James Savas is a Senior HR Professional who has worked in the healthcare (and PT-specific) industries for decades, and there is one common issue that he sees PT owners make. It usually looks something like this: the owner hires someone to fill a position, turns around to work on patients and put out other fires, cross their fingers hoping they've made the right hire, leave the new hire to their own devices, and expect them to come up to speed in a week or two. Most of the time, this process doesn't work well for either party, and frustration mounts to the point where the owner throws their arms up in the air and laments, "if only I could find good people." What most owners don't recognize - or take the time to detail - is that there are a number of steps they've missed between recruiting and getting an employee up to full speed. If they take the time to organize the process, the whole system can be a powerful foundation for establishing a rock-star team. In today's episode, James joins Nathan Shields to list a number of simple things that owners can do to create the team of their dreams.
I've got James Savas. He is the Deputy CEO at Hands-On Diagnostics, and that's how I got to know him. James is an expert in many things related to HR, but specifically, he's a senior HR professional with a specialty in Business Development. He's also a certified educator and executive coach. He brings a lot to the table from past experience and PT specific experience. Not just PTs, he worked in other healthcare settings as well. I'm excited to bring him on so we can talk about HR-related issues and depending on our discussion, how these things go, we're looking at making this a two-part episode where we talk about a lot of things related to HR. I want to do that because James has a ton of experience. James, thanks for coming on.
It's good to be here. Thanks for your time.
Share with everybody a little bit. You’ve got a ton of letters behind your name. You've got a ton of good experience. Give us the breakdown. What are some of the professional experience that you have in regards to PT in the healthcare settings and what you've done and brought to the table for PT owners in the past?
I’ve been in the game for many years on some smaller projects. I worked for dentists and chiros a little bit, but mainly the PT sector. Most of my time happens to be with private practice owners and orthopedic clinics generally. What I'll do is depends on what discussion I have. I have to work with an individual that has a good intention to do something with their game that they want to expand either they're too much in the game to expand. They don't have time to think about the administrative side or that HR side or whatever you want to call it. They want to get out of the game and own and let that machine roll.
I am dealing with guys on my track here on those two different sides. I've worked with guys up and down the Rockies, New York, Southern Florida, Central Florida, a little bit in Texas. Mainly the PT side. I'll go in as an HR professional, as a recruiter, depending on the gig. Business development is a big part of what I do because a lot of the owners out there help that can be of service to you guys. They don't have that guy, that ear or that outlet for, “Can I put something on your shoulders? It's all on my shoulders. Can someone else share the burden?”
I generally had been that guy. I'll be the figure out, organize brain, they know that they can do it but they don't have time for it or they don't want to do it. That's a nutshell, but I've seen the chiro practice game overseas in Ireland and all over the parts of the US. I'm dealing with a national company that has a whole bunch of owners all over, I think 26, 27 states. I like what I've done. I worked in Rural Montana and I've worked in the Story of Queens. I've seen both sides of the game pretty much. I can talk to an Alaskan up there if you might have some troubles and the guy in Miami who’s working.
That's good because a lot of owners that I'm supposing are reading, they're like, “I wish I could afford a guy like you to come in.” I know in my situation, people would ask me all the time, “How's the business going? How are things coming along?” Almost to a tee for about ten years, I was like, “I love treating the patients and I enjoy that, but I can't stand the HR stuff.” Having to deal with the employees, the person who gives me no notice and says, “I'm out of here.” Maybe doesn't show up or someone who does give me notice, but they happened to be a PT. I know it's going to be 2 or 3 months before I find another PT even though this PT only gives me two-week notice.
It's like, “Stabbed me in the heart.” Those things kill me and holding people accountable, all those things were hard. Hopefully, we can get into some of that to give some owners some ideas on what they can do to improve that HR side by spending a little bit of time in there. As you worked across the country, we want to talk a little bit about recruiting, hiring, and onboarding. Before we hit those three things, what are some things that you came across in your experiences with PT clinics, in particular, that seems to be an ongoing trend? It’s like you'd come across and say, “This is how you guys think,” or “This is how you guys work.” There's some kind of trend going on here that you need to correct typically when you walk into a PT practice. Anything like that?
I lean into it a little bit before, but what I'll see is that normally the owner has a bunch of ideas for expansion, things he’d like to do, what people he likes to fire, people he or she like to bring on, and he or she got time for not as much evaluation of that data. They have ideas statements all locked in this idea stage. Some of the fixed ideas that they can't afford an employee to do that. Often a debate I get for them is they need to hire, they can’t afford to hire they bring the guy or girl on, they are no good. They have to let them go. They wasted all this time training them.
It is that the attention on those things is not there and their ideas of when they should build up their staffing, how often they should then let go of the dead weight. You have both sides, you have that spot. It's a manager's function that they don't always do that they're busy in treatment or they're busy in other things. That executive manager role where they should be observing the employee going, “That's no good. Why is she still here? Why is he still here?” It's both sides. It's keeping staff that should be there and dumping the dead weight and no time to evaluate that. On the front end, “When do I need staff? Can I afford the staff? How do we get them productive?” Because I'll bring them in and I'll let them go and then I'm busy when they get it done.
I think I know exactly what you're talking about. You've got an idea and you say the solution is to hire blank. Maybe it's to get rid of blank, but you haven't taken the time to work through the process of how to bring that person on and onboard them successfully. I think that's what you're talking about. You were missing steps in between. We've got this idea. We think we see the solution, but there are a lot of steps in between that make that solution successful. We jumped from idea to solution and then go and work on our patients 40 hours a week without lifting our head up to observe, “How are they doing? Did they get any training whatsoever?” I remember many times sitting in interviews saying, “You have this title, but your job is to do whatever needs to get taken care of.”
It was much less delegation and much more of abdication of any responsibility not knowing that the ultimate responsibility always fell on me if they didn't do their job. Poor job at training, onboarding someone, and having some processes in place. It sounds like then as PTs, maybe healthcare practitioners in general that are independent owners failed to take the time to lay out those steps and bring someone on successfully and train them up.
The other side of that went, “They're not doing good. See you later.”
The idea is this person's bad. The solution is to let them go. There might be more steps in between that make that successful that could help us along the way if we do it right. You've been across the country with PT clinics. I'm assuming your role as an HR professional was to do some recruiting. We can never talk enough about how to recruit PTs and get them on board. What were some of your successful actions to recruit PTs and bring them to even some of the rural settings?
The first thing I do when I got to the recruitment part of the HR cycle is to get communication at schools in my zone. In parts of Alaska, there's no PT school maybe around up there. I would get communication with the PTs in the area and what schools are in the area.
Even if there aren’t any local schools, those PTs can reach out to their alumni or their alma maters.
Getting that line is the first thing I'll do because I want to be well thought of by those schools. I want them to see my name, PT, and go, “We had an intern over there.” “I've heard that.” “He graduated from this school.” I want that PR is done well. As a comment, there's this element of the recruitment side. It is a marketing PR action in bulk, especially the recruitment side of it. The PR value of letting the schools know who you are is one of the first things.
Looking at the current good staff you have, who's been there 5, 10 years, or 2, 3 years, the owner's included. Even the front desk girl, the marketing individual or whatever it is. “Who do you know?” One of the biggest successes I've had in recruitment. I ran it as a pilot for myself to see to test myself years ago when I said, “I'm going to put no recruitment ads out.” I'm not recommending this. We had about a hundred staff, some satellite clinics. It was a big company. I said, “I'm going to only promote to my staff. I'm going to send out a weekly email to my staff, a few bucks ahead for a referral bonus internally for other staff. I'm going to bang it out and I'm going to run it like a campaign.”
Every week, there was a newsletter or a promotion from recruitment HR guy going, “Who do you know?” I get at least a name a week, if not 5 or 10. At one point, I had an 87% retention rate, only dealing with strictly my staff's referrals. That's how I got a guy from the UPS man. His daughter, his friend was in school for PT and we got her. The value of those lines and people never think of those things. They don't think of their staff, the mailman, or even the schools, but those two routes, they keep the new students come in and beat you on this side and they keep your current active good people that you’ve got in your business thinking. Those are two of them.
I love what you said about recruiting through your current team. If they're A-players, they're more than likely going to hang out with other A-players and bring you on. It’s the same thing with the students. If you can get a few of those students from certain classes who are in alignment with your company, and they toot your horn, then they're going to bring on their other awesome PT friends. They're not going to bring on a friend who's no good and more than likely they're not hanging out with those types of people. They're going to recruit for you and tout the benefits of working at your company and bring you on. I know that those are huge successful actions. I know, especially in rural communities.
I've had Dr. Sabrina Starling. She lived in Rural Wyoming and would help people recruit simply by using your network. Go to Christmas parties, “How's the business going?” “The business is going great.” During the course of conversation with anybody, maximize your network and say, “We're looking for someone like you. You're an awesome person. You're productive. You're a rock star. You've achieved many goals. Is there anybody like you that would want to work for me?” Take advantage of your network and leverage it.
To add to what you're saying is generally, they’ll refer people like themselves to some degree. They roll with that crowd, but also, they're not going to refer other people because they don't want to be felt bad of themselves.
It's great to leverage your local schools and alma mater. I know my business partner leveraged local PT schools down in Phoenix. To the point where we had PTs who said, “At any given time, if you have an opening in your clinics, let us know.” We had people “on the bench” and that was our goal. It took about 2 to 3 years to get to that point. He did an amazing job recruiting to the local schools, such that if any PT were to leave at any time, no fears, we would call up people and say, “Put in your four weeks’ notice, we're ready to go whenever you are.” We had 2 or 3 people that we could call at any given time to come on. It puts you in a different position altogether, minimizes the fear and puts you in a power position for sure.Most small PT practice owners hire to fill a position without taking the time to considering what a new hire needs to be successful. Taking a little time on that process would save both parties many headaches. Click To Tweet
The big thing is constantly promoting. Most owners I've seen goes, “The law's leaving. We're expanding. We need only one PT.” They’ll recruit for one PT or they'll lose one and get one back. They'll sit on their laurels and go, “We're good because I have the number of equivalents working for me now.” It's got to be constant action. Owners that are single-handing the business are not going to spend 5, 8, 10 hours a day recruiting. Any constant flowing and constant thought about it. Maybe an Ad, an email to your staff, that takes minutes and email to the school, “How is it going director?” It’s been a while. It's little effort, but it keeps that PR communications live. It's in there. It’s got to be constant. If you guys built it up where you had a waiting list, that's what you’ve got to do. We used to interview for the heck of it when we didn't need an interview 1 or 2 a day. “We don't need anybody yet, but we're here. They can shake, hug, love what you got here. I'll be back.” If they don't come back, I gave them a call and said, “Who do you know?” “You're not looking.”
I tell my coaching clients because we got to a point where we always have the ad out whether we were hiring or not for any position on our team. We were doing interviews for the tech positions, the front desk positions that were a little higher turnover. We were doing monthly group interviews for that and sometimes we were able to pull some gems out of that. Sometimes we didn't. We always had a PT ad out. Never let that strap off. We always had it going, always collecting resumes because you never know, especially where we were in Arizona. It's notoriously hard to recruit, but you were in a similar situation in Rural Montana. Just a little bit of time each week, it shouldn't take too much. If you can set aside 30 minutes to an hour, send out some emails, send out a text, promote, make a phone call. That's all you need to do. We get to that point where then as we are hiring, what are some of the things you recommend that owners establish as a “hiring process?” We had certain phases that we would take potential candidates through or potential employees through, but what do you recommend?
What’s completely underplayed by most is what’s next? We can talk about Rural Montana when I was up working for a client, a handshake, look them in the eyes, and maybe a pump on the back. That was your application. “I like you. You're a stand-up guy or girl, let's do this together.” There's something to that. That should happen appropriately every time again. I look at the recruitment onboarding that part is a bit off, where it stops and starts its own thing. It can be a technical subject because evaluating an employee both current inside but also coming in. I find that tantamount to you seeing a patient and seeing what's wrong with them.
You're going to evaluate them all over the place every which way you can to get to the bottom of what the problem is. I evaluate the heck out of these people coming in. There is the interview process. I have a testing regimen. We always would do. There’s a resume review, application review, a testing regimen. I have a couple that I've used a lot and then interview questions and then reference calls too. After all, that, when they're coming in, if that's what you're talking about, what does day one look like? Employee manual review policy, but let me know what piece we're talking about.
Let's talk initially about the hiring phase prior to offering the job or the day one of being on the team. Our steps taken were, collect the resumes. We do a phone call, but that wasn't much of an interview we wanted to screen for. What was their phone voice like? What was their tone level? Were they an excited person or they sound down? If they could simply pass a couple of those things and as I said, we also did some group interviews, but if we could get to a one-on-one interview, then we were doing some intelligence test. We would focus heavily on values. Make sure we were talking about our values and what those mean to people.
Making sure people were attentive when we talked about values and not swung back in their chairs and not caring any body language, assessing that stuff. There’s time to also talk about the job description and what your productivity expectations would be and what you're required to do. After the one-on-one was then a job shadow, preferably not with the interviewer, but with somebody else. After everyone agreed and they'd gone through all the processes, then we offer them the job. That was ours. What do you recommend on top of some of those things or different from some of those things?
A phone screening and a reference check. There’s like the normal systematic things you do. You do reference checks. If I got only one of the three, I got at least one, but try to get at least two.
Something successful for us in regards to the reference checks in which email was always the easiest. I don't know what it was. If I tried to get them on the phone, inevitably, they didn't have “time” to call me back. If I could say, “I'm interviewing this person. They put you down as a reference. Could you either give me a call or email me back your thoughts about them?” That made my reference checks much more successful and timelier.
For time, that’s a great idea. I liked the opposite of myself. I had time to do this. I had to speak to the person on the phone because I wanted to ask some questions. I wanted to hear what they said. I wanted to hear them go, “Lag, do you have an answer?” I did do that because if I'm doing a reference check, then the applicant knows there are some interests. I'm even going to that point. After the phone call with the candidate and I liked them, I'm probably going to have you come in. What I'm going to do is I schedule them to come in and before they would come in, I do the reference check. If I liked them enough after the testing, “I'll see you tomorrow at 2:00,” but I didn’t hire them yet. When I could do that, I could leverage the applicant. I could say, “I called three people. I couldn't get through to Cindy, Joanne, or Mark because they're hot.”
That's been successful. After the initial little phone thing and then the reference checks and now they're coming in for the interview, what you asked them to interview? You could strip that thing out 50 pages. I think the role and the expectations, the bonus structure, what all of that needs to go. I generally do that at the end. I like to start it off personal, “Tell me about yourself. What do you do?” I love the question along the lines of, “What do you do on your time off?” I don't want someone who’s good at watching television.
They have a whole lot of favorites, no offense, a bunch of favorite podcasts, TV, and that's all they know, all they do or that's a lot of what they do. I'm out there, I'm hiking, especially for the rural parts. I want to be out there. I want someone who skis in the winter and likes the summer. That's a big part of it. Once you get to know them and it's a fluid or it's garbage because you'll know that quick. I want someone to interview me in the interview. I want someone to go, “Let me ask you.” They either go, “I have questions for you.” They have a pen and that’s fine. It’s formal. They’re going to be organized. They interview me, “Why are you here? How long have you been here? Why did the owner do this?” I love those questions.
I look for a great personal character and they're involved in life outside of my business. We looked at PTs in one of my practices, I worked for who wanted to own. It might be off-putting to an undergoing. I don't want someone that wants to take over, kick me out, or open next door. At the same time, I don't fully agree with that because as long as they were qualified, good applicants and everything that you do qualify them under. Once you get them in, if their purpose is like, “Down the road, 5, 10 years, I want to have my place, move back to where I come from.” Why not facilitate that? I think that's a misstep too sometimes. I don’t want someone that's, “I’m just going to live here in two years, at least so I can pay for it.” Think bigger.
There were some things over time that I got used to asking. I started steering away from, “What are some of your strengths? What are some of your weaknesses?” It was surprisingly common. I'd ask them what their weaknesses are and they'd say, “I care too much.” I steered away from that and started asking more like, “What books have you read recently?” I want these people who are intrigued. If they're honest, they're like, “I don't read books.” “What do you do? How are you growing?” Maybe they could be listening to a self-improvement podcast instead of an entertaining one.
Secondly, “What is your five-year plan?” Even with texts, with the front desk and older people who I would interview for positions, I want to know that they've got some goals in place. “I'm not sure.” I enjoyed asking some of those more specific, deeper questions. I enjoy talking about values. A friend of mine who I interviewed a couple of times, Sturdy McKee out of San Francisco, wouldn't hire anybody that hadn't played a team sport in the past. You can understand why, because you are working much like a team in a PT clinic that people maybe they're doing individual sports might not be used to the team concept much. That was one of their filters. I love those kinds of things that filter people out and you find a certain candidate when you start narrowing things down.
I love that idea and you reminded me that we used them at one point. You can be the passive indeed goer where you put an ad and that's all you do, or you can pay a month, which was reasonable at the time and see resumes. What was nice about that is you can search for keywords like NCAA or soccer, football. There’s a word bully in searching a certain criteria. I worked for an agency for a while too. I have a recruitment agency side. I've seen both universities. They're different universities. To be able to search, you're talking about a tool. I can search for football, Montana, and hiking.
What was your experience in the past? We've had some good experiences with on the job interviews. We'd tell them, “We expect you to come in for two hours.” Sometimes we'd pay, sometimes we didn't. I don't remember if we had a policy in regards to it, but either way, there was an expectation that they would come for two hours and sit with the person in that position. Even maybe come in and do some of the work but there was a definite expectation that they would be engaged. You want to see how they interact with patients, how they interact with other employees. Even though they're new to space. If it was a front desk or a tech person, two gold stars if they brought a notebook and took notes. What are your thoughts on the job shadow?
I love that. That's what we call it, a job shadow or a working interview. We didn't use them frequently. I would say it wasn't for every employee equal working interview, but there were somewhere I was especially questioning the fit or their background. What do they know? If I had a billing person come in, I'm going to want to a little bit more, “Sit next to Joanne. Let's see you talk to Joanne about your job. I want to see you at the desk with her. Look at some claims, tell me what these fixes mean.” I want a little more live stuff. For certain technical positions, I loved it. Certain receptionists, what we wanted to see, like we had a girl who was in there for years. She was the boss, a reception manager. We stick girls next to her and let her feel them out for half a day, 4 or 5 hours.
On the PT side too, I had one of my first employee way back was a chiro. She had PTs and she'd hire a massage therapist. She asked him to treat her in the interview. “Can you go back here?” “I'm not a clinician.” “X, Y and Z aren't feeling too good. Can you get back there?” She judged them on their ability to do it and understand your language and stuff. I love the hands-on idea. Every PT we hired, we would have them shadow our clinical director or our lead PT. Any technical clinical position, I'd have her do a little walk around. I do a little intro to the space but then I go, “This is what we do.” She looked for indicators like eye contact stuff. Are they involved? Are they asking questions? I would tell her what I wanted her to do and she does it. That was invaluable. I can work half day or something.
A lot of these people, for 30 minutes to 60 minutes, they can snow you over. They can talk a good game, they can show some personality, but when you get them with peers and not with the “boss” or the head guy, and maybe they'll let their guard down a little bit more. For two hours, they start showing their true colors. How often are they bringing up their phones and checking their text messages? How often are they off to the side? I had a coaching client who was interviewing a PT and she had been working in the home health setting for some time and she said, “You've been working in the home health setting for long, how would you help somebody? How would you screen if they came in for low back pain?” She says, “I would do this and that.” “Why don't you show me?” She's like, “I would do this, that and the other.” “No. Imagine I'm the patient and tell me what you want me to do.” She couldn't do it.Most good applicants that wind up being hires want to know that someone's going to be watching out for them. Click To Tweet
Imagine if she had gone off of the interview, the face-to-face talking portion, and not asked her for some specifics and hired her on. Those kinds of screens are important. They were talking game talk. Maybe they were able to go through that portion, but then they would do a job shadow with a PT in the clinic and you wouldn't see any engagement between the candidate, the PT and the patient. They weren't asking questions. They were simply standing there against the wall, watching what they were doing and I'm like, “You don't have any soft skills. I understand you can technically do what you need to do, but you don't know how to talk to people.” That would simply write them off. Otherwise, we were ready to bring that person on that desperate, but I'm thankful we didn't.
One of the clinics they worked for not too long ago, they had a home health piece and then the clinic and brick and mortar in-clinic services. What was nice is even to some PTs and you didn't want them in the clinic. You want a clinic PT to be a certain individual. You want high communication. You want the comradery there and you want the ability to handle a bit busy-ness. You're wasting 18, 20 plus a day to be productive. In the home, they're saying 2, 4, 6, 8 hours a day, maybe different games. They were even different hires there. I liked them, but he's not a go-getter. Stick him in the home.
That made sense for that guy, because maybe he can on his own terms. Let him take his time with six patients to enjoy, but he's not going to work in my clinic and mess me up in there. One thing to add to what you said too. I wasn't sure about the person's honesty level and I wasn't sure about their real intentions. I would give my clinical director or the other manager questions. I would give them things to say in front of us. It’s almost like a private investigator. Have them talk about their last job or the last employer. The face I get in 60 minutes is handshakes, big smiles, hugs. When they're in front of this peer, not their boss, they could have a different conversation. I'll say it's their scenario, but I definitely will use that too. Even once or twice a patient who I knew was in the clinic, “I'm getting the new PT coming in for their shadow. With legal restraints, give them a hard time.” They roll with it or not. I'll play that side too.
I can't overstate the importance of those job shadows, because like I said, there were plenty of times where people pass through the interview phases with flying colors. They got to the job shadow and we're like, “Red flags done.” It's important to have those. The next step is important because we don't know how to onboard people. I wonder if business schools teach that at all. How do you onboard somebody day one? You would think that it takes much hand-holding and much time and effort. I know that there's a difference between the PTs and PTA and the rest of the team. What are your recommendations to establish an onboarding process for those two different groups?
Behind that, you need general policy stuff. State by state if you have to legally have a handbook or not. I know that depends, but you need to have something to provide. I think most good applicants that wind up being hires want a regimen of some kind. They want to know that someone's going to be on them, not micromanaging. All the people I've hired over the years, they want someone that's going to be watching out for them. They want to be disciplined when they need to be. These are the good people that you hire. I think if you have a regimen of, “Here's the checklist we're going to do here. I’m open with my communication and direct. We're going to do this checklist of steps here.” I always included in my onboarding day one is some kind of orientation. You can look at that from the viewpoint of, “This is where the front desk is and go meet your boss.” That's what a lot of people will do. Shake your hand, “I’m your boss, come to me with problems, I’ll see you later.”
Having the formality there, the regimen, I like to have almost like a scavenger hunt. That’s what I create because I want them to come in for any position. It’s a PT, a trained professional, a little more sideways by that or an administrative person. I literally will have them find out where you're going to work. “Go and see what your cubicle is. Go meet your boss. Go shake the owner's hand. Count the number of chairs at the lunch table. Find out if we have a microwave.” It sounds completely goofy maybe what that does is it orients the person in the environment. I'll have to go out the front door and come back. “Do we have a signup?” “You don't have.” “What does it say?” “It's an old business.” It works as an investigation for me because then, “We have no computers. I forgot that.”
It gets them out of their comfort zone. It throws them a little bit off, gets them comfortable. I have to meet five people at least that first day. “I'm doing this weird checklist thing that HR guy said. Let me shake your hands.” That's a big part of it because it gets them a little comfier. People know who the heck they are to some degree and then I'll give them a buddy. I’ll say, “This receptionist is your buddy. Questions about where the lunchroom is, ask her.” “Betty, here’s your buddy,” shake hands and I'll leave him alone.
They're all for about 30 minutes-plus digging around the office. People are seeing them interact and they're doing whatever and I'm getting the packet ready. I'm getting the onboarding process. There's your checklist. You have to review the purpose of the company. The owner wants everyone to know this, because like you said before, even going through the interview stage. If your purpose and theirs don't align, they should not be there. I had noticed this part, I had an owner that would meet with every PT two weeks every month and go over, “How's it going in life?” The owner would meet directly, 30 minutes to an hour, and go over there like, “What do you want to achieve with 5, 10-year plan? How does it align with us and does it align with us?” I think the formality of a checklist, I like that orientation thing.
An employee handbook, review, simple policies, the dress code, the piercings and tattoo code, and voting policy. If you want to take days off, this is the form that you use. We use an HR professional, it was a onetime shot to develop that employee handbook for us and they are out there. I don't know how I found her, but she sat down with me 2 or 3 times and we'd go back and forth on email. She'd give me the standardized stuff that was required by our state. The policies that we had to provide and federally had to provide. She said, “What is your time off policy? Let's put that in there and what do you want?” She would guide me through the creation of that employee handbook and there are independent people out there that can do that for you.
I think even companies like Paychex also have an element that they can do that too. I fully agree that that needs to be there, whether your state legally needed to have it there or not because you don't know how many times an employee who leaves under unfortunately bad circumstances. “I want my last paycheck. I want my bonuses. I want my unused paid time off.” “You signed this. It said we don't do that.” How many times does it save your butt? Fifteen to thirty policies about functionality in the clinic written down. One thing I would say is that the owner needs to spend the time to know them, that's the thing too. Having an HR company do it. It can't just be in your email and you went, “Did I?” Many times not for bad reasons, but you have to know them because if you don't know those and you're going to be the effect of what you don't know.
I know the APTA can help. I think Rick Gawenda was promoting some policy and procedure manuals that can help you with compliance. That's a different thing, separate from the employee handbook, but you’ve got to make sure that's on your checklist. What's your HIPAA policy? Are they going to do some video training? There's a lot of video training on HIPAA that qualify. Maybe your state requires some OSHA training and Medicare Fraud & Abuse. Making sure you check these boxes, not waiting for the next team meeting, that's maybe scheduled in the next eight months to do those compliance things, doing them at the front end. That's why I like some YouTube videos that can support you in that regard. MedBridge has some of those compliance videos. Sit them down here, “Watch this for the next 30 minutes. If you have any questions or concerns, let me know. Scan over our written policy so we can sign you off on the compliance portion of that onboarding.” I think a lot of people miss that, especially as small clinicians, we don't even think about it.
I think you hit something too. When we have a robust onboarding, I’ll put that in an ad. I'll tell you the truth because we've talked much about the recruitment, the ad side of things, which we can do separately or whatever. When you're advertising for a PT and all that stuff, when I put a robust onboarding process or rigorous, they get the idea that, “They don't mess around.” You're this much more apt to get an employee that, “They have a robust whatever.”
Someone professional or looking for an organized structure. That makes the difference between a mom-and-pop shop and an enterprise. I think that's where a lot of PT owners want to get to. A mom-and-pop shop are at the front of the store. They're greeting every customer. They're taking a reorder and that's what a lot of individual clinic owners are when it's them and maybe one other PT. If they want to truly get some freedom, they want to move over to an enterprise. An enterprise has the structure of a hiring process and an onboarding process to ensure the success of those people that come on board and that they're fully “trained.” I know you can take that to many levels. Our onboarding process was towards the end, there was offsite.
They would have almost likely a full day of onboarding training at a different place. I know even in Blaine Stimac’s case in Montana, I interviewed him. I think his onboarding process was spread out over the course of six months or even a year. They'd have a few days and then they meet up again 30 days later and again, 60 days later, 90 days later. Meet up again at the six-month mark and review some of those principles as they needed to and hold them accountable. You can go crazy with it, but at least having some structure for that onboarding can establish a foundation for the team.
I know Blaine is a basic structure. That is a lot to be said about. You can call it ongoing training. You can call whatever you want to call it. There’s this onboarding element where week one is a whole different game plan than month six, I think you should. There needs to be a 60, 90-day, whatever your terms on your employee manual. Review how they're doing in 3 months, 6 months. It has to be there for sure. That's part of that thing at the beginning, I mentioned where you need to know what this person is doing in your clinic. How has it been going? Spend the time to build out the policies, the regimen, and build out the basics. Spend time now so it’s done. Because once it's done, it's done. Once you have the manuals, it’s done.
Once you get that signature, if they have a question regarding the paid time off policy, go check the handbook, “You don't have to ask me anymore, you know where the handbook is. Go look for it.” That helps the trainer. Initially, it's probably the owner but in the future, hopefully it's not, but if you have an organized checklist, that's something that you can hand over to someone else. That's where you start gaining some freedom is when someone else, not the boss starts espousing the purpose and the values. “This is what we do.” When that goes peer-to-peer, that means a lot more than from the boss talking down. It helps out a lot and it also ingrains in the trainer, those same values and expectations, and helps them along the course of it. If something is written out if there's a “curriculum” to it.If your purpose and your prospective hire’s purpose don't align, they should not be there. Click To Tweet
Even in a small clinic, where you have an owner and a couple of staff, letting a peer having one person. I had a receptionist do it. I've had the lead PT do it but having somebody else responsible for that basic administration. Make sure that this new employee does this and this and report back to me that they've done this. It's off your plate as an owner a little bit. Maybe you give them a little money on the side appropriately for doing that. Maybe they have a little bonus, but you have to give up some of those hats.
I'm going to cut off our discussion here because I want to transition into how to get people out the other end of the business. That is getting rid of dead weight, disciplinary procedures, developing that HR. Not just from the beginning like we talked about, but through the course of the life cycle of an employee. It might be going out the door in good or bad circumstances. Before we move on to that, if people wanted to get in touch with you, James, how would they do that? Are you willing to share?
(917) 312-4294 is my phone number. I love helping people. I worked for the company because I'm helping multiple owners in multiple states at the same time. I couldn't do that years ago. My email is JamesSavas@Hotmail.com.
If people have some questions, they can reach out to you at JamesSavas@Hotmail.com, that makes it easy. Readers, watch out for the second part of our conversation. If you won’t, just move on to the next part and we'll start talking more about the life cycle of an employee.
I love working with ambitious, driven individuals who have dreams of going big(ger) and just need the right support, backup and capacity to see it accomplished. I help them get that done.
The majority of my professional career has been in the Medical sector with the majority of that time in the Human Capital Management/Recruiting and Business Coaching/Development spaces.
Over 20 years I've strategically planned and executed programs and projects for my partner-businesses' expansion from as few as 4 offices to up to 16 office across 3 states. In my time working directly with various Owners and their staff throughout the boroughs of NYC and down the Rocky Mountains, I've hired well over 500 effective and productive Owners, Executives, Managers and Professionals, as well as created the training regimens for those people and their staff.
In addition to my savviness and acumen as a business expansion professional, I'm a successful soccer director and coach and a very very proud father of 3 amazing beings.
My Mantra is - Keep the create in life and be surprised by nothing!
Additional Points of Interest (some outside PT and some for fun):
* Published article in Impact PPSAPTA magazine (2008) "Hiring & Retention"
* Nationally Licensed Soccer Coach
* Director of Development of several Soccer clubs/groups
* Certified Assistant Teacher
* Co-owner (former) of a small family-owned retail dessert business
* International traveller (school in Italy & worked short-term in Ireland)
* Avid survivalist/camper/outdoorsman
* Humanitarian (as I'm able), directly assisted during 9-11 @ ground zero NYC
* Interned w/ MSNBC out of college (Broadcasting Major)
* Was a celeb-host at the 1996 Grammy's and 1997 ESPN Awards (some good stories not for air)
* Was on HGTV (with my family) in episode of a Montana HouseHunters
* Music composer/Short Story writer (Sci-Fi)
* Best hat I wear - DAD; pays shitty but great rewards!
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Reaching out for help from coaches helps us gain the needed insights for the development of our practice. In this episode, we are following up on the owner of Druid Hills Physical Therapy in Atlanta, Georgia, Dr. Avi Zinn, PT, DPT, OCS, about how he has developed his business. Although he has been successful in the development of his practice to this point, Avi reaches out because he recognizes that he needs to gain more business knowledge as the CEO of the business. He shares the importance of the stuff they did not teach in PT schools, such as tracking KPIs, leadership development, culture creation, and more. Learn how he is managing as a PT business owner and get a real-life look into what a business coach can do for you and your practice.
This is the first episode that I have with an individual PT owner in which I'm going to follow along with him as he receives coaching and implement some of the coaching programs into his independent PT practice. Avi Zinn is a Physical Therapist out of Atlanta. He reached out to me to get some coaching and see if maybe we could work together to help him achieve his goals. Full disclosure, he didn't end up going with me as we talked a little bit about what I could provide and if that might fit for him. I actually offered him a couple of friends that he could call and talk to about getting coaching and consulting services with them and he decided to go with a friend of mine, which I'm excited about. Avi’s ready to grow and he needs to take the next step. I wanted to bring Avi in order to not only follow his path but also because Avi is pretty unique. He hasn't followed the typical entrepreneurial path. He didn't go through the burnout, the crash and burn stages that many of us may have gone through before. He did something different. I want to share his story with you.
I've got Avi Zinn, Owner of Druid Hills PT in Atlanta. I'm excited to bring on Avi because he reached out to me in regards to getting some coaching and we've talked a number of times about his needs and how I could help him out, but things changed a little bit. He is looking for some coaching and consulting help and I want to follow his progress essentially and see what the coach or consultant has done for him to forward his clinic and to achieve his goals. This is the first introduction of that series of interviews because I imagine that down the road I'm going to do some follow-up interviews with Avi. I'm going to show you what it's like and what you can expect out of coaches and consultants and how they can help you as an owner. Let's get to know Avi a little bit and some of his influences and what got him to the point where he was reaching out. First off, thanks for coming on, Avi. I appreciate it.
Thanks a lot, Nathan. I’m happy to be here.
Tell us a little bit about you. Tell us a little bit about your professional path. How long have you been a physical therapist? How long you've been an owner? All that stuff so we can bring everybody up to speed on.
I went to PT school in New York. I finished in 2009. Shortly after finishing school, my wife and I moved to California and we went to the Bay Area. We were in Berkeley. I started my PT journey there. I’m looking for places to work, trying to see what was there. I found a cool PT practice based off their website. They’re more independent. The pictures of the clinic looked personal. They had a good vibe. I reached out to them and they hired me on, which was cool. Starting there was a good experience for me in a lot of ways, which ultimately led me opening up my own clinic.
Did you always have aspirations of having your own clinic?
No, not really at all. When I first started there, they had just done some coaching and consulting. They were in the process of transitioning their whole business model. I soon found out that when I started on, there was a huge turnover right before I came. I didn't realize that at first, but after being there for a few months, the remaining people that were still there were starting to talk about the old days or how things were different and not necessarily bad, but I think the change of the business structure led to other people just didn't agree with what they wanted. From following your show and all the people you've had on, it seems like that's a pretty common thing. You guys talk about your culture and your team. If you're changing your business structure and you're changing your team, then you’ve got to make sure that people are in line with that. I would assume if they're not, then they're going to leave or they're going to get told to leave. That led me to start my own clinic because it was an independent clinic. It wasn't a chain and it was two owners and they had a few locations at the time. I started seeing what it was like from the owner's side of things because they were at the clinic all the time.You have to take risks in order to have something you desire to create. Click To Tweet
Whereas later on when I started working for chains or hospital systems, you don't see the owners at those clinics. You just see clinic directors or whatever. Being there, I saw that the community and the PT practice had a great reputation. People knew about it but at the same time, the employees, the staff, the PTs weren't saying the same things that the people in the community were saying about the PT practice. It was interesting to see how there could be a different perception that the patients are loving it, but the PTs aren't. That probably happened because of the change in the business structure and however that played out. I started realizing that there could be different ways of going about this business. Clearly, we're providing good service because people were talking about it and people knew about it but the staff wasn't happy. That was interesting to see. That's what really started me thinking about like, "Maybe I could do this." Everyone thinks, "I could do this." I thought, "If I am going to do this, maybe I'd make it so people are happy at their job."
There are a couple of different reasons why people open up their own PT clinics. Either they have an entrepreneurial spirit and they want to own the job and that's something that they have a burning desire to do. I'm sure there are many other reasons, but the two that come to mind are the second one being, "Maybe I can do this better or maybe I can create something that I can fill a need or I can create some value that I don't see in my current position. I can treat the way I want to and expand on that.” There are a number of different reasons in your situation, in particular, you're thinking, "The owners are doing great. They've got a great connection with the community, but the internal structure and culture could be improved. Maybe I could do that myself and create my own thing." Is that about right?
Yes, that's right, Nathan. You have to remember, I was in the Bay Area, that's a hotbed for startups and entrepreneurs. I do think that was a part of it. I remember a good friend at one point. I was talking about a startup and entrepreneurs. He even said something to me that I could be an entrepreneur if I started my own PT clinic. At that time, I didn't know what that meant to be an entrepreneur. I didn't realize that starting a PT clinic would be the same thing. Getting that entrepreneur bug, that's what I'm sure we'll end up talking about pretty soon in The E-Myth what Michael Gerber talks about. I think doing it better though and realizing that maybe I can do this in a way that would provide that service and also have the people that work there happy as well. What I was seeing at that clinic that combined with getting that entrepreneur bug, those two started the process of me thinking about at one point starting my own clinic.
You eventually went to Atlanta and decided to do that?
My wife is from Georgia. She grew up in Savannah and I'm from St. Louis. We were in California and we didn't know totally, but we started thinking that we would want to be closer to family. Atlanta seemed like a pretty good city. My wife did an internship in Atlanta and that was when I stopped that job. We went to for the summer to Atlanta to do the internship, but also see if Atlanta would be a city we'd want to move to. We liked it and when we went back to the Bay Area, we knew we were going to move there. I knew I wanted to open up my own thing or start my own clinic, but also knew we were going to move at some point. I never really wanted to do it in California. At that point, I started doing other jobs and experiencing different types of PT. I did work comp for two years. I started doing home health, which was interesting. I did that for a bunch of years.
Eventually, we did move to Atlanta and started doing home health when we got here to learn the city also. It was a good opportunity that I learned the city, but I was driving around for home health. I was trying to get a sense of where I would want to start a practice. It all happened at a time where I was ready to do it. This location opened up right in my neighborhood. Literally, a four-minute walk from my house. It's on the main street. It's across the street from this big shopping center on this road where they say 50,000 people drive by every day. It was perfect. Everything worked out. That's when I started to get things going because we found this place and I had been thinking about this all these years. It was time when this place opened up.
How long ago was that?
That was the end of 2017.
During this time, had you been reading any books about business ownership or accessing any resources?
When I was doing home health, I was driving all the time and I stumbled upon Paul Gough's podcast. That was really the first one that I started listening to. That was talking about owning a business and how to run it. I don't know if this is exactly what he said, but this stuck. He said, "You don't have to have the best PTs, you just have to have good PTs. You can hire the good PTs and you have to be the one who's working on the business.” The truth is I could be combining that with some of the other, like Michael Gerber, your show, but I believe he did say that stuff and it started making me think about how I was going to set up a practice and what that meant.
The cool thing is that it set up a mindset for you, knowing where you are. You don't have to be the best physical therapist. Soft skills are more important than hard skills. You already had an idea that you were going to bring on some other physical therapists anyways. It wasn't going to be the obvious in a physical therapy clinic and a one-man show. You had aspirations for more right off the bat. You've opened up your clinic and how did you start working in it? How did you start developing it, so that it wasn't obvious in physical therapy clinic?
When I was trying to figure out what to call it, I was really against calling it my last name, Zinn. A little back story. My father-in-law has his professional experience. He opens a lot of businesses. He was able to guide me through a lot of this in the beginning. Helped me set up the LLC. When I was looking at this place to rent and lease it out, he guided me through with creating a pro forma and talking to the landlords about having my financials in order, even though we didn't have the financials in order. Getting that set up and he was set on calling it Zinn PT. He wanted me to do that and I was like, "I don't want to call it Zinn PT. I don't want it to be about me." Maybe because of listening to the podcast and knowing Paul Gough’s podcasts, knowing that I wanted to bring people on and I didn't want it to be about me because maybe had a little foresight knowing that I would have to do the business stuff at some point and not always having people wanting to go to Zinn but to the PT practice.
What did you start doing initially to make it so that it was not Zinn? You ended up developing Druid Hills Physical Therapy, you were the initial physical therapist. How did you start the progress? This is an important part of the introduction of you. You did things a little bit differently and I'll highlight that as we go through the story.
First of all, I was still doing home health, which was a huge help because home health is super flexible and I was able to bring in some income while setting up the practice as a group. There was no other way to do it. I took out a loan. I could've taken out a loan three times the size and lived off of that for a while. That would have been a little overwhelming. Setting it up, I started getting things in order. I don't know if it was from the podcasts or not. I wanted to experience every part of the business at first to know what it was like so that I could start putting people in those places. When I started, I did everything. I was a PT but I was also running back and forth to the front desk to answer phones and schedule. Instead of a front desk person, I had an answering service, which was helpful and they would email and text anytime someone called. I had a doorbell. That was my front desk person. If someone came into the office, I knew someone was there and I could run back and forth to the front to greet them. I started getting things in place. Aside from the business things, I had to start getting patients.
I tried doing all that I thought would have been the normal way to do it, which was called doctors but that didn't work. It started with that. I was lucky that a third-party work comp insurance called me and they were like, "We want to give you a contract and send some people to you.” I was like, "I need people to send patients," which was also cool because work comp authorizes a certain amount of visits, they pay the rate, whatever it's going to be. You don't have to fight with the insurances. They're not going to like deny certain code, which was a great way to start. Because I got those patients, I knew those visitors were coming in and I knew they were going to pay whatever they paid. That was also a little bit of a hard part, to begin with, was the money part. How you charge people. All of it was hard. I didn't know how to do anything.
How long did you go like that before you took on your first hire and eventually before you got your next physical therapist?
I started at the end of 2017. We had our third kid in March of 2018. It was a great idea to start a business and have a kid the same year. Right after that is when I hired on the first PT. The business was growing slowly. Knowing that we were going to do this, I started looking back at the schedule and tracking what was happening. The schedule was pretty light. Looking back, I don't know how I was confident enough to even hire someone on.
That's the question I have for you. How many visits were you at per week before you hired that physical therapist because you went against the grain?
I don't know. At that point, I was doing three days a week at the office and still doing two days a week home health.
You brought on your PT at that point. This is why I wanted to bring you on is that you hired a physical therapist, what most people would consider is too soon. Based on my training experience and if you were to ask me, "When do I bring on my next physical therapist?" I'm going to tell you, you bring on the next physical therapist when you're meeting at least 90% of your slots that are scheduled out in a given week on average. That's the time when you know, I'm working hard or my other PTs are working hard. It's time to bring on someone else where these people are going to get overwhelmed. Maybe you even have a waitlist, but you went against the grain and you don't necessarily know why. You brought on a physical therapist because this is the thing, the typical entrepreneur story is we don't do anything until we get overwhelmed. Sometimes there's a crash and burn element to it. If you read to some of my previous shows and the successful entrepreneurs but you didn't get to that point, so you brought on the next physical therapist. You must've had some faith that things were going to go in the proper direction or maybe you had some real intent out there in the universe that things were going to grow?
It was a little bit of both, Nathan. I was thinking about starting a business, in general, is a huge risk and I've maybe realized that you have to take risks in order to have a business. That was the same move. I saw the trajectory and patients, it was growing slow but it was steady growth. It looked like things were going in that direction. It was time to hire someone on and keep it going.
During this time, were there some resources that you fell back on that might have stoke that faith or inspired you to bring on someone else so that it wasn't on you? Did you also maybe see that there were some aspects of the business that you needed to work on so the PT would take the treatment side of things off of you so you can focus on those things? Was there a combination of some of those?
Because of how busy things got, I realized that I had to do more of the business stuff. That was what it was. It was the beginning of 2019 or it must have been earlier when I started following your show. I remember in January of 2019 is when I started reading The E-Myth. I don't remember exactly when I found your show or how that happened exactly. Even before that, I realized that I had to be able to step away to do from treating, there were only so many hours in the day. I didn't want to be working all day long and then going home and working all night long. I realize that the only way to do it was to step back a little bit. It wasn't a lot, but it was by hiring another PT that I was able to step away and do a little bit more of the business side of things.You have to take risks in order to have a business. Click To Tweet
The common fear when someone makes that first step is to bring on another PT. The biggest fear is, how am I going to justify that salary? I'm going to be paying somebody $70,000, $80,000. What if they don't work out and they don't produce? Somehow you overcame that fear. How did you do that?
After that first job in California and when we came to Atlanta, I did a traveling PT job. When we went back to California, I started doing PRN. When I learned about what PRN meant, that is ultimately when I hired my first PT, I didn't hire her on full-time. I hired her on PRN and it just happened that I found someone who wanted to do it. She was in a different job and she wanted to switch it up a little bit. She started doing two days a week with me. That is why I was able to not be so overwhelmed because essentially instead of making it five days a week for me, since I was only doing three days a week in the office, I made it a five-day PT but split between two people. I was able to have the patients coming in on all day, every day and then still have two days a week where I wasn't treating and doing some of the business stuff.
You were still running the front desk and taking all the calls and some of that stuff?
I was still doing that stuff and the billing, the front desk. Shortly after that, I got someone two days a week at the front desk. Gradually we started getting more patients, so that part-time PT ultimately wanted to switch all for hours over to this place. It worked out well because I didn't need to look for another person. She was already there. We were organically growing and filling those hours on the schedule without having to hire on a new PT and then have to be scared that you're not filling up their schedule for three months because we did it gradually anyways when she first started by two days and then added on more days.
She started taking on more hours. You started treating less it sounds like and you're working on the business during this time.
I don't think I really started treating less because for the most part, I was still treating the same amount, but it had blocked off certain times from the beginning to do billing, networking, calling people and driving around.
That's a huge part right there and I don't want to overlook that. You blocked off time on your schedule. As I'm talking to PT owners that are treating full-time, that's probably one of the biggest hurdles is to get them to commit to blocking off chunks of time, whether it's four days or 4, 5-hour blocks to work on the business. That is to look over your financials. That is to put together a pro forma like you're talking about. Consider what the future might look like. Do some networking. Even start developing some policy and procedures and hiring the right people to fill the spots that you either have open or are going to have open in the very near future. What you started doing maybe someone told you to or maybe you inherently knew you needed to do was to keep that time sacred for admin work.
Around the beginning of 2019 is when I read The E-Myth. That was transformative. I've heard people say it on your show a million times, working on the business and not working in the business. I think he came up with that. It made so much sense and you can't do it any other way. There's only so much growth you can have if you're working in the business. When I read the part about what a lot of people do is they create a job for themselves. That part was like, “I’m not trying to create a job. I'm sure I didn't try to create a business." I did somehow realized that I needed to keep that time separate to work on the business. Once I read that, it was when I started realizing I need to do more of this and if I want to grow, I need to not just hire more people. It would actually start taking more time to work on the business because once you start getting busier with more and more things going on, you need to have more time to figure out all the things that you had mentioned, which I still have not done yet.
We have to give it proper credit. The book that we're alluding to and referencing is The E- Myth Revisited by Michael Gerber. He does layout a lot of this stuff. When we say you working on the business, what are some of those things that you're doing? I have even some owners say, "If I'm not treating and I'm not catching up on my notes and I'm not paying bills, what am I doing?" What do you do in those admin times?
First of all, I still do the billing. That's part of it.
That's going to change soon. What are you going to do when the billings off your plate?
We'll find out soon. You did mention about policies and procedures. That's what I started doing was creating systems, which is what The E-Myth is all about. I created an organizational chart, which is another thing that they talk about in the book. Even though every single job in the organizational chart was me, I still was breaking up what created the business, all the different parts and all the different jobs that make up the business. I started writing out what happens under those positions, what one does for that job. Basically, I use Google Drive and Google Docs and I have a nice organized folders system of docs for every one of those job positions. Every time something happened that day that I had to troubleshoot or figure it out, I would put it in that doc and then I would try to create a system to make sure it didn't happen again or t try to delegate some tasks to the front desk person or the PT so that they can do it so that we wouldn't have to keep on going through the same mistake every time. We would know what to do every time.
You wouldn't have to learn the same lesson twice.
Yes, we don't have to learn the same lesson twice. Also, we wouldn't have to be where someone had to knock on my door and asked me what to do for it.
This is why I love having you on. You're at a place in your ownership that I would say a majority of PT owners are not. I'm including the guys that have been out there for 10 to 20 years. They haven't taken the time to write up their policies and procedures. I can say I was in that boat 10, 12 years after opening up my first clinic. Didn't take the time to write down policy and procedures. I didn't have an organizational chart. It doesn't matter if you are in each position. At least know what the structure of your company is and what it should be and what it will look like when other people start filling those positions is huge. That comes as naturally to some people more so than others, but you're organized enough with your Google Docs to have everything written up underneath each job with a job description, the responsibilities and the tasks that are given to each position. That's huge and that is the reason why you are where you are is because you've done some of those things. How many therapists do you have?
We have three therapists besides me. They're all about 30 hours or so. Part-time but full schedules. One is actually reducing hours the same original one who wanted to take on more but also step out of her first position and try something different. She's going to try something different and reduce her hours, which is fine. Everyone wants to do different things. There's nothing wrong with it. We're about to hire another person and she's going to be my first full-time. We'll have one full-time, two pretty full-times, one part-time and then me.
Being less than a few years into your ownership. That would be unfathomable for some people. I'm talking to some owners who are one-man shows and they're overwhelmed and they're three years into it and they don't see a way out because they're treating 50 hours a week and not working on their business. Whereas you've set yourself up such that you have multiple providers and you're already experiencing some freedom that most PT owners don't have.
Nathan, you probably would agree with this, but for the people that are working crazy hours, I made sure I did this in the beginning, I worked at the office. I did some stuff at night, but for the most part, I was in the office 9:00 to 5:00, and that was it. I made it a point to stop at the end of the day. Of course, you do some stuff at night, you answer emails or you work on the website.
You had some intention behind putting an end to the day.
I think that's what it is. That has allowed me to keep going. It prevented me from burning out and I didn't get so overwhelmed because I was like, “This is the end of the day. We're going to stop, we'll pick it up the next day.” If I work an extra five hours, it's not going to be any different. You need to put a brake on it every once in a while.
There's some power to that. Number one, the time that you do have is limited. There's going to be an urgency to get things done. If you don't have that end stop, you're like, "I can work until 7:00 and I'll take my time getting things done.” Inevitably there’s something called Parkinson's Law that, "The amount of things to do will end up taking up the time that has allotted to do them." If you're available to work until 7:00, you'll have plenty of tasks to keep you busy. If you put that hard stop at 5:00, you've done two things. Number one, you've set a deadline, but also, you were concentrating your efforts on doing the admin work. You can get more done for the benefit of your company by focusing that time on your business than trying to get tasks done. Instead of trying to get payroll down or pay bills. I'm sure you were focusing on what some people call the MIT, the Most Important Thing of the day and that is developed policy and procedures. Get my organizational structure in place. You're doing the billing, but that's a separate chunk of time. The fact that you spent that time on the policy and procedures and the organization of the structure of the company means you've developed solid integrity around that and you've accelerated your growth as an owner and as a business to the point where you are.There's only so much you know how to do. You need to reach out and ask people for help. Click To Tweet
To be clear, I still have a lot more work to do on the policy procedures and all that stuff. That's ultimately what we're getting at with coaching and consulting. In March of 2019, I hired on the second PT and then that's when I drastically reduced treating time down to twenty hours a week of treating.
Was that a scary transition or something that you're, "I need to do this?"
It wasn't scary at all. It was, "I need to do this." Partially because at that point I had read enough of your blogs and also had probably read to The E-Myth again for the second time or maybe even third time that I realized that it doesn't even matter if it's scary. That's what you have to do. There's no other way around it.
You recognize the need of the company was to go in that direction, right?
Yes and it was my business. If I'm treating, who else is going to work on the business? I have to be working on the business. There's no other way.
You talked to me about doing some coaching and consulting. What led you to that point?
Where I've gotten myself have been a lot of working on the systems and policies, but at the same time, there's only so much I know. As the business grows and when we're getting more patients in one of the main things that I've noticed is there are cancellations and why are we having 30 new patients in a month. We had eighteen new patients in one week and that was awesome. That was the most we had. The following week the schedule was half empty and it was like, "How is that happening?" I started running analytics, WebPT. I called them up asking, "How do I find out how many times each patient is coming in?" I’m trying to see what their plan of care and how many visits per week? I find that a lot of patients are only coming once a week or they schedule two visits and then they're gone and no one was tracking that. I run this lost patient report from WebPT and then all of a sudden, I look and there are 50 to 100 people on this report of people that came in and we never got them back on the schedule. That was a huge thing.
You recognize that you need to start monitoring your metrics and if you haven't taken the time to do that, then the metrics will control you and sink you.
On the analytics and WebPT, they have their main KPIs. There are six KPIs on there and that was cool. I realized I don't know. I feel like I've done a lot to get myself here, but there are people who know a lot more to take those numbers to who've already gone through this, who can tell you how to use those KPIs, those metrics and what to do with them. How to affect them and also, one of the biggest things through all this realizing that I am not just the owner, but a CEO of the company. I need to learn how to do that. I need to know how to manage my employees, train them and set up different structures and have certain people responsible for different parts of the business. I realized that there's only so much I know how to do. That's when I was time to reach out and ask people to help me along that.
You realize that you are the final word. People are going to come to you because you need to have the answers for the company. I don't think a lot of physical therapy owners who are relatively new don't put on that hat per se. They think that the ownership somehow is not as separate from them. They know that they're the owner, but they don't act like the owner and that they should be monitoring all the metrics and the financials. They should have some idea of what to do when a statistic goes bad and how to look and investigate issues in the clinic. It sounds like you had that realization that you need to take on that hat.
Nathan, that part is hard. I went to PT school, I learned how to become a PT. I didn't go to business school. I don't even know if you learn how to do that in business school either. I don't know how to run a company.
We're all in the same boat.
To answer your question, that's what it was. I realized that I needed to be the CEO essentially and I needed to learn what that means and how to do it.
You reached out to me and we had a conversation. I actually gave Avi some recommendations of other coaches to also consider outside of me and he has decided on another consulting company and I'm excited because he's going to do amazingly well. You can see that he's already set up the foundation. I want to follow you along this journey. How will you know if you've been successful with a coach or consultant? How will you know that they've met your goals? Is there a statistic that you want to see? Maybe gross revenues and net profits or is it more freedom for you? Is it growth?
I'm starting to understand financials and understanding gross revenue. I'm at the point where I can look at a P&L and understand it and gross revenue, of course. Let's get that up.
You need a return on your investment to the coach. You expect a multiple of your investment on the coach.
Having the patient drop-off, go away or at least get better. Maximize the utilization, which is something you were saying. If there's so many hours that the PT is treating, they should be treating patients that whole time or at least let's say 85% of it and figuring out how we can make sure that happens. Training the front desk also is the best way to take part in the patient's experience. Also, making sure that they're following through with their plan of care when the PT comes and brings them up to schedule. Making sure that they schedule it and making sure that they understand what it means and the cancellations are detrimental not to their progress but to the whole business. Probably a million other things at the front desk can do but hopefully, they'll help me out with all of that.
Are there some particular goals that you have then over the course of the next year or two? I'm sure the coaches will help you along with this, but what are some of your goals that you have?
As far as freedom goes, I don't need to be not in the office 200 days a year, which is great. Maybe one day. I like being in the office. I like working, but I don't want to work all day, every day. First, producing the treatment hours, that was key. I've done that myself, which is talking to you and talking to other coaches. That's what ultimately is going to set me up for success quickly with these coaches is because I've already done what a lot of people have to do initially once they start with the coaches is to back out of the treating.
You're a step ahead already.
That ultimately is going to allow me to focus on some of the goals a lot quicker. In 2020 who knows? Maybe this will happen in two months. If we have twelve hours of the day in the office, 7:00 to 7:00 and we have five PTs, I want to be able to fill up that schedule, which is ultimately going to bring in more revenue.
You're going to have to expand.
Yes, hopefully. These could be long-term goals. I remember early on Paul Gough that he’s talking about how he owns some of his own real estate and some of the practices. That could be a cool goal. I don't know so much about that on the numbers side. I imagine at some point it's beneficial, but maybe it's not always. That could be five years from now. I want to grow this space location that I have to maximize it. If I have to work twenty hours a week still treating patients, that's fine. I like treating, but I also recognize that I have to do other things. If I need to not and I can get someone else to do it, great. Maybe later on, in a few years, I can start treating again. Wherever the business needs, that's what I'm going to do.
That your decision matrix has to be exactly that. Whatever the business needs. If you're not wanting to set aside time to work on the business and want to treat full-time, then go work for somebody and work full-time. Don't spend the stress and energy to own the business on top of it. If you're going to commit to owning a business, you need to put the business first. That comes first. What a lot of PT owners don't recognize is the clinic needs them to treat less, needs them out of treatment because it's a distraction to treat patients as an owner. You need to set aside times to work on the business and eventually what happens is they work themselves out of treatment because the needs of the business become greater because they were expanding and growing. I'm excited for you and what you're looking. From my perspective, looking at where you're at, you're looking to gain more knowledge so you can confidently and securely wear that CEO hat and become more efficient. You're recognizing that there is a lack of efficiency maybe in your company and you don't necessarily know how to affect it.
That's what I think when I pulled up that last patient report that one time and I realized, that's why our schedule is not full, even though we're getting all these new patients. We need to figure out how to make sure that doesn't happen.Work on the business and not work in the business. Click To Tweet
That's a dagger to the heart when you find stuff like that.
That was hard.
It goes through a couple of things. That is a whole few pages, maybe one or two pages full of lost revenue. More than that, if you're looking at from a higher level, these are patients that didn't get the full complement of care. These are the types of patients that go back and say, "Physical therapy didn't work for me. I've been to Druid Hills Physical Therapy and it didn't help." You don't want that. That can happen unless you're focused on getting them to complete their plan of care. I said this in an interview that I did. I found out about it a couple of years ago when I interviewed Heidi Jannenga of WebPT, and they did their annual survey that most small businesses lose on average $150,000 a year because patients like those on that lost patient report don't complete their full plans of care. That's a detriment to you as a business owner. It's a detriment to them as patients because they're not getting better and the chance of recidivism or the chance that they didn't even get better is significantly higher.
It is a detriment to the profession as well.
We'd become a commodity. They say, “Physical therapy didn't work for me.” They don't say, "I'm going to try a different physical therapist." Like anybody would maybe with a dentist, they say, "Physical therapy didn't work, so I'm going to try something else." It's unfortunate. I'm excited for you and I want to follow along with you and see what you learn along the way and so we can share with the audience essentially the benefits of coaching. I wanted to share your story number one, because it's amazing that you haven't gone through the typical cycle of an entrepreneur that's even spelled out in The E-Myth Revisited. It's not in the physical therapy space, but I think she was a baker of pies and she had that burn out and she's like, "I can't do this anymore. I'm not seeing my family and I hate my job." You never experienced that because you looked ahead and started planning and started acting forward in faith that things were going to continue to grow and it's worked out well for you. You're going to continue to grow that you develop that foundation.
I want to say one funny thing that happened. We're in the process of moving houses. We're going through a bunch of things and I find a box of all my notes from PT school and I open up a folder from my business admin class, the one day that we spent on and pull out the handouts. There was right on the top was The E-Myth Revisited. I don't remember the professor ever talking about that back in the day. If anything, they were doing a good job teaching about business because they talked about The E-Myth. I'm sure there are other ways to look at it, but following that way of setting up systems and organizing the business and working on the business. That is what has allowed me to get to where I am.
What's different about you Avi compared to a lot of entrepreneurs, whether it's physical therapy owners or not, you've had it on the one book and I'm sure you've read other books, but this one's been influential for you. There are people out there that have read the book and I've read hundreds of others and aren't in the position where you are. The differences that you've actually taken action on what you learned. I read The E-Myth Revisited 6, 7, 8 years ago, but I didn't implement it to the level that you did it either. I would submit that people who are reading the business books, if they read The E-Myth Revisited, don't read it as a nice, good story, but to actually implement what he recommends.
The only way to implement it is if you take time away from treating and work on the business.
You've actually put those principles into practice and that's what I separated you from somebody who is simply read the book. I'm excited to see your growth here as you get some greater insight and knowledge on how to improve your stats and become more efficient. We'll follow up with you and do another interview and see what you've learned and what's been influential for you. Maybe there are some pitfalls, maybe there are some things that happened along the way, who knows? You might experience for yourself what your initial outpatient company did in San Francisco. Maybe not everybody's aligned. That or everything is going to go in a great direction because you have your ducks in a row already. I'm excited to see what happens. Is there anything else that you want to share, Avi?
For anyone, if they are reading for the first time, reading your blog has been helpful also. I talked a lot about The E-Myth, especially because I've set aside some time to work on things. I'll read your blog whatever interview person you have on and then try to implement those things that day or that week. It's been also helpful to know other people's stories.
That makes me feel good. Not only a resource but an inspiration to you. Thank you for that. We will stay in touch and we'll come back around to the story that is Avi’s in Druid Hills PT.
I'm looking forward to it.
Dr. 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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