PTO 106 | Running Your Clinic Remotely


Roland Cochrun, PT set out from an early age to be a PT owner and had a ton of immediate success. Over time, he still fell into the trap of full-time treatment which limited his ability to run his business and pursue his goals for a year. Finally, on a day off, he decided that he was going to focus on what was important to him, and he hasn't looked back. He stepped out of patient care, focused on what he really wanted to do. He no longer lives in the same state as his practice (Oregon). He trains and coaches his PT leadership team remotely, and runs other successful businesses. The freedom he developed is exactly what small business owners look forward to. He joins Nathan Shields to share how he continues to have a significant impact in his community via his successful business.


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The Freedom Of Running Your Clinic Remotely With Roland Cochrun, PT

I'm excited to bring on this guest, Roland Cochrun, who I would like to say he's from Oregon, but he's not necessarily. His PT clinics are in Oregon, but Roland is an executive coach and a PT owner, who has gotten himself and his business to a point where he lives remotely. That's why I wanted to bring him on. I consider Roland a great success in his business because he's now developed the freedom to live wherever he wants and run his business successfully remotely. He'll come and go out of the Portland area as he pleases. Otherwise, he lives across the country. He lives across the world for periods of time, owning his business successfully, and also doing other things in ventures that he wants to do.

I'm excited to bring Roland on not only share his story, but we didn't get into that part of it. He's been successful in what he's done thus far, that he lives remotely. It reminds me of a previous episode with Vinod Somareddy. He’s super successful with his PT clinic in New York, but he lives in Florida. That's maybe not the dream of every PT owner, but such freedom is that dream that we're looking for. Roland shares his story and some of the tips and tools that you need to use in order to obtain that freedom as an entrepreneur, as a business owner, and live the life that you're looking for whatever that might be. Let's get to the episode.


I've got a guest that I've wanted to have on for a long time, super successful PT owner, and is doing his own thing, Roland Cochrun. He is an Executive Coach and a PT. First of all, Roland, thank you for coming on. I appreciate you joining us.

Thanks for having me.

I met you at PPS and heard your story. I was like, “That is the exact type of PT owner that a lot of us aspire to be like and want to learn from.” I'm excited that finally got you onto the show to share a little bit about your story and what you're doing now. If you don't mind share with everybody a little bit about your adventure, your journey to this point.

From day one, I was fifteen years old and I went to San Diego. In order to have use of the car, my friend's older brothers, we needed to paint this wall at the new business. It’s no big deal. We came there. I remember looking around. I was seeing these athletes. They're doing crazy stuff soccer drills, sports drills. I was like, “What is this place?” I had no idea. I don't think the signage was even up. It turned out it was a physical therapy clinic. It was a cool environment. The owners were in their 30s. They were cool, relatable, and what a cool experience as a fifteen-year-old to meet business owners who are in their 30s.

The coolest thing was they were passionate about what they wanted to do, it rubbed off on me. I came back every single summer for seven years. Looking up to these guys, I wanted to do what they did, but it was another eleven years until I was going to graduate from PT school. This is the piece that everybody can put into practice. I still do exactly these elements to this day. Eleven years I had to act. I couldn't stand waiting. It was so stagnant. I got right into it. I went to my first Private Practice Annual Conference in Seattle when I was sixteen years old alone.

I’ve never missed a year since. I even went to October 2019 in Orlando. I went and absorb all the information I could. I sat on the Insurance Alliance when I was still in high school. I learned about payment. When you're enthusiastic and genuine, people will invite you into their homes. I got to know all of the heavy hitters, people who own hundreds of clinics, 30 clinics. They took me right in. Between all of the involvement nationally, their mentorship and friendship, eleven years went by and I'd moved on to logo design, employee handbook writing. I absorbed all that I could and it was ready to pull the trigger.

PTO 106 | Running Your Clinic Remotely
Running Your Clinic Remotely: We can't do everything on our own. We eventually need to start seeking advice and coaching.


Are you saying you started employee handbook writing prior to even owning a clinic?

Unfortunately, I didn't update it until a year or two. I was like, “We get our birthday off and paid.” It’s a newbie mistake, but we had to keep that in. It's since grown. That's been an expensive piece of gratitude that I put in there when I was in high school. The employee handbook and policies and procedures handbook were written then.

Did you write them all up before you even opened the doors?

Before I graduated in high school.

You’re ready to go right out of the gate.

As you can imagine, when I opened it, it opened quickly. I would break even at month two and be profitable at month three. I 2x every year.

Congratulations. You were networking like crazy. Did you get some coaching and consulting along the way as well?

I'm a coach now. I’m a coach to my PT clinics and the people who run them for me. I also consult my services out as a profession. The funny part about that question is I grew up a little resistant because being a non-business owner and attending PPS had a different view. I was absorbing. I didn't have necessarily an agenda in mind. I saw a lot more stuff that most people don't see in terms of alternative gains. I grew up a little opposed to coaching because I saw a lot of self-orientation within them. I'd see them circulating and networking. At the same time, it put me off a little and it was funny. Fast forward, I realized what we all do. We can't do it on our own. They eventually started seeking advice and coaching for sure.

My mantra, if you haven't read my blog, is reaching out, step out, and network. You took networking to a whole different level from an early age, but you finally came around to recognizing that you needed to reach out to a coach or consultant. I'm assuming that soon after opening up, you stepped out of treating altogether. Did you even take some time to treat initially?

There was full disclosure, full honesty. There was a year where I got trapped by completely overwhelm. Once you get stuck in that 70-plus hour treatment, weeks turned into months and a month turned into a year. I got to a point where I plateaued. Here's how I describe it.

When you say plateaued, plateaued business-wise?

I kept absorbing all the work. I was still killing it from a financial standpoint.

Financially, you kind of, but you had plateaued professionally.

It was not entrepreneurial. I looked more like somebody who didn't know what they were doing and now that I look back on it. Here's exactly why I made a plan. I even had goals, Nathan, that had a finite end. I achieved them. I bought the RA. I did all the cool stuff. I found myself in this, “Now what?” They always say, “Unless you take control, your default is more.” Without goals and a vision, the default was, “Let's stack it up.” I was focused on a patent that bank account with a scarcity mentality of what if patients’ new visits drop. When it's all about money, it's easy to grow a scarce finite mindset because it's transactional.

The Formula for Gaining Trust: Credibility x Reliability x Intimacy divided by Self-Orientation. Click To Tweet

What a lot of owners go through is what you're talking about and correct me if I'm wrong, but they go from treating and to step out of treating, they don't know what to do with their time. I'm having this conversation with some of my coaching clients who say, “Now that I'm not treating, I've got this vacuum. How do I fill my time? I don't want to be surfing the internet, which will be my default. Inevitably I'm the filler inner when someone goes on vacation. I don't want to do that, but what should I do with my time?” Tell me a little bit about your story there. How did you get out of treating? How did you do what's best for the business after stepping out?

You can either spend 1 year there or 30. It’s an easy place to stay, especially if you're pulling in $500,000 or something like that. If money's your only motivation, you'll stay there. I woke up one day and asked them, we've all asked ourselves this question to some degree. “Do I want to do this for another,” sometimes it's five years? I was asking myself do I want to do this for another 40 years, 30 years? When you say that out loud and put that in perspective to time and your life and what you're saying no to when you're saying yes to work, that was the moment. I remember it was a Friday. I took the Friday off and I remember looking out the window and thinking, “Where did my entrepreneurial, creative, and inventive spirit go?” I can call myself an owner, but I might as well be an employee at this point. It's plug and chug going through the motions. That was the moment where I was like, “I need to do it differently.”

What was your step? You invested in another PT. We don't have to get too far into the details, but how did you find yourself becoming more productive when you stepped out of treating?

I’d love to give somebody an easier answer, but being coached and now coaching, maybe there's a better way. Please, teach me about your experience. The pain has got to be great enough one day to finally say, “I'm going to hire. I'm going to give my hours to that person.” We all make up some like, “I'll do this kind of day.” In the end, “When will you do that?” It ends up being an all or none because you find out how disruptive it is to have you with one foot in, one foot out. That's how it went for me. We were overstaffed and rather than paying a PT to not work while I treat patients, it's pure insanity. I gave my caseload away. I never took it back.

You have to get to that certain point. When I take on a coaching client, I'll have them fill out a survey. Towards the end there, 0 to 10, how interested are you in changing your circumstances? The people that I want to work with are the ones that put down ten. I want to change now. I can't keep doing this. I was at the same point that you were. People would ask me in social instances, “How's the business going?” I'm like, “I love treating patients, but I can't stand the business. I can't keep doing this for another 5 to 10 years.” The burnout is real. It exists in PTs. I figured out I have to do something different. When I finally wrote the check, lots of money to the consulting firm to get some coaching, that was what was the refrain going off in my head.

We've got to do something different. Something's got to change. When people get to that point, they recognize, “I will make the investment. I might lose money in the first month. The time that it will free me up to do X, Y, and Z for my business will more than make up for that initial investment. I'm going to be able to market more. I'm going to provide a structure for my business. I'm going to create a company culture that retains better. I'm going to hire a better one. I'm going to be able to recruit,” you name it. All the things that you should be doing as an owner, you can finally get to. It's not like you said transactional. I treat this patient. I get this amount of money anymore. It's, “I'm going to put in my time and energy. That's going to return to me in multiples than what I do for my business.” That's what you saw.

You have that point of reckoning where it's like, “I don't know how this happened to me.” That goes 1 of 2 ways. You either suppress it and try not to think about it. Some of us can have the power to make the right step. A lot of entrepreneurs spend too much time innovating, dreaming, and wanting to do the fun stuff, which is great. That's where they should be. That's where a coach or a consultant comes into play. It's like, “I could hire someone else who's an expert at organizing my dreams, and then I'll move faster.” You can do 1 of the 2 ways. I find most people wind up hiring a consultant.

A lot of people look at what I did and hiring someone when I was 28 and frame myself from work and money by 30. People joke with me and say, “Roland, I want to be you when I grow up. They're in their 60s and 70s.” I don't find that funny. I try not to laugh because I don't want it to be a joke. I look at them and I always say, “I did this in three years. I created millions in three years. Would you be willing to do it from age 61 to 64? Would you be willing to put it all in or whatever $4 million?” They always say, “Yes.” I don't find that a joke. The moment that you decide, “I'm going to get help and do things faster,” it starts that next day. It's a decision.

It needs to happen quickly. You need to take action relatively immediately or you're going to sit on it a little bit longer. What are you telling the people that you're coaching with nowadays? First off, I've got to ask you. You've got a superpower. There's something about you, even in my short interactions with you, that there's something different about you that would make you go to a PPS meeting at 15, 16 years of age. Having that network at such a young age, stuff that we're learning in our mid-20s and 30s, what's your particular superpower? What are you trying to instill in people that you coach?

That you can choose, I didn't have a bad upbringing. I didn't buy into the crap that people were telling me to do. A lot of people listen, “Go to this school, do this thing, work this hard, achieve this, apply for this, buy this,” and then you're there. I don't know if it was the chain of circumstances of how I grew up, but I never bought into that. I didn't see why you had to do one thing because someone's said to do it. I have to accept the byproduct and the consequences of all of those chains of events and decisions. I didn't see why that had to be the only way. What I saw was what about the way I want to do it?

What about the life that I want? What if all of those checkboxes achieved a lifestyle and an income that didn't serve me well? I looked around. That's my superpower. I never knew what it was. I never thought I was special or I didn't mean it like when people complimented me because I'm like, “I'm just a guy.” In hindsight, looking at what made me different, my superpower was doing me. Taking control of my life, my decisions, what was going to happen to me because I was not going to let it happen and find myself 50 or 60 years old and watch someone else live my life. That was not going to be the way it was going to be.

I'm sensing that you had an inner purpose. Maybe it wasn't detailed, written, and smoking regularly by you to yourself, but you had an inner purpose and you knew there were things that you wanted to do from a very young age. I'm putting out Nathan's theory here on Roland's life. I like to come back to purpose because it's usually when you get to that point on a Friday that you're talking about when you're like, “This isn't working for me.” Your actions and your purpose aren't in alignment. When you get to that point, “This isn't what I'm living for. I'm acting like this. I know what I want and I need to do something different even if I don't know what it is. What I'm doing now is not fulfilling that purpose and I need to go find it.” You were willing to invest in or take your patient load, push it off on someone else in order to take the time to find it. What you've done since then has been a lot of cool stuff.

You can either let your life happen or you can become a little bit more aware of the things that can change it. That's all it is. Nathan, I'm talking about a tiny little bit different. It’s that what if because if you can ask yourself what if at any point in time, I was lucky to start asking myself that at about 8, 9. You can ask yourself at any moment. I had a coaching call with a guy in his 50s. The theme of the call was what if you could and it changed his plans, his perspective on, what if it could happen? You'd be surprised if you make that shift. One of the coolest things about the COVID shutdown is impossible all of a sudden is possible. All this stuff that we refuse to see, it's changing and happening. We all joked about uncertainty is everywhere. It's everywhere now. You cannot deny it. Every time you turn on the computer, the news, something crazy you didn't think was going to happen happened. Anything is possible. You can take control. Even in an uncertain circumstance, you can make the choice all day long.

PTO 106 | Running Your Clinic Remotely
Running Your Clinic Remotely: The coolest thing about the COVID shutdown is the impossible all of a sudden becomes possible.


That's what comes out of these uncertain circumstances are people who would take advantage of the opportunity and make changes for good. Anyone out there that's reading, I challenged them during the pandemic to not go back to business as usual. If you did, you lost a golden opportunity to reset and make your clinic what you want. Make your company exactly what you want, make your lifestyle exactly what you want. Push the reset button, not necessarily pause, which is push reset and let's do things differently. Get out of your clinic, do what you want, figure out your purpose to go back to that, but ask yourself questions. What if, because we have these ideas like, “I can't hire a PT because I'm going to lose money on that.”

How do I afford that? What if you could hire the PT and make money even more than what you're making right now? Now working into that frame of mindset leads you to action and inspiration or using a question that another coach asked, a successful PT owner that I know, Jeff McMenamy, on a previous episode as if you had all the money in the world, what's the next step you would take? We're not talking about go buy an island or your favorite car. What's the next step you would take in your business?

If money wasn't a concern, what's the next step you would take? That takes money off the plate and focuses you back on what you're doing and your purpose again. Are you fulfilling that? Those are viable questions especially ask at this time is what are you doing? What are the possibilities? What could you do to have a more fulfilling life, a better lifestyle and see your family more, be with your kids more, enjoy your hobby, you name it, be in Airbnbs for a couple of months at a time of going all over the world like Roland?

I liked it because PTs are a special group of people. I finally got my first PT client a couple of months ago, which was fun for me because given that was my background. It's a fun thing to do. A little bit more knowledgeable in the area, I suppose. They're a special group of people. They have a gift of healing that is deeper than the hands. These are individuals that chose a profession that they knew going into. It was undervalued, underappreciated, underpaid. They knew this. They didn't care. They signed up anyways. That's number one. Number two is the style of treatment and the way that we are trained to perform, the way we want to perform provides something almost supernatural in the sense that we provide them a safe place to heal. It's the way I've seen it.

The reason I'm going in this direction is that it’s extremely valuable and everyone wants it. The problem is only 10% of the population knows how valuable it is. This shut down, they want normal. Normal is different now. It's not coming back in the same way. It probably won't. It probably shouldn't, but here's what PTs can provide people. It’s that new sense of normal within a healing and empowering environment. You can now allow whoever your ideal client is to come to a safe place where they can have this new sense of normal and almost reinvent, whatever it is that you, whatever your transformation is that you sell. If it's chronic pain and people who have been able to yet forget about their pain, maybe for the first time, or if it's athletes and they're achieving a college-bound dream that transformation is the new normal.

They're no longer going to seek the same things they did. I would also argue that I used to seek comfort and safety in social media. That's been destroyed over this because it's full of so much junk that even that's not a safe place, but we're exhausted looking at it. They're looking elsewhere. If you don't show up for them and become that solution, they're going to find a different place to be normal. It's a cool place as a business owner, especially a PT owner, to be that solution for the people. The intention is there and it's cheap and/or free and they want it. You need to be there and be a PT for them.

You've mentioned that you had your first PT owner that's a client. How does your coaching differ now as you're working with a PT owner compared to other executives that you're working with? Do you notice a trend with the owner that you don't see in the others?

On my website, I created a tool. My team made one for you. It's That will get you to my tool download. It doesn't differ. That's why I invented this tool. That tool made me multi seven figures and still is in my PT businesses. What I realized was it's all the same stuff, clearly being the solution, clearly not to you but them. It’s learning how to communicate what you do for them, not the features, but the real transformation. You probably don't know. You haven't spent the time. It's not your fault. We're caught up in our stuff. Being the solution for them, positioning yourself as an expert, and the answer. Bringing your clients to you and not constantly spending money and time trying to get to them. If you do those three things, it's the same elements in business. Business owners outside of PT are jealous of how easy it is for us to do those things. Be the solution, be an expert, and create an environment where your clients want to be. We have that easier than any other business.

The less it's about you, the more trust you will gain. Click To Tweet

Tell me about step number three. The story that always goes around is that no one wants physical therapy. They want personal training. They want maybe diet help and that stuff, but no one wants to go to physical therapy. How do you create an environment where people want to come? You don't have to go out, grab them, and pull them off the street.

Is this the secret that we’re getting into?

It’s no secret at all. This is the seven-figure answer. I use the same tactic with all of my clients. It's nothing new. It's been done around. There's a difference between those that decided to own it and those that are too scared and want others to own it for us because we don't want to take the responsibility. It's bringing your clients to you can look like anything. You weren’t me and you were doing it now. We're creating a place for safety, content, and empowerment so people can achieve whatever they want. They're going to seek that out. You're either going to watch other people do it or they're going to be the ones helping everyone. That's what it is. It's free to help and it's whatever is your jams.

My tool will walk you through if you don't know what your jam is. It will walk you through why people are drawn to you and helping brainstorm there. I've done a good job of nailing it down, but create an environment there that people can come to you for help safety, security, success and friendship. It does not matter. The only thing that matters is you choose the one that's most authentic to you. Nathan is a podcaster and we love it. He's a great host. He's a resource. He's friendly. We are drawn to you because of that. If I need help, I'm going to reach out to you. That's the same element across all businesses and PT brings them to you.

I love that concept because in a previous episode that I did with the founder of Keet Health. His whole history was that you can triple your marketing efforts if you focus on the patient experience. That's partly what you're talking about here in creating an environment that you say is safe, where they want to be and it's comfortable. If we spent more time focusing on the patient experience, not necessarily the care so much, maybe you are. You already said we're already masters in what we provide in our care. What's hanging on the walls? What are the colors? What does the front office room look like? What magazines do you have there? How is the front desk presenting themselves? How do they call you on that first call? Is it drab? When are we going to get in? What's your insurance? Is it cordial, nice, welcoming, inviting, and safe as you mentioned? Focusing on that patient experience, what his theory was triple your marketing efforts.

It’s word of mouth. I love it when people say, “My clinic's word of mouth,” or “Primarily word of mouth,” and they blow it off. You can control word of mouth and you always were controlling it. It's by giving people something to talk about. That's why these successful businesses are successful is because there's a reason to talk about you. The more we can give them those reasons, the more this thing, this mystery of word of mouth. It's not a mystery. You can dictate that. You're either doing great work, which is good and good for you. That's fantastic. I agree with you. What if you could triple or quadruple that success by simply taking more time to amplify what they're already saying about you?

Be intentional about the word of mouth marketing because I agree with you saying that. It gets me thinking. We think of word of mouth is this nebulous thing that happens outside of our control. From what you're saying is like, what if we took control of the word of mouth and use it to our advantage? We're intentional about getting referrals, improving the patient experience, such that they talk to their friends and family about what you can get out of blankety-blank physical therapy. It's more than the therapy. I love the people. They’re another family. We've heard it all before, but what if you were more intentional on your end to make that a real strategy and a push?

The game as awareness, Nathan. It always has been and it always will be. How aware of other people's worldviews and how they blend with yours and your worldview, that's the name of the game. It always has been. Acknowledging that other people see the world a certain way and that when they see the world, the way that you see it, they feel something different. You want to look for what those things are because that's the difference between a mediocre business and an excellent one. The mediocre one continues to speak to the same 15% of the audience. The aware and enlightened business owner continues to be able to speak to a wider and wider audience and still is the answer for them. Because you are more intentional and more aware of the other world use out there, you're resonating with twice as many people. Emotional intelligence is always where you start. If you think that you've done a great job by the book again and read it. I always say this, unless you're getting 100% of the referrals in town, you can always communicate better to someone else.

If you are getting 100% of the referrals in town, FYI, that's only 10% of the population that needs physical therapy.

There's another 90% who you haven't been able to resonate with yet still. It's always being able to connect with a wider variety is the ticket.

Anything else you want to talk about or have we hit all the magic that comes from Roland? I know there’s plenty more.

The thing I would say would be to speak to the PT owners. As I've gotten more and more involved with a privately-owned business, the more and more I have realized that PTs need to take a step back and realize what we're doing for the community. I don't think it's pain. I don't think it's inferior glides or this and that. I don't think it's returning to anything. Our heads got a little inflated through the DPT era and afterward around trying too hard. When I look around other business owners and even other healthcare professionals, we might poke fun at them a little bit for these little gimmicks and shortcuts.

Let's use dry needling for a great example. We got access to this cute little thing and look at the tremendous response nationwide. We have patients, all of a sudden, are willing to pay cash in areas that they never would have paid cash for. It's all from us being a little open to making things simple, accessible, and allowing them to have a platform to give us money for something. I watched that example and I can't help but think if we stopped trying to be fancy and giving them things that they honestly never asked for. That's the thing I see in PT is the patients didn't ask for a lot of these things that we're trying to give them and do to them. I would ask everyone to take a step back and think about, what did they ask me for?

Gear all of your communication, your skillset, and your internal staff development around what the patient and the physicians asked you for. I don't think we've done a good enough job of that. Every time I go to the conferences, it's always fancier, more internships, residencies, fellowships. The patients didn't ask us to get a fellowship. Keep pursuing them, keep getting better. I don't think we need to tell them about it. We become good and show them other ways via what they wanted from us. We will disappear because the more and more obsessed you are with yourself and what you do, the less people care because you're getting further away from what they want.

What did they want? They'll pay a lot more money for a regular massage than a physical therapy session because they want that. Getting to the heart of what they want and when you find out what they want, then they'll come back for it over and over again.

You'll be the solution if you communicated that you're the solution. I don't think PTs do that. We take up all the real estate on our websites and our luncheons with doctors. We get this one lunch with a doctor group maybe for the first time in three years and they won't have us back again. Maybe you'll get on the phone with them, but this is your time to shine. Do you know what we do? They always ask us to tell and I say, “We're here to eat lunch with you guys. We don't need to ask away and being a resource.” Why would you botch that one lunch with talking about a bunch of stuff they didn't even ask you to do? Every time I say that and I say, “She asks a way,” they ask about my dog's name. They never asked about the PT until the last sentence is like, “How do we refer to you?” It's like, “Thank you.” They never asked. They just wanted a friend.

They wanted to have lunch with a real person. Let's go beyond patients as specific referral sources. They're not asking for this stuff. For you giving it to them, it is a little salesy. Here's my thing I always tell everybody, Nathan, and we can end on this, trust equals credibility, reliability and intimacy divided by self-orientation. It doesn't matter the details of all of those. One you need to focus on is the self-orientation. This can be your phobia of asking for more money. This could be your complex about a competitor in the area who's better. Anytime you say something that indicates a credential you took, a class you took while you're better than someone else. They never asked you for that. You're amplifying that self-orientation meter and it is on the bottom of the fraction. You might think you're helping them by saying all these certifications, they don't care. The more and more you talk about yourself, it might hinder the agenda because you might become expensive than somebody who wants to do your thing. Whereas if you listened, it would go a lot further.

PTO 106 | Running Your Clinic Remotely
Running Your Clinic Remotely: The difference between a mediocre business and an excellent one is the mediocre one continues to speak to the same 15% of the audience; the excellent business speaks to a wider audience.


I love the equation because if you think about it in true mathematical terms, the less that the relationship is orientated around you, the greater that trust goes up. The less you make it about you, the more you increase that trust. Patients don't care about all the letters after our names. That's nice, but when they get in the door, they're going to say to the same thing, “How are you going to help me?” There's a lot of different answers to that. If you make it technical, they'll know that you're not listening. If you ask more questions and turn it back on to them, that's when you'll start recognizing the true answers and what you can provide. It goes even further. I want to talk to relate that to physical therapy ownership.

A lot of owners think that they are their clinics. The less they can make the clinic about themselves, the greater their business will become. When it becomes about a culture, a team and an environment, that's when you see multiplications of increases in business and employee satisfaction, that's when your influence gets multiplied through the community. When your business is focused on Roland Cochrun, if the business is focused on Nathan Shields, I recognize that for years before I finally got some coaching and talk me out of it. The more that's focused on you, the less trust you're going to have in the community and the less impact and less power you'll have as a business itself.

I wrote an article and it was the six stages of business self-awareness. I made them up. I don't like to read. I was talking, but the final stage that I came up with through my coaching experience is exactly what you said, impact-driven. It's when you finally arose above everything. It's no longer about you. It's not about your immediate circle. It's not about your clinic. It's not even about your community. It's bigger. It's about the cause. Once you can become obsessed with the cause and the movement that you're trying to make and nothing else matters, that's not only when we are the most fulfilled, but if you look at people doing that, they've made the most amount of money.

Everything else is a byproduct of that.

They live in their car. We glorify these software tycoons. They might've still been making hundreds of thousands or millions and they're still living in the garage. Buying the house wasn't on the radar. It was the cause. It was the mission. It was what they wanted to do that was important. They have the money now. They got a nice house, but the cause was the most important thing. Most of those guys went bankrupt in the opposite direction, even though they had the millions because it was the cause.

In that situation, it's less about the individual. They had a vision and everyone worked toward that vision. They weren't working for Bill Gates, per se. They were working for Bill Gates’ vision of what computing could be.

To speak to that in terms of what truly gave me freedom, it wasn't the money, Nathan. It wasn't the referrals. The business became free. When I developed a platform for my staff to be impact-driven and to let them define it, that was when freedom happened to me. The money was always there. I'm a business person. It wasn't difficult for me, but I didn't care about money. It was the freedom I was after. Until you give them a platform to thrive and make them excited to thrive, and they believe it, you'll be owned by something until that happens. That's across all businesses. They will never fall in love with the cause until they know you believe it and they know that it serves a greater purpose. At that point in time, they'll work hard for you.

Thanks for your time.

I'm glad we did this. It’s been a couple of years almost since our first email. Here we did it. It took a COVID shut down, but we did it.

If people want to get in touch with you, how do they do that?

The easiest way is right through the website, you need to go to or for purposes of this, to make it easier for your audience, would get you directly right to that tool. Take that tool seriously. I don't want to hear from you until you're done. When you've done it and put your all into it, then you can email me and ask for advice. I'm going to want to hear about the exercises first before we dive into it. You'll find the tool extremely helpful. You'll see the dollar signs there. is the easiest way. I'm accessible. I'm around.

People will never fall in love with a cause until they know you believe it and that it serves a greater purpose. Click To Tweet

I'm going to check it out. I'll be one of those people on the website.

Thank you. I'm glad we did this. I love connecting with you. I love private practice. Always reach out to all of these guys that all of us want to keep private practice owners alive, well, healthy, free. There is no reason why things should not be exactly the way you want them. It is an abundant world out there for PTs truly.

Thanks for your time, Roland. I appreciate it.

Important Links:

About Roland Cochrun

PTO 106 | Running Your Clinic RemotelyRoland Cochrun is a PT clinic owner that has successfully removed himself from his business and travels the world running his clinics remotely.


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TEL 14 | Adapting To Disruptions


Eric Miller of Econologics is back on the show with Nathan Shields to talk about money. His episode, released a couple months ago, is the most listened-to episode in the two-year history of the podcast, discussing what PT owners needed to do financially as they slowed down during the Covid-19 pandemic. Now, as clinics begin ramping up, he's back to discuss what owners need to do to re-establish their financial foundation and set themselves up to weather any future downturns. He lists five accounts each owner should establish and the mindset needed to establish wealth. It's simple yet takes consistent effort and intention.


Listen to the podcast here:

Re-Establishing Your Financial Foundation: Ramping Up After Covid-19 With Eric Miller

I've got a returning guest, one of my favorites, Eric Miller of Econologics. Eric, thanks for coming on again.

It's always a pleasure and a privilege. It's good to see and fear the beard now.

Also, be jealous of your tan. You are doing well down in Florida enjoying the sun. It's great to have you back here, our favorite financial planner. I love going to you for advice. In your episode, we talked about financial management through COVID-19 is by far one of my most read blogs. You shared some great wealth of knowledge, but we're in a different space. People are still hurt. They're not running at peak efficiencies. There's somewhere in the 40%, 60%, 70% productivity range. Private practice owners are gradually getting back into play. Some might even still be shut down, but we want to talk about what we can do to reset financially. I've talked in past episodes about resetting business-wise, our goals, purpose, marketing strategies, how we see our businesses and getting back into them the way we want to build them back up again.

Let's talk financially about ramping back up and reestablishing some fundamental aspects to our financial foundation in our business. That will do a lot of us good as we start looking forward. I know you're going to talk about this, but to summarize, we're going to talk about PPP loans, how to use some of that money and how to eventually be in a better position to withstand these issues going forward. Let's start with some of the PPP stuff, to begin with, unless there's something you want to get off your chest right away.

The whole idea is that we have to get the attitude that we're all going to try to get into financial beast mode. Let’s forget we're trying to get by. Let's have the idea that we can get in financial beast mode, which is a term that we're starting to use a lot more. Let's up the game a little bit. Let's up the intensity of what needs to be done to get our financial house in order.

It does so much for you to be financially sound, provide so much freedom, and puts you in a position of power that you otherwise don't have. When you can establish the foundation financially, be profitable, and force that profit from your business. There's so much power to come from that.

You can relax to that degree and when you're relaxed about your money, it's amazing to watch what happens. The best opportunities that I see that come to practice owners is when they're relaxed about their financial condition. That's when they seem to get the best opportunities that come to them.

It seems like those opportunities find them. You don't have to go far, they'd put the word out here or there like, “I want to invest in something.” They get resources, they do some due diligence and suddenly, you're making money on top of money.

Good things happen to you.

Tell the owners what they should be thinking about with the PPP. A lot of them got funding, probably the majority of them. How should they see that money? What should they expect?

The best owners are very patient with investing money but impatient with the money coming in. Click To Tweet

As you said, a lot of practice owners are around 60% to 65% back to seeing the patient that they were at. A lot of them have gotten this influx of money that is sitting in their checking accounts. The first thing is that when you get a lot of money, you have to pay attention to making sure that it doesn't get spent on the things that it shouldn't be there for. The purpose of the money is for whatever the stipulations were as part of the CARES Act and you should use it for that. At the same time, you're still seeing patients, you're still collecting money and I would be aggressive on my collections line. I would be making sure that when I'm bringing people back, especially in that area, we're collecting money and pushing production back up to the numbers that we need to get to.

You’re saying don’t be compassionate when it comes to copays and deductibles. We need to draw a hard line.

Let's not be complacent. Let's try to break all these bad habits that we had with money in the past. You got to be aggressive on your collections. The best owners that we both seen are impatient with production and not seeing a lot of money come in. They're patient with investing money and being diligent with investing money, but you want to be impatient on money coming in. I would spend a lot of time making sure I was collecting money and then I would make sure that you are controlling that money and you're stacking Benjamins at this point because I don't know what's going to happen in the future. We could get another wave of uncertainty. I don't think the people are going to tolerate another shutdown, but people are still nervous and scared and they may not show up. I would have a lot more in liquidity than what people have told you that you need in the past. For me, it's important that you have that liquidity. I would stack as much money as I possibly can.

If they didn't have it before, people recognize the importance of having a line of credit available to them at any given time. Would you recommend that having a line of credit open and available to you?

I'm always going to recommend that you have lines of credit open for everyone. I would even look at it a little differently. There are five important accounts that every practice owner should have going forward. The level of financial unpreparedness is evident. A lot of practices couldn't survive for more than one month without making any money. That was an economic reality for many practices. There's an engineering term called having a factor of safety. If you're going to cross a bridge and it says, “This bridge can only hold 5,000 pounds,” the engineers didn't build it so that if the car weighs 5,001, then the whole thing is going to come crashing down. They build that factor of safety. As an owner, you’ve got to have that same mindset when it comes to running your household finances or your business finances. You have to have buffers in place. For us, I'm trying to tell a lot of practice owners, “You’ve got to control money differently than what you did in the past.” There are five different accounts that I would set up and make sure that they're part of what my make or break number would be for my business.

Do you literally have five separate accounts?

Yes. I can dive deep into that and quickly explain each one of them. The first one, we call our wealth storage account. That's where the first 10% of your practice revenue transfers from the business to a personal wealth-building plan so that you can create other income streams for your household. That is what we call your owner pay. That is the reward that you get for the risk that you took in putting that business there having to deal with all the employee issues, the debt payments, and the compliance aspect of it. That's your owner pay so we call that the wealth storage account. That would be account number one.

Ten percent gross revenues off to the side down.

Right off the top, like you didn't make it.

I told you before if I had done that from the beginning, my financial situation would be significantly better.

TEL 14 | Adapting To Disruptions
Profit First: Transform Your Business from a Cash-Eating Monster to a Money-Making Machine

It would be good. If you can at least get that one in, you're going to win the game. The second one would be a business protection and liability fund. What's the purpose of this? We all realized that we did not have enough in business reserves to pay our expenses for more than a month. I would start siphoning off money into that account. That's for the purpose of creating about three months of business reserves.

When you say business reserves, would you get that number from your CPA of your fixed expenses only?

You can make it like payroll, rent, utilities and those kinds of things.

A skeleton crew with grants and that kind of stuff. It's not your entire gross expenses. It may scale back a little bit, but multiply that by three.

It may not include all your profits and everything like that, but it would certainly be a number so that the organization can function for at least three months. Not only that, but that money would be there if you ever got sued for some reason. That would be to settle a lawsuit for legal fees. Anything that has to do with the protection of the business. We all realize that big corporations have these kinds of accounts. If they get attacked, they have resources to defend themselves.

Most of our professional liability plans cover us for $1 million to $3 million, depending on our plan but the out of pocket expenses usually somewhere around $10,000. You’ve got to make sure you have that.

It's like weather-related. Sometimes, you have a snow day and you can't see patients. You still got to pay the bills. It's an important fund to have for the protection of the business. The third one was simple. It's a tax account. In any business, most of the businesses that we see are S Corp, partnerships, or LLC’s taxes S Corp. The profits flow through to the owners. You're liable for the tax on the profits of the business personally. It would make sense to work with your CPA, get some a projection of what you think your estimates are going to be, and make sure money is being siphoned in that account. Nobody likes to get a call from their accountant that says, “You owe $50,000.” You’re like, “I don't know where I'm going to pay the money from.”

I've been there a couple of times. I had to learn the hard way. A couple of times, I had to get hit over the head. It's April and my CPA was in a great mood. He was like, “You had an awesome year last year. You made a ton of money. You did great. Do you think you're going to do the same next year?” I'm like, “Yes, I'm going to kill it.” He’s like, “Make sure you put a check in the mail for $80,000 for the IRS because it's April 14th.” I’m like, “What?” I had to figure that out quickly. Setting money aside is important too.

You want to set money aside for that. At the same time when you start making a lot of money, you're going to want to invest or utilize that money to create tax structures where you can minimize your overall tax liability. You need money to do that. They set up structures so that they can utilize them to offset their taxes.

When you say other structures, you're talking about other LLCs that cover your family, toys and cars?

Practice owners are overachievers. If you don't have a target, you are doing yourself a disservice. Click To Tweet

Yes, or other advanced tax structures like conservation easements or captive insurance companies, things that you can create, but you need money to do that. That can help offset. You can either pay that or the IRS, you choose. I'd rather do that one right there. The fourth account is simply going to be a business expansion account. How I try to look at this is there's this idea that you have to use debt to expand. You can use debt to expand, but I don't think it's always necessary to have to use it. In business, you should be able to have enough profit where you can reinvest some of the profits to use for expansion, either buying more equipment, buying satellite practice or putting 20% down on a new building or something like that. The idea that I always have to use debt to expand, I don't think is necessarily true. I would have some business expansion funds that you use to facilitate the growth and expansion of your business.

Especially as physical therapists, when we expand like that, that usually entails hiring on a physical therapist which is going to require some upfront salary before you get a return on that investment. Whether it's a new PT that you've got to bring on or tenant improvements that you need to do the space to build a bigger building. They want the cash upfront for that and the bank is going to ask you to put some cash down in these situations, have some available and ready for you. That way, the opportunities before you with so much cash and reserves specifically for business development make it that much easier.

Let's say that you did borrow a bunch of money to expand a bunch of practices and all of a sudden, they shut down the economy. You then have no money coming in and you have all this debt service to pay. It's another reason why I have a mindset that I don't necessarily need to always borrow to expand. It doesn't mean that you don't borrow money because borrowing money for expansion or cashflow producing assets is warranted but not necessarily all the time, especially for a PT practice. The last account, my favorite account, and I came up with this, so this is mine. It's called a celebration account. A lot of practice owners wildly don't celebrate their victories as much as they should. It's a grind sometimes and you need to celebrate to get off that mental charge that accumulates with that grind. I have people siphoned out. It doesn't have to be much, it can be $1,000 a month or something like that. It’s like, “If you hit the goal, I got this $10,000, $12,000, $20,000 and I'm going to blow and have a celebration of some kind.” It's important to have something like that as well.

Life is all about the experiences. If you want more cool experiences that you can generate, how rich is your life? The cool thing I like about all of these is I've done this to a certain extent myself. It makes it so easy if you have automatic transfers. I have my tax account and I know how much my taxes should be at the end of the year whether it's property taxes or personal taxes, we can estimate and whatnot. I have an automatic draw from the business account into that account. Same thing with my Business Protection Liability. I siphoned off a little bit of money so I never have to think about it. You set it up one time and it siphons money off every month. The money was never there, to begin with. It's not like you're writing a check and grimacing at the same time.

A lot of practices have an opportunity to set these accounts up. You want to set it up automatically and systematically doing this. What it does is it puts an expense on the business and that expense needs to be covered by demand of income. That's why it works. That's the only reason why it works because the business now gets accustomed to it as an expense style. I would start small and then build up over time in doing that but if you can get most of these accounts in as expenses, then you are never going to have to worry about turbulent financial times because everything is covered. That's how it should be. That should be normal. It shouldn’t be, “I have to borrow $150,000 or $200,000 from the government to save my bacon.” I don't think anybody wants to get in the habit of doing that because it makes people not be responsible necessarily for their money condition if there's no way you can lose.

Let's take this as an opportunity as the lesson learned. Hopefully, for most of the people out there that are reading, they weren't completely devastated. They have an opportunity as they're building back up that they can establish these different accounts and set up for their future. The Wealth Storage Concept that I had Christopher Music on, one of my first episodes in 2018. By the way, we had our anniversary here, the first part of June 2020 with a contest. He mentioned 10% off the top and that blew my mind crazy. Since I’ve read about it with Mike Michalowicz in Profit First, and he has a great way of laying it out and whatnot. Even if it's not 10%, to begin with, how easy would it be to start with 1% or 2% of your gross revenues, siphoned off and then increase by a single percentage point every month or two until you get the time? You can either rip off the Band-Aid and go straight to 10%, or you could gradually build up if that’s going to be a little bit hard for you.

I wouldn't encourage that. I would start with like you said, a flat dollar amount and then automatically program it up over a 10 to 12-month period until you get up to your 10%. It gets the business accustomed to that as an actual expense. That's the best way that I've seen it done but it works either way. All of a sudden, you’ve got a couple hundred thousand dollars sitting in your wealth storage account, your business accounts are looking healthy and you feel like you're in control of your money.

It puts you in a position of power because the last thing you want to be is in the same situation that you were, especially if you got negatively affected by the pandemic. You don't want to be in that position with so much going on around us, so much unrest and many questions about the future.

Not me, not at all. Think about how people are feeling now. You almost felt like a dartboard like everything was happening to you. Unfortunately, a lot of that has to do with how the system is set up and a lot of business owners feel that way. They're under a monetary system where your money is not worth anywhere near it was years ago because of inflation and they're putting more money now. You're under a political system where you're like, “I have no idea who to trust. I don't believe either party. I don't believe anything that they're saying.” We were under a tax system that's completely ambiguous and hard to understand. You're under a healthcare system.

I don't have to tell PTs about the healthcare system. You're under a legal system where the rights of you as an owner are underneath the rates of employees or anybody that would want to target you for your money. You're under an investment system where you put all of your money in the stock market. We'll hope and pray that everything will turn out even though I don't have much control over that. I can understand why practice owners are spinning around sometimes but there is a way to fight back. The first thing is that you have to take the viewpoint that I can do something about each of those and then get a plan together on how you're going to fight back because what's the alternative?

TEL 14 | Adapting To Disruptions
Adapting To Disruptions: The derivation of the word decision means to cut off. When you make a decision, you cut off anything else that would prevent you from reaching whatever that is.


It's not hard. That's the thing. There are not a lot of mental gymnastics going on here. You have to open up a few bank accounts and spend an hour or two setting up transfers. Over time, there’s a lot of comfort in knowing that everything is managed financially.

All of those things I mentioned can be done in such a short period of time. The actions that you would need to create in order to change your financial trajectory. People think it's going to be this long and arduous process and it's going to be like, “I'm going to have to change my lifestyle and all that.” You do a little bit but at the end of the day, isn't it worth it to pay the price for the next 2 to 5 years to have the rest of your life where you never have to worry about money again? To me, that's worth whatever uncomfort you'd have to do in the short-term to put in the systems in place so that your household and your business can flourish over the course of the next 30 to 40 years. Don't be shortsighted about things. Don't fall in the trap of, “I always have to have the nicest car or the most expensive house.” You can do all those things but you have to follow good financial habits and pay a little price in the beginning.

I want to touch on quickly that came to me. It was something that an exercise that we went through in your three-day Financial Freedom Summit that you have done. It was simply an exercise that you took. The group of us, but it was me and my wife, sitting down and determining what our monthly revenue goal was as a household. I wonder if that's appropriate for people to consider because you did a previous webinar about readjusting your 2020 goals for your clinic. It's a good time to consider our financial goals for our household. If you haven't gone through the exercise before, figure out what is that monthly goal that you have in revenue that comes from your clinics to your home? We set a number that is that's high for us. At that time, we're like, “I don't know if that could happen.” That's our number. It's not just meeting our expenses, it was double of what we assumed our expenses would be. It was crazy which would make us living high on the hog if we can get to that but it's getting close.

I'm telling you, if you don't have a target, you are doing yourself a disservice. Practice owners are overachievers. They love to achieve targets. This is the problem I have when people are working with financial advisors. I asked them, I was like, “Did they give you an actual income target for your household? How much money do you need to make? That doesn't consist of what's going to cover to pay your ‘expenses.’ That would include you putting money away into investments to create other income streams that would include your taxes and the other goals that you have. How much do you need to make to live the life that you want to live?” It is unlimited. Once you get that number and you see it, it's not a confusion. It's a certainty point. All you have to do is say, “I thought it was $200,000 a year, but it turns out that I need to make $400,000 a year. How am I going to do this?”

The good news is you have a business. How much would I need to get this business up to where I could earn $400,000 a year for my household? You operate on that target. By doing that, it's amazing what happens. Year-after-year, client after client, when I give them targets, I look back and I show them like, “Remember when we gave you that target?” I look back, “How much have you made?” They're like, “I didn't think about that.” I'm not taking credit for it but it's part of giving the observation of things and giving someone some reality that, “This is what you need to do.” It increases your necessity level, financial awareness, and demand for money. That's the secret sauce there because all I do is show people how to channel it, control it and hopefully expand it but it's your job to go out and make it.

It's a cool exercise. The coaching clients that I have, I'll say, “What are your financial goals with regards to the clinic?” “I want to pull $200,000 a year from that clinic.” I'll say, “What does that mean? What profit margins are you running at? How many visits does that entail? Are you working full-time or part-time or not at all?” That stumps them. They want to get to the number. Working backward and figuring out it's not a number, it's an ideal scene that you want to get to. Let's get clear about that. Once we have some clarity about that and what your part is in that ideal scene, let's work back into the numbers and see where the gap is between where you are now and what you want to be at because you'll then recognize that, “I'm only seeing eight new patients a week. I need to bump that up to twenty.” “What are your marketing efforts going to take to get from eight new patients a week to twenty new patients a week?” That starts giving you some action items but if you have some clarity about that number, there's something magical about putting that intention out in the universe.

You hit it right on the head that the clearer you are precisely what you need or what you want your scene to look like, the better you can compare it to where you are now and you can see what the outpoints are. For a lot of people, the gap isn't that much. It doesn't take a lot to bridge that gap but you need a plan. You need someone to hold you accountable to making sure that you're hitting those numbers as well. That's an important part.

That's huge whether it's a financial planner. Honestly, a lot of the financial planners that I have had in the past aren't good at communicating in those aspects. Finding the right financial planner and a coach that can walk you through that thing is important. They make you verbalize and hold you accountable like you're talking about. That's a huge part of the process. Another success story. One of my first guests was Sean Miller. He sold his practices at the same time we did, but five years earlier, he said he had a number in mind that was like, “I want to get to this number as far as wealth. I want many thousands or millions,” whatever that number was for him. Five years later, he hit it and there's something to it. We're talking about action steps and that stuff but sometimes it's simply the intention is out there, you visualize it, you have that number and you keep that number in your head.

It's a decision that you make. You look at the derivation of the word decision. It means to cut off. When you make a decision that you made, you cut off anything else that would prevent you from reaching whatever that is. There's some power behind that. I can't explain a lot of things but you can observe the phenomenon and know that it's true because you observe it.

Once you make that decision or things, that tend to fall in place.

It's important that you get a plan, get some direction, and be very precise on what you're trying to achieve. Click To Tweet

As long as there's a good purpose there. Another thing too, you keep your ethics in good shape and that to me is a secret for success because if you're doing the right things, there seems to be a reward for that. People that are doing immoral, destructive actions, there is a penalty to pay on that one. That's a whole other webinar.

I did another episode with Mike Bills. It was simply not so much that he was doing anything immoral, but he put more emphasis on improving himself. As he did that, as he focused on himself making his time sacred and holding other people accountable around him, his business tripled in about eighteen months.

It can happen so fast.

It can happen quickly. There's some power to maintain your ethics and don't sleep until 10:00 AM. You're not going to get to your number by that, but to maintain your ethics, hold that number fast and steady. As you said, the clinic owners we're overachievers, we'll get there. We'll find a way.

We always do. I love it.

Thanks for coming on. Any parting shots? Anything coming up with the Econologics that you want to share?

I would say to your readers, we're offering 15 to 30-minute free consultation. If they want to contact us, then they can certainly meet with one of our specialists and we'll cover any questions that they have from a financial aspect. I would not wait. I would not pause and contemplate what I'm going to do with my money. Now, it's important that you get a plan, get some direction and be very precise on exactly what it is that you're trying to achieve because the dangers of not doing something like that are too great. There is going to be a different financial scene in this country in the next years.

The people that know how to produce, manage their money, control their money, invest it correctly and stay out of debt, all those things that we show people how to do are going to be rewarded for that. The people that are saying everything is going to go back to normal, I'll do the things that I did in the past. You're going to get punished at some point in time because it goes against natural law. My call to action is to get on a plan, get with someone that can hold you accountable for your actions and you can reach out to us. I'll give you a link or something like that, that they can schedule a 15 to 30-minute time with us to talk.

Go ahead and share that with us. What is that? How can we get in touch with you?

You can always go to and reach out to us that way. We've got a YouTube Channel as well, Econologics Financial Advisors. That will be a couple of ways you can get ahold of us.

TEL 14 | Adapting To Disruptions
Adapting To Disruptions: People who know how to produce, manage their money, control their money, invest it correctly, and stay out of debt are the people who will be rewarded.


You have some great webinars coming out every so often. The next one is Seven Tax Saving Strategies and stuff like that.

We're going to talk about taxes. I do want to mention that too because a lot of people that have gotten all this money from the PPP loan that they're hoping to get forgiven and it may, but at the same time, you're also building up all this cash from the money that you're not spending now. You’ve got to be a little cognizant of how much you're going to have to pay in taxes. I would tune into that. We'll give you four fairly simple, powerful strategies that nobody is using. I'm going to give you two advanced tax strategies that can minimize your taxes by $20,000 to $50,000. It's worth tuning into that and then we're going to talk a little self-storage and real estate investments. We're going to put out a lot of good webinars.

Hopefully, people stay in touch and stay in tune with what you're putting out because you've got some great content.


Thanks for coming on.

Important Links:

About Eric Miller

Eric Miller has been in the financial planning industry for over 20 years. He’s a co-owner of Econologics Financial Advisors – awarded an Inc. 5000 honoree for 2019. As the Chief Financial Advisor for the firm, Eric has had the good fortune to have over 10,000 financial conversations with private practice owners in various healthcare industry and helped guide them into a more optimum financial condition using a proven system.


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PTO 104 | Ownership Journey


It's been two years since the start of the Physical Therapy Owners Club! Hard to believe the podcast has been around over two years and 100 plus episodes. The PTO Club has generated some great content for and from PT's across the globe and is a dream come true. In this episode, Nathan Shields and Will Humphreys, Nathan's business partner, spend some time reflecting on the beginnings of their ownership journey and some of the faults, triumphs, and relationships along the way. Follow along in this special conversation, reminding you of how your journey may not be that lonely after all.


Listen to the podcast here:

2nd Anniversary Special: Nathan Shields and Will Humphrey’s Ownership Journey

I've got a frequent flyer guest. One of my good friends, Will Humphreys, is in the house. Will, thanks for coming on.

Thank you. I appreciate it. I love being in the house.

Thanks for joining me. I had you on before and we're still surviving through the pandemic. PT owners are starting to ramp up a little bit. Some places might still be closed. I don't know if they're getting the 50%, 60%, 70% range in productivity and whatnot. Last time we talked about what people can do while things are shut down or slowed significantly. We're going to talk about a number of different things. We're going to go back in history a little bit. First of, what have you been doing since we last spoke?

It's interesting because as I went to Europe for six months with my family. I came back to Empower Physical Therapy, our company that we love and cherish. Gratefully, they were at a point where things were going pretty well. I started having some ideas of how I could better serve the industry. They've been incredibly supportive over there helping me go out and do other things. What I've done in the last few months are a couple of things I'm excited about. One of them is like a dream. Something I've been wanting to do for many years and I'm actually doing it. One of them is that I started an insurance billing company. It's called In The Black.

You were getting things going at that point.

It's been crazy because I came back with a different proposition than what's out there for billing companies. There are a couple of good companies out there that I love that are PT-owned, but none of them address all of the different influences that impact our profits and finances. We're a full RCM business, which means that we don't just do billing and collecting. We also do insurance verification. We do provider credentialing. I also provide training to front office and back office as part of that. There's no additional fee to that. It's been fun because we look at all the items, including P&Ls and what shape of company. When I was a PT, I used to think that an outsourced PT comp billing company was the worst way to go.

We had some bad experiences. You know how they do it wrong.

The biggest thing is when I did end up having what you and I created, it was your hire that led to this in-house solution that was massive. It was unreal and ultimately, it was the biggest reason why when we came together and merged, our company did so well. I wanted to share that message because I believe profitability unlocks possibility. You and I didn't know how freedom felt until we were able to get the profits to help generate that. When I did that, that's when we looked at Alaska and that's when we looked at all these things. In The Black, the website is coming out. We stopped taking new customers for the next two months because we had such high demand when we've opened. We're satisfying our first twenty locations. They're loving it, which makes me happy. We try and keep close relationships, which is different. It's been going great. We will be taking new customers for any potential audience in a few months.

For those who are reading, your website should be around August 1, 2020. You'll be taking more customers at that point. I don't want to disparage outsource billing, but because of our experiences, you know what people should truly experience from their billing company, whether it is in-house or outsourced. I talk with my coaching clients all the time about the statistics they need to be looking for and the reports they should be receiving from their biller because many of them are like, “I don't even know how to judge if they're good.” That's where we were many times until our biller showed us proper reports and statistics, we didn't know if they were good either. As we got that experience, we started seeing how billing should be managed. Coming from that point of view, you can provide a service that lacks out there in the PT industry.

I appreciate that and I do want to acknowledge, there are a couple of companies that are doing it well. I'm a big fan of MEG. I love those guys. I think they're great. Bob's company, billing solutions. There's another company that's fantastic. We were all offering a little something different, but we're all PT-owned. That's the thing is that as PT-owned billing companies, we offer so much more of that relatable advice, experience, and knowledge. That’s been going great and the thing I’m super excited about as well is I have launched a YouTube channel. You know better than anyone how I need attention. I don't know if my parents didn't pay attention to me growing up, but something feels whole when I'm filming a video.

The cool thing is your YouTube channel isn't specific to PT owners but also PT students, which is cool because there's no one out there speaking to PT students. It is pretty interesting that you would take that tag. You share some awesome input and have some great content for PT owners as well. I love the stuff that you're doing right now in regard to C-players and how to find them and handle them. That's great.

It means a lot to me. You were such an inspiration to even do it with this show. It's one thing to have the time and desire to want to put yourself out there in that way, especially when you've been through hell and back 4 or 5 times. You want to share those experiences with your colleagues and ultimately like you, this show, my YouTube channel is a love letter to my industry. It's given me everything that I have. I'm still this incredibly passionate PT who thinks there's no better job in the world. Everything that you and I invested in with coaches and clients and all these things that we've done over the years. I'm getting that information on Tuesdays. At this point, it might shift but Tuesday is centered towards leaders and owners, Thursdays is for students and new grads. It's things like, how do you stand out in job interviews? How do you find a job in the COVID environment? The seven mistakes in most interviews for PT owners is all talking about all the stuff that we've been through and learn from. It's been a lot of fun. We've had a lot of initial success out of the gate. That's a perfect way to say that guys like you paved the way. When you launched your show, there was a handful of shows.

When I first started, there were maybe 2 or 3 that stood out. The reason I wanted to do the show was simply because there was no one speaking to the business aspect. I liked Paul Gough's stuff. He focuses a little bit more on marketing and he has some great insight. His first two episodes, I was like, “This is amazing.” I know there were a couple of them out there. The PT Insiders, but a lot of them were either about marketing or about patient care. I was like, “I want more help as a leader, as an owner.” You and I had developed this amazing network of PT owners and I'm like, “We’ve got so much information out of just picking their brains.” We'd go to these conferences and you might learn something from a presenter here and there, but it was the in-between sessions and the dinners where you sit down with successful PT owners like Coury and Buehler in California or John and Chad out in San Antonio or Blaine up in Montana. I was like, “Why can't there be a platform for those guys to share those successful actions?” I thought this show is a great way to do that and it's been so cool. We were on our 100th-plus episode as of this one.

I'm proud of the content that Physical Therapy Owners Club has generated over the past two years and hope it's a resource for many PT owners going forward. – Nathan Shields Click To Tweet

You're stealing the wind out of myself. I want to announce to the world that this is your second-year anniversary and you've broken 100 shows. It’s amazing. It's another thing to even stay with it for two years. I love that you mentioned some of those. It’s a big thing I want to acknowledge and I hope all the audiences at home or in their car are grateful for guys like you who are standing out, who are building upon the efforts of others to find additional ways to create value. No one is doing it the way that you're doing it and definitely with this kind of consistency, that builds trust. I love how you mentioned the heroes of our networks before and you mentioned some of them by name. When you said those names, I felt chills. I remember what it was as freshmen in high school and there were the seniors. It was like, “These guys are so cool.” Who else would you say are some of your PT heroes?

Who's not a fan of Vinod? He was one of my first episodes. Here's a guy who's got a killer business in New York City but lives full-time in Florida. Who doesn't want to live that dream? I knew Blaine was super successful in Montana, but then I went to Whitefish, Montana, I was like, “This is a cool place and this is where I would love to live.” Blaine was amazing. Those guys are great. I love hanging out with them, and then Bill out in Detroit with HQPT. He's unassuming and then he tells you he's got 15, 16, 18 clinics. He's just walking around in shorts and a tee-shirt.

I’m sure he has a six-pack. He's got zero body fat and if I ever get to the point where I can see my abs, you will not be talking to me with my shirt on.

I loved these guys and they're so willing to talk to you. We were nervous talking to these guys and we feel like the underlings, but they're totally open. They're like, “This is what we do and this is what we'll share and they do presentations,” and you're like, “You guys are killing it. I wish I could be like you.” I still feel that way. They still have so much to offer and that's why I think I'll continue with the show. There have been a number of times over the last few years where I turned to my wife. I'm like, “I need to pay for more production of my episodes.” I don't do all the editing and whatnot myself. “I have to pay some more upfront. Should I do it? I don't know. Maybe it's run its course.” Every so often, I'd get this jolt and I had an amazing interview with somebody that I think is full of awesome content and I'm like, “The PT world needs to hear more of this.” I guess I'll keep going.

I want to challenge everyone reading to comment if you're able to get on iTunes and give some love because what you've done for the industry has been massive. It’s great because we met these guys through a group called Measurable Solutions, which still exists and still has amazing powerful PTs, Mike Bills. The main thing that they presented besides wonderful information was each other and that's what you're doing. You're connecting our industry. As a guy or girl is reading, they're feeling like they're a part of something so much bigger than themselves, which is why we got into this whole career in the first place. Not a single PT I've met in all of the years of talking to PTs has ever had a boring story. Even when they think it's boring, there's this huge emotional draw. As a two-year anniversary highlight, I'd like to ask a few questions about things I don't even know. You mentioned that you did it because you felt like you wanted to create more value. Emotionally, what was some of the first experiences you had? What were some of the challenges? What were some of the initial wins that you had?

With the show or with PT ownership specifically?

The show, let's go into that. I'm sure your audiences would love to hear about some of those experiences in the company as well.

I remember my first episode and I was interviewing Sean Miller, our good friend and partner. I knew he had a great story and so I wanted to share his story. I remember walking through my house an hour beforehand and nervous telling my wife, “forty-five more minutes and I’ve got to do my interview.” I’ve got to sit down and just shoot the bull with Sean. He's still one of the most listened to episode. It was awesome and I came away with that energized more than anything else I'd done before. Physical therapy is very fulfilling. I rarely came away from a treatment session where I was like, “That was amazing. That was fun.” Even if I did that, there was some crappy patient right after that would spoil my day. I'm sure you experienced that. By the end of the day, you'd seen enough patients that you're drained mentally. After doing my interviews, that carries over to my coaching stuff. After doing my coaching client stuff, I can sit on the phone with owners for an hour and a half, two hours and be like, “That was cool.” My wife tells me all the time when I came out of the interviews or I come out of my coaching client calls, I'm like, “What's up? What's happening? The sky is blue and the birds are chirping. Did you guys notice?”

It's cool because number one, I'm curious. I want to know what's making people tick. Number two, I can come out of those interviews and be like, “There was some cool content out there that if the people out there listened and pulled away 1 or 2 things that could help their business.” Number three, helping people simply feel connected so that they're not alone. That's where I felt so much when I started my clinic. You probably as well since you're out in the boonies of Florence. You feel like you're on an island. You're on your own. Who else knows that I'm even out here besides my “competition” within a few miles of me. It wasn't until I started networking and getting consulting that I recognized I'm not alone. There's a whole bunch of people that have already been there, done that and they're willing to help. That's what I wanted to provide owners. There are people out there and you can reach out to them. Almost every episode, they share their contact information. You can reach out to them. It’s hardly anyone takes them up on it, but they can. They can pick these people's brains and they're open. It's so funny to have Dimi on and he'll share his personal cell number. It’s cool and I love sharing with people. It gets me energized.

It’s neat to see you in this space. I've known you for a long time now. It's been many years. I met you in 2003 at Fat Camp. You were my sponsor. Do you remember where we met?

If I'm not mistaken, I met you at church in the hallway or something like that.

I remember meeting Whitny before meeting you. I remember she came out to me and said, “You need to work for my husband.”

She came home and said, “I found the guy that needs to work for you. I found our next PT.”

PTO 104 | Ownership Journey
Ownership Journey: Having a coach improves you not only as a business owner and leader but also as an individual and a father.


We are here because of Whitny Shields. Shout-out to the amazing mother of seven, your wife. She moves to Alaska to start electrodiagnostic company. She's an unsung hero. Tell me, what was it like for you when you were thinking about those early years? Do you have any memories? This is where I'm trying to serve your audience is trying to get them to understand a little bit more about you and what I know, and maybe what I don't know about your background. Can you think of any experiences that you had that were pivotal to your growth? You've mentioned Measurable Solutions and that wonderful network of people, which we'd be remiss if we didn't highlight Beth and Lisa out at Magnolia, Louisiana. Some of the most powerful leaders of all time. Do you have any other moments like that that you think of as pivotal in terms of, “When that happened, things changed?”

Taking the first step was huge. I still have to attribute that to Whitny because I was working full-time for a physician PT clinic for about a year and a half. I remember after work one time, I was like, “I was looking at this area in that area to maybe open up a clinic someday.” I saw a for lease sign of a new construction built down in South Chandler. I gave Whitny the phone number and she was going to call him the next morning when I went to work. She's like, “The rates there are amazing. It's a brand-new build. We've got to open up a clinic.” I was like, “We do? Is this happening?” She was like “Yeah, put in your two-week notice. Let's go.” You know me and change, we don't jive. That's why I married my wife. She's like, “Change is great.” I’m like, “Change sucks.” Finally, we opened that up. The referring physicians down there were gracious and helpful, especially Dr. Paul Evan reached out to me out of the blue and that was great.

All that was pivotal, but you had to learn so much. Back then, I was doing the billing myself. I didn't even know how to do that. I was doing the credentialing myself. I was marketing by myself. I didn't have any support staff. Occasionally, I'd ask my mom to come in and help, be attack or something like that. That was all crazy but outside of the initial beginnings. That was in 2002, pivotal parts were like you and I opening up the Maricopa clinic. That was a huge change and we thought it was going to be a lot easier than it was.

If I look back on it and I'm going to ask the question to you, what I would have done differently. What I would tell myself as a young owner, knowing what I know now, is to get some coaching or consulting in day one. Hire the people to do the work and trust the experienced and professional people to do their jobs. It will get you so much further so much faster. If I could have seen that. I didn't even know that was an option on the table. I'm running by the seat of our pants and doing what we can and saving money here and there. I thought that's what you're supposed to do, instead of investing in the company to help it grow. That's what I would have done differently and it's when I started making those investments that things significantly changed. Unfortunately, it took me close to a decade or more before we did that.

I remember the day we signed up with Measurable Solutions. We went up there for a two-day course that I paid for because I was desperate for help. I paid for 1,000 courses. Last minute, I'm like, “Do you want to come to Seattle with me?” It’s good for two people. You and I hadn't merged our companies yet. There was some separation in our business model, even though we shared Maricopa. When we went up there, it was mind-blowing. We met Steve Rodriguez who is now family to us. I don't even know how many years it was. At the end of it, they're like, “Here's how you get to freedom and here's how much it costs.” Your jaw draws open. You say you don't handle change but you were the one who was like, “I think we need to do this.”

At that point, I distinctly remember we have to do something different. I don't know what it was. It could have been like a webinar packaged for $500 and this was significantly more than that. I would have done anything to make a difference. I wasn't experiencing a life that I wanted to continue living. I told people all the time that, “I loved treating patients, but I hated the business aspect of it. If I have to continue at this pace for another ten years, I'm going to be done. I'm going to be checked out. I don't know what else I'm going to do, but I'll find a different career.” I think that happens a lot with PTs. That's a topic for another discussion. What's funny is since I got the consulting and coaching and networked with entrepreneur’s organization, I don't get the joy out of treating patients as much anymore. I love treating more patients through other people and creating a bigger impact within the community or even within my small clinic to affect the community, to make it a better experience for not just the patients, but also the team members and grow and improve that way. Now I get so much more fulfillment out of being a leader and an owner and giving back.

I don't think that's everyone's journey. The reason that was true is because you were meant to do what you're doing now. The problem with a lot of us in our industry as owners is that we get into that mindset of like, "I did this to treat and that becomes an excuse to not learn what we don't understand about business. Both of our cases, I had a pivotal moment in my life. When it occurred to me, I was driving home in the dark at the end of a horrible day. My beeper's going off because my charts weigh as much as a human being in the seat next to me. I am so burned and it occurs to me in that moment of clarity that it doesn't matter how much I know about patients and patient care and making that process go well. It would never make up for what I didn't understand about business. That's why coaches are so valuable.

I think you are meant to suffer that way because now you're supporting this mastermind, which I got a chance to be with those guys. It's like seeing all those wonderful people in our old group at our earlier stage. These powerful men who were committed to doing something better. Once they get free of the demands of what they don't know in the business end, you can always opt and choose to go back and treat electively, but not because the business requires them. That’s the difference. In your case, you got free and it was like, “I want to share this message with the world.”

What would you tell yourself as a younger owner?

I can't reiterate enough what you said about finding a coach as quickly as seemingly possible. When I came back from Europe and I'm consulting. I'm still working with Empower, but they were like, “Go ahead and have some space to do some other things.” As soon as I heard there was space, I hired a coach as quickly as I could get my hands on. My beautiful patient wife, she saw how much I put down on that. She was like, “I get it.” That's what it is. Freedom comes at a cost and it comes at a price. We probably paid multiples of our PT degree to ultimately achieve financial freedom.

It was hundreds of thousands of dollars.

That was over years but it was a small investment into what ended up creating impact, income and freedom.

My wife is the same way. I might go a few months without a coach and find one that that's aligned for my purpose and what I'm doing now. I'll tell her, “It’s many thousands of dollars,” and she's like, “Okay,” whereas that wasn't the case a decade ago. What she's recognized in me, and I know your wife’s recognized that in you, is that you having a coach improves you as a business owner and leader, but also improves you as an individual and a father. When you're talking about creating freedom and living the life you want to live, a lot of that is not necessarily about you. It's about your relationships with your significant others, your partners, your children, your friends, and whatnot. When you can improve your business to the point where it gives you the freedom, the space, the energy to share with other people, that's when your life changes.

Profitability unlocks possibility. Click To Tweet

What do you think are some of the things that showed up in your personal life that are a result of you having owned a business? How are you different as a father and a husband because you had the courage to go out and start a company?

I have a better take on what it takes to lead and that leadership is not limited to the business and professional aspects. There's some leadership as a father that are necessary to lead a family and so that's important. What's helped me a lot, and maybe you can speak to this as well, is the ability to have those one-on-one conversations with my wife and children. Come at a place of objectivity out of curiosity, from a point of understanding and not from a place of judgment and learning more about myself as I go through these experiences. It makes me better as a leader. Some of those things that are related to that also include, what's my purpose? What's my individual purpose? I talked about purposes for your family here on the episode or purposes for your clinic here on the episode, but what's your individual purpose? What's your purpose for your family? What are some of the goals, just like you have goals for your company? Do you have some goals for your individual self as well?

Relating so much of that, we'd like to think that’s professional life and this is personal life, but how do you draw the line? People say, “Don't bring your personal life into the workplace.” How do you do that? Because it happens and there's no way you can flip the switch and go home and all the stresses that you felt at work, aren't going to somehow affect how you're treating your family at home. When my wife recognizes that I'm not up at 4:00 AM and coming home at 8:00 PM or 9:00 PM because I'm seeing patients and doing charts and running the business, but rather have more freedom in my schedule and more time for them. I can go on vacation without getting emergency calls every other day, wherever we're at. She's like, “Whatever coach or consultant you need, go ahead.” We'll spend a few thousand dollars to make your life a little less hairy and have our kids have a picture of you as a father.

This isn't just for physical therapists. I think PT owners probably experienced this in large amounts at least early on, but how often do we give the leftovers to the people at home after a long day at work? The hardest hitting thought is for how many years I would come home with a moderately successful clinic that was me dependent. I’m holding onto that from a place of insecurity because who am I when I'm not that? Coming home and faking it through, playing with my kids and stuff. The generations of owners now are hopefully not where I was in that regard but when you talked about that, that resonated with me is how there is no separation between these different environments. We are who we are. We are better or more successful in our environments because we're sacrificing something of ourselves at the other. My favorite analogy when you described is the idea that we're all juggling different balls in life.

There's a ball called work and a ball called church and a ball called home and family, and they're all made of different materials. The only one that's made out of glass is family. Work is as important as it is. It's a bigger ball that we're juggling but it's made out of rubber. It will drop and as painful as it's been to hear my journey but listening to you talk about those moments. What I sense is that overall, understanding of what matters most and when you learn from dropping the ball here, it's so that you don't have to drop the ball of the family, which is the most important one. Thanks for sharing. That's powerful to hear how that shaped you as a person. Do you have any memories of fun time? I don't want to paint this picture that ownership sucks. What were some of the best times professionally that you have. What are some of those moments?

A lot of it was surrounded around the patients. Sometimes you get a certain patient mix and you look forward to those afternoons because you’re all kicking it and chilling and once, I got a TV in the office. I was watching the Olympics or the Major League Baseball playoffs or something would come up on TV that would spark a conversation. Those days were awesome. Getting your first checks from insurance companies back in the day, I was like, “They paid me to do some work that I'm not even sure I know how to do well.” Worrying that they're going to figure you out someday and the auditor's going to come and say, “You're not a good therapist. Give us our money back.” Making something successful like that. We had some awesome fun company parties with people.

Acknowledgment to Stacy Sullivan. She was with me for a long time. It was sad to see her pass, but my memory still revolves around her coming in every day. She’s like, “Good morning sunshine.” My wife said that to me the other day in the morning and I was like, “That's what Stacy used to say.” It’s individual people and individual experiences that I remember more that gives me happy memories about it. It's something prideful to go back and say, “Here's something that started back in 2002 and it's been an amazing journey and changed a number of people's lives. Not only the people that I've treated, but people that I've worked with and team members that we've had through the years.” It's been a cool experience to look back on that. I can't say all that without saying, “Some of the business trips that we had were some of the coolest times ever.”

That's what comes to mind when I was thinking about this interview. We have times and some of the ones that you and I have are epic.

That was probably worth the price of admission for all the money that we spent on the consulting was to simply go to some of the conferences whether to Florida or Seattle. I feel like I know Seattle with the back of my hand.

I calculated it. We spent six weeks back-to-back there after two years.

It's Seattle all the time with the place. We go to Montana or New York City and all these cool places together. We kick it. It was so much fun. Those experiences in that time were what makes it a lot of fun to look back and say, “That was super cool.” To have the opportunity then to share those experiences with my family and now to take some of my kids to New York City or tell them, "Someday I'm going to take you to Whitefish and you're going to experience how amazing Whitefish is,” or “I’ll take my wife to Clearwater once in a while for a seminar and see the amazing white sand beaches.” That stuff was super cool.

It’s that investment is what forced us to open up to what it could look like if we weren't committed full-time to treating and running the aspects of our business that we weren't meant to. I remember multiple times, you and I would make the comment. Who'd have ever thought when we started this tiny little clinic in Florence, Arizona, that we'd be in New York on 9/11 at ground zero, or we would be in Florida on the white sand beaches, or we'd be in Seattle at the Farmer's Market or the Pike Place there? All the different things that we did. Ultimately, we were able to take some trips. We bring our spouses and, in those things, they weren't the reason why. They were these little perks that occurred to help counter some of those dark times. I feel like every difficult time at least that I experienced in that journey being with you came with comfort. It was a conversation I needed to have that I didn't know how to have.

It was usually a relationship that was out of alignment and I didn't know how to address it. I feel what you're saying around that. I want to quickly highlight for the audience that you are an amazing technician. Your skillset of physical therapy is one of the best that I've ever come across. I'm not complimenting that. Nathan and I were looking at setting up this business in Alaska and you were able to grasp the electrodiagnostic understanding, which is a totally different belt. It's not a different tool in the belt. It’s a totally different belt. You pass that exam, which is a whole other board-plus some. To prove a point, I passed a kidney stone, thanks to you. A real short story. My urologist has told me since it's the biggest kidney stone he's ever seen pass from the kidney through the ureter. It was an 8x8 kidney stone and I didn't know I had a kidney stone. I thought I hurt my back and Nathan and I would be in our business meetings and he'd be treating me. I know for a fact, that's what did it. You manipulate that kidney stone out of me.

PTO 104 | Ownership Journey
Ownership Journey: When you can improve your business to the point where it gives you the freedom, space, and energy to share with other people, that's when your life changes.


I milked that kidney stone through your ureter.

It was an intimate moment. Your skillset is phenomenal. When I hear you talk and you're like, “I don't know what I was doing,” I want to make sure people knew that you were a master at your craft.

I had this vision initially set up that I was going to open up my own clinic, but because of the work I had done in Casa Grande, you guys don't have to know the geography of Arizona, but I was working in Casa Grande. I started a clinic in Chandler. I always knew that I wanted to open up a clinic in Florence. That was at the back of my head always and I don't know why I was thinking, "I’ve got to go to Florence.” I opened up a clinic in Florence, bought the equipment, and found the space. I didn't have a single provider in hand. We met you and Whitny is like, “This guy’s got to work for us.” I'm like, “Who's going to want to work in Florence?” You remember the space that we worked in. I showed you the equipment that I had in my garage. I was like, “I'm taking this down to Florence on Tuesday. Do you want to come with me?” Somehow we set up a way to get down to Florence. I was nervous that you were going to see Florence, Arizona and be like, “Why am I working here?” It was the complete opposite. You have to share with us your experience.

It was fun because you've got more years ahead of me than I do and so in terms of experience in PT. It didn't matter that you were only two years of piano lessons ahead of me. To me, you were a grand piano master. We're driving out there and it's 45 minutes from our house and it's getting close to an hour or whatever. We pull into this tiny little town and all you see on the outskirts are jails and prisons. I think the actual number is eighteen. They have eighteen different facilities ranging from high security, maximum, whatever and you pulled me up at this building that was probably 100 years old. It was 600 or 800 square-feet total. It was musky and infested with lizards.

I remember we had termite tunnels hanging from the ceiling.

I'll never forget, you walked me around and there's a big safe, because it used to be a bank back in the ‘40s or ‘50s. We got to the car and you're like, “What do you think? Do you want to work for me?” I'm like, “We haven't talked money.” You showed me this decrypted building but I was like, “I'm optimistic.” Growing up in El Paso, Texas, it gave me this point of reference of community feel. It felt like when it ended up becoming this unbelievable experience being out with some of the most kindhearted family-oriented human beings I've ever known. They were still, to this day, the one population that I believe for more than any other is the people in Florence. They are as kind and generous as they are and anything else, but it doesn't look like that when you're driving through it. When you're driving through it, you're like, “What was that?” I remember thinking like, “He's new at this, I think.”

“He doesn't know what he's doing.” You're dead on.

You're great to work with. You're always easy going you. The reason we were able to succeed all these years was because we laughed at things. Our relationship would have caught in a different direction if we didn't have so much in common over stand-up comedy. He introduced me to Dane Cook when he was okay to listen to. I’m like, “Who is this guy?” He introduced me to Arrested Development. That was a big thing. Tell everybody what the name of our company is that we created. The one LLC. There are two actually. The Hermano Holdings and we have banana stand. That’s one business that failed.

There's always money in the banana stand and Hermano still exists.

I want to highlight some statistics that I wish I'd done right out of the gate. For two years in, you're over 100 episodes in. You are at 35,000 listens that blows my mind. As you look forward for the show, your coaching and your masterminds, what do you see for yourself?

It's hard for me to see that. I'm not necessarily visionary in that regard. My vision is limited a little bit forward so I can see some steps and moving that direction. If I like it, then I'll continue going down that path. The mastermind has been cool and fulfilling. We've had one meeting, but I love these guys and it's exciting to see the banter and the collaboration between them. The coaching, I’ll continue to do that. I enjoy that. Sometime, maybe it will run its course, but I'm enjoying it a lot right now. The show, I'll continue doing it. Sometimes, it's hard to find guests. I come back to guys who I know are solid like you. I interviewed Eric Miller. I'll have some featured guests every so often that are the same dudes, but they do great stuff, and have a ton to share. I'll keep doing the show because I find it fulfilling. At the end of the day, if I did stop, I'd be comfortable with it because we've put some awesome content out there and it's out there in perpetuity. My kids, grandkids, great grandkids can always hear my voice. I think that's cool and I'm able to share some of the things that I believe were successful, not just about business ownership but about life. Where does this all go? I don't know. We're loving Alaska right now and enjoying it. I look forward to doing more and serving more, and helping PT owners out there. That's where my head is now.

I have something I'd like to ask for you to do as a final thing if you're cool with it. It's a little bit different. If it aligns for you, do it. If you want to wrap it up, that would be great. It all comes back to family, that glass ball. You mentioned at the very beginning of this episode that’s the real reason why we're doing all this as we help patients and as we have the courage to fail over and over again as business owners. It ultimately shapes us as leaders in our home to help us make an impact where it matters most with those little children who are growing up. What would you like to say knowing that 100 years from now, your great grandkids are listening to this? What would you like to tell them about what matters to Nathan Shields?

That's where I tend to get spiritual. I believe in God, Jesus Christ is my savior. A lot of it has to do with faith. I go throughout the day constantly thinking and in my mind praying, maybe not on my knees, but I’m praying like, “What do I do next?” I’ve got a list of to-do things here. What's the highest priority. Am I missing something? I'm going to start at the thing that's easiest for me that I think is the highest priority. Inevitably a thought comes to my mind, “You need to consider your wife.” I hadn't thought about that. When the kid is having some issues. What do I need to say to him? It's either an inspiration to like, "Go talk to him now," or “He's going to be okay. Spend a little bit more time with him this week.” That's where I have to be grateful for the influence of our kind Heavenly Father to give me those inspirations to lead my family. That's where I can look back many times where I see His hand in my life that I'd be remiss to not be grateful that that's there.

Creating freedom to live the life you want to live is not necessarily about you. It's about your relationships with other people. Click To Tweet

I've spoken to you about it when we've talked about business decisions that simply either I feel good about it or I don't based on the prayers that I've had and the answers that I feel I've received. My wife and I talked about it all the time, “How great is this? How cool is this?” This isn't a conversation that we have now that we've reached the pinnacle type of conversation. It's been like that throughout our lives. “How cool is it that we witnessed this happen over the past 6 to 12 months? What would have happened if we hadn't been inspired to do that? How well did that turn out for us?” We're talking about things that you otherwise maybe don't pray about. I had an inspiration to sell our house in Chandler and it was not at buyer's market or a seller's market. I talked to my wife about it. She felt good about it and got the house ready in seven days. We put it on the market and got a full price offer in 24 hours. It’s not in a sellers’ market. The realtor was like, “This doesn't happen right now in this market.”

That's a witness to me that number one, He exists and number two, that His hands works in mysterious ways. A lot of it's about faith. A lot of it is Whitny, my wife, the huge support that she is. I think a lot of owners are like that. There's somebody in their life, whether it's a spouse, a parent, family friend or a mentor of some kind that they have to lean on and that helps a ton. You have that someone who's in your corner no matter what. Giving you the push and the inspiration to live outside of your box and make you a little uncomfortable and force you to sacrifice things and things that you otherwise wouldn't sacrifice. A lot of it goes to Whitny and maintaining that relationship and it's those relationships. You would agree with me. The relationships that we've developed over this time are powerful, emotional, fulfilling, bringing not just happiness, but joy.

The people that we've been able to work together with. My relationship with you is super powerful, loving, caring and supportive. You're my biggest cheerleader outside of my wife and family. Even down to Stacy Sullivan, Michelle, Erica and Katie. These people and these relationships that we have with people are so fulfilling and amazing. Even the people who came in and out of our lives, past employees that no longer work for us or whatnot. I still love and I enjoy them and it's those relationships. I think about patients. The physical therapy profession is such a cool experience that affect many people's lives positively and develop relationships in short amounts of time.

It’s a cool opportunity. You get that with your patients. You get the same thing with your team members, especially your leadership team who buys into your vision and has faith in you. You're like, “Why do you have faith in me?” I remember asking Stacy that all the time, “Why do you still work for me? I know you hate what I do.” They have faith and they captured a vision that was probably granted than our own, which is weird. I then develop relationship with you and then we talked about our network, those relationships. If those guys reach out to me, like Vinod texted me, I felt a teenage fangirl. It’s like, “Vinod texted me. Mom, Vinod wants to talk.” That kind of stuff and to meet Dimi and Shaun Kirk, and the benefits of the show.

I've had opportunity to talk to Heidi Jannenga and some of the huge leaders in our industry that have been around for years and years. Randy Roesch and, Greg Todd, and Jerry Henderson from Clinicient and all these cool people that I never would have been able to meet before. I've had an opportunity to develop some awesome relationships, but it all comes back to I feel like I'm living right. I've got my ethics in order. I rely on my Heavenly Father and Savior Jesus Christ to guide me on a daily basis and try to do what's right and it's that simple. That's what I hope my kids would remember. I hope my kids remember that it's not that hard. Your life's going to suck at times. We went through the experiences, but we came away with wisdom and knowledge, an ability to empathize with other people who go through the same thing and say, “You have bent there? Do you want to know what you can do about it?”

Help them in that regard and not just PT owners but with our kids, with our spouses, you can have the same empathy when you go through crap like that. We're not at a point yet where our kids are married. Heaven forbid our kids get married and now have to deal with spouses of their own. They're going to be like, “I had that argument ten times over with my wife.” There we go. They then have kids of their own. They're like, “Dad, what are we going to do?” It's because we went through some of those crappy trials along the way that helped us learn and gain wisdom and humility. That's some of the stuff that I'll always be grateful for. It has been a cool experience in that regard.

Thanks for that answer. On behalf of everyone reading, thank you for being who you are, for creating the show. I love and adore you. It's a treat to be in your life and I'm grateful for the example you said. Not just in the show, but who you were beforehand and your continual application to be a better human is inspiring. I wish people in the audience could know you the way that I do and ultimately, they get teary a little bit. Thank goodness for the PT Owners Podcast.

Thanks for joining me. It was great to sit and shoot the ball with you and reminisce. I was nervous about how this would go because I've always been the one to highlight the guest and I rarely liked to take the spotlight. I didn't know how that was going to go. It's been awesome to think about it.

It’s my favorite show so far for me.

That's cool because you're the one that wants attention. What you didn't say is how do people get in touch with you. When you're ready to take on more clients because you guys are killing it, how do people get in touch with you?

What we'll do for anybody who's interested is if you're not sure about your existing billing solution in the last couple of months, one of the reasons we've been successful is I don't have to grow this thing. I want it to be a major influence in the industry, but I don't have to grow this billing company out of a need to. What we ultimately care about is making sure you get what you need. I've told people that they should stay with their in-house solution. I've told multiple people that. I told other people that they should outsource, but I'm not their solution. I'm not everything to everyone, but who I can serve, I can go deep with. Who I'm serving are people who want to grow. I want people who are anywhere between 1 and 5 locations. I'll consider bigger companies but if you are between 1 and 5 locations and you have a desire to be free of your company, that's who I want to serve. My email is and my billing company is called In The Black. We have a separate email for that, but I'm going to keep it simple for people. It's the same as my YouTube brand. You can call me. I don't know if I should give my cell out because I'm worried for the people that I will spend too much time on the phone with them. The email is fine.

Imagine this is after August 1, 2020. What's your website going to be?

My website is going to be We're super excited. We do have a vision of taking on another ten clients. We’re going deep with them and helping them blow their minds. It's such a fun industry to get into it because there's nothing sexy about it. We're bringing the sexy back in a way it's never been. I'm doing normal things you do in other businesses like appreciation and keep relationships strong. I love it. It's so much fun. I still feel like I'm treating is what it feels like. That's how you get ahold of me.

PTO 104 | Ownership Journey
Ownership Journey: A true consultant is someone who recognizes the needs of the person that's calling and not necessarily the need to acquire another client.


I don't know where this comes from in us because I've done the same thing with coaching clients. I've had people call me and be like, “I don't know if I'm the best fit for you,” or I said, “I don't want you to sign up with me unless you talk to two other people.” I've done that a few times and I'm trying not to say that because we're charitable human beings, but what I'm talking about and the way you presented is that's a true consultant and someone who recognizes the needs of the person that's calling and not necessarily your need to acquire another client. If people who are coming to get a consultation with you, maybe they're going to come away with a couple of nuggets. I do the same thing when people call me about coaching clients, whether they come with me or not, I try to give them a couple of words of wisdom and I share my experience. It’s the same thing for you. You're going to say, “You might want to look at changing your EMR or stay with your current EMR or stay with your current in-house billing person,” but add a couple of statistics or reports that would make them more efficient and hold them more accountable. That's what a true consultant would do.

What we offer is a free profitability breakthrough audit and I've done this a number of times where people will give me their data. We sign an NDA. I completely show them where there's money. There hasn't been a single time. I've done twenty of these at this point. I've never found less than $10,000 sitting in absolute profit in their business right now that we can’t go and get.

That's bottom line in their pockets if they simply made a call or two.

When I show them that, they don't move forward with us because they only needed some tweaking with their existing solution. What you said, I've heard it said differently and I love this, which is, "We can help everyone but we can serve only a select few.” Who we serve, instead of going a mile wide, we're going to go a mile deep. It's a little selfish for us to be helpful for everyone because that's the only way we can find those who we can go deep with. That's where you and I have learned from people like the coaches you've mentioned. They go so deep. You think of them as family, like a father. You can’t separate that. I'm so excited because I know that's what's happening on your end with your clients. I'm grateful that you're doing it. I see you being a master coach in this industry. You already are, but this is your first group. I’m putting it out there in terms of intention that Nathan Shields will have that name of a major influence in the coaching world of our industry.

As long as it gets me out the door and on the leg by 2:00 PM, that's fine. Thanks for your time. Much love. It's always great talking to you.

Thanks again for having me.

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About Will Humphreys

PTO 104 | Ownership JourneyWill Humphreys, the Profitable PT, is the CLO and co-founder of In The Black Billing compnay and has been a PT for 20 years. He owned a multi-locational outpatient practice for 12 years before starting his new venture with Katie Archibald. He is a father of 4 boys, married for 20 years, and a part-time comedian. He is passionate about physical therapy, entrepreneurship, and the freedom that is created through profitability.


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PTO 103 | Ramping Up


The COVID-19 pandemic has provided many of us a little more time on our hands to assess how our clinics are doing in general. Whether you're reopening, slowly increasing production, or stuck in a holding pattern, it helps to make use of this down time to really consider and reconsider some fundamentals of your business. Host, Nathan Shields, breaks down five of the things that you need to look into now: purpose, responsibilities, goals, marketing, and self-control. Being intentional and specific about how things have changed in your business and taking advantage of the opportunity in front of you may set you to a completely different path than prior to the pandemic—a path that leads to greater freedom, fulfillment, and profits. These things take some effort, but going back to the status quo should not be your future. Make something better for yourself, your family, your employees, and your business with the help of this episode.


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5 Things To (re)Consider While Ramping Up

I don't have a guest to interview. I want to riff on my own here a little bit and talk about the five things that you need to consider as you are ramping back up your clinics. A lot of you may still be closed. A lot of you might be trudging along slowly and gradually building up. Some of you might be ramping up a little bit more quickly. Wherever you're at, I'm assuming that a lot of you have a little bit more time on your hands to assess your business in general and take advantage of the opportunity to work on your business and not just in your business. I talked on a previous episode with Will Humphreys about what to do during the downturn.


As things are starting to get busier, the possibility is that you might get sucked back into doing things the way you used to do them. That was the caution that I wanted to put as I've interviewed and talked with Will is that no, this is an opportunity to make things change. I want you to hold fast to that commitment to change. There are five things that I'm noticing amongst my clientele and the mastermind that I've started that need to be addressed and be considered or at least reconsidered. The first thing I wanted to talk about is purpose. Now is a great time to look at your purpose and consider, “Does this still meet my needs? Does this still excite me, inspire me and my team? Is it time for a change and updating?” That's a possibility because a purpose is like that. You don't change it very often, but in certain circumstances and as you're making changes in life, your purpose will change.

Consider does the purpose still meet the needs of the company? Does the purpose still meet the needs of me personally, as the owner? Does it reflect what I want in terms of my business, how it works, what it stands for? Does it reflect the entire team and the team that I want to develop and build? Does it also reflect my clientele? I have coaching clients that are deciding to shift from one clientele to another or to expand the clientele that they're marketing to. That would significantly change your purpose, change how you advertise things and also how you run things in your business. Now is a good time to consider, does the purpose still meet your needs? Does it still meet the needs of what you want out of your business going forward? Maybe it met the needs of that in the past, but does it meet the needs of what you want to see in your business going forward? Now is the time to consider adjusting your purpose to meet your needs going forward.

Take advantage of this challenge and make it an opportunity. Click To Tweet


Second, as you are considering maybe treating less and working on your business more, then your responsibilities are changing. You need to get comfortable with what those responsibilities are and what they look like. Simply going off of treating patients full-time or a significant amount of your time to doing some administrative stuff and stepping away from treating is going to make you feel uncomfortable, and it's going to make you feel less productive. Don't buy into that. Understand that your responsibilities have simply shifted and that under your new purpose, you have different responsibilities to meet the goals that you have going forward.

A lot of them are typically administrative. Consider what statistics and KPIs do you need to track on a regular and weekly basis? Are you creating battle plans to improve the statistics that are falling? Whether that's frequency of patient visits per week, the number of skilled units per visit, the arrival rates and completed plans of care. Those kinds of statistics need to be tracked, but you also need to create battle plans in order to correct them if they are going down. Are you strategizing appropriately for improving the team around you, for developing leadership on your team, for marketing or for improving the care in your business?

It could be any number of things, but you, as a leader, need to be the person that creates the vision and puts a strategy together with the support of your team. Other things that you could be doing that are more administrative, but less numbers specific and project-related. Are you having one-on-one meetings with your team whether that's weekly, monthly, bi-monthly, bi-weekly or whatever? Holding accountability meetings with those people who might be needing some disciplinary action or simply meeting with your team members to see if things are still going in the right direction and that you are aligned.

PTO 103 | Ramping Up
Ramping Up: Set a sacred time that is not spent on patient care because your business won't grow simply by you treating more patients. You are also limited by your energy, time, and mental capacity.

Also consider that with your administrative time that you have set aside to write down policy. You, as the owner in your clinic, are the most productive, the most efficient in terms of both billing and charging and getting patient results and getting patients to buy into their plans of care. Whatever you're doing successfully in those areas need to be written down so they can be recreated. Inevitably, the therapist that you bring on aren't going to be as productive. They're not going to be able to commit patients to their plans of care like you do, because you are so invested, but that also makes you distinct and an owner.

Because you have those responsibilities of ownership, it forces you to be more productive. Everything's on your shoulders. Take the time to write down a policy of how you do things. How do you treat patients at initial evaluation? What do you say in order to get patient buy-in? Are you scheduling out your full plan of care after the initial evaluation? These are the things that need to be written out as policy for other providers and team members to follow going forward. Writing down policy, although it's a grind is a significant part of your responsibilities at this time.

Also consider how can you top grade? Who needs to be let go because they're not aligned or not producing or simply not acting appropriately in your clinic? How can you improve the situation of your team? If you go back and read my interview with Will Humphreys, he talks about A, B, C and D-players. How can you get rid of the C and D-players and get more A-players? Now's the top opportunity to do that, which is called top grading. Also take the time to meet with your CPA and your billers monthly. You should have reports coming from your billers, the statistics that they follow and track that are reported up to you, projections for upcoming months, billing and how they did in relation to what the projection is worth. All those things need to be met.

It's important to revisit your business goals and make sure that you're strategizing appropriately to achieve them. Click To Tweet


With your CPA, feel free to ask him, “Show me what my P&L is. Show me my expense lines compared month to month and year over year. What is the projection going forward?” Also, ask them to figure out your breakeven point. All of these things are important to do as an administrator. Although you're not getting immediate return on your investment, it will come back to you tenfold as you improve your business. The third thing you want to reconsider are your goals. Is it time to readjust them for 2020? Probably what you had in January needs to be revisited. Revisit your goals and get specific. What I'm finding as I'm talking to owners is that they have goals. I want to gross $500,000 a year. Let's break that down. How many visits does that translate into? In order to get $500,000 a year, how many new patients do you need to have coming through the door? What is your profit margin on that? Is that an acceptable profit margin? Getting specific on some of your goals will drive a lot of your work.

Honestly, if you want $500,000 and it's going to take 1,500 new patients to come in the door and you had only 600 last year, what kind of marketing efforts are you going to have to do in order to do that? It's one thing to simply put the goals out there. It's another thing to then do some reverse mathematics and reverse engineering to determine what do I need to do to actually get to that goal and attain that goal? Furthermore or at least another example is I want to treat part-time and be in a bigger space. Let's work it back. If you have a bigger space, you'll have a greater mortgage. You'll have other providers taking on your patient load. How productive do they need to be in order for you to either maintain or improve your profit margins, such that you have the financial flexibility and freedom to achieve that goal. Will that work if you have those things? It's important to revisit your goals and then also work around those goals to make sure that you're strategizing appropriately to meet those goals. They're realistic and that there achievable.


The fourth thing I want you to consider is what your new marketing programs might be. If you were solely reliant on physician referrals for the health of your clinic, you recognize that now you need to change things in order to survive, at least through this part of the ramping up phase. Honestly, it will benefit you going forward but consider new marketing programs. As you consider them, people ask me, “What should I do? Should I do some social media stuff? Should I do some mailers? Should I do some emails? How should I reach out to past patients?” Before all that, consider what's your budget. If you go back to my interviews with Neil Trickett of Practice Promotions or David Straight of E-Rehab. The first question they have to ask as a marketing vendor is, “What's your budget?” Based on your budget, they can tell you what you can do and how much you can expect on your return. First of all, you need to consider the budget.

PTO 103 | Ramping Up
Traction: Get a Grip on Your Business

One book that I've recommended to a number of people, it's called Traction, and it's not the Traction by Gino Wickman. It's called Traction: How Any Startup Can Achieve Explosive Customer Growth by Gabriel Weinberg. It's a good book to consider if you're wanting to know how to spend your marketing money and what to do first. You might have multiple options. Whether it's marketing to physicians, marketing to the community, doing social media ads, marketing to past patients, marketing to your latest patients. You have all these avenues to put your marketing dollar. Do you want to do all of them at the same time with the same amount of money or should you focus on one avenue, spend a little bit of money and see what your return is like before you put more money into it? Essentially spoiler alert, that's kind of what Traction talks to you about and how to focus your marketing efforts to get the greatest return on any particular avenue. Check it out. It might be able to walk you through how to spend your marketing dollar the best way possible. A great recommendation is to reconsider where you're spending your marketing dollars to begin with and consider new marketing programs that tap into communities and not necessarily physicians.


The fifth thing I want you to also consider is make a schedule that allows for you to do your administrative work, your marketing, and more specifically give you time with your family, your loved ones and your hobbies. Don't let patient care interfere with that time. Make that time sacred. That time is what you need in order to achieve your goals. You have to set aside that time that's not spent on patient care, that is focused on your business to achieve your business goals. Your business won't grow simply by you treating more patients. You are limited. Your energy, time and mental capacity is limited. You need to build your business such that others are treating patients that you want them to and are running the business how you would run the business or even better if you find the right people.

Make a schedule that you are in control of, that you are not reactive to. Many times, as we're growing up as physical therapists, we’re simply looking at the schedule to tell us what we're going to do. You were going to treat that patient at this time. Thus, we become at effect of our schedule instead of being at cause, being the causative factor to our schedule and saying, “This is when I can see patients. This is what I'm going to work on my business. This is when I'm going to be home with my family.” If the patients can't fit into my schedule, then unfortunately I can't see them at those times or they need to work with another physical therapist under my roof to be seen for their malady. It's important that you make those times sacred in which you're working on your business and you've set aside for family loved ones and hobbies. It’s uncommon for so many physical therapy business owners to simply get burned out. You don't want to get to that point.

Make the time sacred now so that you can make the business what you want out of it. Give yourself the energy and space to get revitalized and reenergized on a regular basis. Those are my five considerations as you're ramping back up. I hope you appreciate it. I don't do a lot of these solo podcasts. If you like them, let me know at I'd be happy to hear from you. If you have any suggestions on topics, speakers or presenters, but we have a lot of great interviews coming up. I also want to thank you again for being a continued audience. I’m proud of the content that we've put out there. I hope you've appreciated it. I'd like to hear from you once in a while. I like getting the positive feedback, simply saying, “It’s great.” I love talking to people who have read the blog wherever you are across the country. Thank you again for being here. Have a great day.

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PTO 89 | Marketing Strategies


Getting patients to enter the door may seem simple but is actually one of the hardest steps PT clinics tackle. Today, Nathan Shields talks to Peter Decoteau, the marketing director at Physical Therapy & Sports Medicine Centers (PTSMC), the largest privately-owned PT group in Connecticut. Focusing on breaking down any barriers that keep new patients from coming in the door, Peter recognizes that the first barrier for a majority of people is simply knowledge - not enough people know what physical therapy is, thus your message has to recognize that. He shares aspects that make these technical such as location, insurance, and those can be further addressed after you've captured their attention. Peter believes that regardless of the steps taken, it is necessary to know what your brand is, who your ideal client is, where they get their information, and the content they need to hear all of which leads you to begin to generate marketing campaigns.


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Marketing Strategies To Ease The Path For New Patients With Peter Decoteau

My guest is Peter Decoteau. He is a Director of Marketing for a large physical therapy company in Connecticut. I brought him on because I want to talk a little bit about a couple of things. First, the things that we need to consider as we are advertising directly to our local community or direct to consumer marketing. Secondly, what are some of the things we need to do on the back end, which is number one, how did we get that patient who is interested to convert? Number two, how do we track the KPIs related to our marketing strategies.

Important stuff as we're considering that a lot of our marketing strategies need to spend more time and effort either direct to consumers, via mail, email, or social media and rely less on physician referrals. That's the trend that we're seeing. I'm trying to highlight physical therapy clinics that have been successful at doing it. If you do have a marketing strategy, I’d love to see how yours compares to what Peter represents. Also, if you don't have a marketing strategy, consider some of the basics during this episode that you need to do to be intentional about your marketing efforts to grow.


I've got Peter Decoteau. He is the director of marketing, Physical Therapy & Sports Medicine Centers, Connecticut's largest private practice group. I wanted to bring him on because I saw a past impact magazine article in which he talked about marketing. I'm always open to that and we need to consider marketing outside of the traditional physician relationships. Based on his article and further talking with Peter, I wanted to talk a little bit more about marketing and some of the things that we need to do and look outside of the traditional relationships or things that we're doing. Peter can give us some light and insight into how to make it easier for new patients to get in our door in general. First of all, Peter, thanks for coming on. I appreciate it. 

Nathan, thanks for having me. I'm happy to be here.

Give us a little bit of breakdown about you. You're not a physical therapist by trade, you're in marketing, but tell us how you got into this all and your experience with physical therapy.

I came into physical therapy cold. I didn't have any experience with physical therapy personally. I had not gone through physical therapy. It's an interesting experience to come in not knowing too much about the industry. I have a strictly marketing background. I started in a nonprofit in Hartford, Connecticut and then moved onto a private school up in Simsbury, Connecticut. I was an ad agency for a little bit as well. The benefit for me of having those experiences and coming into this environment is that I have a pretty broad breadth of knowledge in terms of different approaches to marketing. The different pieces of marketing like PR, digital or advertising, all those different things that you'd want someone to be doing.

A different perspective.

Working with different audiences. If anybody out there has worked with a nonprofit, they would know that you were pretty much every hat possible there. It was a good starting point for me. I was doing some multimedia marketing for them, but I was also doing some membership relations and some sponsorship relations and things like that. It gave me a good foundation for where I wanted to go next. The opportunity to come into Physical Therapy & Sports Medicine Centers came from working with someone in our leadership group. I was working with her husband at the private school and they needed someone to come in and do a little bit of consulting for some of the digital marketing and social media stuff that they were looking to expand upon and reach a broader audience with. I jumped on as a consultant in that way. I did a pretty extensive audit of their digital presence and gave them recommendations and I was doing some ongoing work with them.

Do whatever you can to break down the barriers for new patients to get into your clinic. Click To Tweet

When the opportunity came out for a marketing director to jump on board here, they reached out to me and things were tumultuous at the ad agency. That's a different story. Suffice to say that they don't exist anymore. It was good timing, jumped on board here. I had already been working with the team here. I knew that it was a good fit and I was interested in coming into the physical therapy world knowing that it'd be doing something that at the end of the day is helping people. Not necessarily for me doing the hands-on treatment, but getting people into the physical therapy clinics, especially clinics that we have that I believe do top-notch work. It felt like it was a good industry to jump into.

That's cool that we have you on because you bring a different perspective than the typical physical therapist that might be talking about marketing. I want to ask you, are there some false ideas that physical therapists have about marketing and how it should be done that you have to come in, break down or challenge and change their perspective about it? If so, what might some of those things be?

The number one thing that I've seen, in coming into the industry and being a part of the private practice section committee, is that physical therapists greatly overestimate how much the general public knows about physical therapy. We tend to exist in an echo chamber of our making. In an impact article that I've put together, we're the fish living in this water all day. We tend to think that everybody else sees it the way that we see it. We talk to the general public. You realize that their knowledge about the scope of services provided through physical therapy, the way that you might come to physical therapy, even where their nearest clinic would be or the difference between outpatient and inpatient.

There's not a lot of knowledge in the general republic and that is a matter of messaging for the industry. For the most part, the industry itself was mainly surviving on doctor referrals to physical clinics. Most of the messaging had to happen from the therapists or if they had marketing people, which a lot of them didn't to the doctors and to trust there and build relationships there, which is still important. Given that direct access is something nationwide that came out in Connecticut. The focus should be on pushing forward on self-referrals, direct access, teaching people even what that means and what that is, especially the scope of service that we provide.

Tell us a little bit about that because that leads to our topic as far as how to get those new patients in the door, direct consumer marketing. It’s getting the knowledge out to the broader audience because the stack gets thrown around and I don't know where it was found. I wouldn't be surprised if it's true that only 10% of those patients with musculoskeletal injuries get the physical therapy that they would need or could need to overcome their injury. That means that all of us are fighting for a pretty small pie. If we're focused on the physician referral route, there's 90% of the population out there that could use our help that isn't getting it because they don't know about us. We take for granted that everybody knows about physical therapy or at least some version of it. Maybe they don't understand how physical therapy could help for minor traumas, for simple injuries and stuff like that. Talk to us a little bit about how you work to help those new patients get in the door from the population and utilize direct access.

I love that you use that number. That's a number that our Vice President of Business Development, Mike Durand. He’s been a part of this company and he was an athletic trainer before. He throws that out all the time and says the same type of thing. It's like, "If that's true, which the study shows that's the case, that we're all fighting for that little piece of the pie instead of working together to try to make the pie bigger for everyone." If we're talking about ways that we can increase self-referrals or increase our patient volume with people who are not coming directly from the doctors, is that we first focus industry-wide on our messaging and create a little bit of consistency.

At least acknowledgment to get the messaging out there in a broader sense before we start doing more clinics specific or company-specific messaging, if we do that successfully in terms of having clear, consistent messaging, talking about the benefits of physical therapy as a whole because that percentage of the pie gets broader. Even if there are fewer people specifically knowing about our clinic at some point, all the whole thing grows. We'll be reaching maybe more of a niche audience, but that niche audience is also bigger. Our patient volume still grows.

It sounds like your marketing starts with developing the knowledge-based of the community as to what physical therapy itself is and how you can benefit those people who are having less traumatic issues. Maybe simply low back pain, you're marketing your message is a little bit more knowledge-based and then you add your tag or logo at the bottom? How do you guys go about doing that?

PTO 89 | Marketing Strategies
Marketing Strategies: Physical therapists greatly overestimate how much the general public knows about it.


We talked a little bit about this, something that David Straight had mentioned on a previous episode of yours, which I encourage everyone to go back and read it if they haven't. He talks about starting with establishing your brand identity and figuring out who your target audience is. Also, figuring out where that audience is in terms of platforms you can reach them most effectively. We always start there. Once we've gotten to that point, we know who we're talking to, we know who we are and how we're positioning ourselves and we know which platforms we're using. We get to this piece about the intellectual property that we can bring to that, the content that we can put together.

The value to the users or the audience while also educating them on this broad range of topics that we're talking about. That doesn't necessarily have to be broad with each piece of content, but that we're covering a lot of bases in the messaging that we're putting together. The more that the audience sees these messages, the more comprehensive of the picture they get and the more personality they get about our companies specifically. The pieces that I'd say differentiate us from the other clinics that are in Connecticut.

I love that you bring up David Straight's episode one of the few first episodes and you talked about marketing. The evolution of your marketing doesn't necessarily change. You've got to figure out who you are and who your ideal client is? Some people might say, "What is that avatar?" Once you have that figured out and what you do best and what patients you want to work with, then you can focus on, where did those people get their information from? Is it social media? Is it mail? Is it email? Is it postcards? Is it community events? You can focus on the content. Based on knowing who your demographic is, you can structure your content accordingly. To invite those specific people in the door, that's how you would structure your marketing program as you're going direct to the consumer.

In terms of what we're talking about with getting people into the clinic, educating the public both on an industry level and then on company or clinic specific level. What we're talking about is breaking down the barriers of entry to the general public. This piece of it that we're talking about is the barrier of knowledge. It's a general knowledge barrier that people have for physical therapy. What are the things that we can do that breakdown that knowledge barrier in a general sense of the benefits of physical therapy? That specific level of physical therapy can help with your recurrent back pain that you might not need surgery for but keeps you up at night. Here are the ways that our clinics specifically can help with that because we offer dry needling. We do hands-on therapy. We focus on the manual. We are closer to you than the other clinic. There are these other things that make us a better option for you. We can start from that broad sense and get more specific as we continue to try to reach that audience in the way, read the messages that resonate with them.

If you look at their websites and some of their content, they might focus more on the treatment they provide instead of the benefits they can provide to the patient. As we're talking to ourselves, we know the benefits of say, dry needling or some manual therapy technique but that's not what you want to highlight and advertise. You want to get down to their knowledge level and also, what's important to them, which are their functional capabilities and how you can improve those and focus there. What you provide is off to the side. This is how we do it. If you can simply get them to buy into what you're doing to improve their lives, you can talk about how we do it later on.

Our motto is improving the quality of people's lives. That's the thing that we always go back to because we do say that PT in general if you're going to a good physical therapist, that's what they're doing. They're improving the quality of your life because you can sleep throughout the night. You can pick up your grandkids. You can play rec league soccer on the weekend, which I do. I've needed to go back to physical therapy for that specifically to get me back out on the field. Those are things that provide quality to my life or somebody else's life that we're trying to get you back to. Starting at that point and then getting more specific.

I like to think about it and you talk about a marketing funnel, getting people down in the funnel and then wondering where do they go once they convert? I made up in a previous position. I tried to visualize what it looks like to me after they've converted and put a little bit of a tornado in the middle of the following, say, "If you've created the awareness and then you're getting to the point where the people exist in the middle point." Especially with physical therapy, which you want them to be aware of the fact that you exist and you have these benefits. Maybe that person doesn't need physical therapy but you want to be there for them when they do need it.

You want them to exist in this little middle part of the funnel that's like a little tornado of information that they can keep on receiving. How can we keep them engaged? How can we keep them interested? How can we get new little tidbits of information to them? That's the way that I like to think about it. The content marketing that we're doing that we are getting people to that point and then staying in front of them with all this relevant information that speaks to both the services that we provide, but also the personality and the differentiator points that we offer. When you talk about something like dry needling, you're right, we're not going out there necessarily promoting dry needling to the general public as a selling point for us.

Reach the audience by reading the messages that resonate with them. Click To Tweet

Once you're engaged with us, we'll do videos about dry needling and talk about the benefits of that and show you what it looks like. I had the barrier to entry for that would be thinking that it hurts. Can we show you in a video that we're dry needling, someone and they're not reacting to it at all? We did a video with one of our clinicians. She specializes in temporomandibular dysfunction. She dry needled two parts of one of her aide's phases. We'll first show the type of treatment that you would be offering, but also, ancillary it showed that it did not hurt her at all. The more we can bring that type of content into the fold, the better.

As you consider breaking down the knowledge barriers and providing them what they need to know about physical therapy and how it can help them? Do you have a secret sauce when it comes to getting that conversion? If they call and they want to utilize direct access and come to you without going to a physician, what can you share about how you get those people to convert and become new patients?

I wish we had all those answers because that would be fantastic. That's something that we're working on daily. I talked to our operations people and our employees as much as I can about the things that we should be doing that are consistent. I see that as two separate things. One is the functionality of getting them to convert. The other is the interface with our employees when they're interacting with them on the phone or when they come into the clinic. The functionality piece is, we try to optimize everything we have. Everything that a potential patient might be interacting in a way that again, breaks down the barriers to getting them into the clinic.

For example, if you're someone who doesn't have any relationship with PTSMC in the past, and you probably maybe even not had a relationship with physical therapy in the past or you've had a bad relationship with them, which is something that we hear sometimes. What's the information that you're looking for? How are you looking for it? How can we get it to you faster and easier and more effectively? How can we make it easy for you to book an appointment? Ideally, what's happening in the person's thinking, "I need physical therapy." The doctor said, "You need physical therapy." I'm going to tell you to find your therapist, which happens more often. They go to Google, they search for it. You come up, they go to your website, they're looking for maybe, do they take my insurance and do they offer the treatment that we're looking for?

We know that those are two things that people are looking for most often than not. Are you getting them to the right page initially? Is it easy for them to find that information? Once you've given them that information, how easy is it for them to book an appointment? The way that we have it set up for us, our organization is that we built a new website specifically with that user process in mind. It's optimized for the user flow. Also, for the SEO flow to the individual pages, search engine optimization flow. On purpose-built out landing pages for every treatment option. We've got that landing pages for every individual clinic so that if you're Googling, "Best physical therapy in Avon, Connecticut." If you do it in Connecticut, the first three things that probably show up are one, a Google Ad campaign that's running for that says best physical therapy in Avon, Connecticut, that when you click on it, it goes directly to Avon's location page.

The second thing that shows up is probably the organic result for that. The third thing that shows up is probably either the maps result or staff result for the same thing. We're trying to dominate the search results there as relevant as possible. When they get to the site, make it easy for them to find that additional information. We have, I believe, two or three conversion points for submitting a request for an appointment through the website on every single page. There are a floating button, a sidebar and a top bar that says, "Request an appointment." Everywhere on the site, it's there, it's ready to go.

Whenever you want to request an appointment, we're ready for you. 

Ideally, what would happen is that they would click on that and they'd be able to integrate with your scheduling and requested an exact date and time. We're not there yet. It's somewhere that I would hope for us to be pretty soon. Also, there's some friction in terms of what's available in someone's schedule. Maybe it's available for a reason that you know all about because I'm not in the clinic. It was a little bit of like, "How much can you do there?" You're breaking down those different barriers to book an appointment or they put them to call and they're going right to the clinic that they're trying to.

PTO 89 | Marketing Strategies
Marketing Strategies: Figure out where clients are and be really specific about what you're doing in terms of the platforms used.


It's great that not every individual practice owner is going to have a director of marketing like you to handle a lot of the Google Ads, the SEO and stuff like that. What it shows is, we put out some marketing promotional material or an ad, you name it, but in what you've done intentionally is, how can we make this as easy as possible for patients to get in the door and make an appointment and convert? That's a necessary exercise for any owner. That is to say, we put out this ad when someone calls or when we're calling out for a referral, how easy are we making it? Are we forcing them to give us all their insurance information before we answer their question? Are we making them jump through hoops and getting the date of births and that stuff?

Are we more focused on them and maybe what their name is? What their ailment is and how it's limiting their life, maybe establishing that relationship right off the bat. I'm saying there are other ways that you can go about it and it's worth the exercise for owners to sit down and say, "At this touchpoint with a potential patient, how can we break down the barriers?" Maybe they've got an understanding, a knowledge-based. What can we do to make it as easy as possible for them to make an appointment? Everything we can or in that call and I'm sure you're doing it with your calls. You're also doing it with your website. How can we make it as easy as possible for that internet traffic to translate into a visit as well? You can look at those touchpoints and say, "How can we make this as easy as possible?” 

You bring that up and that speaks to that other point that I was talking about the interface part of it. One of the things that we try to do, everything I was talking about the functionality wise is called technical side of it. At the end of the day, we always have to remember that we're dealing with people who are probably in some pain or representing someone who's in pain. Not only that, but they have to deal with the pain of going through the healthcare process, which is usually not simple. From that point, can we come to them from a perspective of empathy? Can we make that part of it easier? When they come into the clinic to treat the real pain that they're dealing with, they haven't had to jump through all these hoops beforehand?

Typically, what we do on that end is a lot of different folds to it. I would say that our operations group does a good job of onboarding people to the particular culture that we have at PTSMC. We focus a lot on the differentiator for us being one of the tenants of our mission statement is lifelong relationships. That's a key tenant of that. We want to be known as the physical therapy company that focuses on, we say that the person, not the problem. When we onboard people, we focus on that as a key element of everything that you do when you're working. You're getting people in a database and your scheduling. You're first and foremost, a representative of that philosophy that we have here.

Likewise, we do that with our clinicians too and we have to do that with the front desk people were feeling most of the phone calls. Another thing that we do that speaks more to the marketing side of it is we do a separate onboarding event process with all new clinicians’ call, "Living The Dream," which is they met our president loves to say. We've got to wrap it into that. It's focused more on that what we call the soft skills that you don't necessarily learn in PT school that are related more to that interpersonal piece. What's beneficial for me as a marketing person to be involved in that is again, not knowing that I'm not a physical therapist and I'm not having these face-to-face interactions with them. Giving them some more consistent tools to bring to those interactions that might help the growth of both their client base and the clinic more broadly has been useful for them. Sometimes it's something as simple as always have business cards on you.

When you're discharging a patient, if you think that they had a positive experience, which we think that most people do and our survey scores reflect that, give them a few. You can say, "I'm your person. I'm your PT. Hand this off to any friends or family that you think is dealing with pain and tell them about direct access because people don't know about that. Let them know that you've got a guy and I can get you in as soon as possible." That little intimate touch of saying like, "You've got a guy, here some cards, and bring other people into the fold." It both allows you to get that word of mouth out there for the referrals, but also, it puts the value into their hands that they've got a connection that they get to reveal to people who are in their circle enough to take advantage of. We do small things like that.

As you're Looking at some of these efforts that you're putting out, are there certain KPIs that you follow to see if these are being effective or not? You brought up Google Ads or SEO costs, how do you measure KPIs or ROI on some of these things?

I tell partners at all the different clinics and this is my number one byline to all of them. My job is to get people into your doors. That's the ultimate thing that I do. If all else fails, if we're getting more people into your doors from a marketing perspective, then I'm doing my job. Their job is to provide world-class physical therapy care, so that people want to spread the word and come back as return patients. Let their friends and family and colleagues know and all that stuff. We do a lot more than that in terms of supporting brand awareness within the clinic and supporting the clinicians to get out in the community. The number one KPI for me to answer that question is that if we're getting more patients into the door, either self-referred, returning patients or referred patients, then that's the number one KPI. In terms of tracking the performance of individual campaigns that we're running, it's a lot easier to create KPIs and track them when it's coming from a digital campaign. For Google ads, you can track the clicks through to the website and the conversion rate from those clicks.

PT clinics must remember that they are dealing with people who are in pain or sending someone in pain. Click To Tweet

There's direct percentage of saying, we have a little bit of an equation that we use that's like, "If we're spending $300 a month with this clinic on Google Ads and we're seeing six conversions through that ad campaign because their phone calls and requests through the website, we're going to estimate that only three of them are coming in. What are three patients worth in the life cycle of a patient coming for ten treatments?" The average is nine or ten. That return on investment might be $3,000. We can say those numbers of conversions and the percentage of click-throughs and say, "For that ad campaign, we're getting a ten-time return on investment of those numbers." You start to look at that and say, "How can we get those percentages higher? How can we tweak the campaigns?" Those are the types of KPIs that we start to focus on in terms of like, "We want to get more conversions through that, how can we do that without blowing out our whole budget?"

What's a percentage of return that you're expecting typically? What is the sweet spot for you at least this number and above?

We tend to see it. It works out well because we have the 25 clinics, soon to be 26, where I built out from the start a few ad campaigns on Google and optimize them as much as I could, knowing what our budget was going to be. I pretty much copied them and duplicated them down, changing the location information in the contact information. We're working off of these few optimized ones. We're the good month for one of them, we might see a 10% conversion rate, which is pretty good. Typically, we're probably seeing 4%, 5%, or 6%, which is still pretty high I as an industry average, which is good.

You work with a large company and you had soon to be 26 locations, what would your recommendation be for a guy that's only got one or two locations? He can't bring on a full-time person for marketing, maybe has room for part-time to find somebody or maybe as needed for a campaign. How would you recommend they go about looking for marketing help or doing it themselves?

I always say to start with the low hanging fruit. In this case, if you had to pick out two people who are your ideal client personas whether those are based on payer mix. Maybe you have enough volume, but you want to get volume from a higher payer or payout. Maybe it's volume focused specifically. What's the low hanging fruit in terms of the people that you know or in your area that need PT who aren't getting it or don't know about you? Start with the groups that you would most like to reach as the low hanging fruit, easiest people to get to. Figure out where they are and be specific about what you're doing in terms of the platforms that you're using. One of the things that I tend to see, and I saw this at the ad agency too, that we would bring on clients who wanted to do everything.

They were only working with the small budget or maybe it was a small organization we were working with. We dealt with a lot of that and nonprofit because nonprofits don't have a lot of money for marketing. You want to do a little bit of everything. You want to chase every new trend and you want to be on the TV and get the print ads and also do the social media thing and do the Google thing. It's important to focus on those audiences and focus on where are those audiences are or those audiences are and be that targeted and specific. It's better to maximize the effectiveness of something efficient in terms of your budget and your resources and time that you can put into. Rather than spread yourself thin and maybe see success at a few of those different things which are using up way too many resources. Be specific.

You've brought up a couple of things. Number one, be specific. Focus your marketing efforts on something and focus on that only instead of trying to hit every button out there. You also brought up something else that it's important to bring up in that is most small clinic owners don't necessarily have a budget. Number one might be figuring out what your budget is for marketing or this campaign, and then set that money aside and limit yourself to that budget and see what it does for you. Make sure you're measuring it appropriately. I brought it up with David Straight and I also brought up with Neil Trickett. What your budget is for marketing can vary wildly simply because if you're a startup and you're new. You're opening up a new location, while you want to put more money aside for your marketing purposes and may be up to 10% of your gross revenues if necessary.

Whereas if you're going along and you're nice and steady, you've got a reputation, you've been around a long time, maybe that number pairs down to 3% to 6% of your gross revenues for marketing. Number one, come up with a budget first. I like what you said, "Focus on what you want to do." How do you focus while you focus on where your demographics are? Who do you want to hit establishing your brand identity? Who's your typical patient, the ideal patient? Focus on those platforms with that predetermined budget. That budget can allow for maybe bringing someone on as needed to fulfill that campaign for you or doing it yourself if you have the capability of doing so. 

PTO 89 | Marketing Strategies
Marketing Strategies: Broad messaging is a good marketing technique for building good relationships.


I'm in a unique position at PTSMC because the way that the partnerships operate is at each clinic technically has its individual budget. We all have things wrapping up into a broad marketing bucket budget for us to work with for the most part. I have to have these conversations with each partner at the beginning of the year and then in the middle of the year when things are rolling out. The piece about, how much are you willing to spend to maybe test a couple of things out to see what works? How much are you willing to spend on things that we already know works? What's that breakdown look like? An important piece of it, what are you doing to drive organic results as well? Things that don't require too much of a budget and that's when we get back to this knowing the language to talk about self-referrals.

Having the knowledge and the language to use in talking to patients to tell them to talk about you're going on in the community or leave reviews on Google, leave reviews on Facebook, things that you know have a pretty high yield do anything asking for those things. I was talking about this piece of patient interaction that's called the point of delight. It's a marketing term that speaks to this point where people, I've received great service and they're looking for a way to reciprocate. Especially when it comes to physical therapy. They may not be paying too much for it. Hopefully, their insurance company's paying for it.

Maybe there was small copay, but they don't feel like in terms of the monetary interaction that's happened, that they've necessarily reciprocated for the service that they've received, especially if you're building a relationship. That is trustworthy, caring, they feel like they need to do something to make it up to you. Catching them at that point and saying, "Would you mind leaving a Google review or going on Facebook and sharing some of our staff or I would think most value telling people about us." That's free advertising for you. Having the language to do that, it doesn't require any budget, once you get that point if you're doing those things and you want to continue to grow and expand your patient volume, yes. How much are you willing to spend? Are you willing to test out a few different things?

Not spreading yourself thin, but you did the research, you looked at your analytics, you know that they needed the demographics, they're trying to reach out to you. This is where they are. Let's try a couple of different AB tests and see if we can track results there. Also, having the tracking measures in place to know if it's working or not because I've seen a lot of that too. Where it's like, "We're doing the social media stuff or the Google stuff." It's like, "How are you tracking performance on that? What does success mean to you there?" "We want to see more patients." Like, "Are you separating them and tracking them individually to see that this one's working, this one's not?" It's having all of those points in place before you start rolling things out.

It's important to ask the question, "Do you want to try new things or do you want to continue with what you're working on that will determine your budget?" You're going to spend a little bit more, but you don't want to forsake the stuff that's you've got going already. You want to continue doing what you're doing and then if you're going to do something new, make that an add on so you can see the benefit of it. You have to be intentional about that and plan those things out.

Don't be afraid to cut off the things that aren't working. We saw a lot of that when I came on board originally. We have relationships that had been going at certain clinics, whether or not they're community relationships where we pay $1,000 to be a part of this event. Also, print relationships where we have a monthly percentage of the budget going to these print ads for these smaller local publications. I'll see value in those things, but typically it's not that top-level value. I see a lot of value coming from people reading the paper and seeing the admin like, "I should go to physical therapy." For me, is there a way to leverage that relationship? Can we talk to the sales rep or the smaller publication?

Usually, it's a small staff to leverage the consistency of advertising into actual news coverage? Those things have a value that you might be able to parlay your investment into it, unlike a regular basis. For the most part, you come in and you see that we're throwing a few thousand dollars a year at this print ad stuff and we haven't done any of those relationship pieces. They're expecting it to keep on coming in and you pull the plug and talk to the clinician and say, "Do you know if you're getting any new patients out of this?" I would say, "Someone mentioned it to me one time. I don't know." We'll try to create some metric for measuring success there, but if we don't see that in the next two

Reviews are reciprocations of the services clients receive. Click To Tweet

Move that money somewhere else that's more effective. Anything else you want to share with us before we take off, Peter? 

I'll say one thing and this is a call out to all physical therapists out there, whether or not they have a marketing team or if they're small staff doing the marketing for themselves. I'll push this again because we talk about it a lot at the PPS and APTA and all this stuff. For us, a rising tide certainly lifts all boats. We as an industry, do have a great opportunity to take advantage of the huge percentage of people out there who need physical therapy but aren't receiving it. Also, for some reason aren’t getting the information about the benefits of physical therapy, the scope of services that we have. The ways that they might be able to bypass whatever healthcare system they were working within using referral direct access to come straight to your therapist in ways that that might save you time and money.

If we can be more consistent in not being necessarily self-serving on a marketing side to talk about, we're the best all the time. Let's talk about physical therapies the best because it's a part of a healthy lifestyle. If you commit to it and if you build a relationship with the physical therapist in a way that you might have a relationship with primary care doctor, attendant or anything like that then. Down the line, first off, that's a longstanding relationship that you have. Also, that person's going to have a healthier lifestyle and be able to maintain activity and stay active in the older age. For me it's more about broad messaging, getting those talking points out there, direct access, the scope of service, and then being specific about what the differentiators are for you. That speaks to your brand identity as you've outlined it.

I love the insight and that you're willing to share some of what you guys are doing. I appreciate that. If people wanted to reach out to you and ask you questions or where you might be doing, are you willing to share some of your contact information?

Sure. I'll share my email, Always feel free to reach out to us on Facebook. You can message us on Facebook. We have one account for the whole company. We try to keep it all tight together.

If people want to check out your websites, you were talking about the Google Ads that you use and how you set things up to allow people to request a referral or request an appointment, what is the company's website?

It's easy The individual locations are available there. Hopefully, you'll see in the coming month we're rolling out. This speaks to the idea of breaking down barriers, but we're rolling out an AI chatbot on the site. The goal of that is to get people to the information they're looking for as quickly as possible. We know that people are looking for insurance location or treatment. It pops up and says, "What can we help you with?" If they don't need any things, it goes like, "Here it is." Try to get people to the stuff that they're looking for.

We'll have to check it out. Hopefully, it's already in place. 

Hopefully, it's in place and it's all working correctly. If it's not, you can email me and tell me that it's not.

Thanks for your time, Peter. I appreciate it.

Thanks for having me on, Nathan.

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About Peter Decoteau

PTO 89 | Marketing StrategiesBen has been a member of Teton Therapy since May of 2010. He graduated with a Doctorate of Physical Therapy from the University of Mary in Bismarck, ND and conducted his field work primarily in out-patient settings while in school. During his time at Teton Therapy, Ben has taken many continuing education courses on topics such as Dry Needling, Kinesiotaping, neuromuscular re-education, running analysis, and injury prevention—a topic which he immediately found a passion for and has since conducted classes to the community. Ben quickly applied this vast amount of knowledge to the practice and sharpened his therapy craft. His general interests include water sports, running, outdoor activities such as camping, competing in triathlons, and most importantly spending quality time with his wife and children.

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PTO 93 | Growth Accelerator


Christina Panetta, PT learned fairly early on in her clinic ownership that she needed to outsource in order to grow and improve. When she needed some time and space after having a baby, she hired a PT and came back to part-time work. When she recognized that she needed more business training, she hired a business consultant. Now, decades later, when she needed some support on social media to drive patients into her clinic, she hired a social media marketing company. Too many times, in order to save money, owners will take it upon themselves or leave it to their staff to work in areas that are not their specialty (business ownership and social marketing are two examples). This inevitably leads to poor outcomes, distractions, wasted energy, and little return on the investment. Moral of the story—hire them on or hire it out.


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Growth Accelerator: Hire Them On Or Hire It Out With Christina Panetta, PT

I have Christina Panetta out of New York who not only brings and shares a great story about her growth from a single room clinic to multiple practices, but I'm excited to share this because Christina recognized fairly early on and as a firm believer in either hiring them on or hiring it out. What I mean by that is either hire on another physical therapist if I need more time and space or hire on a coach or consultant to teach me what I need to look for and do that I don't know how to do or also hire it out. Find the resources, find the vendors to do the things that you're not an expert at, which could be many things. Social media marketing and billing come to mind. All these things that sometimes we try to do and we're not trained to do it. We don't know the ins and outs where we could hire an expert and get it done much more efficiently. Christina is a huge believer in that and her story reflects that because she's hired on and hired out. She has grown significantly and continues to grow and continues to look for other resources to help her grow and she's been successful at doing it.


I've got Christina Panetta, Founder and CEO of Panetta Physical Therapy in New York. I've met Christina through Hands-on Diagnostic Services, which we’re both owners of diagnostic treatment centers. I've always been excited about talking with her because she has plenty of wisdom. She's been around for a while. First of all, thanks for coming on, Christina. 

Thank you for having me.

I consider you a great part of my network because every time I've interacted with you a lot, you've had the wisdom to share. I don't know if you remember those instances, but they were important to me. I'm excited to bring you on. Did we meet a few years ago for the first time?

Yes. When we were training, learning how to do EMGs and diagnostic testing.

I always liked our conversations as we were going to lunch and whatnot, but for us in the audience, would you go back and share with us a little bit about your professional story of what got you to where you are? I know you started small, now you're up to four clinics. I want to share what your path was like with the audience. 

I wouldn't consider myself a business person. I went to physical therapy school because I wanted to help people clinically. I never thought about having a business. My husband was a business guy. He had his insurance office and I was working for a big medical group. I had at that point one child, I had my son, he was maybe two years old and we joined a gym. This is back in the time where free weights, we were moving into Nautilus, it's the '80s. We wanted to get back in shape. We joined a gym and we were walking around the gym and they were telling us about how they're going to move some walls down and put in a Nautilus center. My husband says to the sales guy, "Did you ever consider having a physical therapist here?" This was before anybody did things like that. He's like, "No, what would you need?" He looks at me and I'm like, "Room for two tables." The next thing you know, that's how I got into the business. I didn't quit my other job. I got 500 square feet maybe, I don't even know if it was that big. We put two tables in there. My father in law made the sign and it said, "Physical Therapy Office: Christina Panetta, PT." I sat down.

I didn't even have a telephone. I use the club's phone number and my marketing when I would get a phone call, they would go, "Christina Panetta, you have a call on line two." I would run out of the office through the club and answer the phone. I legitimately didn't know anything about anything. The first patient was a gym member and he walked in and he was like, "Who are you?" I'm like, "Physical Therapists." He's like, "I’ve got back pain." He was a landscaper. That was my first patient. I remember his name. I even went in on Sunday mornings to treat him. I started small.

What were the first couple of years like? Did you ramp up quite quickly? How soon thereafter did you get out of your full-time job and recognize that maybe you needed your phone and your space?

PTO 93 | Growth Accelerator
Growth Accelerator: You can't treat everybody yourself, so you have to learn how to delegate.


It was a slow ramp-up. The cool thing was I got to know the doctors in the medical group and the medical group, what would happen is they would have patients. People that were injured at work and in car accidents, which could be treated in or outside of the group. It was a weird situation. Even when I was working there, I was allowed to bill privately anytime anybody was injured at work or in a car accident. They didn't have inside the group all the access. I had access, a pool, and I had access to this new Nautilus equipment and treadmills. I could use anything in the gym. I started two nights and then eventually, I tweaked my hours in the medical group.

I was working three days and then I would work two long days in the health club. The owners of the club, I'm not even exaggerating, my rent was $50. This is the '80s. Therapists were making $10 an hour. My dad was in awe. It's different in the '80s and they were always like, "Are you doing okay?" They love the prestige of having a physical therapist. I was full-time with two nights, then three days a week in the medical group and then two days a week. Eventually, I got pregnant again with my second child. After I had the baby, I switched to two days in the medical group and three days in the main office. Once I was three days full-time with my patients, I bit the bullet and left the medical group.

At that point, you were probably looking for new space. At what point did you finally establish your clinic had set up a lease? I'm sure that was a huge jump for you at the time, but to have your place or jump out of treating full-time and going to your thing.

It was a big jump. I feel like in some ways I was lucky because my main office is still in this health club. What happened was the health club kept expanding. Every time the health club expanded, first of all, they would've given me any amount of space when I first said, "How much do you need?" I was kicking myself because I'm like, "Why did I only say two tables? I need four tables." I eventually did get my phone. In the early '90s, I got a computer. The '80s is pre-computer. I got a dot matrix printer. In the beginning, I had an aide receptionist because I use all their exercise equipment. I always needed an aide in the gym, that was my big plus point. Everybody got to like, "That's got me the whole body concept, come in for your back but I'll treat your whole body." The club liked it because anybody that became a patient often would become a gym member. It was a nice give and take in that period.

It's not uncommon to have a physical therapy combo like that in a gym. One of my good friends, Aaron Williams with OSR in Arizona, worked closely with a gym down there. One of my previous episodes was with Paul Wright. He's in Australia, but the same thing connected with the gym and was able to establish something big with them, especially with that crossover.

It's an easy way because I didn't have to have a big layout of equipment. My most expensive equipment, the same thing, the early '90s. Electric stim units, it was big. We hardly ever use it, but in the '90s you needed electric stim and ultrasound. I remember my electric stim unit cost the same as my Camry, which was my first car. I didn't have to take care of the bathrooms. I kept growing and I was lucky in that the club kept growing. They put a second floor on and I'm like, "I need four tables," and then I was like, "Four tables is not enough. You're not using that conference space. Can I take over that?" I was like, "I need eight tables." As I grew, first, there was me and then Karen Eckardt. She was my first employee. Her father-in-law was one of the owners of the gym. It's convoluted.

Her husband was an insurance agent. Her husband was walking by my office and he was like, "Who are you?" I'm like, "I'm a physical therapist." He's like, "My wife too." I'm like, "I need to meet her." Karen comes and meets me in that summer. I was working. I worked three twelve-hour days and that was my schedule. The other two days, I was a mother. I had two young children. That summer, all I remember is I hired Karen and I said, "This is fantastic. Here are your patients." I was only working three days a week and I gave her the whole schedule and I said, "I'll work on building my schedule in the fall." I took the summer off and enjoyed it. I know it sounds insane, but I was trying to balance being a mother and being an owner of a business.

Success comes from finding experts and surrounding yourself with people that lead you in the right direction. Click To Tweet

Many times I come up with people that I interview that eventually become successful or coaching clients that I have, and they keep thinking, "I'm treating full-time. I need to bring on this other provider and build up their schedule." I try to tell them my coaching clients at least or who aren't at that point, "No, you give them your patients and you worry about building up your schedule or scale back so that you can work on your business." Looking at it from a different perspective, how can I financially afford to bring on somebody else and not treat patients myself? What am I going to do to become productive? You found that because you were essentially living a higher purpose and that being a mother and spending time with your family, especially as young as they were and concerned about building up your patient load afterward. For you to give that to Karen was not only insightful, but it's an example of what people could do. If they have the focus of themselves and their business first. When you bring someone on, it’s investment. It might've been a scary situation for you at the time to take on another salary like that. To invest in bringing on a provider that you can scale back and work on the things that you need to work on, whatever that might be.

My husband, his degree was in marketing. Come the fall, he was like, "We’ve got to go out and visit doctors." That was not easy for me. Because he was insurance, I used to help him. They used to call this X dating where you would call people and say, "When does your insurance expire?" I hate it, but I would do it. I'd be like, "Please don't make me do that." When I had to go and visit doctors, I was like, "No way, this is terrifying." He was like, "I don't understand." He couldn't understand that. I was terrified. I did it, I would go out, but I had a lot of awkward experience.

You learn it over time and you're probably pretty good, I'm sure. 

I feel comfortable. I had a lot of help along the way. For me, I had people that helped teach me how to go and make a relationship with a physician.

Things seemed relatively smooth. When did you hit a point where you're like, "I'm in trouble?" Did you ever hit a point like that? 

What happened was, a lot of my referrals came from the medical group. The doctors wanted their patients to have what I had at the gym. They were referring their patients to me and everything was great until one of them, the leader of the pack, the orthopedic, and then probably hundreds of people have been through the same story. My biggest referral source, way more than 50% of my patients. What does he do? He wants me to open a business with him, but I don’t want to open a business with him. He opens his own PT clinic. The interesting thing is I had an office manager at that time. That was Karen and myself, an office manager and a trainer. Karen and I worked opposite schedules that we could fill up our table, and we only had a certain amount of tables. This is how I got introduced to a survival strategy. The office manager sent us a postcard. It said, "Do you need more patients? Are you afraid of visiting doctors?" I'm like, "Yes." I didn't answer it. I throw them in the garbage. She filled out the postcard and she was like, "We need help." Way back in the '90s, me and the office manager, we fly out to California and then that's when I learned how to make a relationship with positions that I didn't already know. That was either sink or swim. Either I was going to do something to handle the situation or I was going to think.

Was that difficult for you to sacrifice the time, energy, money that it takes to have some consulting through survival? 

The first program I did with them, we doubled our business. Karen and I being together to four full-time therapists. It was a big thing because I remember saying that I always had this target that we wanted to do $1 million. Being able to double the business, that was our big target. I have four full-time physical therapists, I could do $1 million, which is pretty much what we did. That was huge. That was where the club added a second floor and we were able to double our space. I could have gone anywhere, but I've been lucky in the club that I got to stay in the same place because they kept expanding as we expanded. That was huge for us.

PTO 93 | Growth Accelerator
Growth Accelerator: The best patients you can have are people searching for answers.


It took more time going to a weekend course and then coming back and all of a sudden you have four therapists. How much time did that take for you to build up? 

We doubled our referrals in one year. It was probably one year that we've doubled the amount of new business coming in. I did a marketing program with them and then the following year, I didn't know how to manage anything then I did a management program. For us, that’s the basis and it put the organization in the company. The first step is you have to be able to go out and then form relationships, find the patient's people are out there suffering. You have to be able to find those people, bring them into your place but then you can't treat everybody yourself. You have to learn how to delegate. I always say my type of management I call it household management. When I was little, I was treating, but I could hear my office manager and front desk receptionist. She was everything. I was treating and I would be like, "No." My management was like family-style. To me, you could get yourself maybe one therapist. If you want to expand out, we're open from 7:00 AM to 9:00 PM and that's two completely different staff. You have to have a management system in place and an organization. That's what Survival Strategies helped me a lot with setting up, having an organization in place, having systems. Everything even that we do has come from what we learned with them.

The way that my business partner and I looked at it as we were going from mom-and-pop to an enterprise. If you envision what a mom-and-pop place looks like, everything is dependent upon mom-and-pop being there and running everything to an enterprise. The idea of what an enterprise looks like means that there's a structure in place, there are policies and procedures about how you do things. You might never see the owners on site. We recognize that it took some investment in capital, energy and time to make that transition. It’s necessary if you want to grow and if you want to avoid burnout for the individual. The one thing I'm confident I can say this about you is that when you did get that consulting you were adamant about implementing it quickly. You didn't come across and be like, "That's a good idea. Maybe I'll do that someday." I'm certain that you came back and you put a plan in place quickly to get this stuff implemented. A lot of us might read a book or hear some good things at a conference and think, "That's great. Someday I'll implement it maybe, maybe not." You were pretty determined about that.

The big thing is that it wasn't a course that I took. The way that Survival Strategies works is a consultant works with you every single week. More than anything, they were guiding me. I would have assignments every week. There are those people that always get the assignment and they do it right away. I'm the opposite. There's the student that they get the assignment and they're like, "I work good off a deadline." I don't do it when I get it, but I never miss a deadline. I need the deadline to fire me. Every week I would say, "I'm going to talk to this person. I am supposed to have visited five physicians and ask them these questions or I'm supposed to have met with four of my staff and written up their job descriptions." I always had somebody. They were cheering me on and motivating me. To me, I needed that. I was motivated but I needed maybe more than anything the person to hold me accountable.

That's the beauty of having a coach or a consultant, especially one that meets with you regularly, whether that's weekly, biweekly, whatever it is. They hold you accountable. They provide deadlines simply by the meeting. You don't want to let that person down. You want to show them that you're capable and competent. That's the beauty of having that because who else would hold you accountable? You're left to your devices and there's not necessarily a deadline. Essentially outside of the household is the head of the business. You don't have any one individual to answer to when you're at your founder/CEO stage. That's the beauty of having a consultant that meets with you regularly, is to hold you accountable, guide you and teach you. What I find is a lot of them are helping you fulfill your goals and what you want to learn and what you want to figure out. Is that what you found as well?


You've expanded out of four clinics. You've got the policies and procedures in place. You're no longer the household business. You've got the structure, you are an enterprise. What are some of the successful actions that you're handling to overcome the problems that you have?

The biggest thing is keeping my eyes open and being willing to change. In the beginning if you want new patients, you had to make more relationships with physicians. I love that because in New York, we have direct access. People can come right to us. Everybody that works for me other than me has a doctorate. They're all doctors of physical therapy. We have social media. Social media to me has been the game-changer. Think of this, who is on Facebook? People like me. Who makes the decisions about healthcare? Women age 40 to 65 years old and they live on Facebook. They make the decisions for themselves, their husbands, their children and their parents.

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Just like Survival Strategies, there are companies like Breakthrough PT with Chad Madden. They specialize in helping you reach the people that are looking for help. What I've learned is that people are out there. There are more patients than all the private physical therapists in the world could ever handle. Many people want help. Still, when they go to their doctor, even despite all the educating. Thirty years I'm educating doctors and I have educated a lot of them, but they still don't always prefer them first to physical therapy. They're looking for answers and people aren't trusting. They don't trust people. They're skeptical. They don't trust their doctors. They do their research. We can use social media, we can use Facebook. This has been for me the biggest thing, our newest clinic.

I did the numbers, only 25% of my patients come from a physician. 30% are coming because they were past patients but everybody else are direct people, just public. People are searching for answers. To me, they're the best patients you can have because it isn't the doctor who said, "Get some therapy." They're looking and saying, "I have back pain. I'm an active person. I want to get back to doing what I want to do. I want to get back to doing what I love. I don't want to take medication. I don't want surgery. I don't want injections. I've tried all that." They're doing their research and then they come across our educational videos about knee pain, shoulder pain or back pain and they sign up for our workshop. I'm 100% in control of who do I want to see. I can turn it on, turn it off. The fun thing is I can say, "Let's decide what we want." We want shoulder patients. I can go and I can work with all of my staff and say, "Let's make sure we're all doing the same thing." That's a lot of what I spend my time doing because I don't treat it all. I don't have any patient load. Even Karen, she is still with me.

She doesn't have a patient load. We spend all of our time keeping our systems in, but also looking out there and saying, "What's new?" You do the diagnostic testing. It's like, "We should be doing that." We’re researching what's out there. "Therapists can do EMGs, NCVs and Musculoskeletal ultrasound." Does that fit into the practice? Doesn't it fit in? Does it bring the type of patient in? What I find is when you bring that type of patient in and you have to make sure all the staff is capable of delivering the same outcome that you're promising when you deliver the workshop. Our workshops are all about, you have a pain in an area, most likely the cause of it is somewhere else. It's always that message of, "You have a herniated disc. You're bone-on-bone. Yes, you have a torn meniscus." What's causing it? If you never fix what's causing it even after you get the shoulder decompression, you're still going to wear out the other tendons in your shoulder if you don't fix your ribs.

I love the experience that you share because it shows what you would be doing if you're not treating essentially. That question comes up from physical therapists all the time. “If I'm not treating, how am I being productive? If I'm not treating, what am I doing with my time?” You've established that. You're keeping your structures in place. You're still monitoring all the key stats. You've got your KPIs, you're probably graphing them or at least looking at them week-to-week. If you're not, then Karen is doing it for you, reporting up. You're looking ahead and that's what a true leader should be doing. It’s not heading in the ground or buried in patients, but rather looking up forward and saying, "We've got direct access. How can we take advantage? What is our demographic that we're hitting at?" We're getting into marketing strategies. Knowing what your true demographic is and how to message to them is the first step.

I love how you said, "It's like a spigot." You've got two systems in place where you can turn on the patients, turn off the patients or tweak things enough to say, "We're doing this and this is the message that we need to do. We're going to focus on this body part. We need to train the therapists appropriately." Everyone's using the same narrative, the same vernacular, the same vocabulary, they hear these patients hear the same story to build on that foundation. That's what you should be doing as a leader, developing that over and over again, tweaking the marketing and doing the training. It's great that you shared what you're doing as a leader. 

PTO 93 | Growth Accelerator
Growth Accelerator: You have to make sure all the staff is capable of delivering the same outcome that you're promising when you deliver the workshop.


If you know what it is, it's much fun meeting with the therapist. We have thirteen therapists. Every quarter, we meet with every single therapist for 30 minutes. If I do look at their production, I'll usually have a question. I'm always looking for, what's their passion? When you learn things about people, how do I pull that passion out? What do they want? What I see is that most of my therapists other than Karen, myself and Mary Jane, they're all 40 and under.

You guys are 41, 42? 

I'm more in that other demographic of the Facebook people where my staff is the Instagram generation. They will balance in their lives. They want the family and they want the profession. They want to have an impact. I'm reading this book called Impact Imperative. They care about the world. They care about people. They want to treat people who want to get better. I talked to them all the time at the workshop, people are suffering. We have the answers, but there's this big disconnect. They don't know it. When you can take a person, we always do success stories, testimonials, complete a plan of care. We take a picture. The patient talks about the before and the after. You take that person that thought they'd never run again or they'd never be able to walk them all with their grandchildren or go to Disney. That's what's great about being a physical therapist. You can help a person that wants to do that passionately.

We spend a lot of time teaching new therapist, how do you pull that out? I spend a lot of time talking to the therapists about who is it that you love to work with? Why do you love to work with that patient? Let's get down to the bottom of it. I'll find out some crazy things like, "This person loves to work with people that are grandparent’s age that can't walk." You would never think of this. He’s a young guy and he's like, "That's my favorite patient." How do you create a story and how do you find those patients? You can get so good at working with that patient. That's what I'm having. I spend my time and I'm having fun. That's helping me have my therapists have more enjoyment and getting more out of work because they think they're having a bigger impact on their community.

It sounds like what you're doing intentionally, you're creating a culture that is focused on purpose and you're getting to the heart of what the therapists want to do and fulfill that purpose that they had in going to physical therapy school and helping them define that. I saw you're reading The Coaching Habit or Change Your Questions, Change Your Life. Which coaching book was it?

It was one of those, The Five Questions.

It was The Coaching Habit. I highlighted that in a show because that was one of my top books. I know you're probably following that agenda a little bit to help them get in becoming a coach. That's what a coach does. What else do you want to do? There are some books that have been influential as you look back.

The last book I read, believe it or not, was Impact Imperative. It was all about having an impact because I do all the work in Haiti. It was looking at, is what you're doing having the impact that you thought it was going to have? It has a lot of research of sometimes what you think could have a good impact and sometimes have a negative impact. That's why it's called Impact Imperative. Making sure that you look forward and you also look backward to say, "This is the impact I was trying to have. What impact did it have and was it all good? Could some of it have been bad?"

With the knowledge that you have and the wisdom that you gained over the years, what would you tell your past self about what you know now?

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I would say don't be afraid to challenge yourself. Most of the time, people don't give themselves enough credit to have the confidence to move forward. Give yourself more credit. When I would go to visit a physician, I was the one that was afraid and I felt uncomfortable, but my husband was like, "Christina, every time you come back here, every conversation you're like, the one is good." Some of it is your demons, hold yourself back. The other thing I would say is to get help and reach out. Open your eyes, read all the magazines that we have. There are a lot of people out there that can help you. If I had reached out and worked with Survival Strategies years earlier, what would that have done? I would have been twice big in the hay day of physical therapy. Not that I'm not, I've achieved a lot. I've moved through it, but some people can help us. What I'm finding, go on the other extreme, I'm like, "Who's the expert in diagnostic testing?" That's E-stim. You’d go to HODs. I had issues with getting patients to arrive. "Who's out there?" It's much easier. It pays itself off much faster. If you're having difficulty in an area, look out there and don't be afraid of the changing environment. I look at it and say like, "Social media." Even for me, I have an Instagram account too. I know Facebook because I'm that perfect demographic, but when I want to hire a PT, they're not on Facebook, they're on Instagram. A lot of it is being willing to study up a little bit and research.

I love that you've gotten to that point and that surprised me. It took you several years to get to Survival Strategies from when you started?

It was 1996.

It was about the same thing for me. We got coaches earlier than that, but it took me several years before I was willing to invest in getting some coaching and consulting. Frugal as I am, it's hard for me to part with money. Like you, once that I found the benefits of it and how it not only increased my volume and my profits, my revenue, you name it, all that stuff, it also improves my life. The freedom that I had in my life. Fulfilling a greater purpose and helping me achieve that. There was all that stuff that was helpful that came from having coaches and consultants and I would do the same thing. I would tell my earlier self to get a coach much earlier, get some consultants. The same thing I had this accident. 

For me, the big thing is, I am in the second generation in the practice. Transition planning, even Karen and I had talked about that. There's a lot of consolidation going on in the industry. You work hard to create something that I feel is unique in the marketplace. How do you transition? That's I'm exploring not much selling the business but looking at, “How can I offer to my employees to become perhaps owners in a company?” That's the next step, how do I make sure that it lives on? Even for my staff, you have this environment, if you sell out, half of them could lose their jobs and life may not be the same as the way that it is. It's like, "How do you have it live on?" I'm not there every day anymore, so less and less.

Good luck with that but it goes back to you being the leader and looking forward to seeing what's coming down the road. Not for you individually, but also you're noticing what's going on around you and how are we going to survive this? How can we structure it? What do we need to do to survive and do what's best for our team members? You brought up something. Tell us a little bit about what you're doing in Haiti. Do you mind sharing? 

Haiti had an earthquake in 2010. Another 300,000 injured and maybe twelve physical therapists that were all trained in the Dominican Republic. For a country, there are ten million people that live in Haiti, the poorest country in the Western hemisphere. It didn't have a good, stable system to start with. You know the story. I had gone there during the earthquake. I brought back a woman and a baby and I have continued to work at Stony Brook University there, maybe after four years, I brought them down there to help establish a PT program at a university. The cool thing, our first students graduated and 22 of them. The two are my scholarship students from rural, I'm talking rural mountain, no electricity, running water. They live in banana huts, they ride mules. I sponsored two kids and they're graduating. Everyone has a passion. My passion is to help that country together to help grow the physical therapy profession in Haiti. They have 50 something physical therapists in the country. They are all young, smart professionals. There was another school. There are two physical therapy schools in Haiti.

PTO 93 | Growth Accelerator
Impact Imperative: Innovation, Entrepreneurship, and Investing to Transform the Future

You don't have to go to the Dominican Republic and learn to speak Spanish to become a physical therapist. They're at the point of being forming licensure. If they're at those early stages of having physical therapy be a recognized part of a medical program that every hospital would have a physical therapy program. All therapists would be registered by the government. They're trying to set up, they have a legitimate association and they are recognized by The World Confederation for Physical Therapy. They just got that.

That's great and kudos to you for taking on such a massive project like that, but your influence has been felt. Congratulations and thanks for your work with that. 

The cool thing is all the physical therapists that I know, people in private practice, they have helped me with that project. Anytime I've reached out and said, "Can you donate money for a laptop or a table?" People are amazing and that they've helped and they've also brought their talents. Many people have come with me to Haiti. That's where you get to see how good people can be.

If people were interested in what you're doing or wanted to donate, do you have ways to take their money or take their time or help?

I haven't asked much for the money but the talent they can email me We haven't set up a 501(c) officially yet.

I'm sure there are people out there who are like, "I would love to join a trip sometime or if there's any way I can help out, let me know." I want to make sure that's available and to do that, they need to reach out to you?

Reach out to me. Even if you go through my Panetta PT website, there are links and find me on Facebook.

I'm sure you've posted some of the pictures on Facebook or Instagram or both? 

It’s on Facebook.

You've gone from a point of success and you're making significance in the world, and even in the PT industry in regards to Haiti, at least. You're at the forefront it seems like. Congratulations on that.

I feel like I wake up every day, I go to sleep thinking about, “What can I do?” It drives me. It is my passion. I try to share as much as I can with the therapists in Haiti because they have such a thirst for knowledge and know-how. Being able to share, not just me, but that's where you realize how many cool, great people I know that I can bring those talents together to help in ways that make such a big difference.

Thanks for your efforts there. Is there anything else you want to share with us?

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It makes me realize, why I do what I do and how much physical therapy touches many lives. The biggest thing I see is that I don't think any of us know the effect that you have on the person. I came in, I couldn't do this and now I can do it. You don't always fully know. I thought it would be cool to follow-up with people and say, "You've got this person back to anything." It could be walking or running or work or helping their grandchildren in turn. Think about physical therapy in general, you get that active person who's involved in their community back to doing what they love, what do they, in turn, accomplish in the community? That's where I feel like physical therapy has such an impact. I can't think of anything, honestly, that has a bigger impact on not just life, but it's the trickle effect into society. Anything we can do to promote that. If we always keep that in mind, that's why we do what we do because it makes the difference.

Thanks much for sharing your story and your wisdom. I appreciate it. 

You're welcome. Thanks for having me. It was fun.

Have a good day. 

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About Christina Panetta

PTO 93 | Growth AcceleratorChristina graduated from Stony Brook University with a Bachelor’s of Science in Physical Therapy in 1985. When it comes to helping those in critical circumstances, Christina wastes very little time – in fact, just after graduating from Stony Brook, Christina began working at the Brunswick Rehabilitation Center. During her tour at the Rehabilitation Center, Christina worked closely with patients that were recovering from extreme physical injuries; these injuries include patients with spinal cord injuries, traumatic brain injuries, amputees and burn victims. Christina eventually went on to open her own Physical Therapy clinic, and never strayed from her calling to help those in need.
In 2005, after Hurricane Katrina left many parishes throughout Louisiana and Mississippi in ruins, Christina immediately took action working with local Law Enforcement to provide medical care and aid. Hurricane Katrina, as devastating as it was, is only the beginning of Christina Panetta’s dedication and unyielding commitment to others.
After the 2011 earthquake in Haiti, Christina felt compelled to help those that were injured, and went to assist distraught families at the state hospital in Port Au Prince. One of Christina’s most fulfilling acts of aide to humanity was when she successfully cared for and brought home to the U.S. a young woman who had sustained a double amputation due to the earthquake and her eleven-month old baby who was suffering from malnutrition.
During the course of the next three years, Christina continued to provide medical care and aide to the people of Haiti. Recognizing the overwhelming need for Physical Therapists in this region, Christina turned to her Alma-Ata, Stony Brook University. She went to Richard Johnson, PT, EdD, Chairperson, Department of Physical Therapy and through his strong leadership and the stellar reputation of Stony Brook University a successful collaboration between Christina, Stony Brook University and UNIFA ensued. On October 6, 2014 the first University Program in Physical Therapy opened in Haiti.
Christina lives in Oakdale, NY with her husband Richard Panetta; Mana and Wolf continue to reside in the Panetta household. Wolf is 10 years old.

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PTO 90 | Finding Your Personal Purpose


No matter what you want your clinic to become, it still all boils down to understanding why you exist as a business in the first place. Countless numbers of episodes in this show have been spent discussing the importance of determining your clinic's purpose. However, what is not talked much about is the importance of determining your personal purpose. In this episode, Nathan Shields speaks with Craig Filek of Purpose Mapping to shine a light on why having the clarity of your own motivations and purpose in life is just as crucial as that of your business'. He talks about how it allows you to see what needs to be prioritized and what needs to be let go, making you feel accomplished instead of stressed or overwhelmed. Get in touch with your true self and practice acting in alignment with it. Eventually, you will find yourself feeling more free and certain about your actions because, at the end of the day, your company's purpose and values are simply an extension of yours.


Listen to the podcast here:

Your Fulfillment Matters – Finding Your Personal Purpose With Craig Filek Of Purpose Mapping

I have Craig Filek of on. He focuses on helping individuals figure out what their purpose is in life. He's been a coach of mine. As I've been working with him, I wonder if I've failed to make the connection between company purpose and personal purpose. Recognizing that your company's purpose and even your company values are simply an extension of your purpose and values. You essentially created this business to fulfill a personal purpose that you had in your life.

As owners, you start moving out of treating full-time, it will be helpful for you and it will be super-efficient in determining what tasks are most important in prioritizing your day if you can be clear about your purpose. Why are you stepping out of treating? Why are you wanting to see the business grow? What effect do you want to see from doing that? That all comes from knowing what your purpose is. Craig shares a message for the audience at the end that I hope all of you take to heart. It's one of the reasons I do my show and it meets one of my missions in life. I would hope that as you read this, you can recognize and come to the realization that it is an important message that I'm trying to get across specifically to you, the reader. I'm finding this to be one of my favorite episodes in doing this show and I'm excited to bring this message to you.


I've got Craig Filek, a personal coach of mine and the Creator of Purpose Mapping. I'm excited to bring him on to introduce him to the audience simply because we've talked about purpose, vision, values in regards to the companies and the clinics that we own. I want to talk more about the personal purpose and how important that is to figure that out as we are continuing to grow and develop over time. It's a step that I'm seeing some of my coaching clients come across in what they initially had as a personal purpose in opening their clinics is not quite serving them. It shows up as maybe burnout or overwhelm. Craig, thank you for coming on. I appreciate it.

It’s great to be here.

Craig, you worked with me and it was a great experience. The reason I reached out to you is that I felt like at that time, and you probably noticed it more than I did, that I didn't have a clear purpose at this stage in my life. It's such a valuable thing to consider as we're looking individually. PT owners that I come across also may struggle with that a little bit. Tell us a little bit about what got you to this point? What's your professional path to become the creator of Purpose Mapping?

The word that popped up was desperation. I started a business young. I was a young father and it was bonkers for a long time. I was trying to figure out like, "How do I get a grip on this? How do I get a grip on myself?" I've probably read a thousand books. I invested pushing 300,000 hours in coaching, training, therapy and workshops. I became a junkie of this stuff because every insight it felt closer to what I call alignment with my purpose and my mission. There was this sense of like, “I'm doing better for having investment.” I kept getting positive results there. I kept growing. One of my claims to fame is I've tanked more businesses than most people dream of starting in a lifetime. It's funny to say, but it's brutal when I was in it. It's like, "This is not working. I'm burning out." I can flip houses and make $30,000 in a weekend, but how sustainable is that for my nervous system, my family? I would walk away. The business is proper, but a lot of sales and marketing-oriented things.

Your fulfillment matters. Click To Tweet

What I loved about that was it focused on human psychology. I was a Philosophy major. I was trying to figure out life like, "What's going on here? What are we doing?" The root of my story is I was trying to figure it out. I came across personality profiles. Those were super helpful. Also on the more philosophy side, I'm talking about philosophers like Zig Ziglar, Tony Robbins, Michael Gerber, Stephen Covey. The classics of success philosophy and it would all say in their own words but I started connecting the dots. It's not hard to do. They'd all say, "You’ve got to have a purpose. You’ve got to have a why. You’ve got to have a mission." They were all pointing at this thing that I had to have that I didn't seem to have.

There's a quote out there I love. "If you don't know your purpose, then your purpose is to figure out your purpose." That became my path and I went deep with it. Years ago, I walked away from it. I did build a seven-figure business and checked off all the checkboxes of all the mind mapping. Tony Robbins would say, "Write out everything you want to achieve in your life and then rank it. Is it 1, 3, 5, 10 years from now?” It took me twelve years to check off every single checkbox. It was stuff I didn't even know if I'd ever be able to check off. I looked at it and I said, "I'm miserable. This sucks. I'm out."

It was horrible to get the success that I thought that I wanted and to realize it wasn't making me happy. That spun me out into a bit of a night of the soul, so to speak. That's where Purpose Mapping is. I had been working on it compiling it and whatnot. To take it on as like, "I'm going pro." This has been the only thing that's helped me in my life. It combines, everybody is saying I need this big why. They're also saying I need a clear what, I need a proven how. To connect all those dots seems to be the minimum viable framework for enduring successes, sustainable success. Something that I could do and not burn out after a couple of years and get good at and make it my life's course.

That speaks to me because I found the same thing and maybe some of the PT owners out there have experienced the same. I had gotten to a level of success with my company. I didn't have a lot of admin or executive support. I was treating full-time and trying to run the business at night and doing notes on the weekends or waking up at 4:00 in the morning, getting home at 8:00 or 9:00 at night. You did the same thing in a different venue. I would go without seeing my newborn for days at a time. I tell my wife at night before we went to bed, "I haven't seen our baby awake for three straight days." Going through that, it wasn't a financial issue. As you said, you were successful. You had a seven-figure business but I wasn't experiencing life. I didn't have a lot of freedom. I hadn't cultivated any hobbies. I saw some friends once in a while and I got to go on some cool vacations, which typically got interrupted by phone calls from the business. It was at that point and as I'm talking to other coaching clients, I'm not alone and you're not alone. That's where these guys have found this success, whether it's Covey or Robbins and Gerber. You’ve got to get deeper. You've got to figure out what was serving you at one time isn't serving you now.

You use the word stages and that's an important framework. Particularly, I like Maslow. He's got a good framework. That pyramid, I want to dispel some false notions. Maslow never drew a pyramid. That was somebody else. I don't know who did that, but that seems to be the way it's presented in high school. The psychology class is the first time I saw it.

PTO 90 | Finding Your Personal Purpose
Everything flows from knowing who you are and why you're here. Without that, you're shooting in the dark and your success will not be sustainable.


You see the hierarchy of needs and it's the pyramid.

It's helpful, but it's not how he conceived of it. He conceived a bit more like waves. A better description is more like spinning plates. I’ve got to keep the lights on. I’ve got to keep the heat on the house or the air conditioning is the case may be. Keeping food on the table and safety. Keeping the relationships going and then generating success. “I’ve got to make sure that the kids are fed.” There's this process of keeping it all going. If you can get all of that going, then you can start spinning the fifth plate, which is the self-actualization of like, "Who am I and why am I here?" At the beginning of moving into, “How do I become successful?” That's a stage where it's important to do a deep self-assessment of like, "What are my talents? What am I passionate about?" There's the hedgehog concept from Good to Great, which they overlay the three circles of what you're passionate about, what the world needs? What do you need to be paid for? What you feel you can become world-class at? You have to assess that. It's crucial because the business I had built with the partners when I walked away, it didn't collapse. I said, "This was great, thank you. I can't do this anymore." We were training lawyers. It was similar to what you do with your coaching of PT owners. You've got practice, but we need to turn this into a business.

We need to put systems in place. We need to get some structure here so that when you leave, you come back and it's running better than when you left it and went on vacation. That's the holy grail. We did that, we built it to 22 people on the team and it was great from a standpoint of like, "I checked off the checkbox. I achieved success. We did it." That business is still running and the revenue is double now. There's a way that we have to look at going into becoming successful and then what's beyond success. What we were training these lawyers to do that was the businesses that I was doing was we were training them to build a law business. Some of them would come to us and say, "I see your systems. I see that this would work. I don't want to be a lawyer." That was a big revelation. They were on this train there. Their people had gotten them on. In that hedgehog concept, if you're not passionate about it, it doesn't matter if you can get paid for it or even how good you can be at it, you have to have all three. That’s where I was going with that. There's going into success and then there's what's after success, which is where you and I met. You're like, "I did it. Now what?" Those are two different stages that require a slightly different address.

The way I've mentioned it and not that I bring it up all the time, but the way I see it sometimes is people can attain a certain amount of success. To me and I don't know where I heard it but the next step seems to be going from success to significance. That can mean a lot of different things for a lot of different people, but it's almost expanding your influence. You attained some level of personal success. My influence needs to spread out further into not just my family, but maybe my community and my larger network. That's when success lends into significance, which could be measured as success at a greater measure. Getting back to purpose, it fulfills a greater purpose in yourself. Is that what you find? 

It's no longer about the money. It's about fulfillment. That's why I like the spinning plates metaphor because it's hard to be fulfilled if you can't keep the lights on. There's an interesting indicator where it's $70,000 a year and you could adjust it for where you live. Every dollar that we earn an additional up to $70,000 makes us happier for earning more money. That ladder becomes this hamster wheel where we're running faster trying to get more money and it's not making us happier. That's called Daniel Kahneman's number. He wrote, Thinking, Fast and Slow. He's a Nobel Prize-Winning Economist. That's a key insight. If you're making over $70,000, how do you step back and say, "I've got another plate I’ve got to start spinning or I'm going to burn out trying to earn more money for marginal gains in fulfillment?" It's a different gear. It's a different plate.

If you don't know your purpose, then your purpose is to figure out your purpose. Click To Tweet

You use the word burnout. Do you find that it's something like burnout, overwhelm or something like that? Is your body or your mind telling you that it's time to find a different purpose or what you're working on isn't fulfilling your needs?

I'm going to unpack that a couple of different ways because there's a lot in it. For one, it goes back to that lawyer anecdote that I was sharing. It doesn't matter if you can get paid well for it and you can do it well. If you hate it and you're not doing the thing that you are here to do that you are fulfilled by, you're already grinding your gears, you are already burnt out. There's that aspect of it. There's the aspect of even if you do love it and you see this with rock stars, musicians, professional athletes, they only play for a few months a year. Most of the time they're training, but they're resting. They're getting ready for the season. A PT owner, where's your nine months off? You don't get that. There's looking at, how do I maximize, back to the revenue, the passion and the sense of capacity, the skillset? I'll never be good at basketball. I'll never even be marginally good at basketball. Trying to be an NBA player would be stupid. It was like, "What's wrong with you?" There's a gray area where it's like, "I could be good at this thing and it would pay fine. I like it."

If that's why you're in business, that's our recipe for burnout, misery and making your family miserable, potentially losing your family. I've seen it go bad. There's the, "I love it. I'm doing it." Like a professional athlete, it puts my inflow. It's amazing. It's awesome. Maybe you’ve got to get your economics differently shifted. You’ve got to figure out the money piece so that you can work less and make it a little bit more and be able to manage it. I've seen burnout happen in all three of those ways.

It's interesting as you're talking and you talked about stages. My personal experience there was maybe a decade there. I own my company for many years. For the first ten years or so, if people ask me, "How's the business going?" I'm like, "I love treating patients and I'm making a connection with the community and we're growing, but I hate all the business stuff." What was interesting is as I started working on the business as a business and not a job that owned me, essentially, I recognize that treating patients didn't fulfill my purpose anymore, so things changed. As I worked on the business, recognizing that I can create a greater influence then that's started sparking a different purpose in my mind. You see that change in evolution in time. Whereas initially, I would've been happy to have someone else take all the business headache off of me, all the HR stuff and whatnot. I found that changed as I started stepping up to the role that I should have had all along, that was to be a business owner. It's interesting that the transition that took place in me. 

I think Piaget was good at describing new psychological capacities that come online. For instance, I remember being in grade school, 5th, 6th grade, there's a sensitive period of development where a child cannot understand volume equivalent. You take a can of Coke, this is what happened at our lake house. I remember the slightly older cousins and the slightly younger cousins and I happened to be right in that sensitive spot where I realized I didn't know that before, now I know this. There was this learning epiphany and it was the tell a short fat glass and a tall skinny glass and it was the same volume of Coke. I was like, "That's the conservation of volume. I couldn't have learned that six months prior. It's a similar thing. It's like the spinning plates. You have to get enough success going and then all of a sudden you realize there's more for me. Where's the roadmap for that? That's where I'd love what you're doing. This is one of the things we talked about on our first call.

PTO 90 | Finding Your Personal Purpose
Having a goal-oriented framework for your life creates dopamine.

Before we even engaged in working together, you're in a phase of life where you've achieved this success. You have a lot of skills and knowledge, and you've got a lot of passion for helping people, guiding people where there isn't much of a roadmap to do what you've done. That's where the significance starts to come in. The meaning starts to come in because you're not just impacting that individual. You're impacting your whole family, potentially for generations. Everybody that they touch their business growing, more people being healthy in their bodies and alleviating pain has an overall benefit for society. That's where the sense of significance comes in but you have to reach a certain level of development before that's even available to you.

How do you recommend someone that's reading this? Maybe they've spun enough plates. They're sick of spinning them all and holding them all at the same time. Where do they start? They could go directly to you, but if someone were to start, where do we start to figure out, “What is my purpose?” Maybe they might've even done the purpose homework for their business. It's an extension of them, but it doesn't fulfill their purpose. How do you go about helping somebody, or what would you recommend they do to start that process? 

There are many YouTube videos and books. Tony Robbins has a process and Michael Gerber has a process and everybody's got a process. You could find one of those. You're saying before hiring a coach, what could they do? Take an hour or something. It goes back to what we were seeing about stages. The sense of purpose evolves. When I was in my twenties, I had to keep food on the table. I was trying to find something that I could tolerate doing because I'm unemployable. I don't know how you are, but nobody is going to hire me and I wouldn't want them. I had to figure that out and it was a bit of a harder road for me. This is the advice I'll give when young men come to me and they say, "I'm thinking about this. We’re starting a business and we've got a kid." It's like, “Your purpose is being there for your kid. Your purpose is to make sure that the rent or the mortgages pay.” You don't need to be worrying about the top of Maslow's pyramid. You’ve got to be making sure that you're going to know that the hatches are all bad and down.

At that phase, it's more about skills. To take some skills testing, the number one that I would recommend that people can go on and in twenty minutes they can have an insight about themselves and, "I've been focusing in the wrong area. No wonder that's felt hard,” is the test. What's fascinating about this woman, I know you did it, but I don't know if you know the backstory about this woman. Her father was the Wonderlic IQ test guy. She was sitting there at the dinner table at 15, 16 years old. Of course, she's intelligent because she was raised by an intelligent man and she says, "Dad, that's all great but how do people apply this in their lives?" He puts his fork down and looks at her and says, "That's your work. This is my work." He was quick like, "I don't care. That's not what I'm doing." She took that on.

It's an amazing resource and it's amazing to give to your team. I was introduced to it as a hiring tool that you should do this because people will tell you all things about what they're capable of and you don't know. If you give them some assessments, you can get a better sense of it. The second thing I'd recommend is, what we did is we triangulated 6 or 8 different tests because then you start to see where they overlap and the rest can blow away in the wind. That kept coming up. You're never going to forget that.

A business is different than practice. Click To Tweet

Common terms would come up to describe me throughout those personality tests. It’s not that any one of them was dot on. Usually, they were pretty good at explaining to me, but similar things would come up each time. 

The magic of my process is that we triangulate all these different tests and then we put them into a common framework where we check all the boxes. We got the why, we got the what, we got the how. Those will evolve, but the boxes don't. The framework is going to stay for the rest of your life. You'll know, "I've got to update my strengths here." I would recommend the Kolbe. I would recommend there's something called Wealth Dynamics, which you did. Wealth Dynamics is beautiful. It's wonderful and simple with 25 questions. The best $100 you'll spend on your wealth and business development. It tells you where to focus and who to hire next. Those would be the two right out the gate and then you could get something out of the Myers-Briggs but a lot of Myers-Briggs is misunderstood. It's easy to mistype without having a coach to work with you who's trained in it. If you get the right type and you read the right report, I'd like and I love I took their training. They've got the best model for understanding it, but you can get a free result at Those are the three that I would start with. You can do those in an hour. When you triangulate, "They're all pointed this,” dump the rest, double down on your strengths and go with it.

I have to laugh every time I'd talk about Kolbe because there was one section in there that defined me well and to the point, it said, "Do not work on small engines." I shared that with my wife and she busted up laughing. Because she knew that if I took a Saturday to tinker with an engine or try to fix something, try to be the handyman in the house, it would result in crying children and arguments with my wife. Her telling the kids, "Give your dad some space. He's got to work some things out." I'd go jumping through that house all mad and hoping everybody noticed how upset I was. Honestly, one of my goals is to hire somebody to fix all those things for me. To find a handyman and the peace it would give me and my family would be much greater. The tough part is to part with my money. It’s hard for me. 

You're an accumulator in the Wealth Dynamics.

Yes and the thought of that, thinking about hiring somebody out to do that stuff, it brings me peace. To look back in that Wealth Dynamic and say, "That's right. I need this type of a person if I'm going to do well. I'm not the salesperson. I need to hire the salesperson." Looking back in my growth as an owner, I was like, "That's why that move. That's why that hire worked out well. This is why I aligned with these people because they provided this strength to my weakness."

PTO 90 | Finding Your Personal Purpose
The sooner you work with a coach, the better off you're going to be, and the better off your family is going to be.

Imagine there's a big jungle gym in the room. All bars and things to bang your head on. The lights are out and you're, "I can figure it out." You're swinging on the monkey bars and then you hit into something. All I like to do is turn the lights on and then you go, "That makes sense." You can navigate your life with ease. That's what these profiles will help the people reading and start to get a grip on. It’s like, “That makes so much sense.” When you're talking about fishing, the small engines, a lot of people are running their businesses from this place of, "I should. I'm the man of the house, I should fix the dishwasher." The woman stands back and says, "Give your dad a space.” I want people to know how frustrated I am. That's the recipe for burnout. That's a disaster.

It brings much peace because as I went through the process with you, I've got things on my plate that I recognize they aren't my priority. I can get to them and I'll schedule them according to getting things done and I'll put them on my calendar to work on them but not until I get the more important things done first. As we figure out our purpose, you did this with me, is break it down to what my vision and mission are. Also, what are my goals for the next 6 weeks to 6 months? What do I need to do to reach that 6-week to a 6-month goal because that's already in alignment with the other stuff? It's the same thing that you would do with your team. That was an interesting thing.

As I talked about personal purposes with one of my coaching clients, he's like, "You're saying what I learned about doing it with my business, I apply to my personal life?" I was like, "Pretty much." Look at those business principles and apply them to your personal life. To the point where I had a business coach, his family had values that they expressed every day. They all had a mission statement that they would say to each other every day. They had goals as a family. He didn't have written down as you would in your business, but he had processes and procedures for how he cleaned out his closet every six months. He took those business principles into his personal life. 

You know what's interesting is it's like the jungle gym in the room with the lights off. We have values and processes. We have them anyways. Those boxes get checked one way or the other. This is making that conscious and then making a conscious shift in some of the decisions about, "The thing I need to do is move towards my milestone in alignment with my mission and not fix the small engine."

I think about that and I'm like, "What can I do to get further myself?” Also, what things are in my head thinking I should be doing that are taking me away from my purpose and intentionally being like, "I can let that go. I can call somebody to fix it or I can do it some other time. I need to spend more time with my kids or go out with my wife or something like that and develop those relationships?" I'm fulfilling that purpose, knowing that other stuff can get done. It's not as big a deal. What I've learned over time and through making mistakes is if I do focus on things, then I neglect the others. I'm not going to be happy. 

We're always a choice even if we're choosing to give up our choice. Click To Tweet

The results bear out over time. It’s making this conscious both in your personal life. I started with Michael Gerber. My first business partner was in an E-Myth Mastery guy. I had access to all the modules and I went through it. I went through the primary aim exercise probably 6 or 7 times. I kept going through it because I was like, "I’ve got to get this right. I’ve got to get this dialed in." Michael Gerber was clear. Michael Gerber, for people that aren't familiar, his whole thing is work on your business, not just in your business. It's creating it as a business, not just a job that owns you, that type of thing.

There's a principle that he would start within mastery, you start with the philosophy. There's a business system’s philosophy and then you do your primary aim, which is your purpose, then you do your strategic objective, which is more your mission. Because this is my purpose and what I care most about, therefore I'm going to build this business in this way with these processes. Everything flows from knowing who you are and why you're here. Without that, you're shooting in the dark and maybe you can be successful, but it's not sustainable.

What are some of the success stories you can share with us about people? I consider myself a success story, but that's yet to bear out. We'll see how well I do with all this coaching stuff and whatnot, so far I'm loving it. What have you seen and how it affects other people's lives?

There are big examples like the guy that his thing is Ultimate Frisbee. That's what he loves. That's his game. He plays every day. He's in his 40s and he's still out there banging into guys. My knees cringe every time I hear him talk like that. He leveraged an island off the coast of Panama from some investment banker who didn't know what to do with it. He bought it and there's no infrastructure. There's a bunch of ocean waste up on the beach. This guy goes down there 3 to 4 times a year. He brings down a group of people and they'd go down, clean up the beach and play Ultimate Frisbee, and there's nobody to bother them. That's what he loves. That what he wants to do. He's got a whole lot more. That's one example of the alignment that just makes unheard of things. I don't even know if he paid for this island. He might've put down $10,000, was going to do a Kickstarter campaign, came back and told the guy, "I can't raise the other money. Why don't I give you this?" The guy was like, "Take it." That's what clarity will do for you. Clarity is king.

Another example I'd love is the first woman that I worked with. She had worked for me in my previous business. I gifted it to her because she was a single mother and I have a scholarship fund for adoptees, single mothers, and veterans who you are looking to make changes that will impact generations. I gifted it to her when I was doing what I coached you to do, coach somebody and get started. Don't worry about charging. See if they like it. That's swiftly turned into money if it's right for you and it's working for you. For me at the beginning, I started out. I saw her and we were out walking on the beach. I was glad my daughter was there because it was that sense of meaning and fulfillment. Out of the blue, this woman said, "Craig, I think about my purpose map every day."

This woman, bless her heart, ended up contracting Lyme disease. It was something awful. She couldn't get out of bed for six months with two twin boys. It's not like she has some huge rah-rah success story, but it impacted her at such a deep level. It's sorted out her insides and what mattered most to her. She had a bucket. I could talk about them as checkboxes or a framework, but these are buckets and as you're going through reading something, learning something, experiencing something, you go, "I know where that goes." You don't have to chew on it wondering, "Why did that happen?" It's like, "That fits there. I'm not going to do that anymore,” or “I'm going to double down on that.” It makes sense. Don't fix engines. That's bad for me. “I got it. It makes sense.”

PTO 90 | Finding Your Personal Purpose
Take one tiny action step towards a life that's sustainably fulfilling and successful.

There are some things that I'm doing that play to my strengths that we figured out that I only have to give a little bit of time to it. When you figure out your purpose, you don't have to spend all day in your purpose. In this enlightened state, if you could give it some attention, 1 or 2 hours a week as far as playing to your strengths. If you do something in line with your purpose every day, it doesn't have to take a long time to do it. You fill the bucket. Put a drop in the bucket here and there. It makes your life feel more meaningful. It comes down to this and I know you train people on this. If you did nothing else except that one thing, you would be fulfilled and in the flow.

Let's break it down. We're talking about dopamine. The only thing that makes you happy is your dopamine, serotonin and oxytocin ratios. Do one tiny little thing, because even having a goal-oriented framework for your life, that in and of itself creates dopamine. Otherwise, we grind and burnout. It's like, "I don't know why I'm doing this. I don't know where this is going. Why do I keep doing this?" I’ve got to keep the lights on so you keep doing it. Putting that one little drop in the bucket, that homeopathic dose. We talk about it as your mission, your big hairy audacious goal, your milestone in 6 weeks to 6 months and what do I have to do? Where I got that from are two places. One, because I triangulate everything and everybody pretty much saying the same thing over and over. One is from a book called The ONE Thing by Gary Keller. It's such a great book.

If you guys don't know, Gary Keller built the largest real estate company in the world, Keller Williams Real Estate. How did he do it? He focused on the one thing that he could do each day that would move that business. It wasn't fixing the dishwasher, it was something else. He asked all of his frontlines, all of his executives, "What is the one thing you can do?" They would ask all of their managers, "What is the one thing each of them could do?" They would ask all their frontline people, "What's the one thing you can do?" I could call that prospect, one thing and that starts to build. You get dopamine every time you do that one thing.

Overtime that starts to take on this exponential curve of fulfillment. That's where it comes from. The good life is a healthy ratio of dopamine, oxytocin and serotonin. Where do you get those things from? Doing things that are aligned with meaningful goals that serve people beyond yourself. It's not harder than that. Coming up with the things that are on track for your unique strengths, your unique interests, passions and purpose. That's the work. That's a lifetime, but getting the framework that's what I do in a nutshell. To give you a framework at least you know which boxes to check. Everybody's talking about all the same stuff, but it's a big soup.

Do you find that going through this process is different or unique when you're dealing with small business owners or healthcare practitioners like us? Is there anything unique to maybe our physical therapy set?

I would break it down more this way. I work with executives who have a boss. I work with entrepreneurs who technically we don't have a boss. You would be in that subset, but I would more say you're professional. A professional is somebody who's got a specific credential versus an entrepreneur who was the C-student that hires the A-student. I work with investors, people that however they got there, they're investing their money. As far as professionals go, what I love about working with professionals is you're in control of your time. You get to decide how you're going to grow this thing and turn it from a practice to a business. That's where you fall into the category of entrepreneurs. That's an E-Myth distinction, the Michael Gerber distinction. A business is different than practice. As far as that goes, you are in control of your time. You do get to make the decisions about where you want to focus and who you want to hire.

You're not a cog in a wheel. You've got freedom. Click To Tweet

You don't have to focus on those areas. You get to decide who you want to serve. It's Claymation. You get to sculpt it any way you want. To me, that's the level of Maslow's hierarchy where like, "You're successful in certain regard working for yourself." If you can keep the lights on working for yourself, that's a certain amount of success. I never thought about this before, but the answer to your question is, you're closer and you arrive at the point of, "How do I get more meaning and significance in my life quicker than people who are grinding away at a job where they don't have any control?" It doesn't give them a lot of options and make a huge contribution.

It's interesting you talk about being in control of your time. What's unique about physical therapy owners is we take a little bit more passive approach to our time simply because for many years we've been servants to other people according to a schedule, patient appointments. We like to think that we aren't in control because as providers to patients, we are at the mercy of our patient's schedule. Whereas that was a choice that we made. It was to forgo our schedule, forgo our time to serve those patients. Sometimes you have to take some control back or make the conscious decision that, "No, I am in control of my time. I've given it to this time frame to the patients to serve them. I need to work on the business. I need to make a conscious choice that I'm better served to not serve the patients one-on-one, but to serve my business." That's a tough mindset for me to get over with some of the coaching clients I have. 

It makes total sense. We're always a choice even if we're choosing to give up our choice. For a lot of professionals, particularly the ones that I've worked with. I have worked with PT owners in Purpose Mapping, but largely it was lawyers that I worked with. It was hundreds of them that I'm working with. Carving out the time to sit down with a coach once a week and do some thinking, there's a mentoring that happens of like, "Let me show you how to think like a business owner. Let me show you how to think through the processes that you need to turn this into a business." Even carving out one hour a week. What does a PT owner going to make in that hour versus what are they going to pay a good coach for that same hour? That's a hard nut to swallow. When you think about it in terms of the freedom and the wealth you can create over the years and decades ahead, there's a good metaphor for this. We talked about Elon Musk. If we send a rocket to Mars and we're a fraction of a degree off on the trajectory, that rocket is not getting nowhere near Mars. You’ve got to do that thinking as early on in your business as possible because you set your trajectory for the next years or decades ahead. The sooner you work with a coach and get a business owner mindset, the better off you're going to be and the better off your family is going to be.

That's my mantra. They've got to reach out to a business coach or they've got to step out of treating full-time. They've got to network with others, like-minded individuals, small business owners and whatnot. That's the formula for success for all of these successful PT owners that I've interviewed over time. It's dead-on. I know you don't have a lot of time and I appreciate what you've provided thus far in terms of the value. Is there anything you want to share before we wrap things up? 

The main thing I'd like to say is your fulfillment matters. You're not a cog in a wheel. You've got freedom. You've got choice and at some point, you've got to pick up that plate and start spinning it. It's not working for the weekends, it's got to become part of your daily practice. Michael Gerber would say, "A business is a dojo. You go in every day and you're shadowboxing." You're dealing with the part of you that would let yourself be devoured by the needs of your patients who would rather never pay you and just take and take and suck you dry. What have you got left for your family? You have to start with yourself. A drop in the bucket a day adds up over time. Do one tiny thing. I learned partly from The ONE Thing book. The second thing I learned was from Tony Robbins is he never left the site of a meeting where something was decided without taking one tiny action step. He'd be in a meeting with some investors or whatever. He'd walk out before he was out of that board room, he would call his secretary. He would say, "Fax over those documents,” or “Can you schedule this for me?"

He didn't sit down and draft documents for six hours. He told the secretary, "Book me six hours where I can do this." One tiny step is all you've got to do every day. Whether it's reading this blog, whether it's scheduling a call with Nathan, with me or some other coach, buying a book like The ONE Thing or The E-Myth by Michael Gerber. Taking one tiny action step towards a life that's sustainably fulfilling and successful. That's what I want to leave everybody with.

PTO 90 | Finding Your Personal Purpose

If people want to reach out to you, Craig, how can they do that or find out a little bit more about your process? is my website. You can begin purpose mapping for free. There's a little, about a 30-minute video halfway down the webpage. You could book a call with me or you can email me at I'd be happy to hear from you if you got something out of this. I always love hearing from people, hearing their insights and what are you going to do about it? What's the tiny step you're going to take from reading this blog? The one little thing you can do that will move your life forward and in alignment with your purpose.

Thank you so much for taking the time. You've been an inspiration to me and hopefully, you've been an inspiration to many others. I appreciate it.

Thank you so much and it was an absolute pleasure working with you. I'm looking forward to seeing how things unfold for you as you drop by drop every day, start to fill that bucket.

Thank you.

Important Links:

About Craig Filek

PTO 90 | Finding Your Personal PurposeHave you ever laid awake at night wondering what’s next?

What do you do when you’ve achieved all the success you ever dreamed of, and it’s still not fulfilling you?

Today’s guest walked away from a 7-figure business that he co-founded, because it was making him miserable. He took the time to rest and allow life show him what’s next.

His name is Craig Filek, and he created Purpose Mapping® to bring his life into alignment after 20+ years of deep inner work and entrepreneurial experimentation. These days, executives, entrepreneurs & investors around the world seek Craig’s guidance when making life-changing decisions.
You can begin Purpose Mapping for free at

Today, we’ll get Craig talking about how to find YOUR true fulfillment by maximizing your natural talents in service to a larger mission.
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PTO 101 | Future Of Physical Therapy


What will the future of physical therapy look like going forward after we gradually recover from COVID-19?  What should owners be doing as we walk into that future? Nathan Shields is joined by board-certified Clinical Electrophysiology Specialist Dr. Dimitrios Kostopoulos to talk about what Dr. Dimi sees in the future, what he recommends, and what his clinic is doing to prepare for the inevitable changes that we'll have to deal with as physical therapy owners. Are you ready for the new normal of the post-COVID-19 world?


Listen to the podcast here:

Ramping Up And The Future Of PT Post-COVID-19 With Dr. Dimitrios Kostopoulos

I'm bringing back a frequent flyer and multi-time guest back on to the show, Dr. Dimitrios Kostopoulos. I am excited to bring him back because I always respect his opinion, foresight and vision especially during this time when there's so much going on and so much change occurring. I’d love to get his opinion and his recommendations on how to handle things and ramp back up as PT owners. Dimi, thanks for coming back. I appreciate it.

Nathan, thank you so much for having me back. I have no idea what's going to happen when we start flying again and how much our frequent flyer miles are going to be able to take us. A lot of changes will be happening. I heard that there is a possibility that Virgin Atlantic, the airline, maybe going down.

Isn't that crazy? It's amazing how widespread this is affecting everybody and it's unfortunate. Hopefully, you don't have any frequent flyer miles on Virgin Atlantic that you're trying to cash in. We're going to talk about what you're recommending and how people can prepare to ramp it back up as we're on the road to recovery. At least it seems like the numbers are trending in that direction. Prior to that, how do you think this is going to affect the physical therapy industry specifically from your point of view? A lot of clinics have closed down and starting to do telehealth. What are your thoughts on how it might affect our industry going forward?

I believe that we are going to have some fundamental changes moving forward in many different industries. I know that people may not be thinking so much about that but a lot of things will be different. What do I mean by that? I cannot fathom that all of us will go to a restaurant in Manhattan and we are going to be sitting about 8 to 10 inches away from the next table. This is not going to happen. There has to be some degree of social distancing that will continue at least for a couple of years. I do expect some fundamental changes. Let's talk about the airline industry. I cannot fathom that you are going to have somebody sitting in the middle seat with a person to their right and to their left. All of a sudden, somebody clears their throat and the whole plane jumps up in the air trying to escape the potential Coronavirus contamination. We have to have some changes that will happen in the industry.

In terms of physical therapy, will physical therapy in clinic services go away? Absolutely not. However, they will be modified. For example, a patient would want to know that you have implemented some degree of cleaning, sterilizing and disinfecting procedures within your facility. They would not feel very comfortable if they are extremely close to another patient in another bed next to them. They will start valuing perhaps private rooms for manual therapy instead of doing in an open gym space. I believe we're going to have changes in terms of space. This specific period of time creates opportunities of access of patients and reach of physical therapists. Those who are smart and are implementing and investing on advanced technologies or physical therapy delivery for the future will be able to have a 180% increase of where their business and production was before COVID-19, based on my projections.

Are you basing that mostly on telehealth services? What kind of delivery methods are you talking about?

I'm basing it on the delivery of telehealth services in both proximity and distant location delivery, as well as in implementation of diagnostics. I will talk about both of these things as part of my five mitigation factors.

Considering we recognize some of those changes are taking place, we also have to recognize that if we haven't already, we need to make sure that we have policy and procedures in place to disinfect, sanitize, have more precautions and whatnot. Even if you don't think the Coronavirus is that serious, infectious or whatever it is, a lot of it is about perception. It's all a lot about what people perceive and if you're not there, you're going to lose business.

We filmed a new commercial for our physical therapy location in Astoria where we are going to put it on our website, YouTube, and other social media. The whole verbiage in the message, the pictures and video shots that were taken for this commercial all show large spaces. They show distancing, protective equipment, therapists and patients with masks so that they can give the audience and the consumer the feeling and certainty that they will be protected. This is going to be a deal-breaker or maker for some practices. If you have a competitor next to you that it’s business as usual for them, I don't believe they'll be able to survive in this day and age.

Those who take advantage of this opportunity to change their PT clinics will improve 180% and thrive in the new normal. Click To Tweet

It's going to be tougher for them for sure. For those people who are on the edge, they're going to say, “I have kids at home,” or “I want to visit my elderly mother every so often. I better go to a place that's a little bit more cautious in their approach.” Now is the time to get those policies and procedures together, to start planning on how you're going to approach, and show that you're following some of the precautions. I love the idea of putting a video together and posting that on your website instead of just saying, “We're following precautions.” Pictures are better than words. Are you using telehealth yourself in your clinic?

Yes, we do. About 37% of our visits are on telehealth. My intention is to have 70% of the visits on telehealth if possible. I know that if I manage to maintain a high telehealth ratio, the in-house visits will only increase when the economy is back up and open. We're in New York, we're ground zero, but we're expecting that they’ll open and lift the social distancing regulations. People will start going out and going to various offices. We expect that at that time we're going to have a significant influx of in-office patients. If you maintain the telehealth up there, then you start waging in having an increase in your overall visits.

That's a great goal because a lot of people might be looking at telehealth as a Band-Aid that when this is all over, they’ll just take it off and get back to brick and mortar manual services. For people who want to take advantage of how physical therapy is going to be done in the future and how it can positively affect your clinic in the future, consider what can it do for you if their cars break down or their kids get sick or they get stuck at work. Instead of a cancel, that can be switched over to telehealth service if you set it up appropriately. I love your intention of keeping your numbers high on the telehealth side because inevitably, people are going to still walk in and get services. Not to go down that road too far, if there are 1 or 2 things you could share with me and the audience that you have found successful in maintaining people or providing telehealth services. Are there a couple of things that have been successful for you?

Here are a couple of things I'm going to bring up in regard to that. I'm going to bring this up not because we made that mistake, but because with many therapists that I see in the webinars and the town hall meetings that we do, I hear what they say. One big mistake that somebody can do is to give their staff a platform and say, “This is Zoom, this is TelePT for me, this is whatever platform. Go ahead and start doing telehealth visits,” without training the staff on how to do a telehealth visit. Therapists then are at loss and they don't feel certain about something. The less certain you are, the less you want to do that something. If they are not certain, they don't want to do it, and they are not effective in converting patients from non-telehealth to telehealth.

Train your staff. A training solution for that is a course, the Hands-On Seminars skills, which is a certification course in telehealth. It's only five hours long and you can certify your staff on how to do it. It covers all the special tests and everything. That is one thing. The second thing would be when you implement telehealth, you have to decide based on the reimbursement that you are getting how you are going to pay the therapist. Are you going to pay the therapist per hour of delivery? Are you going to pay the therapist based on the number of telehealth visits they do? That's something that each private practitioner has to decide. For example, in our practice, what we do is for two 30-minute telehealth visits, we pay an hour of work equivalent.

Your therapists aren't salaried.

We start talking about my mitigation factors.

As people are starting to get busier, as things are starting to loosen across the country in terms of restrictions and regulations, and patients start having those elective surgeries again, what are some of your recommendations to ramp your clinics back up?

First of all, I have five specific mitigation factors that every single physical therapy private practice must be implementing. The first one has to do with money. The first one is liquidity. I don't care if you have $1 million in the bank or $5 million in your business account, apply for the PPP loan. If you didn't get it, hopefully with this new package, you are going to get it. Having the money there or some portion of that money can be forgiven. It's a no-brainer, you must get that money. Tap into that and tap also into the EIDL. Some people are thinking that EIDL is only $10,000. It is not. EIDL can be up to $2 million based on the size of your practice at 3.75% interest rate. You can take an EIDL loan and you can use that money to expand your practice. Practice expansion is important. There are tremendous opportunities out there, even for other practice acquisitions.

PTO 101 | Future Of Physical Therapy
Future Of Physical Therapy: There has to be some degree of social distancing that will continue after the lockdown and quarantine are lifted.


I was going to say at 3.75% on a commercial loan, that is crazy. It is historically low. Could you buy real estate if you wanted to buy an office space. Do you know if there are restrictions in regard to that?

I am not certain if EIDL specifically can be used for real estate, but SBA has specific real estate loans that you can get. However, acquiring a practice, you can do that. Think about this, there is a projection from IFA, the International Franchise Association, that about 17% of the restaurants around the country will be permanently shutting down their doors. That is significant. That can give you an approximate idea about other practices. There will be physical therapy practices that will not be able to recover. That will provide opportunities for those who have cash or those who have liquidity to be able to acquire these practices at a great discount.

If expansion is your goal, now is the time. People are going to be suffering. Maybe they want stability or maybe they want cash that if you are in such a position, you can acquire other physical therapy practices and expand. There’s an opportunity there.

That takes us to the second mitigation strategy, which is controlling your expenses. I want to give this message. I have heard from several people, “We are going to take the PPP money and we're going to bring all these therapists back full-time. We'll have them in our practice even if they are not producing and we'll still pay them.” I believe this can create a major problem. It will create a morale problem among your staff. If you start paying someone where they have no production, they deliver nothing back to you, that's a criminal exchange. They are getting something for giving back nothing. That can create a tremendous problem. Instead, give them specific tasks to do. Give them tasks to study. Give them tasks to help with organizing your business. Redo your office policies and procedures and have them do the project. Create your new strategic plan. Have them do some of the work. Create or update your marketing plans, strategies, protocols and marketing final products. Have them do the work. If you bring them back and you pay them so that this money can be forgiven from the PPP, have them produce. Once they produce, they'll feel better about it and they'll be more vested into your business.

Especially if you as an owner are doing a ton of work watching webinars and trying to stay on top of things, if you've ever needed an assistant, now is the time to use one of those people to become your assistant. If you're not doing any digital marketing, now is the time when all of your consumers in your community are on the internet. They're on social media and now is the time to look into digital marketing vendors. I had Tracy Repchuk on and I’ve had Edric Zheng. It's important to look into those other things because productivity is the basis of morale. If they aren't productive, your culture is going to shift and change. I’ve seen that in some of my coaching clients that talk about techs that they have still on staff because they've got the funding, but they're in the back office on their cell phones. He said, “These are techs that were super productive when we were busy. They kept us humming. They were great. They were ahead of everybody else. They were looking ahead to see what the providers needed next. With this downtime, they can't simply keep the office clean and I have to get on them all the time.” You have to keep them steady, busy, and productive like you talked about.

I believe that's very important. The two mitigation strategies that I talked about, liquidity cash and reduction of expenses, those have nothing to do with production. They are strategies where you are using either free money because they will be forgiven or a low-interest loan. How long a country, a nation, the planet Earth can live on borrowed money without creating new resources? Only for a very limited amount of time. We have to start creating again. We have to start producing. Through the webinars and the town hall meetings, I’ve talked to hundreds of people and here is what I'm saying at this point in time. We felt bad about the whole thing. Maybe we even lost a relative or a friend or we know of somebody who did. That was horrible, but we cannot go into a state of apathy and do nothing about it. We have to shake ourselves away from that state, move forward, start doing things and taking action.

Shake off the dust, get up and start moving along. Let the emotions flow through you. Let them happen. Let them pass but come through it with greater resolve.

That is our third mitigation strategy, which is implementing telehealth right here, right now. Telehealth is here to stay. It’s not going to be going away. Very soon, Medicare will be announcing that they'll pay for full telehealth for physical therapy. It makes sense. The Coronavirus is not going to disappear in 1, 2 or 3 months. There is a large possibility that we're going to have a significant rise of incidents again. If we are prepared as a nation and as a profession to handle all this in a more efficient way and more practical way by having Medicare pay for telehealth, the whole process will be seamless and the economy will be affected much less. HHS and CMS are looking at these things. In the town hall we're doing, we're going to have APTA's Director of Government Affairs who will speak exactly about Medicare. It is a matter of a few weeks until Medicare will be paying full payment for telehealth for PTs. I'm confident about that.

If people wanted to join in on your town halls, where do they go?

Implement telehealth because it is here to stay. Click To Tweet

They can go to They can register there and also watch past town hall meetings.

We were talking about these mitigation strategies. You also have a website for that. I want to make sure we cover that.

What we are doing is we offer to people a free eBook. If they go to, they'll be able to get an eBook that describes all of these five mitigation strategies and more. I talked about telehealth, the importance of it, and something that I mentioned in terms of the future and the greater access, not only at a restricted locality but a wider access. I want to talk to you about what I mean by that. The new commercial we're putting out talks about our practice in New York. That's our main practice. We will be offering telehealth evaluation and treatments in five different states, New York, Florida, Maryland, Pennsylvania and New Jersey. In all of these five states, we have licensed therapists. The requirement is to have a licensed service on the state where the patient is receiving the telehealth visit. Provided you have contracts with insurances or you create contracts, you'll be able to bill for those. That starts creating a unique opportunity to offer these telehealth services across states either in a third-party reimbursement capacity or in a cash paid capacity.

Are there some states that will recognize your license as long as you simply apply to do so? Most states might have you go through the whole licensure process. Are there some states that work together and allow you to simply turn in an application?

That is correct. There is a website. If people go to the APTA’s website, they can find the states that they have this immediate reciprocity across the board.

You have licenses in those states and so you can provide them across borders. That’s a great business opportunity there for sure.

That takes me to mitigation strategy number four. Mitigation strategy number four is right here, right now, implement diagnostic testing in your practice. This is the future of physical therapy. I'm talking about the implementation of musculoskeletal ultrasound and electromyography testing. These are tests that our organization, Hands-On Diagnostics, teach you how to perform them. Nathan, you've been a veteran on diagnostics. You're board-certified in clinical electrophysiology. These tests have great patient value. They reimbursed significantly more than a PT visit. With the new program that we have, not only do we make it very real for you to join Hands-On Diagnostics even during this difficult time, but also for you to start performing the testing and getting reimbursed within 30 days from the moment you get your training. Essentially people can join HODS with an initial payment of $5,000. They can start learning all of this technology and implement it, then we work out a payment plan.

It's heading that direction anyway. I'm seeing more and more practices providing ultrasound in their clinics. It's an opportunity to provide some objective data to your providers and to your patients and show exactly how well you are performing. To begin with, if you're working on the right thing, if your idea behind the diagnosis was appropriate or not, it gives you that real objective data that you can use going forward to treat patients and change your treatment plans if necessary.

The way you implement the diagnostics is as part of that continuum of care, after you do your initial evaluation for these patients who are appropriate, you perform also the EMG and/or the ultrasound. You create a treatment plan based not only on the findings of your clinical evaluation but based on the findings of also the objective diagnostic testing data. You implement that not only as an in-house business but as an outside business. You can perform the services for various physician’s offices on-site and you can get paid from those.

PTO 101 | Future Of Physical Therapy
Future Of Physical Therapy: Physical therapy won't go away, but practices will be modified. A patient would want to know that you have implemented cleaning and sterilizing disinfecting procedures within your facility.


If you don't mind, I would like to talk about a couple of people who have been with HODS. I don't know how many of you know of Jeanine and Tim McLellan from Northern Physical Therapy. Before they joined HODS, they were making $85 average per PT visit. With HODS, they're making $116 a visit. That is a 36.7% increase on what they make per visit. In a period of twelve months, they made $800,000 from diagnostics. Bart McDonald from Superior Physical Therapy, before HODS, was making $104 a visit. With HODS, with the diagnostics, his average per visit is $137. That's a 31.7% increase. In a period of twelve months, he made $360,000. That's what I'm talking about. There is potential.

To talk about the effect on patient care, studies have shown that with the diagnostics, 60% of the plans of care change significantly.

You can have a 61% better patient management because of the proper implementation of diagnostics on the appropriate patients. There is a tremendous value. This is the future for physical therapy.

It's not something that's an adjunct or niche that's totally separate from what we're doing, but rather something that dovetails into what we're already doing. It enhances our care and in turn, it enhances the value that we provide to patients and then also increases reimbursement and the profit margins.

Sometimes therapists tell me, “What do you think? Should I invest to put diagnostics in my practice or should I go and open right now another new practice?” Here is what I'm going to say. Those two things are very different. I would say you can do both. Why? When you open a new location, you still need to do marketing from the beginning. You need to pay overhead expense for the space, the lease, rent or mortgage. You need to have lots of fixed expenses like electricity, utilities, all that stuff. The diagnostics, you implement them within your existing practice. You don't need the additional or new space. You don't need more marketing. If you do, that's great. You're going to get more patients. You use your existing patient population who perform the diagnostic testing. You have a captive audience ready for you to give them more information about their condition and to give them more value of service.

What’s the last mitigation strategy?

Number five mitigation strategy is for those practices that are in the verge to decide to either stay open or they have closed their doors already or they're thinking of closing their doors because they have low patients. Here is what I'm going to tell you. Stay open for as long as you can and modify things. Put people hourly instead of salary. Put them part-time. If you furlough them, you go and you work in it. Keeping your doors open creates the perception from the community that you are maintaining care. You are still there. It is different when you are here open and your competitor who is let's say five blocks away, they have shut down their doors. The public perceives that. They perceive the fact that your doors are open and you are still delivering service.

I believe that is important. There might be ethical dilemmas. I’m not going to deal with those right now. These five mitigation strategies, what they are going to do is this. If a practice before COVID-19 was making let's say $100,000 a week, per month or whatever, I don't care. They bring in maybe $30,000 or maybe zero in some practices because of the reduction of production. If you go from zero or from 20%, 30%, start climbing up back to normal. It's going to take you forever. It's going to be a slow path to recovery. It's possible that you may not even recover completely. If you implement these mitigation strategies and instead of you going down from $100,000 to $10,000 or zero, you go down maybe to $50,000 or $60,000 or $45,000 or something. Your recovery will be much faster and you're going to be able to go above and beyond where you were before. That's what I'm talking about.

I truly believe that those people who take advantage of this time and are intentional with the opportunity that they have before them to make serious significant changes for the better in their clinic, they will see exactly that. They will thrive after this. They will see and look back on this as a difficult experience that ended up being a blessing in their lives going forward if they handle it appropriately and intentionally.

You can have 61% better patient management if you implement better diagnostics. Click To Tweet

That's the way it is. I want to make sure that I also give my sincere appreciation to all of these physical therapists across the nation who have joined the effort. They are providing free physical therapy services to our first responders.

Tell us a little bit more about that.

This is not an organization. This is a community grassroots effort. We decided to put it together. We paid a little bit of money and we created a website, It’s a commercial that gives awareness to the doctors, nurses and other healthcare providers in the frontlines of COVID-19. They can receive free PT services, OT services and speech services for them and their kids. They can receive these services from providers who are willing to do that across the nation. We have a couple of hundred practices across all states that are participating in the program. They are writing their stories. They are writing stories about the people that they treat. It's a beautiful thing. It has taken a life of its own.

If people want to join in on the effort, they just go to

Please share your stories, share videos and put your practice up there. It's for the greater good.

It might go on for a while as you said. People are going to be dealing with this for a few months. We're talking about business, but there are opportunities still to serve, especially the immediate communities that we're in. With telehealth, maybe even the communities that are distant to us. It's an opportunity for us to serve even if our immediate community is not affected.

Also, this grassroots effort does something else. It brings the physical therapy, occupational therapy and speech pathology professions in the frontlines of COVID-19 by offering those services to the people, to our heroes who are serving the patients. They need help.

Thank you for spearheading that and getting it going. I appreciate it. Anything else you want to share with us, Dimi?

I want to share that if anyone is interested to find out more information about how you can learn the diagnostic testing, how you can implement it in your practice, and how you can join with the COVID-19 special financial deal for $5,000. Go to and schedule a discovery call or go to and grab a free eBook.

PTO 101 | Future Of Physical Therapy
Future Of Physical Therapy: If you implement the best mitigation strategies, you will be able to recover very quickly and even be able to go above and beyond.


Thank you so much for your time and efforts. I know you're putting out free webinars and town halls to guide people through how to process these loans, what to do with their money, what's happening on the regulatory side of things. You're providing a lot of content. I highly recommend people at least follow you and see what's happening because I know you're on the frontlines of what's happening in PT industry and are willing to share that. Thank you for the efforts and the work that you've put into it. This PT for Heroes is a great value add to our communities. I appreciate you setting that up as well.

Nathan, thank you not only for having me again in the program but also for everything that you do. You’re reaching out to the physical therapy community and informing people about many valuable things that they can be doing to get back on their feet and develop other practices to the next level. Our best days are ahead of us.

Thank you so much for your time, Dimi.

Thank you too, Nathan. Take care.

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About Dimitrios Kostopoulos

Dr. Kostopoulos is a Board Certified Clinical Electrophysiology Specialist with over 29 years of clinical experience and over 20 years experience in electrophysiology testing. He is one of very few Electrophysiology Specialists who have achieved a Doctorate of Science (DSc) in Clinical Electrophysiology Testing.

He is a Clinical Affiliate Assistant Professor. at Charles E. Schmidt College of Medicine at Florida Atlantic University, past member of SACE (Specialization Academy of Content Experts) for the electrophysiology board exam of ABPTS and serves as an elected member of the Nominating Committee of the Academy of Clinical Electrophysiology (ACEWM) of the APTA. He is also an Adjunct Faculty of Springfield College teaching the Clinical Electrophysiology module.

A world renowned, leading expert and best-selling author in Myofascial Pain and co-founder of the Hands-On Companies (Est. 1992 in New York). Dr. Kostopoulos has extensive training and teaching experience in different areas of manual therapy with an emphasis in Trigger Point, MyoFascial, NeuroFascial Therapy and Manipulation.

He earned his Doctorate (PhD) and Master’s degrees at New York University and his second Doctorate of Science (DSc) degree at Rocky Mountain University (Clinical Electrophysiology). Dr. Kostopoulos has obtained his MD degree as a medical graduate from UHSA School of Medicine.

He has numerous publications; he is an Associate Editor for the Journal of Bodywork and Movement Therapies published by Elsevier and has taught thousands of students worldwide through Hands-On Seminars.

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