PTO 140 Avi Zinn | New PT Owner


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


Listen to the podcast here:

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

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

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

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

Thank you. 

Organizational skills are one of the main characteristics every good front desk officer must possess. Click To Tweet

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

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

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

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

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

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

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

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

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

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

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

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

PTO 140 Avi Zinn | New PT Owner
New PT Owner: Always let your patients know that you are caring about them at all times.


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

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

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

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

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

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

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

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

By hiring a CPA to coach you, you can rely on the numbers which is much easier than mere feelings. Click To Tweet

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

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

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

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

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

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

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

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

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

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

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

PTO 140 Avi Zinn | New PT Owner
New PT Owner: Past, satisfied patients are usually the main source of referrals.


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

Have you been overall happy with Prompt? 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

PTO 140 Avi Zinn | New PT Owner
New PT Owner: With the front desk managing the clinic's patients accordingly and the physical therapists doing a great job, cancellation rates can be drastically reduced.


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

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

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

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

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

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

Physical therapists are almost salespeople by nature who are trying to complete the care plan of their patients. Click To Tweet

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The truth is I did that for the last one. We created a little bit of an onboarding process of 12, weeks in 30 to 90 days. It was more of training them. We startedI have a lot more room to start enhancing that and focusing on that. 

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

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

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

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

PTO 140 Avi Zinn | New PT Owner
New PT Owner: Hiring fresh graduates provides the perfect opportunity for extra mentoring and shadowing early on.


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

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

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

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

Thanks a lot, Nathan. 

Important links: 

About Avi Zinn

PTO 140 Avi Zinn | New PT OwnerDr. Avi Zinn, PT, DPT, OCS is the owner of Druid Hills Physical Therapy in Atlanta, Georgia. He opened his practice at the end of 2017 and has slowly built it up—transitioning from a staff of one (himself) to a team of administrative staff and treating therapists. He continues to grow the practice gradually. Avi’s main mission for Druid Hills PT is to provide high-quality, personalized care to each and every one of his patients.
Avi has his doctorate in physical therapy from Touro College and is a Certified Orthopedic Clinical Specialist. He lives with his wife and three children in Atlanta.

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PTO 83 | Transitioning Out Patient Care


Tom Dalonzo-Baker is well known for his work as the Founder of Total Motion Release Seminars, but in his past he is also a successful PT clinic(s) owner that had to go through some tough transitions in order to run his business. From early on in his ownership, he recognized, however, that he needed help - another PT that could take some of his patient load as well as some consulting on how to run his business. Once he started taking the time to systematize his processes and manage his business through statistics and observation, Tom began to see real growth in his company as well as freedom for himself to develop Total Motion Release. His story is not unlike many other owners that have been on the podcast, and it represents the struggle that many owners face during their ownership - how do you get the freedom that you want without sacrificing the production of the clinic? Tom shares his experience in transitioning out of full-time patient care which led to real success.


Listen to the podcast here:

How To Transition Out Of Full-Time Patient Care With Tom Dalonzo-Baker

I'm bringing back Tom Dalonzo-Baker who is very well-known for being our prior guest. You might know him from his Total Motion Release seminars, in which they provide a ton of continuing education and great content for physical therapists. They’re also getting into some dry needling over the past few years and have done a great job in the field in doing that. I wanted to bring on Tom and I'm probably doing double duty with this topic because in one of our episode, I talked to Aisha Wilbur about how she got out of treating full-time in order to salvage her practice.

I also wanted to get that information from someone like Tom. He's been around a long time. He had multiple practices. I want to get his take on what he did to pull out of treatment full-time so that he could focus on his seminars. The story isn't the same as Aisha's and that's why it's valuable. He's got a ton of wisdom and insight on what led him to not only pull out of treating full-time, but also the message that he needed to take to the doctors and the mindset that he took with him. There's a lot of trepidation and pulling out of treating when I talk to coaching clients of mine about, what do I do now with that time? What am I going to do in order to be productive? It's a mindset shift.

Talking to Tom, we're able to go through his story and his experience about pulling out of treatment full-time so that he could move on and get the freedom to do other things that he was passionate about. The overall concept is the same, but his story is quite a bit different than Aisha’s. I wanted to share his insight as well. Even though we're hitting this topic two times in a row, it's a topic that comes up quite a bit as I'm talking to clients of mine on how to get them out of treating full-time so they can focus on their businesses. It's the step you have to take in order to get the freedom and ultimately improve the profits and achieve the goals that you want for your clinic. Let's get to the interview.


I’ve got Tom Dalonzo-Baker, the Founder of Total Motion Release. If you read the first episode with Tom, he shared his backstory and how he got to where he's at, how he developed Total Motion Release seminars. We also mentioned at that time that he sold his practice in 2017 to his employees. He had four small practices. If you read that episode, you'll learn a little bit more about Tom's backstory. I wanted to bring Tom on because he's got a wealth of information, but also a consistent question or concern that I have in dealing with some of my owner clients is, "How do I get out of treating full-time so that I can work on my business or achieve our goals or growth and that stuff?” That or, “I'm getting burned out of treating full-time and I want to transition into an executive role.” I thought this would be a great opportunity to talk to Tom because he had to do that in order to develop his seminars. We'll get into that a little bit more. First of all, I want to say, Tom, thanks for coming on.

Thanks for having me. It's always fun to be here.

I love bringing you on because you’re a wealth of knowledge.

Thanks. I'm not sure my kids would say that but it's a lot of fun.

Tell me a little bit about your story and then we can get into what you've seen as you've talked to other owners across the country and what it took for you to step out of your practice. When I say step out, step out of treating full-time in order to work on your business and company. I’ll share some of my thoughts as well as we go through this and my experience. What did you do and what are some of the things that you would recommend others do in order to make that step?

I'd go back a little bit because sometimes people have to realize, where did this person come from? How was he able to think like this? How did he better develop those skills? I was a teacher before I was a PT. Being a teacher, you're always constantly trying to find the patterns to help somebody learn. I was constantly doing that. In some regards, it’s second nature to me. I want to be able to give my skillset to somebody else because I know it's going to free me up to a degree. My kids joke because they tell you that I had them to do the chores around the house. Each got chores and then they’d send me a little video even when I'm gone and they have to validate it. I’ve got that mentality. When I got into practice early on, I made sure that I had my front desk, I had myself.

I tried to hire even a part-time person, somebody who could step me out because I figured, “Let me do the other parts of running the business. At the same time, I still took all these millions of courses. It was a balancing act there. I had that mindset to begin with, but I was nowhere near wanting to do it. A lot of times I know that when I talk to people, they're completely therapist-driven, which means they're technique-driven, but they didn't have necessarily that mentality and they'd be forced into. Let me tell you, it's not easy no matter where you come from because you will be forced into it becoming an owner.

That's what I noticed is you had that mindset. I don't think a lot of owners go into entrepreneurship with that mindset. What I find myself doing is talking to them about, “If you're going to improve your business and grow your business, you can't be treating full-time.” The hiccup becomes, “If I step out, I'm going to lose money. How do I become productive? How do I take on this next salary?” It seems you might not have had to overcome those hurdles or did you?

Yes, without a doubt. I said, “I'd like to bring somebody else on.” Remember I started from scratch. I had a handshake with a fitness club. I was one of the first people in a fitness club in North Carolina and I convinced them to take over a storage room. Luckily, the guy I had a handshake with was an honest guy. It was a big wellness center because the next day, one of the big organizations in town came and wanted a contract. He’s like, “I’m a man of my word. I’ll let him do that.” I started with not a lot of expenses. I realized when I got to a certain point, we're not talking hundreds of thousands of dollars. When I got to 20, 25 people, I made sure I wasn't doing the billing by any means. I might have started with somebody doing billing, but then I brought somebody on to do part-time.

I was always looking for the mom or somebody who could help me out there. They could start into it and they could then become the next person and they had the flexibility. I was very fortunate. I found three of them probably along the way that helped out. I remember I even went into my old school and I said, “Anybody that’s a student now that wants to come and work at a PT place just to help out, I’ll give you a couple of bucks here and there an hour.” It's where I fell. I was willing to take less money for myself with the potential that I felt that if I had this part-timer, it would free me up to do things.

You had that mentality and that's a mentality that I constantly have to work on with owners that I work with. Stepping out doesn't necessarily mean that your company is going to regress. Stepping out is a sign of progress that you're going to move forward. By working on your business, your revenues will improve, the business flow will improve. You'll have time to handle HR issues like hiring and firing and all that stuff.

I got to look at it from the outside. I also want to mention this too because a lot of times people think,
“He must have loaned. They had this backup or this backup.” I started with $2,000. I didn’t have any money, but my wife was working so we did have something to fall back on. It was nothing huge or anything like that. As I went through, I realized, “I can at least get ten more people in here if I were out there. I can do this.” That was the push. I can get out there and meet people because if I'm all working, how am I supposed to get out there? In that stage of the game, it was about going out and meet and greet doctors, having workshops, wellness centers, things like that.

PTO 83 | Transitioning Out Patient Care
The 4-Hour Workweek

You had the mindset and sometimes other owners have to get to that point, then you also were willing to essentially invest by taking other people on that might not have been the best for your financials, but you considered it an investment to bring these people on. You could then turn around and market more, see more doctors, grow the practice from that regard instead of having your head down in treating patients all day.

Myself being in it and now pulling back out and watching, then setting up other clinics and trying to get them to grow, looking back, I sit there and I go, “I seem to take the right steps,” but none of them were easy. Going from being a therapist, I’ve always been the boots on the ground person. I’ve always been in it too shifting to say, “I need to bring somebody else on.” With all the fears of the money it's going to take, there are ways to get somebody. There's somebody out there willing to do some work, whether it's a PTA. In North Carolina, a tech is allowed to bill for and stuff. That helped out. Those little baby steps that free up certain space for me was beneficial.

You didn't immediately step out of treating full-time. How many days per week did you take? Half-day here or there, one full-day? What did you do?

I brought a PT on first and I tried to bust both of us. Before I stepped out, I probably had two PTs or a PT and a PTA. I’ve got to step out. At that point in time, I realized I can get out there and do more of the marketing. I also had the mindset of, “I'm scared to do it,” but once you do it, I get a fear of, “What do they think I'm doing now with my time?”

How long did it take to get over that?

It took me two years. That was not easy. I kept pushing through and doing it anyway, but it was still in the back of my head. It was like, “What did he come doing now with it?” It always felt if I went in the clinic or I was outside in the clinic doing work, that I had to justify somehow and go back in and, “Here are all the things I was doing.” That sometimes talking to other owners was more things that pushed them backward and back out of not doing it than anything. I went through phases of that. When I started doing it, what was I doing? You've got all this time. I felt I was being questioned. I don't think I was questioned by my employees.

It probably never came up.

If you decide to be an owner, you do it for a reason and fill the vacuum that needs to be filled. Click To Tweet

No, I would come in after I was out and about. Whether I was home doing the work and all, I would wonder the same thing. I got into seminar business, but I was still running myself from home. What it made me realize is how much I had to have systems in place. What systems do you want in place for that? You don't think about them early on and as soon as you step out. That's why it's nice to step out a little bit and then come back in because you’re like, “I didn't set up those systems.” Even right now, I started with one seminar, TMR, then we got TOTS. We got dry needling, 1 and 2. I'm going to add a pelvic floor. It's like, “I’ve got too many plates spinning.” I realized I’ve got to process this stuff out. That's what you got in mind. That takes time. It's more of a journey and it should be more fun that you're learning all this, but don't think that I haven't readied my house for sale on 2 or 3 occasions.

You led me down the path that I was going. What did you do? Because all this time, we're trained to be technicians. We’re supposed to be therapists. We spent however 25 years of our lives building up to be this therapist and that's what we were trained to do. That's what we know how to do. We can exchange our treatment time for insurance reimbursement. That's our production where you don't readily see that immediate exchange when you step into an executive role because now your hour is an exchange for a check from the insurance company. You have to get over the mentality that you're investing in the business, which will show in other ways that will increase revenue. Getting over that mentality is difficult. What did you do then with your time? The first thing you did, you talked about processes. You need to develop a process. When you say set up process, you're talking about grind and write it down.

First, I stepped out. I had to grind. I had to hustle to get more patients through the door. I had to get out there and do marketing. I didn't have processes yet. I had them in my head and I had to do it. I'd come back and do because I only had three people. It's not as difficult to maneuver around and be an owner of yourself and two other people. It’s when things start adding up, now all of a sudden, “I’ve got to get up with these doctors. I have to do this stuff.” Now you have a pile of work over here you're doing, plus you have to manage the clinic. You said, “When did I step up? When did I realize I needed help?” It got to a point that I sucked. I was good at this and this, but when I realized that I’ve got too many plates, I was literally going, “I'm not sure whether I'm going to have to close the clinic or not.” I spent the most money probably still to this day, when things are the worst. I was almost going broke on, “Do I have to close this down?” I said, “I need to reach out somewhere.”

I remember that time there was a company called Measurable Solutions that sent out a postcard that said, “Get new patients out the wazoo.” I go home and I go, "This is true.” I probably talked to them for a while and I decided to go in and I got all that leadership training. That was a hard swallow to get in there and get the training done. I had to step out and get consulted because I thought I knew what to do. I was doing it. I had to find other people that had been through the same crap that I’ve been through and pulled it out at the other end. Back then, we didn't get to see a lot of people and it wasn't things like this where people talked about it.

I think that might be an initial mentality that if I pull out, I can market. We're not trained in business. Getting some of that coaching/consulting and getting some business acumen takes it to the next level. We could try to get new patients. Shaun Kirk and I talked a lot that there are holes in the bucket. You can pour more water, as in new patients, into the bucket but things are leaking out. That comes down to, are you managing your statistics properly? Do you have processes and procedures in place? What's your hiring, firing flow? All that stuff. Those are business aspects that we as therapy owners need training because that's not what they taught us in therapy school. We were trained to be technicians.

I don't know that I want somebody one step ahead. I want somebody who made it all the way through and pulled out and said, “I'm going to help somebody.” They may be one step ahead because they're trying to get through their crap of the next step. It's nice to get somebody who has gone through the process of it and can relate completely to you. There are many more people like yourself that had their clinic and now are in there going, “I want to help.” It's a lot of fun to help people do this, but it's grueling to be on this end watching people struggle.

You know what it takes and you want to hit them in a good way and go, “Come on.” If you decided to be an owner, you did it for a reason. You will fill the vacuum that needed to be filled when you step into the idea, “I'm going to spend this money.” Here's what Shaun Kirk had said to me. He goes, “Tom, what would it be like if you were as good running your practice as you were treating patients?” That changed everything for me. I said, “That's what I need,” or I’ve got to go back and be a regular PT and working for somebody else. I didn't want that. You sway back and forth because sometimes you can go, “We've got to get paid more money as a therapist than being an owner,” but it's a hope that that will change.

PTO 83 | Transitioning Out Patient Care
Transitioning Out Patient Care: There are business aspects that therapy owners need training on because that's not what they’re taught in therapy school.


It follows along with my mantra of reach out, step out and network. You recognized that in order to grow your business innately, you needed to step out. Initially you did the marketing but you’re lacking in the business acumen, so then you reached out to your consultants. You got that so you could standardize your policies and procedures and learn how to be a business owner, manage, follow the right KPIs. All that is certainly valuable. You've been super successful to the point where you have been able to step out of treating full-time and develop the seminars. What you exemplify is that not everyone wants to go out and teach seminars or has a product, but that gave you freedom to do whatever you wanted to do and your profits followed with you.

To a degree. Now I had two companies to run. I got two sets of processes to try to figure out. I had done enough because going out there and a good consultant made it, so I realized what was causing something to go wrong perhaps or how to at least observe it so that I could fix it. When I had those in place, I was able to step out. I seemed to, personality-wise, step up quicker than somebody else does. I said, “Do I have the capabilities to do the seminars too?” I remember in the beginning of seminars, you’re doing one seminar every month to 2 months or 3 months when you’re starting. It's not that big of a strain, but then all of a sudden you realize, “Now I made the point, what do I do?” Now I’ve got to have both of them. It took me fifteen years to decide to get rid of one of those and cement.

Share that with us because what you did can tie back to our conversations. How do you step out of one role into another? You have to step out of treating and executive roles in clinics to make the seminars work.

My path is the way things worked for me. It doesn't mean it has to be yours or anybody else's. The first thing is I was a good clinician. I went out and took 40 courses in the first three years and it was crazy. I had that mentality of, “I'm in the top 10%. This is why my doctors sent for me.” The very first phase was to get out of that mindset. How do I get my people to be believed in by the doctors who are sending for me? I'm fortunate that I ran into Total Motion Release that I could easily facilitate that and teach them quickly. I knew that I could say to the doctors, they're doing the same thing I am. I'm checking off. When I then had an easement about doctors trusting my company to send to rather than just me, then I had the phase of when I'm stepping out, what do my employees think about me with this time I have on my hands? I'm sure other people feel it too is that, “What will the boss do?” You're not the one doing anything. Even as you're going out there and reorganizing the company, what is it you're physically doing? I think that was more of a mental, of my own pressure than they might actually be saying and doing that too.

When I stepped out completely, I stepped out because I'm an online guy. I'm a virtual guy. I read Tim Ferriss' The 4-Hour Workweek many years ago. He talked about getting virtual assistants. I have virtual assistants doing stuff in my clinic as cheaply as I possibly could. That's probably what I should do a class on. It's how to get virtual assistants because I had them doing tons of stuff for me. From there then, when I stepped out and I ran my clinic from home, I had to have it set up that my people could look at their stats or their graph. They could send me data, send me a report and they would send them to me on their time. I would look at them on my time so that we didn't both have to meet at the same time. We even set up meetings that were very efficient. I was taught how to do that with consultants, then I could do two companies at once.

It seemed like you took a lot of time, not only developing processes but you developed a culture. This is how we do things at my seminars because that's another hiccup. I have plenty of clients who are talking to their referral sources. As they're bringing on new PTs, the doctors are saying, “I need you to go and see so-and-so.” They might not write that down on the prescription but, “I want you to see so-and-so at such and such physical therapy.” When the patients come in and they're not seeing so-and-so, I had to go through the same thing. I was one and the same with Pinnacle Physical Therapy back in the day. When doctors would send me, a lot of times they say, “I want you to go and see Nathan.” They didn't even know the name of my clinic sometimes. How did you get over that with patients?

By far, TMR helped the most because it was so easy for me to come in and say, “Is this what they did on you?” There were many abilities with that that simplified my process. What was unique about the Total Motion Release, I had to create a process to make TMR. I took that process, the way in which I created it and then did the exact same thing in my clinic. Chip Moseley and I, my lead therapist at the time, we would constantly go, “How do we build this and build it within the company too?” In TMR, we look at the entire body. We move it to observe what's working and not working. That's easy. In the company, you have to first of all observe your departments to see how it's working and what's it doing, and then determine what's working and not working. You have to have some standards in which you want to see happen and then continue to follow them. That's what we talked about in the first one, setting those standards.

Everybody can do different things, but with the same mentality on it. Click To Tweet

First of all, you've got to know what they are. How do you know what they are? You've got to talk to your staff. You’ve got to get things about them. You've got to get a consultant. “He's talking about so much stuff.” There’s a step by step. I'm a math teacher back when I taught school. I love a step by step stuff. I don't want to be a teacher. I want to be an instructor because an instructor gives you instructions to follow a recipe that you then follow, and then from following that recipe, you've learned the knowledge. That's where a coach comes in because they've broken down the steps. They are your instructor that knows the recipe. It's going to keep on hounding you because you keep wanting to put salt where there's supposed to be sugar or something.

I wanted to reference back to our previous interview. What you did to establish that culture and how you do things was a team effort. From what I remember in our conversation, and correct me if I'm wrong, you would bring your providers together and say, “We have a lower back patient, we have a sciatica patient. How do we treat that patient successfully?” A lot of that is the owner sharing what their knowledge is. That way, it becomes, this is how we, as physical therapists, treat low back or sciatica patients. You can tell that to your physicians, “Whether they see me or they see another provider in my clinic, they're going to get the same type of care.” You can make it consistent and get similar results throughout the clinic. That's how you developed your culture.

I didn't like seeing that if somebody came in, this will be a common thing. I’ve had seminars on this and webinars and just asking owners. If somebody came in, a VIP came in, who'd end up treating them in your clinic? If the answer is you, then you haven't set up a path or standards that everybody's not doing different things. Everybody can do different things, but with the same mentality on it. For example, we have the same TMR or daily note. I don't care what technique you do, everybody can tell what's being done from it. I hate to keep putting up TMR, but TMR allows manual therapy, corrective exercise to be done in any technique and it’s still on the form and everybody knows what to do. That's probably what changed my clinic the most is because then we could simply say, “What are you doing with it?” What we found is rather than our differences, how many similarities we had and then we crossed off the other things and then we created standards. Standard would be the biggest thing.

If you can tell the doctors, “Whether they see me or whether they see somebody else in my clinic, they are going to get the same level of care. I'm no better than the other therapist. In fact, some of my other therapists are better,” that's a conversation that needs to be built on top of the relationship you already have. Many times, to appease the patients, maybe you see them the first visit and then introduce them to the other physical therapists and say, "They know exactly what we're doing. We have the same notes.” It takes some work, but you have to come together with mindsets as providers in order for it to not become Tom Dalonzo-Baker physical therapy, be your clinic.

I think that's more a mental thing these days because look how many doctors have their PAs. I don't think it's a big deal to them anymore. When they see, "Here's how it's instructed and taught. Here's what we're doing,” that mental block is one of the easiest ones. Now there are easier ones to deal with.

You've given us a lot of great insight on how you did it and to the point where now, over the last few years, you've been so much more focused on seminars. The clinics have essentially run themselves that you've turned it on over to the employees and without a significant change. They're continuing to do what they were doing before, I assume.

I sold my clinic in 2017, but I was out of the clinic for seven years. They knew what they had to send to me and every week we'd come in and we'd have a meeting. I had good people that will tell you they were illiterate. They can’t even turn on a computer and they were doing massive cool Excel spreadsheets. Maybe you guys might say, “I have my people do different work and more work.” If it's facilitated the right way, oftentimes with a consultant helping you on the things, you can see that you can empower them and they'll see that it's going to save them time. One of my front desk, she totally dragged her feet on doing a front desk routine. I said, “I promise you, you’ve just got to give me time. This is going to save you so much money or so much time having it organized like this.” Three months later, she came back and say, “You're so right, Tom. I don't have to search all over the place.”

PTO 83 | Transitioning Out Patient Care
Transitioning Out Patient Care: You have to set some standards in which you want to see happen, and then continue to follow them.


You shared that with us in the previous episode about what you had your front desk people do. I recommend the readers to go back and read the first episode because you had a separate Excel spreadsheet for your front desk people. You told me that your front desk person was offsite. Is that true?

If you observe enough about what happens at your front desk and how much stress and pressure from getting things done they are, you'll see that patients and therapists are always talking to them. They're always being asked to do this and that. I observed one day and go, “I couldn't do that.” In fact, I had to cover a couple of times for them and I go, “This is insane. How do I even expect them to get anything done?” Being a virtual guy, I took my front desk and made them work from home. People say, “It couldn't be done,” but we had a success rate that if a patient called for an evaluation, she would go through a scale taught by Shaun Kirk. They go through a scale to ask them about their problem. From there, listening to them, “What would you do about it? I think we can help. Would you like to set an appointment? Great. I will tell you right now, typical treatments, three times a week for four weeks. I'd like to get you on the schedule because we're so full. We can always change it later, but at least it's there.” She had a 90% success rate doing that from home before the patient ever came in. Anybody would take that statistic.

They’re getting full buy-in and full scheduled out appointments even before they came in for the initial eval.

You ask the front desk, “Why can’t they take the time for the person on the phone?” Because they're not the person in front of them. They don't have the person in front of them. They have the person on the phone. They have much more time. There's a big thing I always say. If you've worked hard enough at a problem and it's not solving, it's the environment. It's not the people involved. It's usually the environment. Look at the environment, and so I went to the front desk and I said, “Let's watch what's happening with that.” I am getting frustrated on why this is happening. I was like, “Why do they get inundated with interruptions constantly? How do I take away those interruptions?” You go in and observe a therapist who isn't performing up to par. There's something oftentimes in their environment. It might be training, which is internal stuff too.

That's great advice for people to look and see, “We put a lot of conjecture out there. They're probably not doing this. I need to train them more.” Sometimes it's as simple as sitting down and observing for 15, 30 minutes and seeing what does their environment look like. Do they have the tools that they need? What are some of the interruptions to their flow? What can we do to knock all those things away and make it easier for them? That's amazing that you’ve got such great statistics by having them work from home.

I’ll pull something else out. If you're an apprentice for let's say a blacksmith. All that's ever happening is you're watching them do it. They put the steel in, lots of fire, learn it, come out, hammer it on, and then they're turning around giving that to you. What do they have to do? They have to watch to see if you're doing it correctly to give you the next step. Most of the time, me being an owner going in and watching sessions gave more help to my therapist than me hiring somebody and letting them be on their own. Oftentimes, what are you going to do with your time? Sometimes it's seeing what it is they're doing and say, “We have to change this one little bit.” Your people are canceling out before their twelfth visits. It looks good, but people are only staying for seven times. When we look for the satisfaction score and we look through your data, they're not leaving content.

That goes to the point of a lot of times, we might step out and then not observe. We maybe delegate and we say, “Here, go do this.” We're essentially absolving ourselves without doing the first step, which is to train them, step out, observe, reinforce, train and correct, then you can fully step out and then come back on a more regular basis to check in once in a while. If you step out and absolve yourself from any responsibility over that person, you're setting yourself up for failure.

When you systematize the process of treating, people can all relate together. Click To Tweet

This is the other one that happens. This is our biggest one. You'll go out and you'll get taught. You'll eventually get to the point where, “I’ve got to get help.” I will tell you though, remember you're the one giving help and you're going to go back and make it. It's going to feel now you're micromanaging everybody. You're having to tell everybody what to do and it's a sucky feeling because you're pushing things in and you're trying to balance it out. I understand that from people who take TMR, then they try to go back to their coworker. You had sixteen hours to deal with TMR. You as an owner had sixteen hours or 2 or 3 days to get the mental process in there and you're trying to take in little fifteen-minute increments to do the same to your staff.

When I realize that part of it, that helped me the most and I began being able to high-five them rather than micromanage them. I began setting up. The biggest thing is setting up those things that you go, “There it is. You've got to push it in without a doubt.” Eventually, you'll see that you're not micromanaging. You’re high-fiving your staff. That was the biggest thing. I was guilty so much and I would have to listen to my staff how much of a jerk I was and change. “Now that I did it that way, how would you like me to present it to you?” They always gave me a wonderful answer. I go, “I can do that.”

I’ll tell you a little story. My wife did work when we had one of our kids. I’ve been grumpy because I’m usually thinking of something. I said, “When you walked by me and you see that look on my face, just say prick.” It would totally re-adjust me just like that because I had something on my head that I was trying to think in the future and help out, but I wasn't totally right here. A lot of times as the owner, I wasn't being right there. I was twelve steps ahead wondering how I was going to get these people one step. That's very difficult. It was nice to have the reflection back and forth to people and the people in front of you. If you will be vulnerable enough to say, “I feel I'm doing this,” they'll probably say, “You are.” You can say, “How can I help you get there?”

That’s a ton of great advice that you gave from your personal experiences and what you've learned over time. I want to give you time, and I know you're limited in time, so thank you for coming on. For the people who want to get in touch with you or find out what's going on with Total Motion Release, how do they find out?

PTO 83 | Transitioning Out Patient Care
Transitioning Out Patient Care: If you've worked hard enough at a problem and it's not solving, it's the environment. I’ve gotten to a point that I give away this free training that is so elaborate and so cool. I’ve automated it and it takes you through step by step of exactly what I did. When I treat 100 patients, I was repeating the same thing, so I automated it. You literally can go through it on your own. You can even submit things and have access to me as you go through, so that you're not feeling alone. I took little things about that and you will get an enormous amount of, “This is pretty cool.” If you look at that and you go, “I'd like to figure that out from a business perspective,” that's the part that somebody like Nathan can help you with. He’ll help you see that this can be done. If you're looking at, it’s a great way to learn a technique. I took my physical therapist and let them be the core of my company. I got them in the system first. It’s systematizing them, then very quickly, I got the front desk. I almost had to do it hand-in-hand. When I systematize the process of treating, we all can relate together. We're in the same mindset and then we could make sure on how do we help the front desk get there. Notice how I shift from how do I do it, but how do we help each other get there?

Now you're multiplying yourself, and that's where the growth comes into play. That’s awesome.

With my seminars, I’ve got many going on. I'm trying to do the same thing with them. I look back and go, “Here it goes again.” You're a little bit more attuned to it. I hope I gave your people enough to think about.

It was great. Thank you so much for your time. I appreciate it.

Nathan, thanks.

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About Tom Dalonzo-Baker

PTO 83 | Transitioning Out Patient CareHi. I am Tom Dalonzo-Baker and have been a PT for over 20 years. Was a teacher and business man prior to this. I live in Raleigh, NC with my 6 kids (5-18 yrs old) and my awesome wife.

I have owned and operated 4 PT clinics in North Carolina and sold my last one to my staff in January 2017. I am the founder of the Total Motion Release (TMR) Method and a seminar company called TMR Seminars. Our courses include TMR, Dry Needling and TMR Tots.

A patient once asked me, "How good are you at fixing your patients?" And I answered Top 10%. He didn't blink an eye and then he asked, "How good are your patients at fixing themselves?"

That one question changed the entire trajectory of my career and my skillset as a PT & owner. I wanted to be good at giving my skill to my patients and my staff.

From that point on I observed, explored and learned again and again how to get others to help themselves.

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