone else. I would say a benchmark is a 24 to 48-hour window for any new patients coming in. They need to make sure they learn the schedule enough to leave those spots open and get your patients in.

The other one that you brought up that I'm very big on is the copay and patient money. I'm huge on that because the minute your patient is discharged, it dropped 60% of you collecting that money. They are out of sight, out of mind, “I'm not going back there again. I don't have the money. I'm not paying it. I wanted to spend it on something else.” It's very important to train your front desk person right away, “These are the reports from your software that you should be running every morning because this will tell you what you should be collecting. At the end of the day, did you meet that? Did you collect all of the money or did you not?”

My goal is always 100%. I almost find no one that can do 100% but if you keep it 100%, you will get the most you can get out of your front desk for collecting. Why aren't they collecting? Is it because they're asking the patients, “Do you want to pay?” If that's what they're saying, you want to train them to say, “How would you like to make your copay? Cash, check, or charge?” Not do you because if you say do you and you have a 21-year-old and it's a Friday, he's going to say, “No, I'll pay next week because I'm going out tonight.”

Have you found a way for owners or front desk people to keep credit cards on file and make that transaction easier for copays?

I would say it's a 50/50 out there with people wanting to do it and people not wanting to. It's all above board and you can. There is a form that does need to be filled out from the patient because the patient needs to give you the okay. I do recommend trying to get the patients to leave a credit card on file. If they know it's on file and they've signed for it, then you should have no problem every time they come in saying, “Hold on, Stacey. Let me finish running your card and give you a receipt.” It's not a question and you're not asking. It's, “You agreed every time you came in, I was going to run your card. When I see you, I'm running the card.” It's little tips like, “Don't ask.” They already gave you their okay so run it when they come out, “I’m running your credit card. Your receipt is coming up in one minute.”

I came across a coaching client who used COVID as a nice excuse to minimize that hand-to-hand transaction contact and transmission or whatnot like, “We're going hands-free as much as possible especially here at the front desk. What we'd like to do is keep your credit card on file. That way, we minimize that hand-to-hand transmission.”

That's perfect because everybody is in the same boat. No matter where you live, you can use that as your excuse. Everybody is dealing with COVID so that’s a good one.

 

You could say an excuse. You could say, “According to our new COVID-19 guidelines, this is what we would like to do.” Make that part of simply how things go.

The other benchmark you may want to keep in mind is cancel and no-shows. If your front desk person doesn't know how to track them properly, you might think you have a lot more cancels and no-shows than you do. Make sure that your front desk person knows that if it's not a true cancel, they're deleting appointments rather canceling appointments because that's a benchmark you can set not only for your front desk, you can set that for your therapists. I like to go, “How many? Why are they canceling? What are the reasons?” If you have a cancel no-show policy that has a payment associated with it and if your front desk is collecting, less likely your person will keep canceling and no-show. Those are my top three benchmarks I always give to people.

The cancel and no-show rate seems to be a team attack. If you're below 90% arrival rate, the whole team has to be involved. One of my mentors has said in the past, “The patient will only take their therapy as seriously as the therapist takes it.” If someone cancels and on their follow up visit after that, no one says a thing at the front desk or the therapist about the cancellation, how important it was that missing that appointment sets back their care and the results they're going to get with physical therapy, then the patient is going to think, “I can cancel. It’s no big deal.”

Being a billing company, we've seen mostly every denial, especially in the work comp insurance companies. We've had a few companies come after us for certain clients because they're wondering why it's taking so long to get better. When we send all of the documentation, they know that they've canceled and no-showed so many times that they stopped paying. It’s not only you at the clinic that’s like, “Now I have a therapist that doesn't have an appointment.” You can tell the patient but sometimes, it comes to the insurance companies. If a twelve visit is the norm for whatever part of the body for this insurance company but you're more like the ‘80s going another month that you may get questioned. These insurance companies are going to be mad at you because you're not making it important enough to get the patient in there. You want the patients in there.

The front desk is so vital in that aspect because the therapists aren't answering the cancel call that comes in. They’re not on the phone. It's so important that the front desk understands exactly what we're talking about now and how not coming in for therapy is going to inhibit their progress in care and prolong their care. Also, it's imperative that the front desk also understands the purpose of the clinic and they buy into what physical therapy is all about. If they're casual and laissez-faire about physical therapy and patients coming to physical therapy, that's their attitude on the phone.

That's why people get away with it because they're calling your front desk. “Stacey, can you tell my therapist I can't make it.” “No problem. Goodbye.” If the therapist doesn't say anything, they're like, “I didn't have to talk to the therapist because I see him three days a week.” If you said, as therapists, “Stacey, you missed yesterday. That's the third no-show you've had or the third cancel. We're trying to get you better. I built this plan specifically for you. We want to get you better. If you need to cancel, maybe you could come in at a different time the same day.” If they're not saying anything and your front desk doesn't know, your front desk will keep taking the call, “I'll tell them.”

You need both of them to come together to say, “I took a call from Stacey. She canceled again. Do you want to talk to her? Do you want to say something on the next visit?” They should be working together. Typically in the PT private practice setting, there's always a wall built up in between the therapists and the front desk or your admin staff. I am one consultant that loves to go in with my big wrecking ball and break that wall because it's very important that they communicate for the scheduling and for the no-shows. I can't tell you how many therapists hate their front desk because they always schedule the new people for the last visit of the day. My answers are usually, “Have you told them?” “No, I didn't.”

If you don't talk to them, they don't know. You want to make sure in your practices that there's no wall being built and there's complete communication. That will help your cancel, no-shows and anything else that has to do with your patients because if your front desk doesn't feel that they are going to be undermined or not listen to, anything that comes up, they're going to run to the therapist and say, “I just saw Stacey in the hallway. She said XYZ or whatever.” If there's no bridge between the two sides, you're leaving each one open to not say anything and your patients are doing whatever they want.

For those owners out there that have a front desk person that they're questioning, “I don’t know if this is working out,” or they’re not fully satisfied, do you find that front desk personnel who has been there a long period of time, say a year or more, and then you try to implement this stuff, that it’s hard to teach an old dog new tricks? Is it hard to push in some of these benchmarks, products, and training into people who have been there for a while?

Make sure in your practices that there's no wall being built and there's complete communication. Click To Tweet

Yes sometimes and no sometimes. What I will say is this is where the owner has to be a true leader. I know you've been with me for a year. We're making changes. They're non-negotiable. I am the owner. This is how I want it done. This is how it's going to be done. When you do that, it goes pretty well. Your worker might be a little upset for a few days getting to know the new process.

They can’t control how they're going to respond.

You can't. You have to stick with what you say. What happens sometimes is this is how we're going to do it. The next week you check-in, “It didn't work. I know how to do it this way. I've been doing it this way for years.” If the owner says, “Okay, fine,” and walks away, you've not bettered your company at all. You're staying the same and you're probably missing things. There was a reason why you wanted to change something in the first place. If you stick to your guns and they will not change, they're not the right person. If you stick to your guns and they're like, “This stinks but I'm getting the hang of it.” The next week, “It's a little better. I still don't like it, but it's better.” The third week, “It's not that bad. I’ve figured it out.” That's how you would approach your people that have been there. As an owner, when you make that decision, don't go back on your decision. It's this way. Once you do it correctly, prove to me that it won't work and we'll change it again but I'm not for changing until you prove me wrong.

I liked a couple of things that you said there. Number one, the leader comes in and says, “This is how things are happening. This is the structure that we're going to use. These are the checklists that you're going to follow. In the morning and the evening, you're going to turn them in.” What you said inherently in there without saying it was that you were also following up on a routine basis. It's not like, “This is how we do things. Good luck. Go do it and tell me how it goes.” No. It’s, “This is how we're going to do things.” Follow up on a routine basis and say, “How did that go? Can you show me what you did? Did you follow the process? What did that look like? Here are the checklists that I expected out of you.” If you draw the line in the sand but then don't follow up, then the front desk will go back to the same thing.

I can give you great examples because you're all probably saying, “She just talked about me.” What I see is a front desk person that has had that job for years and they've always done things manual. I'm talking mostly about copays and they're recorded on an Excel spreadsheet and/or a paper form that you have to fill out or a paper receipt. It’s then put into your new updated software that tracks everything for you. It happens to everyone. I'll say, stop the manual systems. You have three systems for a copay. You have software. It's 2021. It works. Use your software, “I don't trust it.” If you do that, you will have discrepancies because you're doing something three times.

If you have a patient asking you a question and you only did 2 of the 3, you'll forget the third one, “How come my three balances don't match up?” The perfect example would be, “Stacey, we're stopping the written process. We don't need the written receipts. They're all on the computer.” If you’ve never checked back in with me and this has happened. I've checked a month later, “How's your front desk doing after the training?” I'll start asking questions. “We still have the written one.” “Why?” It is follow-up. You want to make sure, as the owner, to be a leader. They're going to follow you. “This is how it's done. Do it this way successfully for three months. If you still hate it and it's not working, we'll change it again.” You've got to stick to your guns. If it fails, it fails. Not everything is going to be a winner but you can't let your employee tell you it's going to fail without proving it's going to fail. It's all about the follow-up.

They're not running the ship. They're trying to and they shouldn't be. You need to take the helm. You talked about it and while I have you, I also want to ask you about this. The communication and the relationship between the front desk and the billing department can sometimes have some animosity. How do you help that? Fortunately, we got to a point where the front desk love the billers and the billers love the front desk. They worked very cohesively and they share data. They shared their evening reconciliation forms on a regular basis. They were able to talk back and forth. The billing department could train the front desk on certain items and all that kind of stuff. For people who don't have that type of relationship, where do you start in healing that animosity between front and billing departments?

The first thing is you have to set the company culture as you're a team. I am passionate about communication and being a team. In my company, we all have hybrid schedules. The new people haven't even met half of the other people that work here. I'm big on team-building events. It's important to close your place down periodically to have your entire staff and forcing them to work together. There are a million things on the internet that you can get for, “What should I do for team-building exercises?” Pair people up with people they normally don't work with. They don't like each other because of their positions at their job. If you get that out of the equation, chances are they will like each other.

I also have an army background and anybody that's been in the military, it's one big team. You're not singled out. The goal of the company is to have 100% collections at your front desk and have your cancel and no-show rate at 0%, if possible. It's the company goal. You can set individual goals for people, but you should be bringing your entire company together at least once a month for some type of meeting. More than just lunch to say, “Stacey at the front desk, what are some of your issues you're having when it comes to scheduling with the therapist?” That's the opportunity to get someone to say, “I think this one gets mad at me every day because of the evals but there was nothing available. I'm not sure what to do.”

That's the opportunity for the therapist to say, “That's really easy. Whatever the answer is, this is what I would rather you do. Come to see me. I'll move another patient. Whatever the case is.” It's all about forcing them to talk to each other. What we've done in other practices through the years is we would help host that first real meeting and almost force them. I would be bringing up, “When you're scheduling, what do you have trouble with?” It gives the opportunity for everybody like, “Don't take this personally.” We have one company goal in mind and what is the company goal? Everyone should be working toward the company goal.

Your personal feelings are non-existent. This is work. After work, if you don't like someone, fine. If you want to go out with someone, fine, but during work, the company should be all the same vision. Where is the company going and what is the job? Have those meetings. Don't have a meeting just for your admin staff and the therapist. You should at least do one company meeting and make it almost mandatory. Who are your managers? They should be getting other people to talk, “Didn't you say last week you were mad about whatever?” Call people out on what they're saying to get them to talk. You'll find once the mouth starts opening, it all comes out. People are usually, “If you would have said this to me a week ago, I could have given you the answer. I would have told you don't book my schedule XYZ.”

It's all about communication. Communication is the number in any business. Communication is certainly key. To bridge the gap, I would strategically form meetings or events where you're forcing them to work together. As I said, chances are they're going to like each other. If you put them in an environment where they come in and they can see, “The wall is up. These are my people because the therapists are in the back.” That’s how they come on board. Your orientation for your new people whether it's therapists and/or admin staff, you should be taking your new person, “This is Joe. He's the new therapist.” “Hi, Joe. I do all the scheduling. If you don't like what I'm doing, come see me immediately.” That's when you set that. As your new people are coming on, make sure they meet. Everyone they are going to work with and open, “This is my job. If you see any problems, you come to talk to me. I'll help you out.” That will help tremendously to bridge the gap.

Going back and thinking about it, the billing person was a part of the front desk training process. It wasn't some office manager, the therapist training, or the front desk themselves. There was a portion of our onboarding and training where the billing person would get on the line or come in person and train the front desk person as well to know what was wanted and expected on the billing side. There was that clear communication and they understood, “She wants it this way and she likes it filled out that way because of this reason. That's what I'm going to make sure I do.”

It’s funny you say that because I have a billing company. We have billers that come in and that's all they do is billing. We have people that come in, they are payment posters and then we have collectors. They all know what each job is because what was happening early on in the billing company is you'd get complaints from one of them about, “The payment poster this and the biller this.” If you don't know what they're doing, you need to appreciate their position. It's the same thing in an office and this is where your big company meetings come in. The therapist might be like, “This is an easy job. You're sitting at the front desk.” They all think that.

If you said to Joe, the therapist out there, “Since you have a cancel, why don't you come to sit at the front desk for the next hour? Listen to me answer the phone. I'm taking a copay. I'm scheduling. I’m entering new data into the software. I got a call on a referral because this one just left.” If they don't appreciate or know what someone's job is, it's so much room for them to criticize about stuff they don't know. You're a front desk person. They're not going to be a therapist but they should go back and see what they're doing. What is it that Nathan does when he goes back there with the patient? Is he nice? How does he talk to the patient when he comes in?

It should be, “This is what the therapists do. Every time a patient leaves, this is what the documentation is. When they're complaining notes, ‘I hate doing notes,’ this is what they're doing.” Otherwise, a new front desk person can be like, “What's the big deal? Just write a note. Stacey came in and she feels better.” If you don't know what someone's job is, it's very easy to criticize and point the finger until you sit in their seat. Going back to what I first said, I've sat in every one of the admin seats in a PT private practice. I 100% appreciate whoever is at that front desk with ten arms trying to get the job done. I sat in the back and watched therapists. If we're going back decades, there was no documentation. It was all manual. “I can't read your writing. What are you doing? Why do you have to write so fast? You have to do the whole SOAP. There is a lot of notes.” It's all about trying to not teach someone, someone else's job but to let them know what the job is so they can appreciate what each other is doing.

As we're wrapping up here, is there anything else that you'd like to share that you might recommend owners consider as they're looking at their front desk personnel?

Going back on everything we've touched on is look at your benchmarks. Start coming up with what you want to do because when you make the decision to make your changes, stick to your guns. Even if it doesn't work out, prove that it doesn't work out. Don't give up on it. We did write a book and it happens to be all about the front desk to create your own front desk guide. Go to our website AccountMattersMA.com. We have a link on there. There's a book on Amazon and it is tailored specifically for PT and OT private practice front desk.

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This will help you write a workbook that you can say to every new person coming in, “This is how we answer the phone. Everybody answers the same way. This is how we schedule and do the cancel and no-shows.” Go to our website and check it out. My biggest thing with owners is appreciating every person that's in your business and getting them to appreciate everyone else's position in your business. It's a ship that needs to move together with nobody jumping off.

What's the name of the book?

The name of the book is The Administrative Power Center because that's what we developed. Under it, it's billing for rehab private practices. It's oddly enough hard to find on Amazon because if you type it in, it comes up with everything that does not say administrative power center. When you find it, we’re the only book called The Administrative Power Center. It's your revenue cycle that we've renamed, we'd beefed up, and we made it a little more fun for people to learn instead of looking at your typical revenue cycle.

I love that you hit on reminding the owners that if they're going to make changes, be certain and clear about it. Also, make sure you verbalize what your expectations are. Our arrival rate is 85%. Successful arrival rates are at 92%. Make sure that's the benchmark. That's what we're expecting. Our over-the-counter collections rate is 75%. I expect it to be 100%. This is what my expectation is. Be clear about those and put it in writing. That's part of the book that you're talking about is to create that workbook, put it in writing and that workbook ends up being, “This is how you get to 100% over-the-counter collections.”

It's your guide on how to run a front desk from A to Z. My partner, Diane, and I wrote it. We have close to 60 years of this particular business. Diane has only worked in PT/OT private practice as well as I. My final thought is to check the book out. It's a great tool for you that you can use for your entire company.

If people wanted to reach out to you or Account Matters, what would you recommend? How do they reach out to you?

There are two different ways. You can go to our website. You'll see a little Ask Dan A Question and you can click on there. There's an info box you can send anything to. If you want to email me, my email is Stacey@AccountMattersMA.com and I will get back to you personally.

Thank you so much for sharing your wisdom and your years of experience in this space. You shared a ton of great value. Thank you so much for taking the time to come on.

You're welcome. Thank you.

Have a great day.

Important links: 

• Account Matters
• Bit.ly/turnoverguide
• The Administrative Power Center 
• Stacey@AccountMattersMA.com
• https://www.Amazon.com/Administrative-Training-Workbook-Private-Practices/dp/0986330930

About Stacey Fitzsimmons

Stacey Fitzsimmons is the President and COO of Account Matters Inc. Prior to Account Matters Stacey served in the US Army as a paratrooper and a mechanic in the 82nd Airborne Division and then owned and operated a sporting goods retail shop for several years. Stacey has 18 years of experience working with physical/occupational Therapy private practice owners across the country.

Stacey along with her business partner Diane McCutcheon, have recently written and published the book “The Administrative Power Center” to help educate the importance of the front desk position in a private practice setting. Stacey’s mission is to provide the tools and or services of outstanding administrative support to physical therapists nationwide, allowing them to get paid right the first time.

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Aaron LeBauer, PT, DPT has successfully opened and coached many out-of-network PT clinics over the past decade. Based on his insight, he believes that in-network providers could do SO MUCH MORE with their marketing and conversions if they took the time and energy to master those aspects like their out-of-network counterparts. In this episode, he joins Nathan Shields to share what makes him successful in his cash-based niche that could easily translate to in-network clinics and make their marketing and conversions more effective. 

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Listen to the podcast here:

Marketing Like An Out Of Network Provider With Aaron LeBauer, PT, DPT 

I've got a returning guest, Aaron LeBauer. He’s a physical therapist and a business coach for PTs. Mostly for cash-based PTs, but his focus is to help PTs make more money. He is also a host of another podcast called The CashPT Lunch Hour with Aaron LeBauer. Aaron, thanks for coming on. I appreciate you joining me again. 

Nathan, thanks for the invite. It's always great to be here and share the knowledge that I've gained because I don't want to hold on to it. It takes too much space in my head. I got to get it out. 

That's why I have successful PT owners like you on, simply to be a resource because you have so much knowledge to share and share from your experience, of course. If people would like to know about your professional story, I first referenced them back to our previous episode with you. We won't rehash that. We'll just do the cliff notes version and say, “Aaron has built a successful cash-based physical therapy clinic.” He is also a successful coach for PTs and has done a lot of hard work for over a decade. 

I opened my cash practice in 2009 right when I graduated from Elon’s DVD program and I've been helping other people grow and scale their business since 2013. 

The reason I wanted to bring you on and I know you've got plenty to say about it is there's got to be something that in-network PT clinic owners can learn from the out-of-network guys, the cash-based guys, whether it's marketing or how we do things or how we convert or how we talk to physicians or whatever it is. I know you've got a ton of ideas. I’ll let you take the stage here and let us know what could in-network physical therapy owners learn from you guys? 

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The number one objection that we have isn't copays too much or, “I don't have enough time.” It's, “Do you take my insurance?” I've had to develop marketing and sales strategies that get people who would otherwise go down the street and pay $20, $50, even $150 for a copay to come and pay us up to $250 an hour or $2,000 for a plan of care and forego their insurance benefits. Without logically explaining, you might save money coming to us and you might not. It's not a logical conversation. 

We have to create a whole system of marketing that allows people to do that. The one problem that I see most traditional clinic owners make is not a problem or a mistake that they would recognize. It's that the actual service of physical therapy and the reimbursement from the insurance is the top of the value ladder in the clinic. It's like, “We're going to do all these things and then where we make our money is delivering physical therapy.” The reason I see that as a problem is because insurance is decreasing. That's not the top of the value ladder. A value ladder is where we have one on the left. It's something that costs me less time or little time and the prospect doesn't pay anything. 

Maybe there's a free eBook and they give me their name, phone number, and email. The next thing, like in our clinic, would be a total body diagnostic for $35. It’s a twenty-minute visit, which is a sales visit. We have a $2,000 eight-visit plan of care and then after that, we have a wellness warrior program. For us, all of it is cash. My friend, Greg Todd, has a clinic and he's got 2 or 3 locations down in Tampa. They're making tens of thousands of dollars every month on all their wellness programs. It's not just the gym membership. 

The number one thing is if we look at physical therapy. Medicare is a better payer now than then it used to be. It's consistent. A few years ago, there were some other companies that would pay better than Medicare. Now we're like, “Medicare's consistent paying $80 or $85 a visit.” What we have to do is look at like, “How can I set up my business so that Medicare or Blue Cross or UnitedHealth or whatever the insurances that I'm willing to still accept is going to be decently profitable? How can that be the reason people come in the door, but we have other programs to keep them?” 

In the grocery stores, they put the French toast ingredients upfront in case of emergency or whatnot. It's the reason you come in. What do the grocery stores do is they put their loss leaders in the back of the store, so you have to walk by all the other profitable items. Can insurance be the reason people come into our business, but we have other products and services, whether there's vitamins, supplements, gym programs or health coaching? I wouldn't say massage is profitable. I've employed massage therapists and had been one. Are there other wellness services and programs we can put people through to generate income that's not insurance-based rehab and pain reduction? Does that make sense? 

Yeah, because you have to focus on all those things. It sounds like you've got a menu, essentially of what you can provide a patient that's not just physical therapy. They can pick and choose some of the other things that they might come to your clinic for and pay cash for. I don't think a lot of in-network providers consider that or maybe they do, but they don't spend a lot of energy considering it. 

Your energy is probably spent on, “How do I maximize my insurance collections?” What if insurance collections were the thing that paid for the advertising and the revenue came from what's next? Whether it's a return to sport program. What is it the insurance isn't going to cover? There's a huge gap between us and getting someone back from a labral tear to competing in CrossFit again. Whether triathletes, runners or cyclists, there's a big gap there. We can create programs and memberships and even group training programs where people are getting a specialist physical therapist, maybe even a doctor to supervise their return performance. They'll pay cash for that. Blue Cross won’t. 

Those are programs that people might look into. The thing that’s coming into my mind is how do you get potential patients or customers to get past the, “Do you take my insurance mindset?” What do you do to overcome that or work around it? 

I've said to people, “If only people who took insurance market it as hard as we did, you shouldn't have a problem as long as your amount collected is profitable.” People still have a problem. What we have to do on the front-end is built so much value to our patients about the transformation that we can help them make about their goals and touch their wants, needs and desires. By the time we get to the price of the program, they're like, “Dr. LeBauer is going to help me get my life back, so a couple of thousand dollars is nothing.” 

We have to build that up versus, “Where are your orders?” We're going to do “the physical therapy” three times a week for six weeks because someone else made the decision. For me, when someone calls us and says, “My doctor gave me a prescription for the physical therapy,” which is what people call it, they're not calling us to help them make a decision and they won't be our patient. I'll probably recommend that come in once, maybe twice a week, not three times. There's no one I see three times a week. Even if it was in-network, that would be a deal-breaker because I wasn't the one that made the decision with them. 

Talk to me a little bit about it. You weren't the decision-maker and the doctor referred them over to you. You weren't the decider as to if they should get physical therapy or not. 

I haven't made that decision with them. In that role, I'm the technician. It's going to be hard to change the course of care if someone's coming to see me with a prescription for physical therapy. In North Carolina, we've had direct access for many years. I'm lucky that I grew up here and I got into the profession. I was like, “It’s no different.” The big thing is if someone comes to see me because of my marketing in our social media, emails and website, they come in for a visit and they allow us to work with them to create a plan. 

They're much more likely to agree to my plan of care than if the only reason they're coming to see me is because they found me online, someone recommended us because we were close or we were the first search result. The reason they're coming isn't because they made the decision with me. They made it with their other provider. Thank God they recommended physical therapy because most orthopedic surgeons don't recommend physical therapy first. They made this decision with someone else, so it's hard for me to change the course of care when they have this piece of paper that says what they need. 

I know where you're going. The next step for most in-network providers or owners is then, “What is your marketing message so that you get them in the door? Where have you found success, either in the channels that you're using or in the message that you're putting out there?” 

There are three different things that have been the most powerful. One is word of mouth. It’s the easiest for everyone, but it's not just like, “Tell your friends to do X, Y, and Z.” We have to cultivate word of mouth by requesting referrals and reviews and by making it easy for our patients to send others to us. A lot of people have great word of mouth, but they don't cultivate it. There's a way to ask. There's also our website/Google Maps, but people come to our website and it's a website for our patients. It’s not about me or my degrees or the treatment or skills that we have, but it reflects the problems people are experiencing. 

Our website does a lot of different things, but it reflects to patients like, “Here are the problems you're probably experiencing.” We've helped these people do X, Y, and Z. “Here's some information you can get to learn about why you have this problem and what you can do about it.” What you can do about it leads you to, “Physical therapy is the thing.” I'm not trying to sell my degree and certifications or even physical therapy. I'm trying to get them to understand that we help people go from frustrated and in pain to doing things that they were told they could never do again like run, lift or squat. 

We've all heard patients, “My doctor told me never to lift 35 pounds again.” It's a new mom with a two-year-old and just holding on to the two-year-old daughter that weighs 50 pounds. Instead of marketing physical therapy and like, “We treat ACLs and labral tears and X, Y and Z,” it is talking about, “Here's the type of people we help and here's the result we help you get. Here are some other people like you that have had success.” That drives our marketing message because if a person finds us and they like that, then they apply to work with us and we make a decision, and we go through the eval with them. They're much more likely to pay us in cash, do all their home exercises and get better and tell their friends. 

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I like the message that you're putting out there. It falls in line with a book that I read called Building a StoryBrand. The whole idea is that people see their lives as a story and they are the hero of that story. What we're promoting as physical therapists is that we will come in and be the hero to your issue. Whereas, that's not what they're looking for. They're looking for a guide. 

We’re Obi-Wan and they're Luke Skywalker but we're trying to be Luke Skywalker. 

We're coming in saying, “We're going to fix it all for you. We're going to kill it and do great things. This is how we're going to do it because of all these letters behind my name.” Whereas the message should be more along the lines of what you're talking about, “This how we help you this is what happens when we work with people. They go from this to this.” That's what people want to see. They want to see, “Who can be the guide to make me the hero of this story?” That's what sounds like your message is coming across. 

How do we speak to patients, not in our words, but through our marketing, our website or social media in ways that it resonates with them? They don't know what physical therapy is. They think it's hot packs, leg lifts and ultrasound or it didn't work, “I tried physical therapy before and it didn't work.” Physical therapy is much more complex and the thing that works or not. 

It's become commoditized so much over the years. You wouldn't say that about a dentist that says, “Dentistry doesn't work for me.” You find another dentist. 

Or you lose your teeth. 

It hasn't worked that way for our profession but we've been lumped together like that. You said there were three things. You focus on the word of mouth and your website, but quickly regarding cultivating word of mouth. You guys are actively promoting your word of mouth referral program in the clinic on a regular basis, I'm assuming? That's something which is a routine. 

Here’s how I do that. You come in and we see you and we make a plan, “Mrs. Jones, I'm on a mission to help 100,000 people in Greensboro avoid expensive imaging and unnecessary surgery. If I can help you reach your goals of running a 5K and feeling strong, healthy and confident so you can be a good role model for your daughter, do you think you can help me reach my goals?” She'll say, “Yes.” I’ll say, “Great. When the time comes, I'll let you know how you can do that.” 

Visit number 5 or 6 when she's like, “I feel better than I ever have.” That's when you say, “Can we shoot a little video of you saying that or would you mind leaving us a Google review?” That’s one part of it. In all our new patients, they get a specific email series from us and in some of those emails, we're asking them to refer their friends or giving them ways to share about our business or our group and all that stuff. 

Here's a link to Google reviews. This is a link that you can send to your friends and family. You are making it easy and simple for them. 

Also, something valuable like, “We came out with a brand new book on back pain. If anyone who might benefit it, just send them this link,” versus, “Review us.” I don't want anyone to review us. I want people who feel compelled to review. The email and the initial conversation helps but what it comes down to is, if I can set it up in the beginning, when the time comes and they're happy, then I can ask them. They've already been pre-framed that the consequence of getting better is telling other people. 

We talked about word of mouth and website. What's your third channel?  

It’s social media. 

You hit that hard. 

2020 has been a great year to do it. It's not only social media. It's not only Facebook Ads. It's being present in the conversation where people are. Prior to 2020, anytime I can do an in-person workshop but in-person workshops are a lot harder to do now. We can do them online but where are people right now? They’re on social media. They're on their phone. I've got over a million views on our clinic’s YouTube page. 

 

What are you posting on your YouTube page? Is it all how to get better, how to improve your shoulder and back or are there other things also? 

There are other things. The most popular ones are I did a Self-Massage for Your Feet video and I did this a couple of years ago, but within the first 30 days, all of a sudden it got 20,000 hits. I was like, “What happened?” A foot fetish community got a hold of it and posted it on one of their forums or websites and got tons of views. This has over 250,000 views. I've got one where I was cutting a chicken and I was like, “Here's some fascia.” I took my phone and my kids in the background and I was like, “This is interesting.” I put it up on YouTube and it has tens of thousands or hundreds of thousands of views. I've got a neck pain relief video. 

The videos I put up didn't grow as fast because YouTube back then had fewer people on it. Over time, it's one of those platforms that the sooner you get on it, the sooner you'll get results with it even though it takes time. I do have a video that we put up sometime during the pandemic. It’s already got over 20,000 views. I would have to go look and see which one that was because I do have a ton of different videos. There'll be things that you don't know what is going to hit. 

Here's the thing, the people in Greensboro aren't like, “I saw your video on YouTube and I got to come to see you.” What they're seeing is they see us on YouTube, they see us on Google Maps, they see us on Facebook, Instagram, maybe they'll see our Facebook Ad, and they'll get our emails and their friends will talk about us. It's the omnipresence strategy. We become the go-to for people that are hurt or in pain or active in Greensboro and want to feel better, stay fit, healthy and strong. They’re like, “I’ve got to go see Dr. LeBauer. I’ve got to go to LeBauer Physical Therapy.” They look us up, call us and we put them through our system. 

I learned long ago that any paid advertising is tough when we say, “It's LeBauer Physical Therapy. You deserve to feel great. Call us.” It's not enough. Any paid advertising we do outside of Facebook Ads is educational. You've seen Dan Kennedy stuff and a lot of people might not know who it is but it's if you look in the newspaper or a magazine and you see what looks like a news article, but it says, “Paid Advertisement,” that's a direct response type of marketing strategy. It's an informative ad. We have to create information, educate people and give them a reason to contact us versus blasting them with our name. That’s some of the things that we're doing. That’s the main thing that we do with social media. 

I'm thinking about some of the therapists out there that are treating full-time. I'm thinking, “How much time do you spend on social media work? Do you have someone else doing some of that for you to keep you constantly posting and engaged?” 

What's the number one problem that we all have? The number one fear most business owners have when they go from being self-employed or a small business, it’s like, “If I want to grow my business, it means I have to work harder. I'm going to explode.” I don't do our social media for either my coaching business or the clinic. What I do is I'll record a video. Maybe I'll do a Facebook Live video, make a little caption, or I'll do an Instagram Live video and add a caption. I take the video, I download it, I put it in a Dropbox folder, someone on my team gets it and we create a blog post, content and other images out of it. We’ll pull quotes up from it and they'll go and post it. I'll say, “This is awesome.” She's like, “What's exactly what you said.” 

Since you brought up Dan Kennedy, isn't he the one that brought out the Who Not How book? 

No. I haven't heard of that. 

He had Benjamin Hardy write it for him. What you're talking about is finding who can do it for you not how you can do it. All of us have that limited amount of time. We don't have the expertise. Who can you find to do the social media stuff for you? It all is dependent upon you. 

That's Dan Sullivan but they're both great. The Dan Sullivan question is a great question. I want to come back to that, but yes, it's who can do this not how do I do it? It's exactly it. Dan Kennedy and Dan Sullivan are two powerhouse people. Dan Kennedy does all the direct response old-school marketing. The Dan Sullivan question, we ask this to our patients. Do you know the Dan Sullivan question? 

You deserve to feel great. Click To Tweet

I don't. I think I know where you’re going because I know some of my PT owners have asked this question of their team members. I know what you're talking about. I'd love to hear it. 

This is a question we use in our sales process. As physical therapists, we have to sell. It's our obligation to sell physical therapy but only when we think people will benefit from it. It's only sleazy if people won't benefit from it. The Dan Sullivan question goes like this. Imagine if we start working together. I teach you everything I know and do everything I can to help you get results. Fast forward a year from now, we're having the same conversation. Looking back over the last year, tell me what's happened in your life personally and professionally for you to feel happy with your progress? It’s not amazing and the best ever, but happy. People start to answer and you basically say, “Tell me more and why is that important to you?” 

That's how I find out not that Mrs. Jones wants to get her knee pain resolved because she's afraid of having arthritis, but she wants to be able to run, feel strong and be a good role model for her daughter which is what people are paying for. You can go anywhere and get physical therapy but where can you go to return to running programs so you can feel a good role model for your daughter and that's LeBauer Physical Therapy. 

I love that question and it gets to the heart of why the patient is coming to see you in the first place, whether they have a prescription or not. I love how that question can get buy-in for a patient to the point where they're not thinking about what the copay is anymore. 

If you asked that question to everyone, no one cared about their $20 to $150 copay. My copay this year to see PTs is $150 or maybe it's $175 in 2021. 

At that point, they're thinking, “I'll pay $1,000 to be able to run again.” 

Who wouldn't? 

Also, be a role model for my children. Sign me up. How many visits is it going to take? Let's get it on. 

Being able to move my knee or run isn't enough. It’s, “Why is running important? Why is that thing important?” What's that 3rd, 4th or even 7th level of why. Why is this activity so important? When I was working in a high volume clinic as a student, I didn't have time to ask these questions. Even with an eval, we would do one person at a time. They get an hour eval, but you didn't get to when the questions are asked. I didn't have any time to dive into what was happening beyond that initial assessment. 

We all know, after 3 to 5 visits people either get better quickly, get better slowly, or maybe we miss something and need more time. It's tough to not push people through based on a decision we made a few weeks ago when I'm being pressured as an employee or a student to meet productivity levels or to see a certain amount of people when I'm like, “I’ve got to put my hands on you.” That means I can't talk to this other person and find out how does that exercise feels. 

That'd be a great provider training program to roleplay and work through that one question and the follow-up questions after that, “Why is that important,” to get buy-in to improve the patient's commitment so there are less fallout and drop-offs. Also, getting their commitment to show up as often as frequently as you're telling them to show up and do their home exercise programs. It’s that patient engagement. Simply going through that one question, that one exercise, could do a lot to improve patient buy-in in any clinic. 

What we do is we do that three times with them. People go to our website and there's an application to work with us. You don't have to do it but what 55% of people do is they go through our website from an email, an ad, social media or Google. There’s an, “inquire about availability, talk to a PT and request a free total body diagnostic.” In that, we're asking not this question but other questions. We're pre-framing that we have other services beyond physical therapy. What service are you most interested in? We'll put all five of our services, PT, massage, health coaching, private yoga, performance and etc. in there. Eight to nine percent of people are choosing PT. We got this application and when we call them on the phone, we're asking sometimes the same and sometimes different questions. In our free total body diagnostic, we'll ask this question plus others because we want to find out why is this important to people. If it’s not important enough to them to do anything about it and they can't connect with it, they're not going to say yes. 

I need to be able to build value that's worth $10,000 or more. I have to build that because health doesn't have a dollar value. I have to build a vision of like, “There's no way I'm going to get that going down the street or with anyone else.” When we say, “Mr. Jones, my recommendation is you return to running or back to the box. Your total body complete program is $1,998 and we'll help you feel better, faster, stronger so you don't have to worry about damaging your knees and you can be a great role model for your daughter. How's that sound?” They'll be like, “Sign me up.” We do get objections. If I can do it right, we don't get objections. If you're not getting objections, you're not selling. We have to get objections. 

We have to remember that purchasing is an emotional process more so than a logical process. You'll pay more for things that are illogical. If you can tie it to the emotional process and where they're going to get better, you'll get a financial commitment in spite of the copays that they have to pay. You and I both know that any mother would gladly pay a $100 copay each visit if that meant their daughter could get back to playing volleyball. They wouldn't pay that for themselves to overcome their shoulder because they can't lift it above her head and they haven't been able to do so for two years. They don't pay that extra. If you can get to the heart of it and get to the emotional part of it and tie that to, “This is going to get you that,” picture of happiness that we're talking about, then the dollar figure can immediately be tied to a value. The value and the dollar amount can be equal and they can buy into that. 

The most valuable thing is time. It’s like, “How much longer are you willing to wait for this to go away on its own? How long have you been trying to fix this problem?” 

How much longer is it going to go on if you don't fix it now? 

 

“If I can help you do this in the next eight weeks or at least make a 50% difference, would you like to give it a shot? Would you like to work with me?” People are like, “Yeah.” If we can make a 40% change, it’s like, “Yeah.” I would say that because I know I can make a pretty significant change in 3 to 5 visits if I can help someone. If they've been struggling with this for three months or three years and they've gone to five different people, “I know you've been doing this for a long time. Do you want to keep struggling or do you want to give it the best shot? How much time would that be worth to save if we could save you?”  

I try not to quantify it because it is an emotional decision. We have to somehow bring in a quantifiable understanding of time lost or gained and not just money lost or gained. The time gained has to be greater than the money spent. If I can get that equation right, it doesn't matter. Going back to your original question, what’s a thing that a traditional in-network clinic owner can do is how do we work on not just the marketing process but the sales process and reposition something beyond rehab and the physical therapy we were doing so that people are coming back to see us month after month? People who've been our customer before were 80% more likely to buy from us again than someone brand new. 

From your perspective, why don't you think in-network providers go through these processes? Why don't you think they focus more on sales, the conversion, getting to the heart of it or even the marketing process to be more patient-centric? 

It's hard not to make a generalization. Generally, there's not been an objection. If a physician says, “Go get physical therapy,” you go get physical therapy. “My copay is $50.” I've had physicians say, “Aaron, I would send you patients but only if you took their insurance.” I’m like, “You don't even know how much I charge. In some years, it's less than a copay.” I've seen receipts from physical therapy in outpatient settings where people are being charged $600 and $800 a unit or even $1,000 a unit. We can't make a judgment on that. Going back to my original thing is if we focus on sales and what's next for people after therapy, those two things are going to shift but people haven't been doing it because the way it's always done and it's been easy enough. 

It's the easiest path. You get your prescription, you come to me, I provide you the service and you move on. What you're challenging the in-network owners to do is to think a little bit more. 

Level up your sales and back-end products and services. 

Think about what more could you provide. How can you make physical therapy simply another option on the menu of services that you provide with the others being cash-based alternatives that can add some greater revenue and consider your conversion process? Market like you're an out of network provider. You have to sell what people are going to gain by coming to you versus other people that might charge you more or charge less. 

Stop competing on physical therapy and start selling results that people want. When we try to sell physical therapy, it's like, “I'll go wherever it's cheapest or wherever is in-network.” If I can sell them the result and something that they want, they can’t get it anywhere. 

I love what you're talking about. Is there anything else you want to share? 

Based on this, it's something like dry needling. Dry needling is a big thing. People will sell dry needling. Dry needling is not covered by insurance, it's a cash-based service. If you want to get a needle, it's going to be an extra $50. Patients are going to see needling as an a la carte item that if I feel like it works, then I get to go where it's the cheapest. Maybe the guy across town isn't all above the board and they're including needling for free in their treatment. You're charging me an extra $50, I'm going across the street. 

I get dry needled and we provide it but we don't sell it. I'm not knocking it. I'm saying the strategy of selling the treatment technique that I've learned or the treatment technique that I provide allows patients or customers to price shop. It’s like, “Here’s what they get at the price shop.” They'll go wherever is cheapest. I have this done to me and I hate it. I'm like, “I guess I missed something in the conversation.” 

It would be more of how do we create a bigger picture and a bigger goal that people want? “Mr. Jones, the good news is your insurance covers 50% of this program. Instead of the $3,000 program, your cost is only $1,500. If you'd like to pay in full now, I'll give you a 5% discount.” That includes the therapy that the insurance covers, plus the wellness program or the needling that’s not covered by insurance and the other things that they need. 

I love that different perspective and the way you package it up like that. 

The good news is your insurance covers 50%, 40% or 10%. The good news is all of our patients have great insurance and we can help you. Whether insurance covers it or not, how about we get started now, get you some results and we'll take care of the insurance piece together. 

I love how you package that and if there was some way that you could get a provider team to agree on the different packages that you provide and say, “This cost a blank number of dollars. It’s $2,000 if you're going to come to us without insurance, but because you have blankety-blank insurance, they're going to cover this much of it.” It'd be cool to reword that and consider it. 

It's the framing of it. I'm also including multiple services. We can break up the charges on the bill however we want. It's up to us. What we're framing is a bigger result and how we're going to get you there. 

I love what we can learn from you. When I say, “We,” the in-network providers can learn from you because that's where I'm coming from. It would challenge many owners if they thought, “What if I didn't rely on insurance?” There are many owners out there that should be dropping some insurances that pay less than what their expenses are. You've seen that. 

I've worked with a lot of clients who are like, “I have to drop insurance because I'm losing money no matter what I do.” 

They're scared to do it. If you could see the benefits of it, try it. Act like you're out of network and market accordingly, change your message, package it accordingly and provide the value. I don’t think you're going to miss that insurance. 

The one ace up your sleeve that you guys have that I don't is you already have the systems in place to bill on behalf of patients in or out of network. I would have to go hire someone new and build new systems or pay someone else money to do it. If you've already got it set up, it makes it a lot easier and it becomes less of a barrier because people will ask you, “Do you take my insurance?” You’re like, “We do.” We're out of network and this is how we're going to do it and we'll file the claim on your behalf or we’ll just file it for you. That's the big barrier that I face every day. 

It's easy to find you on The CashPT Lunch Hour. They can find you on the podcast but if they want to reach out to you individually, how do they do that? 

The best way is to send me a message over on Instagram, @AaronLeBauer. You can find all the resources and things that I've got over on my website at AaronLeBauer.com. 

Thanks for your time. I appreciate it, Aaron. 

Nathan, thanks so much. I appreciate being on your show. You've got a great voice. Keep rocking and rolling. 

I've got a face made for it. 

Important links: 

• Aaron LeBauer - Previous episode 
• The CashPT Lunch Hour 
• Greg Todd 
• Building a StoryBrand 
• YouTube - LeBauer Physical Therapy, LLC 
• Self-Massage for Your Feet video - YouTube 
• Neck pain relief video - YouTube 
• Who Not How 
• @AaronLeBauer - Instagram 
• AaronLeBauer.com 

About Aaron LeBauer

Aaron LeBauer PT, DPT is the host of The CashPT Lunch Hour Podcast, the founder of The CashPT Nation Facebook group and as a business coach has helped 1000’s of passionate physical therapists build successful businesses without relying on insurance. He owns LeBauer Physical Therapy in Greensboro, NC, a multi-therapist 100% cash-based physical therapy practice. Aaron's personal mission is to save 100 million people worldwide from unnecessary surgery by inspiring other healthcare providers to start their own businesses and learn how to market directly to patients, not physicians.

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Many people have given up or temporarily set aside their formula for success when the pandemic hit, putting a halt to their professional growth. But even with such a huge obstacle in front of you, should you really stop moving forward? Adam Robin, PT, DPT is proof that you can achieve your goals even when faced with a pandemic that threatens to derail your business. Adam recognized early in his ownership that he needed help and guidance to become a better owner, and so he focused on getting a coach and implementing the things he read about in business books. Since then, he's moved out of treating, hired more people to implement his procedure, and looking forward to expansion. In this discussion with Nathan Shields, learn how Adam's constant desire for progress allowed him to make a successful career transition. 

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Listen to the podcast here:

Living The Formula For Success With Adam Robin, PT, DPT

My guest is Adam Robin, physical therapist, Owner of Southern Physical Therapy in Picayune, Mississippi. Thanks for joining me, Adam. I appreciate it. 

Thanks a lot, Nathan. I’m super excited to be here. I’m looking forward to the conversation. 

I brought you on because you've had a ton of success over 2020, especially in spite of the pandemic, you've been able to achieve a number of goals. Not necessarily because in your area you haven't had been hit by the pandemic, but in spite of being hit by the pandemic, you've been able to still do what you wanted to achieve in 2020. I want to pick your brain a little bit about it. What are some of the successful actions that you had, some items you can share because the whole idea behind the show is to be a resource for other PT owners? Maybe you can be an inspiration and support for the readers. Before we get into that, Adam, go ahead and share with us a little bit about what got you to this point in your professional history? How long have you been an owner? 

I’m thankful to be here, Nathan. I don't know if you remember, but the first few weeks in our coaching relationship, I remember telling you, “I'm going to be on your show one day.” I put it out in the atmosphere. Here we are. I live in Picayune, Mississippi. I'm from New Orleans, Louisiana. I love to work. I'm a hard-working guy and graduated from PT school in 2017 through my passions for health and fitness. After PT school, I hit the ground running. I wanted to do more than the average bear. I didn't know what that meant at the time. It meant work harder. 

That's what I did. I worked harder. I had a full-time job. I picked up a home-health job on the side, working as many hours a week as I possibly could. That work ethic carried me through to eventually opening up Southern Physical Therapy Clinic in late 2019. It was two years after graduation. After about a year into that, I quickly realized that I didn't know how to run a business. I had to work hard, but I didn't know how to gain control over the chaos that is business. A lot of my fears and insecurities built up to a place where I didn't have an option. I had to reach out and get some help. I found you through the show and the rest is history. 

You've been a coaching client of mine. What was interesting about you is number one, you started early. There are very few owners that I've come across that get coaching as soon as you did into your ownership lifespan. Usually, it takes a number of years for people to get their feet underneath them and they're working hard or maybe they get to the point of burnout, a decade or two into ownership or they say, “I can't keep doing this. I want to do something else.” The cool thing about your story is that you reached out for a coach early on. Maybe you knew it from reading the show before, but that is the formula for success. 

You recognizing that number one, you need to reach out and get some help. Number two, you need to get step out of treating full-time in order to run your business and number three, start networking. Since you started that path, that's when things started to align for you and you could achieve your goals. Reaching out and getting a coach, was that something that you had thought about even before getting into ownership that, “At some point, I'm going to need some guidance,” or did it take some rough patches in your ownership to recognize that you needed help? 

Definitely, some rough patches. I wouldn't say they were rougher in my head than they were because everything's rough and you don't know what you're doing. You're wandering around like a chicken with your head cut off, don't know what's going on. Everything's overly dramatized. You don't have that clarity and focus that control that you need to stay composed and make strategic decisions. I was an anxious mess and I knew that I couldn't sustain it. I have a good friend of mine who is a nutrition coach. I reached out to him initially. I got his perspective on coaching, and this and that. His mentorship on that subject along with my understanding that I needed to learn more, those two things combined led me to give you the call. I called several coaches and lead to our relationship. 

The growth of any company is directly related to personal growth and understanding. Click To Tweet

What are some of the most successful things you've done to help you achieve your goals? 

My goals have changed in 2020. I used to think that money equals success and that has been a huge mind shift for me, but I can boil it down to two things. Number one, stepping out of treatment to have a little bit of quiet time to be able to think and work on the business was helpful, and being willing to trust that process. Also, embracing the understanding that the growth of the company was going to be directly related to my personal growth and understanding. Diving into learning more about business, leadership, and developing a team, those were the two biggest things if I had to break it down. 

Let's back up a little bit because I want to delve into the mindset there. What was it that changed? I’m cut from the same cloth as you are that the money is what equals success. What helped you change that mindset that you had thinking, “If I had more money then I will be successful,” and where are you now along that? 

A lot of books, a lot of reading. When you and I first started, I wasn’t into reading. I listened to a lot of podcasts, watched a lot of YouTube, but I didn't grasp the power that reading books could have on your mindset. That is the biggest influencer and being intentional about placing quality information like that in front of me on a consistent basis. Over time, shifted my mindset in a way that gave me a lot of peace, clarity, focus, and understanding. Reading books was the big one. 

Were there 1 or 2 books in particular that you recall being impactful? 

Getting control of my team was a big one. Leadership and Self-Deception was a huge leadership book for me. Crucial Conversations was a huge leadership book for me. The Five Dysfunctions of a Team, The E-Myth Revisited. I can go on and on. I've read all these books. Those were huge. 

Think and Grow Rich, was that on the list? Did you read that one too? 

That was an older one that I've read before. Those other books helped me tie it together. 

It gave you some things and tools to work with, and recognize that leads into where your personal growth equaled company growth. The episode prior to this one is a conversation with Jenna Gourlay about how to have hard conversations with your team. That's not something that we typically learn anywhere. You don't necessarily learn how to have hard conversations in college. You have to read the books, you have to find the coaches to help you have those hard conversations. Having hard conversations can be one of those things that if you improve on that personally, as a leader, then your company is going to improve within. You're addressing the important aspects of the company that needs to be addressed. 

People need to be held accountable, need to be taught, need to be buy-in. You have to align purposes and values with those conversations. Your conversation here reminds me of that conversation there because as we grow as leaders and having important conversations is one example of that. Our company will grow as well as we have those hard conversations. Was that something that you had to learn how to be a leader? Is that what you gleaned from a lot of these books and how to act better or did you think that was something that came naturally?

You could call it naturally, but it wouldn't have happened without the reading. You mentioned conversations with other people, but those books also teach you how to have conversations with yourself. Those internal conversations and conflicts that you have with yourself help you organize them, prioritize them and enter your day with a level head, cool, calm, collected, and with an understanding of what you need to accomplish. Having those relationships with your team further develops the culture of your organization. It's a powerful thing. 

When you start to implement change, not everybody on your team will be on board with it. Click To Tweet

You said one of the other things that you realize is pulling away from treating so that you had the time to work and think about your business. That quiet time became important to you and something that you recognized that you needed. What there something that you noticed that was dramatically different in your thought processes when you weren't treating full-time? I’m wondering if there was a light bulb moment where you said, “Now that I'm not treating it. I'm thinking about these things or I have the time and energy to consider blank.” Did you have any of those light bulb moments? 

It was a series of light bulb moments. Being comfortable, stepping out of treatment and quiet time takes practice. The first time you step out and you're sitting in front of your computer with a blank piece of paper, you don't know what to do. You're like, “Now what? I'm sitting in here by myself and what do I do?” Developing that skill takes practice and like anything, the more practice that you have, if you want to be a great PT, you have to practice. You have to go in front of patients, you have to fail, and you have to learn from that, stepping away from treatment and being strategic with your admin time. You have to get in there. You have to be unproductive at first. As you start to learn and develop new skills, you become exponentially better over time, especially when you use that time to learn how to leverage your team. A series of light bulbs. I still have light bulbs. Every week I'm having light bulbs. 

Was there ever a time that when you were going into patient care, “Thinking this is a waste of my time?” 

I wouldn't say a complete waste of my time, but I did feel that it wasn't quite aligned with my true purpose at times. I love treating and I love helping people. That is why I ultimately decided to go into business for myself. I do know that if you want to be a business owner and your purpose is to truly make a large impact, something that's larger than yourself, that you can have a sense of burnout and mental fatigue when you have too much treatment time on your plate. You're not fulfilling your purpose when you're sitting there one on one with somebody. It's fun. It's not something you want to lose contact with, but you can't truly make the impact that you want if you're stuck in that bubble. 

What were some of the hardest things you had to deal with in achieving your goals in 2020? 

I had to go through a few things. A lot of change in the way that I led and the way that we organized our efforts as a team. One lesson that I had to learn is that when you start to implement change, that not everybody on your team is going to be on board with it. You're going to lose people and that's a hard thing to do. I had to go through that about 2 or 3 times over the course of six months, but like everything, the more you do it, the better you get at it. 

It reminds me of the old adage, “The people that got you here are not the people that are going to get you there.” The people that you have at this time served a great purpose and you appreciate them, but as you change and implement you grow and as you start implementing policy and procedures, I've seen it time and time again, it weeds people out for one reason or another. Either they act up or you find out that they're not a fit and they have to move on. As you get more clear about how you do things, and as you start creating that culture and refining it, and becoming clear about your purpose and living to the values, some people start getting weeded out, but you start attracting the right people. 

Those people are the ones that are going to get you to the next level and who's to say, if they're going to get you to the next level beyond that? They're going to get you to the next level of where your company needs to go. It's an inevitable part of changes that you're simply going to lose people. Some people don't like the structure that might be put into place. They want to say, “We're becoming too corporate. You're too focused on the numbers if you start bringing up data and looking at your statistics,” but it's in the best interest of the business. Therefore, you have to remember that and move forward. I've seen it time and time again. It happens all the time. Once you become clear on your purpose and values, and you start pushing that, once you started implementing procedure, implementing structure and statistics, inevitably people start falling off that wagon. You've noticed, as you becoming a better interviewer and a better recruiter, you start finding the right people. 

You found understanding and whatever it is that you're working on at a time, whether it be numbers or whatever, then you can immediately implement that in your new hire. They become exponentially better than the one that left you. 

That's their normal, they don't know any different. Is there anything that you would have done differently in 2020? You achieved all these goals. You did some great things and we didn't even allude to the goals that you have achieved in 2021, but what would you have done differently?

I hadn't sat back and thought in-depth about that. Stepping out of treatment sooner is always good. “Get out of treatment. You got to.” I was a little bit resistant in that regard, finding a coach sooner. 

It is a huge thing to identify your biggest problems and create systems that solve them instantaneously. Click To Tweet

You can do it quickly, to begin with. 

It's been such a transformation in 2021 for me and in the business that it's hard to imagine me doing anything different because it's been so rewarding. All I can say is that I wish that it would have been sooner. 

You stepped out of patient care. Before we started the show, you started telling me some of the issues that you're having, pandemic related, and people falling off the wagon. Without your issues, it's not blue sky, easy sailing, but what is your focus on where you're at? 

To paint a quick picture of where I was before, I was treating in the clinic full-time with a PTA. I was completely overloaded with treatment, overwhelmed, and didn't have much. I am not even on the schedule anymore. I have hired 2 PTs full-time, 3 PTA's in the clinic, 2 front office admin staff, and we're looking to hire a third. It’s a huge transformation. I work from home a lot. I work remotely. I meet with my team and my focus is on empowering them in whatever it is that they're trying to accomplish. I help them understand some of the things that I've learned to understand so that they can be better at what they do. 

What does that mean to empower them? What exactly are you doing to empower your team? I agree, the next step to most people's growth as they're stepping out, developing policy and procedure, and developing leadership teams is the next step, if that's where you want to go. If you want to expand, if you want a bigger clinic, that's not dependent upon you, or if you want another clinic outside of the place where you exist, you have to get the right people in place. What are some of the tools that you're using to empower them? 

Policy and procedure are huge, dialing that in and becoming obsessed with your policy and procedure to understand that's your problem-solving template, period. Identifying the biggest problems that there are in the company, the ones that give you the biggest headache, and creating systems that solve that instantaneously, is huge. Also, instilling that understanding into your team that this is the policy and why it's the policy, and then providing tools, whether that be checklists or systems or reports that they can utilize to hold themselves accountable. All the while, you’re helping them understand the purpose of why we're doing what we're doing. That is empowering the team. They become more efficient and more effective. They have a fulfilling place to work and they enjoy their work more. Results come. 

I still remember that from an episode with Roland Cochrun. He is a guy in Oregon who travels the world, still checks in with his physical therapy clinics, and they are successful because his sole mindset is to create a foundation for which his employees can succeed. Whatever he does is for that purpose. That is policy and procedure, reports, statistics to monitor and what to do when they're going up, what to do when they're going down. He's got this all dialed in. It is all meant to empower his team. 

That’s exactly what you said there, empower other people to do it, and the effect you can have in doing that becomes multiplied exponentially. Your effectiveness as a provider is one-on-one and it's that one patient that you work with every 30 minutes, but now if you empower a number of providers, now you've multiplied your effect. You've multiplied your purpose beyond yourself doing the work. That's the next step. Do you have them reading some of your same books as well or are you sharing YouTube snippets and inspirational things like that? 

With some of the members of the leadership team, we talk about books and ideals, some of that we want to hold true to the company that is from the books. I do a lot of teaching and coaching, especially when there's a problem that I helped them solve. I use the principles that I've learned in the books. I don't necessarily reference that directly to them, but that's my understanding. 

That's part of it. Empowering them is coaching them like you needed a coach, they need coaches as well. Younger and older business, the team members, the employees on your team value that. They look for someone who's going to be a mentor in one way or another, whether that's a mentor from a physical therapy standpoint or a mentor from a leadership standpoint. They want someone who's going to help them learn and grow. No one wants to stay still and continue to do the same thing they were doing, hoping that someone recognizes what they're doing and no place to go if there were any issues or concerns. That's one of our jobs as leaders is then is to focus on coaching our team underneath us. Looking forward, are there any books now that you're reading? 

I finished Good To Great by Jim Collins and I'm reading The Coaching Habit by Daniel Maté. 

It makes it easier. It gives you a step-by-step process. You can into any meeting and you can ask this set of questions, almost resolving any problem that comes up against you by using that little template. The Coaching Habit is great. Thanks for sharing your time with us. Anything else you want to share with the audience? 

If you're not just a physical therapist, but a young business owner, if you're feeling overwhelmed or there's something that you're missing, I would highly recommend a coach. I would highly recommend investing in your education, find somebody who has done what you want to do, and that knows more than you do, and seek their guidance, and you will come away a much happier and fulfilled business owner.  

Reach out, step out, network. That's the formula. If you got it done, you would achieve some great things in 2020. Congratulations. I look forward to seeing what you're able to achieve in 2021 too because I know you have big plans. I see great things from Southern Physical Therapy. Thanks for your time, Adam. I appreciate it. 

Important links: 

• Southern Physical Therapy 
• Leadership and Self-Deception 
• Crucial Conversations 
• The Five Dysfunctions of a Team 
• The E-Myth Revisited 
• Think and Grow Rich 
• Roland Cochrun - Past episode 
• Good To Great 
• The Coaching Habit 

About Adam Robin

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With 15 years of experience as a clinic owner, Beth Winkler has dealt with her fair share of challenges – from the aftermath of Hurricane Katrina to multiple providers leaving at the same time.  Through all of that, Beth and her partner Lisa Taglauer, PTA have built clinics that thrive and grow on policy, procedure, and a healthy dose of quirky, fun culture. Those foci have allowed Beth and Lisa to grow from one clinic to four and focus on solidifying their company culture to weather any future storm. Beth and Lisa own and run Magnolia Physical Therapy in New Orleans. You are going to learn a lot about culture building in this episode as Beth shares that story from her point of view with Nathan Shields.

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Listen to the podcast here:

Strategies And Challenges To Improving Culture With Beth Winkler, PT

Our guest is someone whom I've wanted to have since the beginning of my podcast, and I finally tracked her down and got her. Beth Winkler is a physical therapist, CEO and Cofounder of Magnolia Physical Therapy in New Orleans. Beth, thanks for finally coming on. I finally got you.

Thanks for having me. I'm glad to be here.

You've been in New Orleans for a long time and you've successfully built up four clinics. Will and I looked up to you and Lisa for the longest time during our ownership. We thought, “Here are two women who are great owners, they created a great culture and they are doing everything right.” That’s why I'm excited to finally tap into some of your wisdom and knowledge. You guys have always been someone that we've looked up to as owners.

Thank you.

Tell the rest of the audience a little bit about your professional path and what got you to where you are now.

Lisa and I met when I was a new grad, a couple of years out of school. She came to volunteer at the clinic that I was working at, and we became instant friends. We talked about not opening our own clinic as of yet but we work well together. She has gone in a PTA school, so I wanted to make sure that when she got out of PTA school, I'd love to have her come back and work here and work together in some capacity. While she was still a tech, I got offered a position at another clinic where they were going to pay for my manual therapy fellowship. I couldn't pass that up and that was when PTs were in great demand. It was like, “Name your price,” which was nice but there's one caveat. I said, “I don't come alone. I have a great tech that I want to come with me,” and the owner was happy to hire her. He was looking for someone, so we worked together through her. She went off PTA school and we hired her back as a PTA.

There were some changes in the company that we weren't too happy about. We had suggested a few different things on how to become more efficient and have Lisa go out and do some of the marketing while she could also see patients. It was like, “Thank you for your input but no thanks. This is the route we're going to go.” It felt like our voices weren't being heard, so I started talking about doing our own thing and we could be our own boss. It was never to grow to four clinics and see all these patients, it was just so we could have more freedom to do what we wanted to do. Lisa thought I was joking all along. When I finally said, “Let's do this.” She's like, “You're serious?” I'm like, “Yes.”

Honestly, we looked at our bosses that we worked for, and no offense to our former bosses, but we're like, “If they can do it, we can do it.” Let's go ahead and start this thing. We always have the default at home health, which as a PT, there's always the default of home health. I knew I didn't want to do that. That was the alternative, so the alternative was not an option. It's like, “We need to make this go or I'm doing home health.” That was not what I wanted to do. It wasn't my vision for future plans.

The irony was the day that we were going to put a deposit on a tiny space, I don't even know how Lisa and I would fit in this place. I was dropping off home health notes across the hall from where we used to work, I saw the owner in the hallway, and we were still on good terms. He's like, “What are you doing here?” I said, “I’m dropping off notes.” He had lived out of town and I said, “What are you doing here?” He goes, “My therapist quit. Do you want your old job back?” I was like, “No.” He goes, “Do you want a clinic?” I'm like, “Maybe.” It was the old text phones and I mentioned this at Will’s where I was texting Lisa like, “A, B, C.” I was like, “David is selling his clinic and he offered it to us.” We took over his lease, the patients, bought his equipment, had it owner-financed the equipment, and there we go.

You were all set up and ready to go. It was that easy. You opened up a clinic and you immediately had a room full of patients and everything went hunky-dory after that, right?

Not really. Three weeks later, a little storm called Hurricane Katrina hit New Orleans and that was a little insane. My friends would ask me, “How did the clinic do?” I said, “I don't know.” We didn't have that many patients to begin with. I was getting going and I was ready to go. Lisa and I were so driven to get back. We both lost our homes. Lisa's home completely went underwater. The water was all the way up into her attic, so her home was completely destroyed. I had 4 feet of water in my home, we had to gut it and completely renovate it. We didn't move back into it until a year later and that was considered as, “You're back in your house soon.” Everything is relative. We have the clinic, so we would take turns. She’s like, “I'm going to go.”

Our husbands were not there because they needed to be with our kids. There was no daycare in the city, so that's why most people were back, you couldn't bring kids back. My husband and I are not together anymore, but at the time he had got a temporary job up in DC, so he kept our daughter up there. We would alternate going to my house and Lisa would go to her house, gut it a little bit, and try to salvage some clothes. It’s the same thing with me. We were doing that and also seeing home health patients, which is the other irony of that.

That's what we’re trying to get away from but there was no one doing that. They didn't even have nurses going out to some of these people's homes. We were bringing people supplies. Lisa and I will go to our church and get toothbrushes, toilet paper and clothes, then bring them to these people. She got a puppy for a patient one time. This woman's dog drowned in the storm and it's awful. She's like a vigilante coming in with these hot pink colored scrubs that she had donated, “Would you buy some new scrubs?” It was funny. It was an interesting time but it was one of those things that if we were starting off that way, there's nowhere to go but up.

I was going to say the same thing. Everything had to be easy after that.

Pretty much.

When was Hurricane Katrina? That was how long ago?

That was August of 2005.

You're always learning. When you stop, that's when you have a problem. Click To Tweet

You've been a longtime clinic owner and you've run the gamut. You've done many things opening up new clinics and you started by purchasing a clinic. You've got a ton of experience. What were some of the biggest challenges that you had in developing your clinic over the past couple of years?

We were talking a little bit about it before. It’s finding that sweet spot. When you have therapists that are working for you, it's like, “When do you hire that first new therapist? When do you hire the second one?” In the beginning, we thought we had a formula. What was happening is we would get to a certain percentage, hire too quickly, and we would be inefficient for a while. It was nice because you can sit back a little bit as far as a treating schedule but the profits on the other end suffered for that because you're not having efficiency. You have the other end where you don't have enough therapists. We've had two waves of 3 to 5 therapists leaving at a time. It was like, “How do you rehire?” Us going back into patient care where you have a ringleader that doesn't agree with something that you're doing and takes everybody with them. That was challenging.

You have the therapists that are there with you who are overloaded and overworked. That's no fun either. Still to this day, I'm still struggling with that. What is that perfect balance because we were growing so quickly and we were hiring people, but if you're hiring that quickly, do you have time to get people on board and hone down on your culture, your core values and that kind of thing? That's what we're going to focus on in 2021. Let's do a slow growth so we can get people connected to our core values and what our culture is like so they don't go and leave and work for the big hospitals.

It’s focusing on the training and not sending them out into patient care immediately. They may do start seeing patients but you're going to focus on what it means to be a part of Magnolia Physical Therapy, “This is how we do things, these are the expectations, and laying that stuff out upfront.” We wanted to talk a little bit about the culture that you have created in Magnolia over the years. It started with you guys and everything that you did to focus on making it survive after Hurricane Katrina. You guys are so much about service and you want to provide that service for your employees. You want them to work in a great environment, you want it to be a place where people enjoy working and will attract top talent. What are some other benefits that you might see in creating a culture in your clinic?

One of the best benefits is having fun. Work doesn't have to be about coming in, going with the grind and pushing through. I know that Lisa and I are goofy. We have different senses of humor. Bringing that into the clinic with our patients and our team, we have students that come in and they see how silly and goofy we are in the clinic, that’s one part of our culture, that's not all of our cultures, but it's a big part. We make fun of ourselves. It's opening up a sense of vulnerability when you can make fun of yourself and poke fun at things that the team might be like, “Here they are trying to push this policy in or whatever.” We go ahead make fun of it and it lightens it up a lot.

That was one of our values as well. We had our core values but we did have a cultural value that was about fun. There was so much about me and Will that was about humor and a shared sense of humor. That was one of our cultural values and we define it. We let our teams know that if it's not fun, that's not worth working like this. To be intentional about that, it’s important because it's a place where you want to work. You’re the owners, so you should be in a place that you want to be on a regular basis. You don't want to be in a place that you dread especially if you're the owner of that company. Maybe not specific to having fun, but what are some of the things that have worked culturally? Then we'll turn to the flip side with things that haven't worked.

It’s investing your time to spend in the clinics. There was a period in time, especially in the beginning of COVID when it was like, “If you can stay put, stay put.” I wasn't visiting the clinics a lot. Being in the clinics and having team members see me interact with patients. When we first open and we've hired our first therapist, it's like, “How am I going to make this person a mini-me?” Not an exact stamp or replica, but how am I going to get them to instill how I would treat a patient or how I would have fun with a patient?

It's important for them to see us immersed. It doesn't have to be necessarily treating patients, although that can help. Sometimes I'll go to a clinic, sit in the waiting room and talk to the patients. It’s like, “How long have you been working here?” “How long have you been coming here for therapy?” I’m like, “No. I’m one of the owners.” I'm talking to everybody and I love doing that. How nice is it when you go to a restaurant and a chef comes out and talks to you? That's how I look at it, not like, “You're the owner.” It gives a sense of that patient feeling special. It’s like, “I met the owner,” that kind of thing. It’s to create that feeling in them a little bit and show the team too that I'm interested in what the patients have to say.

I've come across owners who have got to a point where they've got some freedom. They're not treating patients and they could work from home remotely. I have to remind them sometimes you need to still be there because they get too comfortable working from home. They’re like, “They don't need me. They're doing fine.” I want to remind them, “It's important that your presence is there on occasion because you want to exhibit part of that culture and personality.” Honestly, you want to make sure things are going well and make sure everyone is following the policies that you would expect. It's nice to have your ear in on conversations, whether that's at the front desk or between provider and patient. That's part of maintaining culture and having that presence. You can still maintain that culture at larger clinic members like 15 to 20 clinic members. That means you simply have a lot of other people that already know the culture, how you do things and have bought into the purpose, values and all that stuff before you can feel comfortable with not physically being present in the clinics.

I've done it wrong the other way. At the beginning of the COVID crisis, I’m not going into the clinic and having team members get these videos for me. It’s not an order but it’s like, “Let's work on this,” and here I am sitting at my house. They don't know what else I'm doing and that didn't come across well. I remember our COO was like, “They don't see you as I see you.” They need to know the goofy Beth so you can create that mutual respect in that.

There was a clinic that Will and I had. It was always awkward when we visited. We weren't that present often. It was a little bit out of the way but it was successful, our guys are doing great numbers and they don't need us. When we'd show up, there was a weird vibe. Sometimes, you get that sense that something is off here. That's when we had like you where someone quit, another one will quit soon thereafter, and another one quit a little bit later after that. Being present and recognizing the feelings and atmosphere, you can get a lot of sense simply by observing and being present.

There are other times where I might not have been so invested. It’s not only going to clinics but even with a marketing team. I've been working closely with them and we had a couple of team members in that area that were not getting along. It’s like, “Let's dive in and figure this out.” Let’s get in, work on rebuilding trust, and spending a lot of time with them doing that. I can tell you that they've told me, “We would not be here if you would not have done that. If you wouldn't have taken the time to show that you care, you value both of us, and us getting along, that meant much to you.” That was a wow moment.

It's cool to hear that you share some of the issues that you're having even years across four clinics. I see you as a successful physical therapy business owner and Lisa as well. It's still a work in progress. Things aren't perfect. You have your own difficulties. Who could have guessed that the pandemic would come along and it presented its own set of difficulties? This is something that you're constantly working on. It's not a one and done. It's not like you can open up a McDonald's franchise and it's going to run as it would anywhere else in the world. You guys are still working hard at developing the culture that you want.

It's still a challenge. It ebbs and flows too. You have periods that I look back on where we were doing even better than we are now. For Lisa and I, we took off a whole summer and we came back to a mess. Our numbers looked good, we were doing well and the culture was good. To me, it's not always about how well are the numbers and how are our profits are. It has become more than that now. We have four clinics and instead of doubling or tripling, our purpose is let's get what we have and get it humming. Get everybody happy and engaged. I look back to the team, we had fun but it wasn't like this team approach where it's like, “I’ve got that, I’ve got your back.” Whereas now, I feel like we have that. It's more fun and inspiring to be here.

When things were running well or at times when the culture was good, what were some of the things that you recognized from that? What were some of the benefits of having a culture that people bought into?

We've been working a lot on trust and getting people to be more open and willing to say what they think and feel. We started with these anonymous surveys. Be careful what you ask for because you'll get it. We got back not so great feedback and I was like, “What's going on?” We started honing in first with the management team. Let's be open and vulnerable. It was hard work on my end because I had to sit back and say, “What am I doing that is creating this environment of people not wanting to speak up?” It took a while to recreate that trust.

We're so used to this top-down management approach, which got us far to a certain extent but that's not how I wanted to run my company anymore. I wanted it to be more of, “Let's get everybody's input, and let's come up with decisions together.” Number one, you've got more brains that are pitching in. People who are on the front lines know the systems better and can come up with better ideas than I can. It’s being open to that instead of, “I want things done yesterday.” I can sit here, write up a whole plan, have it done tomorrow, and try to shove it down everyone's throats but that I learned does not work. It's taken a lot on me to sit back and say, “Let them come up with a solution or whatever.” Most times, it's better than what I would come up with. Even if it wasn't something I would have done, it still gets the end result. It's like, “Why does it matter how you get there if you take Road A or the scenic route?”

Creating that and having everybody pitch in and not be like, “Why would that person say that?” One of our core values is giving everyone a chance to surprise you and me. Let them come up with it. I've noticed that they take more ownership that way. It's been a little more fun. Our management meetings and team meetings to be able to see they are pushing the core values instead of me, Lisa or Ron are on an island by ourselves.

Give everyone a chance to surprise you. Click To Tweet

That's one of the keys to a functional team is the relationship of trust. Are there certain books that you've read that have helped you develop that team and that feeling of culture?

It's called Leading with Gratitude. That was a good one. The Five Dysfunctions of a Team takes you through the different steps. It's like a workbook and implementation on how to do it. That's been great getting people to open up a lot more. We also hired a coach using the Scaling Up Methods. What he helps us with is making sure everyone's voice is heard like the quarterly surveys, “What worked? What didn't? What are some of your barriers that help us create that safe environment for people to say what they need to?”

I immediately thought of Five Dysfunctions of a Team when he talked about open conversation and vulnerability because my mastermind group is reading that book. That’s first thing that came to mind. Our leadership team went through that book very much so to make sure that we were addressing things openly and people felt they could talk honestly. I don't know what it is but there's something about that lack of trust. When the team members can't feel like they can share their opinions and their voice isn't heard, that's when they start looking elsewhere. They're like, “I'm not being heard here so I'll go someplace that will.” That can sow a lot of discord. As you've been through this process when culture is good and culture is bad, what are you learning about your team in general? What do you learn about some of the people who have been with you for years at a time?

The ones we’ve been with us for a while, I think of resiliency because there are team members that come in that aren't a culture fit. The more we have those core values honed in, the more they stick out a sore thumb. It's that loyalty. You have someone who might be for whatever it is behind our back saying negative things about management and owners. Other team members are like, “We don't do that here.” It's the loyalty to the team and not loyalty to the complaining, that type of thing. When you do have team members leave, it's hard. You have to regroup again, revamp, get back in deep, and go over those core values because it can be a disruption. That's the biggest challenge. If a therapist leaves, they want something different, they think better or whatever. It's different when we're not a match and how that affects the team.

There are other things where people aren't a culture fit where other team members might not see that. They see what they see and they don't know what goes on or what has been done behind closed doors. That team member has lashed out at another person. That's something we're not going to share with the whole team, so that’s a struggle. It's like, “They let that guy go. If they let him go, my job must be in jeopardy.” That's been a real big setback that we've had. People are thinking that if someone is being let go, they may be speaking out of a meeting, and it so happen to happen after that but that wasn't it at all. It's trying to rebuild that trust again.

When you've had people leave, and it's such a blow to your company, you almost take it personally. I did and I'm like, “I’ve got to re-assess what I'm doing and I've created.” We’ve got to go back to the drawing board, “How can I make sure this never happens again?” It's not the type of environment that you want to create. It's not an experience that you want your employees to go through so what do I have to do to change it? As you said, that's the dirty work you have to get. Get back into it and decide, “What are we going to do to make this better? How are we going to hire? Who are we going to look for? How are we going to filter those people out that aren't good fits?” You have a little bit more determination as you go back to it but it's not easy work.

You want to be able to be safe for the people who are working their butts off and pushing, and not bring someone on who's going to gossip, argue or do whatever. If you want to let that person go because they're not a culture fit but you also don't want to create that feeling of fear like they're going to lose their job. That's one of our biggest struggles that we've had with our culture, especially since COVID. All our cups are empty and we're running on fumes. It’s the smallest thing. It's the frustration, so you’ve got to maintain that.

It's not all rosy and things don't always go swimmingly. Even at your size, you're still dealing with issues with the pandemic, and in your case, a mass exodus which doesn't help. At the same time, you're always going to be coming up with these problems as an owner. The strength that you have is the management team. You have a shared experience with Lisa, a commitment to each other and the clinic that you guys are going to get through this. It's like weathering another Hurricane Katrina, it's not as bad but you're in a completely different place as a company and you have some idea of where to start from at this point.

That has made us more resilient with things that happened. This has been the biggest blow since Katrina but almost everything else is like, “We can handle this.” I see the light at the end of the tunnel, so that’s good.

We're talking so much about the culture and it's something that you're working on. You've had these issues related to the pandemic come up, but owners should know that Beth and Lisa have policies and procedures in place. You've got many other things that are going well and you're doing swimmingly. You've got the admin in place, you're following your KPIs, so you know what to do. You have so much of that established, I assume that coming back around is going to be a little bit easier because you know which buttons to push and where to look. Your focus is on training. It should be simple because you do have many policies and procedures in place. It's a matter of, “How do we train people on this?”

It’s finding the right time to train them. One of the famous things that we say is, “It fell out.” It’s like, “I thought we had that in.” We joke that I'm the Chief Reminding Officer but it is. It’s like, “Let's get back to basics on what fell out that we need to get back in.” Our percent arrivals have been below 90% and I can't tell you the last time they were below 90%. I’m like, “We need to start from square one.” We have what works. We don't have to recreate that wheel, we just have to get it back in.

Congratulations on getting 90% on a regular basis because there are plenty of people who have never been to 90%. I’ve never talked to them before, so you guys are doing something right for sure.

Thank you.

Work doesn't have to be about coming in, going with the grind and pushing through. It can also be fun. Click To Tweet

As you're looking at creating this training program to hopefully improve your culture and the people that you have come through the company, what are some of that looking like? If you had someone in front of you who is a newer owner and they said, “Tell me what does your training program look like.” What are some of the skeleton structures of something like that?

We started using an online system for our training. I forget the fancy term that they use for it but it's online. You can assign people lessons and we've created different lessons and paths for their receptionist. There might be 8 or 10 lessons for that receptionist. It's videos, it's interactive and we can ask questions. If it's a receptionist, we can have them talk about percent arrivals like, “What would you say if somebody cancels?” We'll show a video of us doing a drill pretending to be a patient and we'll have the new team member video themselves telling a patient why they shouldn't cancel. We can see what their reservations are if they are someone who might be a strong candidate and hone in on where they might need a little bit more work.

That’s been fun and cool to be able to set someone up on these training programs. We still have people do it. That's the second phase but it's not so much legwork on the front end because we already have it into a system and we can refer back to that. That’s been great. In doing in-person training, we have some of the key components that we do for our patient compliance. We'll revisit that every 3 to 4 months to refresh people. I’m sure you're familiar with some of the stuff we've learned with our previous consulting companies, the awareness characteristics, getting them to realize how this is affecting their lives, and how it could get worse.

It’s reminding people to use this and the eval, that helps with the percent arrivals and things like that. I’m also looking at leadership training, not just our own policies and procedures but let's pick a book. The chiefs, me, Mary, Ron and Lisa are reading Crucial Conversations. We're reading a chapter a week, we're discussing it and starting at the top there. We're going to help figure out how we can filter that out to the rest of the team. When you're ready to be vulnerable and say what you need to say, that helps you figure out how to do it. I’ve worked with many team members who have conflicts with each other using that strategy and that's been helpful. It's that model of constant learning. You never graduated from PT school. You're always learning and when you stop, that's when you have a problem. It’s the same thing with leadership.

When you do training with a front desk person, are you taking them off the front desk for 1 or 2 hours or once a week? How do you schedule your training?

We're revamping that especially now that we have this new program. They take the lesson and there's an observed period. We observe them for 1 or 2 weeks with an existing receptionist who does well. We have someone who's an essential scheduler and now in our HR department. We have two other people who are rockstar receptionists that are in different positions. We might have them observe them doing it. Have them watch you do it, have them do it and mastery. That's still in the baby phases. What we used to do is have them read the manual and two weeks shadow a receptionist that's doing well. We would do drills once or twice a week to try to hone in. We're working on doing a better job of getting that onboarding process more solidified. It's never just done. There are always ways to improve, hone in and make it better.

If you want to know an intense training program, go back to the episode with Blaine Stimac. For their training, they go out for six months. For the 1st and 2nd week, there's a little bit of training every day. It's weekly, monthly and quarterly. They've got it all lined out and I'm like, “That is involved.” The results speak for themselves. They're a plug and play company now. They've got 30 clinics, so when they want to open up a clinic, it’s plug and play, train the right people or move this guy over here to over there in the new clinic and it's successful. They've got this successful method and he ties a lot of it back to the training, which then cultivates a culture of this is how we do things. It's not necessarily the atmosphere culture that we might be thinking about, that's their business culture. This is how we train, do, interact, run policy procedures and run a meeting. It goes on and on. That, in itself, is also a culture.

I have to go back to that because organization is not my greatest attribute. That's why I have Lisa.

I wish I was more organized. As you were thinking about culture and coming into this interview, was there anything that came to mind that you thought was important that you might want to share with the audience or even younger PT owners, if you will?

The one thing that sticks out to me is you're never done. You talked about Blaine, you have these systems in place and you have these training so it's plug and play. It's a constant work in progress because things change and industry changes. We have lots of industry changes. I'm finding more with the team members that we hire, they are demanding to be more part of the process and to have more of a say, and they should. It's our business model of, “This is how we do it here. Here is the policy and you better do it this way.” It doesn't fly that much anymore. Try to create something where we can have the team's input and come up with ways to constantly improve and evolve. That’s what I've learned in 2020.

Thank you so much for sharing. I brought you on because I know you guys are successful and you've created something great in New Orleans. This goes to show that even the seasoned owner is going to come up against different hurdles. Some of these might be similar hurdles that you had when you were a younger owner, but you visit them now on a larger scale. I’m thankful that you're willing to be open and share that in that regard. There are still issues that people are dealing with. The pandemic is something that hit all of the owners in different ways. Even the larger practices suffered like you were talking about in one way or another. It's cool that you're willing to share as we're talking about culture and some of the benefits of it because you've seen the benefits of it. You know what it’s like, what it could be, you have to reset and get that mojo again. Thanks for your time, Beth. I appreciate it. I've finally got you in. It's been great to talk to you.

Thanks so much for having me. I appreciate it.

We'll talk to you later.

Thanks. Bye.

 

Important Links:

• Magnolia Physical Therapy
• Lisa Taglauer
• Leading with Gratitude
• The Five Dysfunctions of a Team
• Crucial Conversations
• Blaine Stimac – previous episode

About Beth Winkler

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