To succeed, we have to know how to build great relationships. But, how do we do that? Is there a specific process or guideline we can follow? Jeff Sallade PT, DPT talks about successful expansion of business through partnerships. Jeff and his partner have expanded to more than five clinics in the 10 years they've been open, all with a partnership business model that's allowed their PTs to grow into new leadership roles. In this episode Jeff shares with us how they've established each partnership as well as some of the details, considerations, and pros and cons to partnerships in general. This episode is a great follow-up to Eric Miller’s discussion just a few episodes earlier, on what to consider when determining if partnerships are right for you.
I've got a PT owner from New Jersey, Jeff Sallade, Coowner of 3 Dimensional Physical Therapy, who has been reading the blog for a while and reached out to me via email saying, “I read your blog about partnerships with Eric Miller, some great insight. We've put it in practice and thought it would be cool to share some of the pros and cons of what we're doing.” Jeff, first of all, thanks for reaching out and thanks for joining me on the show.
Thanks a lot, Nathan, for having me on the show. It's great to be here. I’m a big fan of the show.
I've said this before and I tell readers, “Reach out anytime if you have questions, comments or even recommendations for topics or desks.” Thank you first for taking me up on that. First of all, share a little bit about you so people know where you're coming from and then I can start asking you some questions about your partnerships that you're developing.
I've been in practice as a therapist for years. Similar to many private practice owners, I got to a point where I felt like, “I could probably do this better if I did it myself.” There was another therapist that I knew who we two decided, “Let's do this together.” That was years ago. We had an awesome event in our community. We got a bunch of small businesses out. We had a mechanical bull there. It was awesome. We've had our practice for years. When we first started, we were hoping to get enough patients to be able to take up our time during the day.
We didn't want to be sitting in the clinic, looking at each other. After 1 or 2 years, we had a decent amount of growth but we never gave a lot of thoughts of how we want it to grow. We're an orthopedic and sports clinic, what I think is a pretty typical outpatient clinic. The numbers kept growing. We had hired a couple of therapists. The way that the second clinic came about was we had a sports performance coach that we knew. He was about 20 or 25 minutes away. He said, “A vacancy opened up in my plaza. Would you guys ever have interest in opening up here?” I remember my partner and I looked at each other. I was like, “I don't want to be the one to go there.” He was saying the same thing. We were like, “What do we do if we want to open a second office?”
We had a therapist who had only worked for us for about a year but we liked him. We knew he wanted to do some bigger and better things and have more responsibility. He was from the area pretty close to that opportunity. We said, “Let's give him a chance.” At first, he stepped in as a clinic manager. My partner funded a new clinic. It became apparent that he was going to do a good job once he got in there. That's when we started kicking around the partnership model.
How many clinics do you have?
We have five and then we're opening two more locations. We're in the crazy mode of managing the build-outs and the permits of the two offices. It's a little bit crazy but it's a good crazy.
Congratulations. I assume that you've taken this partnership model that you started but then refined over the years and we've expanded that to the other clinics as well.
Once we allowed Ryan, our first partner, to buy into that second office, my partner Ken and I looked at each other and was like, “Ryan's working there. He's benefiting from having ownership in that office.” We have an outstanding employee who's super motivated because of the financial incentive that he has to do a good job. We said, “Maybe this is a good idea. Maybe our retention rate will be good.” We had another guy that was working for us. He wanted to have his own practice but he didn't want to start it from scratch as we did. We gave him an opportunity. This guy’s name is Chuck. He's a total go-getter. He opened his office a year after that second office was open and he is doing phenomenally as well. My partner and I always own at least 50% of the office and then the partner there has percent ownership as well. It's usually based on their comfort level with how much risk they want to take.
Are you also asking them to put in some money to buy into that clinic?
From the beginning with these two locations that we're opening, we identify the location and then the therapist that works with us that is going to go there. All the costs are split according to the percent ownership. Let's say if a total clinic from start to finish costs $100,000, my partner and I are 50% owners and the other person is 50%, we're each putting up $50,000 whether they know it from the beginning and they know what they need to be responsible for financially. We have found that that works best. They own the clinics in the beginning. They feel like they're an owner right away from the first thing that's purchased.
In this situation, I've got a couple of directions that we can go with this but since we're talking about their percentage of ownership, do you agree to a basic salary for that partner to simply be there? What do you do with distributions after? I don't want to get too detailed if you don't want to but how do you establish the financial relationship? Also, consider that you are doing not only management but also providing backend services. How do you account for that? How do you establish this financial relationship going forward?
The therapists that take over the clinic run the day-to-day stuff and they have guaranteed pay. They have a salary for all the work they do related to their clinic. Most of the time, they've been a staff therapist for a couple of years. Their guaranteed pay usually takes a step back. They’re not a drastic step back. They're not eating peanut butter and jelly every meal of the day but we want them to feel like they're not happy with the guaranteed pay that they're getting because if that would be the only way they would get, they wouldn't be happy with that.
You scale back their salary a little bit because they're going to get more on the backend based on performance.
What we do is we calculate profits monthly. We have a way of setting up a bank account. Each of these offices from an accounting standpoint have own separate LLCs and own separate bank accounts. Everything is separate.
For each LLC, you have your own books as well. They always have their own financial.
My wife used to do our accounting. When we got to five clinics, she said, “I'm tapping out.” We have the guy who does our taxes. He has taken over the month-to-month QuickBooks. They have their own books in each clinic. We know on the first of each month how profitable or unprofitable the clinic was. If there are profits, my partner and I take our distribution. We choose how much we're going to put back into the company and then the partner’s free to do with what they want. Potentially, they get a monthly payout of their profits. You can talk to some of the partners. They're all pretty happy with the setup of their deal.
How do you set it up? If you're 50/50, have you already predetermined the tiebreaker? Do you have the final vote if you can't come to an agreement on something?
Maybe during COVID, there were some crazy votes that we took but normally, on a day-to-day process, there hasn't been a time. Each partner has an operating agreement and it's defined there. If there are ever big decisions, here's how it works. My partner and I get a vote and then the other partner in the office gets a vote too. That's clearly defined. We haven't had to do anything like that but you got to think of everything before it all happens so that you make sure that when you do run into some things, the rules are clearly defined.
I'm sure you establish this with a lawyer ahead of time to walk you through these scenarios and that's a few thousand dollars that's well-spent in order to establish this stuff. I highly recommend that. Not to get too detailed or into the weeds but have you had to agree on set aside accounts for rainy day funds and stuff like that? How much in a line of credit that you have for each LLC? Do you go that far with each partner to figure out some of those things?
When we were first setting this up, we consulted with a bunch of different private practices. Here's what we came up with. Each office has a bank account. In one of the accounts like our checking account that we pay all the bills from, there's a certain threshold that always has to be there. It's like 3 or maybe 2 months of expenses. We know that we can't go below that. There's a buffer built in there. Every once in a while, when payroll falls at the beginning of a month and rent hits, it goes below that but by the end of the month, it has to be back at that threshold.
At the end of the month, if it's not at that threshold then we know that the clinic wasn't profitable that month and everybody has to do an equity call. If it is profitable, everybody gets to take distributions. There are good and bad with being a partner. That's one of the cons. The partner has to get in the mindset of, “If I'm not profitable by X amount of money, I'm responsible for doing an equity call and contributing money back to the office.”
There's a difference between hard equity and soft equity, where soft equity might be you're going to get some bonuses, some profit-sharing model or something like that but hard equity being their name is on the legal paperwork for the LLC. Is that how you've established it? Are these hard equity partners?
Yes. They're on all the paperwork. We have a couple of clinics where there's a partner. For instance, the clinic that I work and treat in, we have a clinic manager. He doesn't have ownership in the office but he has a profitability incentive. He has less risk. If there's a month where we're not profitable, he isn't putting money back up. He hasn't been penalized for that. He isn't getting paid out an incentive for the month. We've done that model as well. People who are as willing to take the jump into ownership. We have another account. We have savings account for each LLC or clinic. Five percent of the profits go into the savings account before anything gets paid out.
To set aside for rainy days or taxes.
If there’s a big piece of equipment somebody wants to buy like a BFR and all the clinics have BFR units, they can use that money to purchase it. We learned during COVID. that we didn't have enough money in our savings account. We make sure that we're not spending that money as readily to have anything that the clinic would want to use.
I'm assuming that you've already established an umbrella company that charges each clinic to do the billing, payroll, accounting and legal services. There's a number of things that the umbrella company has. Do you have something like that in place as well?Communicate with all the partners on a regular basis one-on-one. Click To Tweet
We do our billing in-house, billing authorization. We have 6 or 7 employees that do that. We have a marketing employee and an operations employee. There are certain positions that don't generate revenue that is central to the company. Each office contributes to that. The way that we determine that is by the percent of collections. If we have $100 in collections in a month and one office does $20 of collections, they're paying 20% of the expenses. We call them management expenses.
That's one way to do it the way we did it. Maybe it's similar to yours but we simply charged a flat percentage and we called it the management fee. Based on what I've talked to other PT owners and also other industries that sometimes land between 15% to 20% of collections that will go towards the management fee to cover those types of expenses whether it's marketing payroll, billing and collections, do you think that number sounds about right based on where your collection is at?
The percent collections pay for the salaries of the employees and then there are some other expenses that are sent. We charge a flat percentage to the clinics to account for those things. Those are our expenses for the EMR system and liability insurance. All that stuff falls under a flat percentage. If it benefits all the offices, we pay for that centrally.
Is the lease held by each separate entity for each location?
Each location leases under each of the individual entities.
This partner would still be on the hook for the lease as well.
We had a lease where we had all of our billing and insurance employees at a separate location. That was all paid for by all the offices individually. They each contributed. What happened was after COVID, everybody worked from home and after that, nobody wanted to come back to the office. We had this sweet office that nobody was going to work in. Each still pays the least. It was a management facility so each office had to contribute a certain percentage to make up for the fact that we were getting out of that week. Everybody's much happier working from home. They do a much better job working from home too. Going forward, we have less expense. One last lead to worry about.
To add these additional locations with separate LLCs, do you have to go through the full credentialing process or do you have relationships with your insurance companies where like, “We're adding another location. It's a separate LLC?” What's that process like?
It's automatic. The person who does our operations knows all the steps to follow. It's like hiring another physical therapist who has credentials. With these two offices that are in the process of being open, she's already on top of the credentialing for those offices. It happens pretty quickly.
It's a whole new process. If you stay under one LLC, you say, “I'm going to add another location.” It's a full-blown credentialing process again.
Each LLC has their own tax ID number but we do all of our billing under that umbrella company. Everything falls under that tax ID so that credentialing is easier.
I see where you're going. The tax ID number of the umbrella company is the one that's adding a location.
This might be good to cover. A question that we get from partners is, “How do I know that the money that my clinic is producing is being distributed to my office if all the money is coming into the central location?” We've made sure that our billing software is able to account any collection that happens at clinic X, Y or Z gets credited to clinic X, Y or Z. Every week, we move money around from our central bank account out to the individual clinics so that every week, they're getting their collections into their bank account.
Your bookkeeper's got to be almost full-time on this stuff.
They're getting more and more hours. We've become known as this biggest headache.
To expand like this, there seem to be two things that are necessary and there could be more but I'm talking off the top of my head. Number one, you've got to have a partner that's in alignment with you, someone that you've known. Not just some PT that you hired off the street and started opening up a clinic but probably has worked in one of your clinics for a period of time. You know they’re value-aligned. You're on the same page but then you also have to have a pretty solid standard policy and procedure manual so that everyone's not running off doing their own different thing. It's six different clinics. Talk to me a little bit about those two things.
In the first part, we were careful from the beginning with everybody that we hired. We've learned that the hiring process is super important. From the first time they meet somebody, we interview them 3 or 4 times. We want to make sure they're a good fit. They come and hang out with us in the clinic before we hire them. It's fair to both of us. We want them to know what the day is like in our clinic as well, if they can see themselves fitting in there. Anybody who potentially becomes a partner has worked for us for at least a couple of years. That way we get to know them as a clinician but also as a person. That is an important part of this whole partnership process.
Even from the beginning, we ask people what their long-term goals are with physical therapy. If somebody mentions that they would like to have some ownership one day then we recognize that person and we'll start to do some things from the get-go with them to maybe help foster those ideas and see if they're serious about it.
Is that something where you advertise?
We don’t advertise. We have seven clinics in Southern New Jersey in between Philadelphia and Jersey Shore. PT is a small world. There's a lot of PTs that don't work for us that know what our model is. I get a ton of resumes because people know that we have at least have the potential to move into some type of partnership profess. It's not super easy to get to that point but we have proof that this is what we do and people like that. It's a good recruitment tool for us as well to get PTs interested in us who are motivated enough to possibly have their own clinic or be a partner down the road.
Are there some people who have expressed interest in that where you said, “That's probably not a good fit?” Have you ever across that?
A lot of it is self-realized by them. A lot of people feel like they want to open their own clinic or want to be a partner but then sometimes when it comes down to it, the realization is there that this is a lot of work and it's not easy. One thing that we're doing is being motivated by us recognizing the need. If we're going to continue to grow, we don't want to grow to be able to say we have 10 or 15 clinics. We want to make sure that any clinic we open has a good chance of being successful.
We're starting what we call a leadership program. We have 25 PTs in practice and this is open to all of them. They have to apply for it. It's a year-long program where we're mentoring them to become clinic managers or partners. We're only going to take 4 or 5 people a year because we want it to be a little bit exclusive but we want the group to be small so we can get a good discussion going. If we took everybody the first year, I don't know what I would do the second year anyway.
That creates a demand. To say that it's exclusive to a certain number of people means you're going to weed out some people but it also inspires some people like, “I want to be part of that group.”
I hope that's what it does. There might be people that are disappointed if they don't get into it the first year but we'll make sure that it's not because we don't think you can’t do it. It's because these are the 4 or 5 people we thought were best for this now but like, “I hope you're still interested when the chance comes again.”
What is their commitment? What are you providing? Do they have to be available certain days of the week or once a month? What is your routine? How much detail can you share with me about the program?
I can still put it together but there's going to be six. Our clinics are all pretty close together. Nobody's more than 40 minutes from another one. Six times a year, we're going to have on-sites where we do probably 3 or 4-hour blocks of on-site learning. We'll have them be shut off from patient treatment for that time. In between each of those six on-site meetings, I'm going to do some one-on-one meetings with each of the people in the program. They're then going to have some readings. We have some required readings.
I got your episode with Stephen Rapposelli where you were talking about books like Who Not How. I immediately got that book. That was a life-changer for me. That is going to be one of the required readings as part of the program. Also The 7 Habits of Highly Effective People. That's the first reading to be read before the whole program starts crashing. We're going to do good books, some TED Talks, podcasts, that kind of stuff.
We had something similar. We had a leadership development program and there was a library of books that were required reading. This is how my partner and I came to have the business beliefs that we have. It's imperative that you read those same books and we discuss what's important about them. They can have their own mindsets as well but it aligns with the mentalities and mindsets. They can see, “That's why you guys do that thing. Now I understand.” They go back and put 2 and 2 together.
We want to create an attitude of lifelong learning. A lot of the people in the program are probably more focused on their clinical learning, which is great because, believe me, we want to have awesome clinicians. We also want people to take the next step like, “How can I further myself as a manager, leader or partner in the company as well?” I'm looking forward to that component for sure.The hiring process is important. Be careful and make the right decisions. Click To Tweet
That's going to be cool because, honestly, we're physical therapists. We haven't had this kind of training before. For you to share that with your team members like, “This is how to be a leader. This is how we run a business,” to pull back that curtain and give them that training that all your 5 to 7 partners have is something that most people pay money for.
We want to put that as an investment in our employees. I know that it's going to come back to pay us dividends big times.
The second part of the question then is how much effort and what have you done to unify policy and procedures across all those clinics?
I'm the COO of the company. I always joke with my partner. I'm probably the least organized person in the whole business. Somehow that got thrown onto my plate, which is ironic. I have somebody that works with me that’s a total all-star for us. We know that's ever-evolving. We meet every week to make sure that, “Here's the gap here. We have to figure out a way to fill in the gap.” Something as simple as keeping track of our co-pay collection rate or pay to the plan of care get all faxed out. We missed three from last time. It's ever-evolving. We're becoming better at being organized and having some centralized processes and systems. Otherwise, stuff would fall apart.
It sounds like you found your who to help you with that.
I'm not the who for that. I would probably be the worst one. The company would fall apart if I was the who on the operations part.
It's a worthy investment because to pay her to do that with you and coordination is going to be essential for you guys to continue to expand. This is probably something that you might have seen as you took that first location on and the next location. As you started expanding, those holes and weaknesses started to get magnified and exaggerated.
We saw and recognized that. We said, “We need an employee that is dedicated to this.” At first, you're like, “Are we going to pay somebody to do something that seems easy?” Once my partner and I didn't have to do it as much anymore, it was like, “How do we even think that this wasn't going to be worth it?”
As you're working with your partners, it's not like, “Here's your clinic, go off and do it. That's great. We'll talk and collect some money.” What kind of communication schedule do you have with them? Do they report things to you? How does that all workout? What is your relationship?
Another thing that's high on our priority list is we want our relationships with our partners to be as good as they can be. One of the tough things that we went through in having partners was my partner and I took some things for granted. We didn't do a great job communicating some things. That led to some frustrations on the partner's side and with my partner and I as well. That's demonstrated to us, “Here's how important it is for everybody to be on the same page.” As a leadership team, my partner and I meet with all the partners once a quarter. We do a three-hour partner meeting.
My partner and I communicate with all the partners on a regular basis one-on-one. Everybody is a little different with how they want to communicate. One guy I talk with every week, another one I talk with every two weeks and one is once a month. As long as we feel that our relationships are good and we're not losing anything, whatever frequency they want, we're happy with it. There's a structure to each call. There are certain things that we talk about and go over. Sometimes it ends up being like half the conversation is talking about non-PTs, talking about life too, to develop the relationships not just the professional component of it but even the personal component.
You the COO. Are you the one that's also getting the clinical statistics on a routine basis, reviewing them and then also discussing if there are issues out points or decline in stats?
That's on my task list for sure. We've gotten good at defining what metrics are most important to us and getting them in an organized fashion in one centralized spreadsheet. We still have a bunch of spreadsheets and one of the frustrations was, “I got this and that spreadsheet. I don't even know what to look at.” People ended up not looking at anything. There’s a time where we've been like, “Here's what you guys need to look at the most.” It's all on this one spreadsheet and that has made life a lot easier for all of us, for sure.
When you guys are all together, what things are you discussing on those quarterlies?
Stuff that's relevant to the entire company. My partner is a big fan of The Five Dysfunctions of a Team. Probably one hour of the meeting is he’s going to be doing an exercise where I don't even know what's on tap for that. I saw it on the agenda so I'm pretty excited to see what he has in store for us. There's almost like a team bonding component to that meeting but then there's like, “Here's the policy we didn't think of.” We meet collectively to come up with decisions.
Another thing that was hard for me and I would imagine for my partner too was by including other partners with us, all of a sudden, we're not the only ones making the decisions anymore. I could only think of a couple of situations where there was some frustration. Our partners share the same values so it hasn't been as much of a negative as I think it could have been if we weren't careful about choosing who our partners are but you lose some of your decision-making authority.
I am assuming you and Ken still have veto power and hold that to some extent.
Yes on the basis of the individual clinics. In 2020 when we were faced with the proposition of closing or staying open, we put it out to a vote. At the time, there were seven of us. My vote was on the losing end and I had to accept it. I won't say what's inside I was but my vote lost and I had to live with it. That ate at me for a little bit but then eventually, I came to accept it. This is the route I chose.
That says a lot to the relationships that you've established with your other owners in that. It sounds like they were willing to accept it as well if it didn't go their way but once it did then it would be like, “This is what we're doing. In this direction, we're going to do this. Get over yourself. This is what we're doing as a team.”
We accepted it and moved forward. I'll toot our own horn. In 2020, I talked to a lot of other practices and they were down in visits and revenue. 2020 compared to 2019, we were up in visits and revenue. A shout-out to all of our partners and employees that were able to pull that off.
What do you think it was? It's because of this maybe one action or simply one characteristic that you could name as a descriptor for your company. If you look back, what would you think that reason was that things went well?
Sometimes pride gets in the way of a lot of things. Everybody's ability to put away their pride accepts it. There's a lot of different decisions we made and there was disagreement with all the decisions. Once the decision was made, we were able to put away our own personal biases and said, “This is what we decided to do. We're going to move forward and make the best of it.” It’s not just my partner and I but the leadership of all the partners and then the rest of the employees.
We have 65 employees seeing a unified front and it felt like it was a huge factor. With any decisions we made, we were transparent with all of our employees. “Here's what we're doing.” We furloughed people for a while and that was hard to do but we were upfront with them. We told them what was going on. “This is our plan to be able to get your back.”
Congratulations on what you've developed. It's amazing to see the growth of your business overtime. It sounds like you've leaned on the things that you've been reading. You and Ken have put some of these things into practice. You've been intentional about your growth. This opportunity was afforded to you. You weren't necessarily seeking to open that second location but once you did, you recognized here are some of the things that we need to do in order to make this successful.
That took off from there.We said, “This is a good idea.” We like giving people opportunities to be in positions of greater responsibility. We think it's awesome when we tell a partner that they can write a profitability check for their profits for last month. To give them the power to hire the ideal therapist they want at their clinic, they're in charge of all that. We might help out if they want an opinion but we are allowing the ability to put people in a position where they can succeed and do their best. I know that might sound corny but that's a cool thing to be able to do.
We've covered some of the pros and cons. Are there other hiccups that you've had along the way that you want to share?
The hardest thing is the organization of it all. That's getting back to that COO stuff. My partner helps out plenty with the organization because there's the financial and the metric organization. That's the hardest thing. My partner and I still treat but we're treating less than less. We're dedicating more of our time towards some of these centralized things that time needs to be spent on. We want to grow but in an organized and controlled manner. One of the biggest challenges is keeping everything organized as the company gets bigger.
Do you foresee a point where you and Ken won't be treating anymore? To follow up with that, would you be okay as some of those clinic partnerships’ businesses started growing if they started pulling away a little bit more from treating so they could work on the business?
One of the partners is decreasing his treatment a little bit. He's having one of his current PT takeovers managers in his office and he has our full support. We think that's great because he's thinking about, “Maybe I want to have a second office that I'm a partner in.” He'll have somebody that can run the day-to-day of this current office. I like to treat.
I have a bunch of friends. They're runners and athletes. They're all getting banged up. If they call me and they need to be treated, I want to say, “I'll get you on my schedule. No problem.” We have awesome therapists in all of our clinics. It's cool to put them in positions where they're getting the chance to treat maybe the patients that would normally fall in on my schedule. It's good to mentor and help them to see it as a clinician as well.Create an attitude of lifelong learning. Sharing your equity with partners has a lot of benefits for you. Click To Tweet
Along this way, you've read some books. Did you get any consulting or coaching along the way to guide you guys a little bit on some of these decisions? Did you have a mentor?
We started working with Steve Stalzer and Mike Osler. They’re with 8150 Advisors. They were recommended to us by a couple of people in my peer-to-peer group. Any private practice owner out there who is wondering if it's worth the investment, it's hard. It costs money. It's not free. I've only been doing it for months and I'm not even batting an eye. I don't even know what the cost is but it could be anything. It holds you accountable and spurs you to do things that maybe you wouldn't think of to do on your own. My partner and I sit with them. We do it together every other week.
Do you want to share with us a little bit about what you're doing in New Jersey that you might want to share with other owners across the country?
I have to give credit to my partner for this. We're in New Jersey. In terms of the collections, we have probably one of the lower reimbursement rates from private insurance companies in the country. We want the private practice to survive. All around us, there are private practices that have been selling to corporate and hospital entities. We don't want to do that. Our intention is for our current partners to be the majority owners of the clinic down the road when I decide not to work anymore. We're making a push to form what's called a supergroup where we're getting other private practices to join up with us.
We're not purchasing them. There's no equity exchange but we have to share certain services in order to be considered a common entity. We're going to take over their billing. They're going to use our EMR. We'll do their payroll and benefits to allow us to gain geographic scope and also to become a bigger company so that insurance companies would maybe listen to us a little bit more readily in terms of negotiating contracts. We're starting that. We've done all the meetings, met with the lawyers and all the paperwork's in place. We're trying to recruit clinics that are interested in joining up with us. That's a big thing on our radar.
You're taking this umbrella company that holds all these major administrative tasks where all of the LLCs underneath that umbrella are the ones that you either own, partners with or partners of your clinics. You're expanding that to include people who you have no financial relationship with. You're going to unify some of the admin-related stuff, whatever it takes to be considered a shared entity.
From experience, we know that there are practices out there that the owners have many headaches and can't focus on the things they want to focus on. We'll take away some of the headaches like billing and payroll and allow them to build their practice. We have some interests and we're confident in the next years that we'll have a bunch of clinics that have signed up with us.
Anything else you want to share in terms of the partnership models, LLCs that you established that you would like to tell?
We've had people who think we're crazy for sharing our equity with partners and the amount of equity that we allow people to have. I wouldn't do it any other way because there are so many benefits to it. I still work a lot of hours but I have a wife and kids. I can spend time with them because I'm not doing every single thing for every single clinic that I own. For private practice owners that are thinking about doing this, I'm happy to be a resource as well. If you want to reach out to me, I'm happy to talk to you about the pros, cons and any of the details that you would want to know about. I'm a big fan of doing it this way.
From my point of view, the people in my network that have multiple practices greater than five, the ones that are the most successful and are expanding the most are those that have established these kind of partnership relationships with value-aligned people on their teams that they've vetted and know they're going to work well. The personalities match and the values aligned. They understand their purpose and their vision. That all align and it's been successful to the scope of some of my friends. I had Blaine Stimac on the show in the past. He's over 30 clinics. A vast majority of those are partnerships and they're across different states. It's the way to go. If people want to ask you or reach out to you, how can they get in touch with you?
My cell number is (508) 259-5481. You could call or text me. My email is JeffSal@Hotmail.com. That's the easiest email to get in touch with me. I'm happy to be a resource for sure.
Thanks for sharing. I appreciate that. We'll have to stay in touch in 2023. We'll come back around.
Keep the good shows coming.
Thanks. I appreciate it.
Jeff Sallade is co-owner of 3 Dimensional Physical Therapy, with 7 locations throughout southern NJ. Jeff and his business partner, Ken Guzzardo, recently celebrated 3DPT's 10-year anniversary. The one thing that Jeff attributes to lasting 10 years is having the confidence to surround himself with great therapists and partners who are just as motivated as he is to succeed.
As you will hear in the podcast, Jeff feels he chose the best possible path for his business by opting to offer a partnership to PTs at each of his 7 locations. Outside of the clinic, Jeff enjoys reading leadership books, playing soccer with his kids, competing in triathlons (although he has slowed down recently due to having both hips replaced) and traveling with his wife and 2 kids all over the country.
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With 15 years of experience as a clinic owner, Beth Winkler has dealt with her fair share of challenges – from the aftermath of Hurricane Katrina to multiple providers leaving at the same time. Through all of that, Beth and her partner Lisa Taglauer, PTA have built clinics that thrive and grow on policy, procedure, and a healthy dose of quirky, fun culture. Those foci have allowed Beth and Lisa to grow from one clinic to four and focus on solidifying their company culture to weather any future storm. Beth and Lisa own and run Magnolia Physical Therapy in New Orleans. You are going to learn a lot about culture building in this episode as Beth shares that story from her point of view with Nathan Shields.
Our guest is someone whom I've wanted to have since the beginning of my podcast, and I finally tracked her down and got her. Beth Winkler is a physical therapist, CEO and Cofounder of Magnolia Physical Therapy in New Orleans. Beth, thanks for finally coming on. I finally got you.
Thanks for having me. I'm glad to be here.
You've been in New Orleans for a long time and you've successfully built up four clinics. Will and I looked up to you and Lisa for the longest time during our ownership. We thought, “Here are two women who are great owners, they created a great culture and they are doing everything right.” That’s why I'm excited to finally tap into some of your wisdom and knowledge. You guys have always been someone that we've looked up to as owners.
Tell the rest of the audience a little bit about your professional path and what got you to where you are now.
Lisa and I met when I was a new grad, a couple of years out of school. She came to volunteer at the clinic that I was working at, and we became instant friends. We talked about not opening our own clinic as of yet but we work well together. She has gone in a PTA school, so I wanted to make sure that when she got out of PTA school, I'd love to have her come back and work here and work together in some capacity. While she was still a tech, I got offered a position at another clinic where they were going to pay for my manual therapy fellowship. I couldn't pass that up and that was when PTs were in great demand. It was like, “Name your price,” which was nice but there's one caveat. I said, “I don't come alone. I have a great tech that I want to come with me,” and the owner was happy to hire her. He was looking for someone, so we worked together through her. She went off PTA school and we hired her back as a PTA.
There were some changes in the company that we weren't too happy about. We had suggested a few different things on how to become more efficient and have Lisa go out and do some of the marketing while she could also see patients. It was like, “Thank you for your input but no thanks. This is the route we're going to go.” It felt like our voices weren't being heard, so I started talking about doing our own thing and we could be our own boss. It was never to grow to four clinics and see all these patients, it was just so we could have more freedom to do what we wanted to do. Lisa thought I was joking all along. When I finally said, “Let's do this.” She's like, “You're serious?” I'm like, “Yes.”
Honestly, we looked at our bosses that we worked for, and no offense to our former bosses, but we're like, “If they can do it, we can do it.” Let's go ahead and start this thing. We always have the default at home health, which as a PT, there's always the default of home health. I knew I didn't want to do that. That was the alternative, so the alternative was not an option. It's like, “We need to make this go or I'm doing home health.” That was not what I wanted to do. It wasn't my vision for future plans.
The irony was the day that we were going to put a deposit on a tiny space, I don't even know how Lisa and I would fit in this place. I was dropping off home health notes across the hall from where we used to work, I saw the owner in the hallway, and we were still on good terms. He's like, “What are you doing here?” I said, “I’m dropping off notes.” He had lived out of town and I said, “What are you doing here?” He goes, “My therapist quit. Do you want your old job back?” I was like, “No.” He goes, “Do you want a clinic?” I'm like, “Maybe.” It was the old text phones and I mentioned this at Will’s where I was texting Lisa like, “A, B, C.” I was like, “David is selling his clinic and he offered it to us.” We took over his lease, the patients, bought his equipment, had it owner-financed the equipment, and there we go.
You were all set up and ready to go. It was that easy. You opened up a clinic and you immediately had a room full of patients and everything went hunky-dory after that, right?
Not really. Three weeks later, a little storm called Hurricane Katrina hit New Orleans and that was a little insane. My friends would ask me, “How did the clinic do?” I said, “I don't know.” We didn't have that many patients to begin with. I was getting going and I was ready to go. Lisa and I were so driven to get back. We both lost our homes. Lisa's home completely went underwater. The water was all the way up into her attic, so her home was completely destroyed. I had 4 feet of water in my home, we had to gut it and completely renovate it. We didn't move back into it until a year later and that was considered as, “You're back in your house soon.” Everything is relative. We have the clinic, so we would take turns. She’s like, “I'm going to go.”
Our husbands were not there because they needed to be with our kids. There was no daycare in the city, so that's why most people were back, you couldn't bring kids back. My husband and I are not together anymore, but at the time he had got a temporary job up in DC, so he kept our daughter up there. We would alternate going to my house and Lisa would go to her house, gut it a little bit, and try to salvage some clothes. It’s the same thing with me. We were doing that and also seeing home health patients, which is the other irony of that.
That's what we’re trying to get away from but there was no one doing that. They didn't even have nurses going out to some of these people's homes. We were bringing people supplies. Lisa and I will go to our church and get toothbrushes, toilet paper and clothes, then bring them to these people. She got a puppy for a patient one time. This woman's dog drowned in the storm and it's awful. She's like a vigilante coming in with these hot pink colored scrubs that she had donated, “Would you buy some new scrubs?” It was funny. It was an interesting time but it was one of those things that if we were starting off that way, there's nowhere to go but up.
I was going to say the same thing. Everything had to be easy after that.
When was Hurricane Katrina? That was how long ago?
That was August of 2005.You're always learning. When you stop, that's when you have a problem. Click To Tweet
You've been a longtime clinic owner and you've run the gamut. You've done many things opening up new clinics and you started by purchasing a clinic. You've got a ton of experience. What were some of the biggest challenges that you had in developing your clinic over the past couple of years?
We were talking a little bit about it before. It’s finding that sweet spot. When you have therapists that are working for you, it's like, “When do you hire that first new therapist? When do you hire the second one?” In the beginning, we thought we had a formula. What was happening is we would get to a certain percentage, hire too quickly, and we would be inefficient for a while. It was nice because you can sit back a little bit as far as a treating schedule but the profits on the other end suffered for that because you're not having efficiency. You have the other end where you don't have enough therapists. We've had two waves of 3 to 5 therapists leaving at a time. It was like, “How do you rehire?” Us going back into patient care where you have a ringleader that doesn't agree with something that you're doing and takes everybody with them. That was challenging.
You have the therapists that are there with you who are overloaded and overworked. That's no fun either. Still to this day, I'm still struggling with that. What is that perfect balance because we were growing so quickly and we were hiring people, but if you're hiring that quickly, do you have time to get people on board and hone down on your culture, your core values and that kind of thing? That's what we're going to focus on in 2021. Let's do a slow growth so we can get people connected to our core values and what our culture is like so they don't go and leave and work for the big hospitals.
It’s focusing on the training and not sending them out into patient care immediately. They may do start seeing patients but you're going to focus on what it means to be a part of Magnolia Physical Therapy, “This is how we do things, these are the expectations, and laying that stuff out upfront.” We wanted to talk a little bit about the culture that you have created in Magnolia over the years. It started with you guys and everything that you did to focus on making it survive after Hurricane Katrina. You guys are so much about service and you want to provide that service for your employees. You want them to work in a great environment, you want it to be a place where people enjoy working and will attract top talent. What are some other benefits that you might see in creating a culture in your clinic?
One of the best benefits is having fun. Work doesn't have to be about coming in, going with the grind and pushing through. I know that Lisa and I are goofy. We have different senses of humor. Bringing that into the clinic with our patients and our team, we have students that come in and they see how silly and goofy we are in the clinic, that’s one part of our culture, that's not all of our cultures, but it's a big part. We make fun of ourselves. It's opening up a sense of vulnerability when you can make fun of yourself and poke fun at things that the team might be like, “Here they are trying to push this policy in or whatever.” We go ahead make fun of it and it lightens it up a lot.
That was one of our values as well. We had our core values but we did have a cultural value that was about fun. There was so much about me and Will that was about humor and a shared sense of humor. That was one of our cultural values and we define it. We let our teams know that if it's not fun, that's not worth working like this. To be intentional about that, it’s important because it's a place where you want to work. You’re the owners, so you should be in a place that you want to be on a regular basis. You don't want to be in a place that you dread especially if you're the owner of that company. Maybe not specific to having fun, but what are some of the things that have worked culturally? Then we'll turn to the flip side with things that haven't worked.
It’s investing your time to spend in the clinics. There was a period in time, especially in the beginning of COVID when it was like, “If you can stay put, stay put.” I wasn't visiting the clinics a lot. Being in the clinics and having team members see me interact with patients. When we first open and we've hired our first therapist, it's like, “How am I going to make this person a mini-me?” Not an exact stamp or replica, but how am I going to get them to instill how I would treat a patient or how I would have fun with a patient?
It's important for them to see us immersed. It doesn't have to be necessarily treating patients, although that can help. Sometimes I'll go to a clinic, sit in the waiting room and talk to the patients. It’s like, “How long have you been working here?” “How long have you been coming here for therapy?” I’m like, “No. I’m one of the owners.” I'm talking to everybody and I love doing that. How nice is it when you go to a restaurant and a chef comes out and talks to you? That's how I look at it, not like, “You're the owner.” It gives a sense of that patient feeling special. It’s like, “I met the owner,” that kind of thing. It’s to create that feeling in them a little bit and show the team too that I'm interested in what the patients have to say.
I've come across owners who have got to a point where they've got some freedom. They're not treating patients and they could work from home remotely. I have to remind them sometimes you need to still be there because they get too comfortable working from home. They’re like, “They don't need me. They're doing fine.” I want to remind them, “It's important that your presence is there on occasion because you want to exhibit part of that culture and personality.” Honestly, you want to make sure things are going well and make sure everyone is following the policies that you would expect. It's nice to have your ear in on conversations, whether that's at the front desk or between provider and patient. That's part of maintaining culture and having that presence. You can still maintain that culture at larger clinic members like 15 to 20 clinic members. That means you simply have a lot of other people that already know the culture, how you do things and have bought into the purpose, values and all that stuff before you can feel comfortable with not physically being present in the clinics.
I've done it wrong the other way. At the beginning of the COVID crisis, I’m not going into the clinic and having team members get these videos for me. It’s not an order but it’s like, “Let's work on this,” and here I am sitting at my house. They don't know what else I'm doing and that didn't come across well. I remember our COO was like, “They don't see you as I see you.” They need to know the goofy Beth so you can create that mutual respect in that.
There was a clinic that Will and I had. It was always awkward when we visited. We weren't that present often. It was a little bit out of the way but it was successful, our guys are doing great numbers and they don't need us. When we'd show up, there was a weird vibe. Sometimes, you get that sense that something is off here. That's when we had like you where someone quit, another one will quit soon thereafter, and another one quit a little bit later after that. Being present and recognizing the feelings and atmosphere, you can get a lot of sense simply by observing and being present.
There are other times where I might not have been so invested. It’s not only going to clinics but even with a marketing team. I've been working closely with them and we had a couple of team members in that area that were not getting along. It’s like, “Let's dive in and figure this out.” Let’s get in, work on rebuilding trust, and spending a lot of time with them doing that. I can tell you that they've told me, “We would not be here if you would not have done that. If you wouldn't have taken the time to show that you care, you value both of us, and us getting along, that meant much to you.” That was a wow moment.
It's cool to hear that you share some of the issues that you're having even years across four clinics. I see you as a successful physical therapy business owner and Lisa as well. It's still a work in progress. Things aren't perfect. You have your own difficulties. Who could have guessed that the pandemic would come along and it presented its own set of difficulties? This is something that you're constantly working on. It's not a one and done. It's not like you can open up a McDonald's franchise and it's going to run as it would anywhere else in the world. You guys are still working hard at developing the culture that you want.
It's still a challenge. It ebbs and flows too. You have periods that I look back on where we were doing even better than we are now. For Lisa and I, we took off a whole summer and we came back to a mess. Our numbers looked good, we were doing well and the culture was good. To me, it's not always about how well are the numbers and how are our profits are. It has become more than that now. We have four clinics and instead of doubling or tripling, our purpose is let's get what we have and get it humming. Get everybody happy and engaged. I look back to the team, we had fun but it wasn't like this team approach where it's like, “I’ve got that, I’ve got your back.” Whereas now, I feel like we have that. It's more fun and inspiring to be here.
When things were running well or at times when the culture was good, what were some of the things that you recognized from that? What were some of the benefits of having a culture that people bought into?
We've been working a lot on trust and getting people to be more open and willing to say what they think and feel. We started with these anonymous surveys. Be careful what you ask for because you'll get it. We got back not so great feedback and I was like, “What's going on?” We started honing in first with the management team. Let's be open and vulnerable. It was hard work on my end because I had to sit back and say, “What am I doing that is creating this environment of people not wanting to speak up?” It took a while to recreate that trust.
We're so used to this top-down management approach, which got us far to a certain extent but that's not how I wanted to run my company anymore. I wanted it to be more of, “Let's get everybody's input, and let's come up with decisions together.” Number one, you've got more brains that are pitching in. People who are on the front lines know the systems better and can come up with better ideas than I can. It’s being open to that instead of, “I want things done yesterday.” I can sit here, write up a whole plan, have it done tomorrow, and try to shove it down everyone's throats but that I learned does not work. It's taken a lot on me to sit back and say, “Let them come up with a solution or whatever.” Most times, it's better than what I would come up with. Even if it wasn't something I would have done, it still gets the end result. It's like, “Why does it matter how you get there if you take Road A or the scenic route?”
Creating that and having everybody pitch in and not be like, “Why would that person say that?” One of our core values is giving everyone a chance to surprise you and me. Let them come up with it. I've noticed that they take more ownership that way. It's been a little more fun. Our management meetings and team meetings to be able to see they are pushing the core values instead of me, Lisa or Ron are on an island by ourselves.Give everyone a chance to surprise you. Click To Tweet
That's one of the keys to a functional team is the relationship of trust. Are there certain books that you've read that have helped you develop that team and that feeling of culture?
It's called Leading with Gratitude. That was a good one. The Five Dysfunctions of a Team takes you through the different steps. It's like a workbook and implementation on how to do it. That's been great getting people to open up a lot more. We also hired a coach using the Scaling Up Methods. What he helps us with is making sure everyone's voice is heard like the quarterly surveys, “What worked? What didn't? What are some of your barriers that help us create that safe environment for people to say what they need to?”
I immediately thought of Five Dysfunctions of a Team when he talked about open conversation and vulnerability because my mastermind group is reading that book. That’s first thing that came to mind. Our leadership team went through that book very much so to make sure that we were addressing things openly and people felt they could talk honestly. I don't know what it is but there's something about that lack of trust. When the team members can't feel like they can share their opinions and their voice isn't heard, that's when they start looking elsewhere. They're like, “I'm not being heard here so I'll go someplace that will.” That can sow a lot of discord. As you've been through this process when culture is good and culture is bad, what are you learning about your team in general? What do you learn about some of the people who have been with you for years at a time?
The ones we’ve been with us for a while, I think of resiliency because there are team members that come in that aren't a culture fit. The more we have those core values honed in, the more they stick out a sore thumb. It's that loyalty. You have someone who might be for whatever it is behind our back saying negative things about management and owners. Other team members are like, “We don't do that here.” It's the loyalty to the team and not loyalty to the complaining, that type of thing. When you do have team members leave, it's hard. You have to regroup again, revamp, get back in deep, and go over those core values because it can be a disruption. That's the biggest challenge. If a therapist leaves, they want something different, they think better or whatever. It's different when we're not a match and how that affects the team.
There are other things where people aren't a culture fit where other team members might not see that. They see what they see and they don't know what goes on or what has been done behind closed doors. That team member has lashed out at another person. That's something we're not going to share with the whole team, so that’s a struggle. It's like, “They let that guy go. If they let him go, my job must be in jeopardy.” That's been a real big setback that we've had. People are thinking that if someone is being let go, they may be speaking out of a meeting, and it so happen to happen after that but that wasn't it at all. It's trying to rebuild that trust again.
When you've had people leave, and it's such a blow to your company, you almost take it personally. I did and I'm like, “I’ve got to re-assess what I'm doing and I've created.” We’ve got to go back to the drawing board, “How can I make sure this never happens again?” It's not the type of environment that you want to create. It's not an experience that you want your employees to go through so what do I have to do to change it? As you said, that's the dirty work you have to get. Get back into it and decide, “What are we going to do to make this better? How are we going to hire? Who are we going to look for? How are we going to filter those people out that aren't good fits?” You have a little bit more determination as you go back to it but it's not easy work.
You want to be able to be safe for the people who are working their butts off and pushing, and not bring someone on who's going to gossip, argue or do whatever. If you want to let that person go because they're not a culture fit but you also don't want to create that feeling of fear like they're going to lose their job. That's one of our biggest struggles that we've had with our culture, especially since COVID. All our cups are empty and we're running on fumes. It’s the smallest thing. It's the frustration, so you’ve got to maintain that.
It's not all rosy and things don't always go swimmingly. Even at your size, you're still dealing with issues with the pandemic, and in your case, a mass exodus which doesn't help. At the same time, you're always going to be coming up with these problems as an owner. The strength that you have is the management team. You have a shared experience with Lisa, a commitment to each other and the clinic that you guys are going to get through this. It's like weathering another Hurricane Katrina, it's not as bad but you're in a completely different place as a company and you have some idea of where to start from at this point.
That has made us more resilient with things that happened. This has been the biggest blow since Katrina but almost everything else is like, “We can handle this.” I see the light at the end of the tunnel, so that’s good.
We're talking so much about the culture and it's something that you're working on. You've had these issues related to the pandemic come up, but owners should know that Beth and Lisa have policies and procedures in place. You've got many other things that are going well and you're doing swimmingly. You've got the admin in place, you're following your KPIs, so you know what to do. You have so much of that established, I assume that coming back around is going to be a little bit easier because you know which buttons to push and where to look. Your focus is on training. It should be simple because you do have many policies and procedures in place. It's a matter of, “How do we train people on this?”
It’s finding the right time to train them. One of the famous things that we say is, “It fell out.” It’s like, “I thought we had that in.” We joke that I'm the Chief Reminding Officer but it is. It’s like, “Let's get back to basics on what fell out that we need to get back in.” Our percent arrivals have been below 90% and I can't tell you the last time they were below 90%. I’m like, “We need to start from square one.” We have what works. We don't have to recreate that wheel, we just have to get it back in.
Congratulations on getting 90% on a regular basis because there are plenty of people who have never been to 90%. I’ve never talked to them before, so you guys are doing something right for sure.
Thank you.Work doesn't have to be about coming in, going with the grind and pushing through. It can also be fun. Click To Tweet
As you're looking at creating this training program to hopefully improve your culture and the people that you have come through the company, what are some of that looking like? If you had someone in front of you who is a newer owner and they said, “Tell me what does your training program look like.” What are some of the skeleton structures of something like that?
We started using an online system for our training. I forget the fancy term that they use for it but it's online. You can assign people lessons and we've created different lessons and paths for their receptionist. There might be 8 or 10 lessons for that receptionist. It's videos, it's interactive and we can ask questions. If it's a receptionist, we can have them talk about percent arrivals like, “What would you say if somebody cancels?” We'll show a video of us doing a drill pretending to be a patient and we'll have the new team member video themselves telling a patient why they shouldn't cancel. We can see what their reservations are if they are someone who might be a strong candidate and hone in on where they might need a little bit more work.
That’s been fun and cool to be able to set someone up on these training programs. We still have people do it. That's the second phase but it's not so much legwork on the front end because we already have it into a system and we can refer back to that. That’s been great. In doing in-person training, we have some of the key components that we do for our patient compliance. We'll revisit that every 3 to 4 months to refresh people. I’m sure you're familiar with some of the stuff we've learned with our previous consulting companies, the awareness characteristics, getting them to realize how this is affecting their lives, and how it could get worse.
It’s reminding people to use this and the eval, that helps with the percent arrivals and things like that. I’m also looking at leadership training, not just our own policies and procedures but let's pick a book. The chiefs, me, Mary, Ron and Lisa are reading Crucial Conversations. We're reading a chapter a week, we're discussing it and starting at the top there. We're going to help figure out how we can filter that out to the rest of the team. When you're ready to be vulnerable and say what you need to say, that helps you figure out how to do it. I’ve worked with many team members who have conflicts with each other using that strategy and that's been helpful. It's that model of constant learning. You never graduated from PT school. You're always learning and when you stop, that's when you have a problem. It’s the same thing with leadership.
When you do training with a front desk person, are you taking them off the front desk for 1 or 2 hours or once a week? How do you schedule your training?
We're revamping that especially now that we have this new program. They take the lesson and there's an observed period. We observe them for 1 or 2 weeks with an existing receptionist who does well. We have someone who's an essential scheduler and now in our HR department. We have two other people who are rockstar receptionists that are in different positions. We might have them observe them doing it. Have them watch you do it, have them do it and mastery. That's still in the baby phases. What we used to do is have them read the manual and two weeks shadow a receptionist that's doing well. We would do drills once or twice a week to try to hone in. We're working on doing a better job of getting that onboarding process more solidified. It's never just done. There are always ways to improve, hone in and make it better.
If you want to know an intense training program, go back to the episode with Blaine Stimac. For their training, they go out for six months. For the 1st and 2nd week, there's a little bit of training every day. It's weekly, monthly and quarterly. They've got it all lined out and I'm like, “That is involved.” The results speak for themselves. They're a plug and play company now. They've got 30 clinics, so when they want to open up a clinic, it’s plug and play, train the right people or move this guy over here to over there in the new clinic and it's successful. They've got this successful method and he ties a lot of it back to the training, which then cultivates a culture of this is how we do things. It's not necessarily the atmosphere culture that we might be thinking about, that's their business culture. This is how we train, do, interact, run policy procedures and run a meeting. It goes on and on. That, in itself, is also a culture.
I have to go back to that because organization is not my greatest attribute. That's why I have Lisa.
I wish I was more organized. As you were thinking about culture and coming into this interview, was there anything that came to mind that you thought was important that you might want to share with the audience or even younger PT owners, if you will?
The one thing that sticks out to me is you're never done. You talked about Blaine, you have these systems in place and you have these training so it's plug and play. It's a constant work in progress because things change and industry changes. We have lots of industry changes. I'm finding more with the team members that we hire, they are demanding to be more part of the process and to have more of a say, and they should. It's our business model of, “This is how we do it here. Here is the policy and you better do it this way.” It doesn't fly that much anymore. Try to create something where we can have the team's input and come up with ways to constantly improve and evolve. That’s what I've learned in 2020.
Thank you so much for sharing. I brought you on because I know you guys are successful and you've created something great in New Orleans. This goes to show that even the seasoned owner is going to come up against different hurdles. Some of these might be similar hurdles that you had when you were a younger owner, but you visit them now on a larger scale. I’m thankful that you're willing to be open and share that in that regard. There are still issues that people are dealing with. The pandemic is something that hit all of the owners in different ways. Even the larger practices suffered like you were talking about in one way or another. It's cool that you're willing to share as we're talking about culture and some of the benefits of it because you've seen the benefits of it. You know what it’s like, what it could be, you have to reset and get that mojo again. Thanks for your time, Beth. I appreciate it. I've finally got you in. It's been great to talk to you.
Thanks so much for having me. I appreciate it.
We'll talk to you later.
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