PTO 138 | Growing And Scaling

 

Growing and scaling your business while maintaining your lifestyle is a challenging feat to pull off. How do you go about it, and where do you begin? Dr. Joseph Tatta, Founder of Integrative Pain Science Institute, has been through the full cycle of business ownership – start, struggle, grow, struggle, learn, implement, scale, and sell. Along the way, he recognized that he needed to do things differently if he wanted to scale and maintain his sanity. Tune in to this episode where we discuss what he did to manage the stress and maintain a lifestyle that allowed him to grow to 16 clinics in a saturated market.

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Growing And Scaling While Maintaining Your Lifestyle With Joseph Tatta, PT, DPT

My guest is Dr. Joe Tatta, the Founder of Integrative Pain Science Institute and host of a podcast called The Healing Pain Podcast. Dr. Joe, thanks for coming on. I appreciate it.

Nathan, it’s great to be here with you. Thanks for having me on.

I'm excited to bring you on because you have a great story in terms of the success you've had in owning physical therapy practices and subsequently selling them. We want to lean on your experience in terms of the ability that you had to grow and scale your practices and how to maintain a solid, comfortable lifestyle at the same time. Before we get into that, would you share with the audience a little bit about you, where you came from professionally and what got you to where you are now?

Like yourself, I'm a physical therapist. I've been practicing since 1996. I did it in the beginning of my career a short stint in inpatient rehab. I live in New York City. I worked in a practice that specialized in sports medicine and performing arts medicine. I did that for about two years, which was fun. It is an active and high-performing population. I got together with another colleague and we started our own outpatient physical therapy practice. That was in August of 2000. What was interesting thing about that practice, for those who can think back to August of 2000, it seems like yesterday to me, but it's many years now.

We were one of the first, if not, probably the first cash-based practice in New York City in Manhattan. We hear so much buzz about cash-based now and getting around the insurance system. We were one of the first practices that did that in New York City. It was interesting to set sail into waters that we knew nothing about and to see what this is going to look like, how are people going to react and respond to this, how's the market going to respond to this, what's our catchment area going to be like for this? The first six months was spent on building out the initial practice, deciding our cash-based model. We took one insurance at that time, which was Worker's Comp and everything else was 100% cash-based.

Why did you decide to go cash-based many years ago? Did you see where things were going?

My partner and I, when we got together, we both had a diverse background. We were physical therapists. We had other skills that we brought with regard to patient treatment. When I worked with dancers and performers, I got into certain types of manual care, as well as using Pilates as a form of rehabilitation. Pilates was booming at that time in the general population, hot amongst actors, performers and athletes. There was a big boom around that. In addition to our PT clinic, we had a small Pilates studio attached to it. My partner did some personal training as well. We had all these different things that came in. We said, “We have already had this cash-based training Pilates aspect.” We have the PT aspect. They feed each other in a way which is useful and beneficial, both for us as a business, as well as for our patients and clients at that time.

We saw that the quality of care out there was sub-par. There were a lot of practices in New York City at that time. We were already heading into a market that was saturated. We're moving into a saturated market, plenty of PT practices, the doctors all know the practices, how do we make ourselves stand out? The way that we did that was cash-based care. Our initial treatment sessions were an hour long. We also positioned our practice in a relatively wealthy area of New York City, which helped as well. It was a convergence of a number of factors with regard to moving toward that cash-based, but initially it was, “I want to treat the way I want to treat and to do that, I need a little bit more time than the faster pace setting we were in.”

You did grow up to a number of clinics over time. As you scaled, did you maintain the cash-based model throughout all your clinics?

There's not a direct line to the story, Nathan. It's like this jagged line. The first two clinics were cash-based. We had this model that we could replicate. We said, “Let's start to replicate this model.” We replicated it. We got to about 3/4. What we found was it was difficult to provide the same level of care. If you're an owner in the practice and you have employees who work with you, you realize that you put all your blood, sweat, tears, guts into your practice and into your treatment. With that, patients respond more positively to you. They're more likely to come back to see you, a longer treatment and refer friends and family. The whole process is easier.

We found it was a little bit more difficult to do that and asked the high price New York City cash-based fee we were asking when it wasn't “the owner.” We started to transition to an insurance model. By the end, we had sixteen clinics. We had a mix of cash and insurance. Some insurances we didn't accept. Even the insurances that we did accept oftentimes, in New York City, the market is tight with regards to medical management. They'll trim down visits in New York City quite rapidly. Once people come to the end of their insurance care, then we offer them wellness and cash-based offerings at that time. We had a mix at the end.

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Sixteen clinics, it's a ton. You had to have some growing pains along the way and some challenges. It wasn't smooth sailing. There was a zigzag pattern there. Tell us a little bit about what some of the biggest challenges were that you recognize when it came to growing and scaling up that much?

There's a memory that I have. There's a patient that I saw for a long time. He was a high-powered, successful investment banker in New York City. He had chronic low back pain so he was a frequent patient. He was sitting on the bike one day warming up before his therapy session. I can see him scanning the clinic, looking at the activity toward the front desk, in the gym area, watching all the patients walk by and all the therapists run around with charts in their hands. I came over to him, I said, “How is it going? How are you feeling today?” He stopped. He looked at me and said, “You're a little bit light on the management side.” I was like, “Interesting observation.” We had three clinics at the time. He would go to both of them. In New York City, he lived near one clinic and his work was near the other clinic. He would go back and forth. He was watching us grow and he was watching my role grow and change.

What he was saying in his own way, he probably could have been a little bit more delicate with the way he said it. He probably should have said, “You're growing. That's awesome. Keep in mind, there's a management part of every business that needs to be nurtured and cared for as much as the patient care side.” That's where, as professionals, we come out of school. We're highly skilled. We continue to nurture our skills, and then we wind up in practice and we're continuing that. We know the patient is priority one, and they are priority one. There's this whole other aspect of the business that needs time and attention for it to grow and for you to grow with it, which is what he was saying. Interestingly enough, shortly after that time, I started what I would consider rapidly backing myself out of treatment.

You recognized what he was saying right off the bat. Did you know in the back of your mind that he's right?

Yes and no. Other therapists probably, if you're at this phase of any growth, you see that, “There's a bottom line to what I do when I treat a patient. When I treat a patient, it's money in my pocket. How do I pull away from that?” There's the other part that’s like, “What's my time worth as far as growing and scaling a business?” Try to put a dollar sign on that. I recommend people, sit down and do that exercise, put the paper on the wall, step away for a week, treat your patients and then come back, look at that paper again and look at that number you put on it. My guess is you'll probably scratch it out and increase the number.

At this time, as far as patient care goes, my day would start at 7:00 AM. It probably ends at around 7:30. That was going on for a couple of years. There was a burnout factor to everything we do. After work was paperwork, management, insurance, hiring, firing, all those things come into play. My other business partner and I went out and had probably a drink or two and we were like, “If we feel we have the scalable model, let's put it to the test. For us to do that, we need to back ourselves out so we can put on a different hat and develop a different context for who we are as professionals.”

Was it that easy for you to step out or did it take some mental energy to see yourself as not the full-time treating therapist that you were for so many years?

It takes a plan because you can't just rip yourself out of the schedule. There has to be a thoughtful plan over the course of about three months. To say, “Right now, I'm treating 40 hours a week. My goal is to go down to twenty.” You can be a part-time clinician and a part-time manager. There's a caveat to that too. When you look at your schedule on a weekly basis, my recommendation is to have days where you're the manager and then days where you're the practitioner. They're two different skillsets and two different hats. If you start in the morning 7:00 to 12:00 treating patients and then you think you're going to switch right over into management mode at 1:00, it's hard.

I told the coaching client that the mental energy that it takes to switch from treating patients to the admin stuff is hard to explain. There's this mental switch. It's not like you can stop seeing patients and then go sit down at your desk immediately. Recall all the admin tasks that you have to take care of and jump right into the creative mindset of, “What do we need to do for our marketing strategies next?” They're two different thought processes. It takes some strain. It takes mental energy to switch those positions, those hats. I love your recommendation though to make a full day of admin stuff. If you can't do that, at least take a half day and take a lunch break in between. That's a perfect place to start. Plus, you recommended, give yourself a plan of a few months to gradually go down. It’s highly recommended. I had to do the same thing. You did the same thing. It's important because those tasks are diametrically different.

Our goal first was to bookend our week. We started with a Friday where Friday was no patient care. There was more management. We move to Monday, it’s management. I had Monday and Friday that were bookend with management type of activities. The middle of the week was more patient care. From there, it slowly evolved. I always kept my hand in patient care to some extent, I still do to this day. You don't need to have a schedule of 40 patients to be an effective clinician. To continue your clinical skills and development, you don't necessarily need that. Professionals, if you’re like, “I don't want to ever lose those skills.” Think about this, you went to school for seven years to be a DPT. You've already treated for a number of years. You're not going to lose them. They come back quite rapidly than if you did lose them. No fear there.

To go back into your story a little bit though, what do you think that investment banker client saw in your practice that made him say that? Did he give you some detail into the things that he saw or did that strike a chord with you because you recognize some of the management needs of your company?

PTO 138 | Growing And Scaling
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That was a point in life where we were making more money. It was exciting as far as the bank account goes, but the credits you're pulling out of your own energy and your own life is a whole other aspect to it. It’s like debiting into the bank account, but I'm constantly crediting into my personal life. You can't continue that way. If you find yourself in situations where you're exhausted, tired, extremely stressed, angry or any other challenging emotion that's arising, it probably means that something you're doing is not sustainable. Not to look at it like it's a problem, but to look at it as there's an opportunity for a solution here. If something's not sustainable, it's not going to continue.

If you continue with it, when that part of whatever you're doing goes down, it's probably going to take you or a part of your business down in some way with it. That's where we were. Nathan, investment bankers, what they do is they look at businesses and they identify what's a good business, what's not a good business for them to invest in. I wasn't so comfortable about someone analyzing my practice as they're sitting in it. At this point, I was in my late twenties. This gentleman was probably in his 40s at that point. I was like, “This guy has some experience. What can he share that I can use to help build the practice?”

Was that then the germination of, “Let's sit down, have a drink and try to figure this out.” Talking out with your partner and generate a plan. At the time, you had 3 to 4 clinics?

We had three at that point.

When I was at that stage, people would ask me, “How is business going?” I'd say, “I love treating patients. I just can't stand the business stuff. If I could get rid of that stuff, life would be so much easier.” I told a couple of them that I was close to. I was like, “I don't know if I can continue doing this for another 5, 10 years. I will be burned out for sure. It's crazy.” I recognized it was at that point where I need help. It starts with me. I didn't know where to go. Did that come internally or did you reach out? Did you find someone to help you and guide you in some of this business stuff?

I read lots and lots of books first. I took pieces of books. We started to implement that into our ongoing business plan, our monthly meetings and quarterly meetings where we got away from the office. Monthly meetings are in the office, that's fine. Quarterly is like, “Let's get away for a weekend.” Give yourself a day to detach from life, somewhere around day two, you start to feel relaxed and then you can start to brainstorm and germinate new ideas. You can come back to the clinic and put those into an action plan.

What were some of those more influential books that you followed?

Good to Great was a big one. It's funny, someone asked me this. The first one, which is an older book now and people don't talk about it anymore. It was pivotal in not only starting a business, but the scaling aspect of it was The E-Myth Revisited. I still probably should go back and read the book on some level. That book should be an eye-opener to any business owner, who you are, what the role you play and the role you need to move into. If you're not comfortable moving into that role, you have to hire people to fill that role or else essentially, what you have is a practice where you're the only employee, or maybe only the few employees. One of our goals was to grow a practice, multiple locations, which is what we did.

Like Robert Kiyosaki says, “You end up owning a job instead of owning a business.” There's a big difference between the two.

The job owns you.

The other thing that you mentioned that I want to highlight is that you started focusing on meetings. I've recognized that many owners aren't having meetings on a regular basis. If you have a partner, you'd have to have them, but with the teams on a weekly, bi-weekly basis, then on a monthly and quarterly basis and figure out, “Where are we going? What's the strategy? What are our priorities? What are our goals for the upcoming quarter or a year?” Get on the same page, that way you can gain some traction in progressing forward. I'm sure you couldn't have scaled unless you had those regular meetings.

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Monthly meetings were essential to our growth and success. At first, it started with us. It trickled down through the entire company. It’s a little bit less with the front desk reception, but with clinic managers, then clinic managers that had meetings with the clinical staff below them. We had meetings with our billing staff with regards to insurance. The biggest part is communication. Your values as a company should, in some way, connect to your business plan and should connect to all your employees that are in the company.

You talked about debiting from your life. Even though your bank account is good, there's a sacrifice there. As you continue to scale, you got up to sixteen. What did you do, maybe unintentionally, to make sure that you started protecting who you were as a person and had a lifestyle that was enjoyable while your business was continuing to grow and succeed? Many people say you’ve got to put in the time and the effort, you’ve got to put it in the blood, sweat and tears. There is a part of that when you're getting started. Some owners might hesitate on growth because they think that growth means they have to sacrifice more of themselves in order to do so when that's not necessarily the case. What did you do to maintain that lifestyle and continue to grow?

The most important part is to change your perspective around a business. When I first entered the business, the way the business runs is I'm steering the wheel. I got the wheel on my hands. I put my foot on the accelerator or the brake. I'm the one that's “running” the business. It's a challenging place to be in, because what happens is when you're the only employee, the job runs you, the business can wind up running you as well. Just because you're scaling, it doesn't mean that's going to solve your problems either. This should become almost like a game, because if you approach it in a serious way, and it's a serious topic because we're talking about people's lives and their income, their livelihoods and their families. The way you approach and create a different perspective is like, “How do I gamify this and see if I can create a business where I don't have to be there 40 hours a week?” Be playful with that. If you are entering it in a stressful way, what happens when you run through things with stress? Fist clenched and jaw clenched and shoulders tight, it becomes an unpleasant experience.

If you're entering things a little more playful, like, “How can I flexibly and malleably take what we have here, grow it and still have a connection to it?” It is important to have a connection, it's fun to work, but how do I grow this without it becoming a monster? That's a bad place to be in as well. You don't want the monster of the business to swallow you whole either. Looking at this as a little bit of a game, what could this do? It's almost like you have this speed car. It says that the car can go up to 240, but you're like, “Let me see. Let me get this baby home and see what happens.” Approaching in a different way is a healthy strategy.

One of the things I recognize is, and I don't know if it's necessarily taught or said so much, but we tend to be owned by the schedule. What I mean by that is when we're treating full-time, our schedule, we give so many hours to our patients and we expect that to get filled up. If a patient needs to come in after hours, “The patient needs me. I've got to work after hours.” At the sacrifice of our personal time and our family time and our hobby time. It might be hard to get out of that mindset to control your schedule and say, “I treat patients these hours. If patients want to see me, they need to work their schedules such that they can see me during those hours. I treat during those hours, and these other hours are sacred. Those sacred hours are my admin time, family time and hobby time.” There is a stop and end time for each of those.

Getting therapists to take control of their schedule, per se, can be a difficult thing to do when that mindset in our heads that, “I can trade my time for this amount of money and I know how productive I am. I know what the insurance company pays me on average, but my time is worth more. If I dedicate more time to the more productive endeavors that don't pay me immediately, I can do more, I can be more and I can grow this more.” Did you find that you had to do some of those types of things and work through some of that stuff mentally?

What you're starting to touch base on is a task mindset versus a strategy mindset. There's a little point in between those two that's sticky. As physical therapists, we’re highly skilled in what we do. There's also an aspect of what we do that's task-focused. Our schedule, you have a patient who comes in one every half hour, that's task-focused for the most part. Treat the patient, write the note, on to the next one. It’s task-oriented. Management, in some ways, can also be task-oriented. For example, if you're looking at your monthly billables and receivables, somewhat task-oriented as well, following up to that is a great number of concrete task-oriented process.

As you scale a practice, whether the clinic you have is growing or you're growing other clinics, that can happen both ways as you know. Your mindset should shift more towards strategy. Strategy requires large chunks of time where you're thinking about reflecting and brainstorming probably on one topic. For example, how do we make our therapists better clinicians so that our patients have a more positive experience? That's not a task. You may come up with tasks or you may delegate certain tasks down to your manager, or you may have the task yourself that you train people on. That project is more of a strategy. That takes time to develop. If you're looking at what do we need to do better with regard to marketing, there'll be tasks that come out of that. Visit ten more doctors a week, run Facebook ads, but the strategy behind that is a larger time-consuming block. I used to block things out on my schedule. I had big chunks of time and some of those quarterly meetings, we're focused on that. It was more strategy versus the actual hands-on management.

As you were talking about specific projects, but I'd imagine, at the size that you got, you started thinking about certain people that you would spend blocks of time thinking about, “How can I help? What does so-and-so need?” You need time to reflect on that. Sometimes you might have to get through a little bit of emotion, whether that's positive or negative, to get a little bit more honesty and think about what they need. Did you find yourself doing that as well?

To this day, I still think, in our type of business, you should somehow have intimate contact with the people you're managing and the roles that they have. If you've never sat at a front desk and did that job at all, I recommend that you do that before you start to manage that person, and see what the challenges are, what the obstacles are, what barriers people have to overcome and work that way. I'm not saying you have to do that for weeks at a time, but those are important. Learning every position and every aspect of those roles are important before you start to manage people. Your people will be able to tell fast that you don't know what you're talking about. Some employees may tell you that's not going to work. You have to have some legitimate reasons to come back and say, “Here's why we should try this. Here's why it potentially could work.” Remember, they're in the situation every day. They're going through the motions. They have those tasks that you're trying to optimize. They're looking to you for support and ideas.

As owners, as they start pulling out of treating and have their admin times, they underestimate the benefit or the importance of coaching their teams. I'm speaking from my personal experience, but I expected them to get it. I was notorious in my interviews when I was a younger owner. I would tell my employees for whatever position they came in, “Your job is to do whatever the business needs.” That was my scapegoat. Instead of me coming up with job descriptions, responsibilities and KPIs that were important to each position, my scapegoat was, “Do whatever is needed and do what I ask you to do.” It needs more structure than that, but then they also need more training and coaching.

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Even if you don't see yourself as a coach and think, “I don't have anything that I can provide to these people, I don't know why I would sit with them one-on-one.” You're the owner. You took on that responsibility when you opened the business. If you're looking to grow, it's imperative. They want you to talk to them on a regular basis. Tell them how they're doing, see what they're like and try to get alignment in with what they're looking to do professionally and what you're wanting for your business. We underestimate the need for that coaching of our team members.

The business that we're in is a high-touch human business from the clinical side all the way through to the administration side. We found that as well. We give job descriptions, job duties and all those types of things that belong in employee manuals. They're important. You realize, if that person doesn't feel valued in the role that they have and they don't feel valued in the larger company, a larger process of your practice, your organization, turnover will happen. In the beginning, people like that structure. They’re like, “Here's the computer system. Here's my schedule. Here are my responsibilities.” That's all clear for people. What you find fast, probably around month two, people look for, “I got this. I know where my desk is. I know what the schedule is. I know what my tasks are. Why am I here? Do you value me being here?” That only happens through relationship building and coaching, which in general, we're good at as professionals. We're good at it as therapists, but it's a different type of therapy when you're working with your employees.

As you started growing, what were some of your most important hires when it came to leadership? Who were you looking for? What positions were you looking to fill that helped you accelerate your growth? What were some of the characteristics of those leaders?

Clinic director was one of the most important, especially early on as we were growing multiple clinics. You can't be in multiple places at once. The clinic director was critical and important. That's important too, whether you have one practice or multiple practices. A clinic director is a challenging job. Over time, I started to see this is challenging because you're asking people to be excellent clinicians, usually treat their own patient caseload, be a good enough teacher that you could nurture and mentor new graduates or therapists underneath you and have some touchpoints with KPIs that you're tracking as far as the outcomes. It's the most challenging job in the whole PT practice.

Did you find that certain clinic directors did better? Whether that was in terms of certain characteristics that they had or those who were homegrown per se, people that moved up within your company. Did you have greater success with those versus hiring from outside?

The moving up is an interesting thing for me to think about. In the beginning, we would move people up based on time seniority. We wound up putting some people who were excellent therapists who've been loyal, happy in their job, who have been with us for a long time. We promoted them, sometimes willingly and sometimes a little bit unwillingly, to clinic director positions. Some of them failed. Not only did they fail, but we failed. That's probably more important. We failed by not recognizing that excellent clinician can maybe have a role in training other therapists, but the management side of it is not their thing. That's fine.

One, it can save you from losing an excellent clinician. Once you forced that a little bit and it doesn't work out, whether you pull the trigger and say that this is not working for you, or whether they pull the trigger, on some level, you’ll feel like, “This didn't work out for me. I don't feel comfortable now in my role here working in the company.” They oftentimes look for other opportunities. It's important to be conscious and deliberate about, “Here are the qualities that are required for a clinic director. Does this person have that before I put them in?” So often as a manager, especially when you have an open position, if you're just looking for a butt on a chair, that's a dangerous place to be in. When you feel desperate like, “I need to put someone in this spot, and then I can fill the position. I can move on to other things.” That's going to circle back around at some point and say, “You filled the position, but it wasn't necessarily with the right man or woman.”

A lot of times we think that we're delegating the responsibilities when we're abdicating that position and taking no responsibility whatsoever. You take care of it and if it fails, it's your fault. I love it that you shared that that is our fault if they failed many times, especially if we set them up in a position that has a job description and responsibilities. We still need to be there to check in on them and guide them and answer their questions. There's no correlation between being a great technician, a great physical therapist and being a great manager. There should be some leadership development in your company. I'm assuming, over time, you develop that as well.

Back to that patient who was observing what was going on, shortly after that time, we developed a clinical training manual. We took some of the more common diagnoses that we see in every single clinic. If you look at your diagnosis, you see 80% of what you're treating is probably spine, knee and shoulder. It’s different diagnoses, but they all have commonalities with regard to optimizing range of motion, strength. We tried to standardize that. As much as possible, it still leaves some flexibility for professionals to access their own skills and tools, worked well with regards to maintaining our quality of care, and then we had to do the same thing for our clinic directors.

There's always an opportunity for a solution to every problem. Click To Tweet

Before giving him that clinic director title, I'm assuming you took them through certain exercises, had them read certain books that you had also read. Maybe they were part of some team trainings or leading out on staff meetings and little things like that to see how they would do over time.

We'd have them shadow with other clinic directors to see what their day was. Let them chat amongst each other and compare notes about what their day is going to be like, what their week is like, what their responsibilities are, how it's different from being a regular staff therapist. A lot of time was invested in clinic directors.

What would you say then in order to maintain a healthy lifestyle, per se, in having so many clinics under your belt or growing at the scale and the acceleration rate that you were, what was one of the most important things for you to maintain a healthy lifestyle?

It’s mindfulness. People are a little bit shocked by that. Usually as professionals, we think, “If we're going to alleviate stress, we go exercise.” That's important for us as professionals, but there's a whole mindset or a cognitive/psychological process to what we're doing, working with patients and the interactions we have with staff and nurturing. If you're super excited about what you're doing, that's great. If you've got lots of different balls in the air, and you're juggling lots of different things, that's understandable, but realize you have to be intentional about what you're doing. Mindfulness is a great way to do that. It's stressful to run a practice. You have the responsibility of a lease. You have employees that are responsible that you're responsible for, that helps them care for their families. There are lots of different moving parts to it.

Somewhere along the lines, I started looking into mindfulness. It helped me with regulating stress. There are going to be stressful and challenging aspects that come up within the business. I'll give you an example. We had to move out rather rapidly out of one of our locations. In New York City, that's not an easy thing to do because real estate is tight and it's expensive. We had to move our busiest clinic within a matter of about three months to a whole other location. If I didn't have those skills to fall back on, this is where people get heated or they get lost, or you start turning to other things that are not healthy, such as drinking, eating too much, losing your mind in the internet and on your cell phone. Those things happen because you're avoiding things that are unpleasant in your current existence.

Some of those unpleasant things may be in your practice, but you can't escape them. How I can develop some psychological flexibility and mindfulness is a big part of that. I can start to be with these uncomfortable situations that I have to manage and face each day, but confront them in a way that is as effective as possible for me that doesn't wear me down over time and doesn't wear the people you're working with and the business down over time as well. When that starts to show its face, you're managing multiple people and you have to start supervising, sometimes even firing or letting people go. Knowing how to compassionately and kindly let someone go who isn't in the right position, or maybe that you're responsible for it because you didn't put them in the right position, is an important skill because your entire staff around you sees this happening. They see a wrong person in the wrong seat, that person is stressed. Usually, there's a virus that starts to infect the clinic. Everyone starts to feel stressed, you feel stressed. Learning how to handle that in a way that's compassionate is important. Mindfulness is a nice way to train all that.

Tell me a couple of things that you use to make sure that you have appropriate mindfulness.

It’s ten minutes every day.

What do you do?

PTO 138 | Growing And Scaling
Growing And Scaling: If you find yourself in situations where you're exhausted or extremely stressed, it probably means that something you're doing is not sustainable.

 

It’s ten minutes, five days a week. First thing, wake up in the morning, go to the bathroom and pee and then my butt is on the meditation cushion. It’s somewhere between on the low end five minutes, on the high end twenty minutes, but most of the time, it's about ten. Think about it. I used to wake up in the morning and jot out all the things I had to do for the day. The list would follow me from Monday. I'm crossing things off. The list keeps getting bigger. We don't realize that the human mind naturally wants to solve problems. It does that through thinking. Just like your heart is beating all day long, your mind is thinking all day long. That evaluated function, that problem-solving function is useful and important, especially to a manager or a clinic owner.

It's also important to realize when you start to tell yourself, or you start to develop stories about what's happening or what could happen that aren't necessarily true. Those stories hook you and start to take you out of the present moment. That's where stress starts to develop. It's also where poor decision-making happens. It's difficult to make good decisions when your mind is chattering away in the background. It's running you in. Mindfulness, psychological flexibility and ACT, which is the other thing that I have studied and trained, teaches you that you run your mind, your mind doesn't run you. That's a different perspective because people think, “I am my mind.” The question is, if you followed every command, every instruction, every recommendation that your mind has, what would your day look like? Your mind would, in essence, run your day. Most of that is happening because of fear, stress and anxiety. Those are the three biggest. Learning to realize that, “My mind is chattering in the background. How do I notice this chatter?” Acknowledge it, see it's there and bring yourself to the present moment, say, “Here I am. What's important? What should I do?” My mind can chatter away in the background, but not adversity affects my physical or my mental health.

For so many years I've heard about these practices, the same thing, I'd recognize when I am stressed that meditation is important. Other people might use journaling, gratitude journals, prayer, all of these things to help you recognize that you are in control of your thoughts. You are also in control of your emotions. The more that you can be in a quiet, reflective state, that's when things, answers and solutions come to you. When you can stop all the chatter, you can let your mind think productively.

Perhaps more importantly, if there are instances where you feel like you're not in control of your thoughts, and you feel like your thoughts are racing, what mindfulness teaches you is that you can relate differently to those thoughts. If you're not noticing the flow of thoughts that are constantly flowing over your head, in and out of your ears at all times, they can sweep you away. It's common that when you are stressed and anxious, those thoughts increase. We use like the waterfall increases. Mindfulness teaches you, “I can let this flow over me. It's happening. I know what's happening, thoughts are coming. It may be affecting my emotions, but I don't have to necessarily act on them. They don't have to influence my behavior.”

You shared a ton of information and wisdom on growth and maintaining a successful, healthy lifestyle as you're growing. Is there anything else you might want to share as we start wrapping up?

We touched on those mindfulness aspects of health and wellbeing. Professionals see this being adopted more and more into corporations, professional athletics. One of the things that we need to be aware of as professionals is that there is a mind that our patients have as well that is chattering. Things like mindfulness, Acceptance and Commitment Therapy, which is a form of Cognitive Behavior Therapy, those skills work well for your clinicians as well to help your patients have a better patient care experience and to have better patient outcomes.

Share with the audience a little bit about ACT because I know you're training on that and you do some continuing education. It can be beneficial not only for the individual, the provider themselves, but also for their patients. Tell us a little bit about that.

Cognitive Behavioral Therapy is a family of different types of therapies. ACT, what's called Acceptance and Commitment Therapy, is one type of Cognitive Behavioral Therapy that has a ton of research, meta-analyses and randomized controlled trials supporting its use in specifically chronic pain, but also many of the lifestyle related behavior challenges that we see in practice like helping people engage with exercise and physical activity. Some professionals are into things like nutrition and health coaching. ACT, in essence, is a behavior change model. Everything that we're doing as professionals with regard to clinical care as well as our management has to do with helping people with effective behavior change.

If people wanted to learn a little bit more about ACT or what you are training on cognitive behavioral therapy, how would they be able to find that? Where can they find you?

The best place is to go to my website, that's IntegrativePainScienceInstitute.com. They can find all the courses, books and resources there.

If people also want to reach out to you individually, is that the best way to do so?

They can reach out to me on the website at the IntegrativePainScienceInstitute.com or I'm always happy for anyone to email me. Email is pretty easy, it's Joe@IntegrativePainScienceInstitute.com.

Thanks for your time. It was awesome to learn from you. Thank you so much for the wisdom that you shared.

Thanks, Nathan. It’s fun chatting.

Important links:

About Joe Tatta

 
PTO 138 | Growing And ScalingDr. Joe Tatta is a global leader in integrative pain care and an advocate for the safe and effective treatment of chronic pain. He is the Founder of the Integrative Pain Science Institute, a cutting-edge health company reinventing pain care through evidence-based treatment, research, and professional development. For 25 years he has supported people living with pain and trained practitioners to deliver more effective pain management. His research and career achievements include scalable practice models centered on lifestyle medicine, health behavior change, and digital therapeutics. He is a Doctor of Physical Therapy, a Board-Certified Nutrition Specialist, and Acceptance and Commitment Therapy trainer. Dr. Tatta is the author of two bestselling books, Radical Relief and Heal Your Pain Now, and host of The Healing Pain Podcast. Learn more by visiting www.integrativepainscienceinstitute.com.

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PTO 117 | Grow Using Social Media

Angie McGilvrey, PT of Apex PT had the opportunity, after a hurricane shut down her clinic in Florida for a prolonged period (sound familiar?), to revamp her clinic and create her ideal scene. One of the things she committed to when she opened back up was greater usage of social media to market her clinic and attract her ideal clientele - female athletes between 30-40 years of age. By focusing targeted messaging to her avatar on a couple of social media platforms and posting content consistently, she has been able to not only grow her clinic but see more of the clients she wants to see. Plus, she's created a reputation as being THE place for athletes to recover in her community. She's been able to niche down and grow because of it.

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Listen to the podcast here:

Using Social Media To Niche And Grow With Angie McGilvrey

I've got a fellow friend and HODs or Hands-On Diagnostics owner with me, Angie McGilvrey, out of Florida. She and her husband, Joe, own Apex Physical Therapy in two locations. I want to bring her on because she's done a lot of great work in growing her practice and has used social media to do a lot of that work. I want to get into her story to share what she's done on social media and how it's been successful for them. First of all, Angie, thanks for coming on. I appreciate it.

Nathan, thank you for having me.

Before we get into the social media stuff, you've been an owner for many years, so congratulations. You’ve got multiple practices and you guys have been successful. I'm sure the story hasn't been sweet-smelling roses all the time. To give everybody a little bit about your journey, do you mind sharing your professional story quickly?

My husband, Joe and I, opened Apex Physical Therapy in 2005. We packed everything we owned up in U-Haul. We were from Chicago and said, “We're going to Florida. Forget this cold weather. We're going to give this whole PT private practice a try.” We are blessed to be here growing and being productive many years later.

Have you been in the profession for a while? Had you been practicing for a while before you decided to open your clinics?

We did. We were practicing underneath other owners for about five years before we decided to take the leap.

Did you practice in that area in Florida first and then open up your clinic? Or did you go to Florida and decide we're going to open from scratch?

We opened from scratch, cold turkey.

That takes some courage. You had some confidence and I'm sure you hit the bushes. You worked and marketed hard, all that good stuff. I'm sure you've pushed hard and it's part of your success. Are there any particular times along the way that were somewhat hard on you that turned out to be a learning experience and a success in the end?

Yes. I would say two large things come up. The first one being in Florida, we have a high Medicare population. I can't recall the year right off hand, but we went through a Medicare audit one where they put us on 100% prepayment review, which meant that in order for us to get paid by Medicare, they had to review all of our documentation first on 100% of our patient volume. I did learn how to document for medical necessity.

Florida got hit with that, didn't they? It's a Florida thing.

Unfortunately, there are some fraudulent things that happen. Secondary to that, everybody was looked at with high scrutiny. I am proud to say that we came out of that on the other side, but it is a huge learning experience and something that made me a lot stronger in understanding medical necessity, billing, coding, documentation and all those things that as PTs, we don't sometimes want to care about, but I figured out fast why we have to care about it.

Social media, strategically utilized, instantly puts you in front of your ideal patient without dealing with a physician's referral Click To Tweet

How long were you under review?

It lasted about six weeks until we finally were able to get off of 100% and down a different percentage. We had to work with an attorney and all the things. It was rough.

How far into your ownership was that?

I believe it was about 8 or 9 years in.

You are going strong, but that’s a huge roadblock in the middle.

Medicare was our payer, like 75% of our population, especially the season is Medicare. This was a big undertaking.

That was number one. Did you have a second one?

My second one was in 2017. We were hit with Hurricane Irma and that was a big deciding point and a big pivotal point, which leads us into the conversation that we're having around social media in the sense that we chose after Irma to rebuild our practice. One of those building blocks that we used was growing and niching through social media.

Did you have to close down your clinic for a period of time?

We did. We had some damage. We had no power for about ten days in the entire Florida, which was 90% of our patient population left and evacuated. Even if we would have power and been ready to operate the day after, none of our patients were here. Everybody was gone. The whole state had been evacuated, especially in our area. That was a scary time to figure out how do we get through this. I do have to say with the COVID pandemic that we've all been dealing with, Hurricane Irma was the best thing that I could relate it to and figure out, “What did we do then to navigate?” Our practice went down to almost nothing. How do we use that experience to navigate through COVID? I'm grateful for them looking back because I know that they contributed to our successes.

It's not uncommon. As I'm working with clients or talk and interview people over the years, it's tough to go through those hard experiences and you wouldn't wish them on people or yourself, but after having done so you come through having learned so much and having grown stronger. In your case, you were able to create a different practice than what you went into Hurricane Irma with. That's relative nowadays, even with the pandemic. That was a lot of push over the pandemic as I talked to people on the show and my clients. It was like, “Here's an opportunity. It sucks, but how can we make the most of it? What can you do so that you can make the changes in your clinic to reflect what you want in your clinic? Who are the clients that you want to see? Who are the fellow team members you want to work with? Are you seeing the paramix that you want to see? Do you have policies and procedures in place that make things easier? Do you have time set aside for admission or tests?” I could go on and on, but taking advantage of these opportunities is what makes us stronger. It gives us opportunities in the face of challenges. As you did that, how did you then work social media to your advantage to create what you wanted? I would love to know what you did, why and what were some of the instigating factors? What was your clinic like before to what did it become?

The clinic was very much a general outpatient orthopedic, physical therapy practice. It has no different than any other outpatient orthopedic. If you looked out the window, it would look like all of the others.

PTO 117 | Grow Using Social Media
Grow Using Social Media: Social media allows you to bring patients into the clinic without having to rely on a third party referral source.

We take all comers, whoever has got a script, we bring them all in.

We take them all, we do it all, we market to everybody, we take all the insurances. We do everything. We market 75% of the time to referral sources, mostly physicians and those others in the medical community. That's what we looked like going into Hurricane Irma coming out on the other side. One of the biggest things that the storm taught us was that, as you said, we have the ability to create change. We have the ability to reset this practice to what it is that we ultimately wanted to be. We wanted it to take more control and be more at the cause of the specific patient we were working and identifying our avatar. Also, be at cause at bringing those patients into the clinic without having to rely on a third party referral source. That's where social media started coming into play for us big time.

Social media is something that I wish I had more time to do that. Did you think about that in the past or was this something that forced your hand into, “How are we going to take advantage in social media came to mind?”

It was more the latter. I've never had my own Facebook, Instagram, Twitter, nor Pinterest. I was the person who fought social media for a long time until I started listening to a mentor who I've used in, Gary Vaynerchuk. I have to give him credit for what I've done and what I've learned through social media. I started to learn that if I wanted somebody's attention and especially my avatar's attention, I had to go where they were and they were on their phones. More specifically, they were on social media. I was like, “Angie, you better get your butt on social media.”

What's your avatar?

Our avatar is the 30 to 40-year-old female athlete, specifically the CrossFit athlete.

You're CrossFit as well. Are you performing CrossFit athlete yourself and Joe?

Yes.

You can speak their language, you know what they're dealing with, you know the moves and the lifts, and some of the common injuries that go along with being a CrossFit athlete. That's exactly where you live in that space and it's easy for you then to talk to those people I assume.

Yes.

It's a little counterintuitive to what I heard and that was to create where you live and that is, if you're on Facebook all the time, create a lot on Facebook. If you're on Instagram all the time, create a lot on Instagram. Maybe there's something to that, but you had to learn how to navigate and use some of these social media accounts. Was that a tough learning curve? Was that hard for you to adopt? Has it become easier for you?

It's like anything else in life, you have to start doing it. That was it. I had to start doing it. Joe was always involved with it on a small level, but it was when I decided that we had to put a ton into this and I wanted to be that driving force. I had to learn by doing. The first 500 posts that I made, it's like a therapist, the first 500 backs that I treated didn't do that great of a job, but the more we do, the more we learn. It's the way that it goes in. I still am learning all the time and I'm trying different things, seeing what captures attention, what is giving more value and what do people respond better to. It's a work in progress.

People want to do business with people. Click To Tweet

To get into the weeds a little bit, are you using your own personal account or is it an Apex PT account that you're using on these platforms?

It is a business account. My practice is a small business and our philosophy is much that mom-and-pop small business family feel. We have in two locations. We know our patients and we develop meaningful and lifelong relationships with them. We infuse a lot of Angie and Joe's story, Angie and Joe's history and some personal things with Angie and Joe in there because people want to do business with people. That's what we've done.

How much time are you setting aside to do all these posts and get your stuff out on social media?

As a team, there are three of us that do this, myself, Joe, and one other gentleman in my practice. Between us, we can talk about what I mean by working, but this is working. The entire part of working social media, we do 5 to 6 hours a day collectively between the three of us.

You're each doing a small portion, at least an hour or two. When you're talking about that, you're talking either you're creating video or content, you're editing, posting a video in some form or another.

That side of it, but then also there's the other side of it and the engagement side.

Tell me about that.

We work from two different angles. It's the content creation and the posting, and then also the customer engagement. We will go through and literally either search through the #CrossFit or #Fitness or something like that. We'll see the accounts that pop up and you go on and somebody posts something and you comment on their posts. We’re engaging in two-way conversations with that avatar patient of ours. Sometimes this person could be across the country. You never know what that brings because maybe that person from across the country says, “Let me give you a follow.” They follow you. They see something cool you're doing. They post it and maybe they've got 100,000 followers and all of a sudden, you’ve got the attention to somebody down the street. With what technology has done in the way, it opens up our market so big to who we can create conversations and engage with and get our product out in front of them. It's not limited to our 10-mile radius like we used to think.

A Gary Vaynerchuk thing to do is to get engaged on all those hashtag groups and throwing your two cents and then people follow you and it cross-references each other. It sounds familiar. Do you use any gadgets to help you along the way with a few accounts and platforms running? Are you using something to help you out?

I tried to dabble in Hootsuite for a little while, which is a platform that lets you do all of the pre-programming and setting. It wasn't fitting for me. I know there are other people that use that, I don’t. We post to the date, to the moment like, “What is happening?” I'm like, “Look inside the clinics.” That lends itself to doing it on the fly sometimes.

If I see something on your posts, more than likely it's been done sometime in the last 24 to 48 hours, and it's not something that was done a week ago that was scheduled to post at a certain time, which Hootsuite will do for you.

Sometimes that does happen. We do have some scheduled content to create like, “I want to do some videos around musculoskeletal ultrasound. Let's make sure we get those videos.” The majority of it is me and/or others in my clinic being followed by a video camera. The way that I get my content is I have a videographer that follows me about 4 to 6 hours a week. Based on that, he creates content off of the rides me working with my team, working with our patients doing our thing. It's extremely authentic. It's not like, “Let's sit down and let's rehearse what we want to say about this.” It's seldom that we do anything like that.

PTO 117 | Grow Using Social Media
Grow Using Social Media: As long as they have the intention, anybody who wants to use social media to niche and build their practice can.

What platforms are you on? To follow up, is that something you filter down to certain platforms after starting on a bunch or have you stayed on all of them? Where did you start and where are you now?

We started with simply Facebook because that’s the largest out there. However, when you start to look at some of the demographics, my avatar spends the majority of their time on Instagram. I do both. We put the majority of our stuff on Facebook and Instagram. I also do a personal page and an Apex page on LinkedIn, where I will reuse a lot of the same content or videos, but I would spin the messaging a little bit more knowing that I'm talking to another physical therapist or somebody savvier in my space versus talking to the general public about physical therapy.

In LinkedIn, you're talking to business professionals typically, and that's what they're looking for business-related stuff. You're sharing your story and what you're doing and I've seen many of your posts on LinkedIn and you do a great job. Do you also do stuff related to physical health and caring for certain injuries? That's a lot of what I don't see on your LinkedIn stuff. I'm wondering if you massage your content on Facebook and Instagram for injuries and diagnoses in particular as you're talking to your avatar.

Facebook and Instagram stuff is a lot more about like the last post I did. I was doing a contract relaxed technique with a runner's hip, but it was all talking about my youngest runners with hip pain, this is why it happened and this is what we do about it. It is basic.

You have a videographer, but for a guy who's maybe a smaller clinic size and treating quite a bit, when you first got started, was it simply you and Joe and an iPhone essentially?

We would be on the iPhone and we would be going throughout our day. I would look across the clinic and I would see a patient doing cool exercise and be like, “Let me pull my phone out.” Video fifteen seconds of that exercise, knowing that later, I'll post that and talk about what they're doing. I have a patient come in that I would have one of my CrossFitters. We were working on with the PVC pipe working on a lift and I'd say, “Let me video her or video me. I'm going to post that later.” It was not until within 2019 that I started having the videographer be with me.

Do you get consent from your patients to post those videos? Is that something that's part of the intake paperwork or do you let them know verbally ahead of time that this is going to get posted?

Yes, we have a video image release as part of our standard paperwork. On the days that he is there filming, they see that he's walking around or whatever, and I always make it a point to be like, “Is it okay that we get some of this on video?” I make sure I get that extra okay any time I do work with minors that are athletes as well. I always reask verbally mom or dad again to make sure everything is good. The cool thing about getting their consent and doing that is I make it a point whenever I'm posting about a certain athlete or there in my video to build that person up into talking about how they're inspiring this post and this is how awesome they have done.

I'm proud of them because that gives them a huge amount of value and self-esteem coming back at them. It's turned into, “That's cool. Apex posted my video.” It makes them feel good about themselves and their progress and that piece of it I love. Being able to tag them and say that is amazing for them. On the other side, it also drives business for us because then they will typically repost it with, “Thanks Apex. You guys are awesome or whatever.” Not that I'm looking for that, but when it happens, that's wonderful and I'm grateful for them to do that.

It's cool on two levels that you get to highlight these amazing people that come through your clinic and share how awesome they are because it's not all about Apex all the time. If you read, Building a StoryBrand, we are the guides in their hero story. The patient or us as we're looking at someone who can help us, we are the hero of our own story. We're looking for the guides to help us be better. That's what you're able to show in those videos. It's nice that you get some turnaround because these people who are more than likely your avatars are going to post on their websites to other avatars of yours with the people in your network that you would be able to treat as well. It's such a cool concept that you highlight them so much because a lot of what you see with PTs is, “This is what you do for your back. These are the stretches. Here's the anatomy.” That's not engaging. When you see other athletes performing, getting treated, exercises that they're doing, that’s somewhat engaging because you pulled into a little bit of a story there and that's cool.

I try to tell a little glimpse of each of their story, like, “She had this and now she has this. That's why we're working on this.” It brings it to real life.

Don't you use YouTube?

Friends and family are always huge referrals. Click To Tweet

We do, but I need to be better at it. I was told by a digital marketer that it becomes the second search engine behind Google. We need to become better at YouTube.

We got into the weeds there a little bit. You made it intentional to use social media to your advantage and grow in a different way than you were before. How has it changed your clinic by niching down and using social media?

It's been awesome. The two pain points that we went into Hurricane Irma with were marketing to the physician as well as seeing anybody and everybody. I treat two days a week. I love treating. If I choose to treat. My entire schedule that is all I treat. I treat is athletes and most of them are CrossFit athletes, but it has blended into, “If she knows how to CrossFit and she knows how to treat Spartan racers, and she does CrossFit and Spartan Race then I know she can help me because I am a baseball player.” That's amazing as well as my practice has been branded in our area as the place for athletes to go, which is super cool.

I've heard that from various physicians in talking and communicating. We are having a PA or a physician say something to a patient and the patient comes and tells me, “They told me because I golf and I need to get back to golfing. I'm an athlete so I need to go to Apex because that's where the athletes go.” To hear that is super rewarding. It has completely flip-flopped our marketing. We market 80% now direct-to-consumer and 20% of it is massaging the relationships and the rapport that we have built over the past years with the various medical people in our community.

To be honest, the coolest flip of the table is when I have a CrossFitter who hurt her wrist doing a lift, doing a clean. She bent her wrist all the way backward and was like, “This is bad news.” The way she contacts us is she direct messages us through Instagram. I want that to be a point there in that this opens up a new line of communication for people to get it. She didn't go to our website. She didn't call our number. She direct messaged us on Instagram and said, “Can you help me?” I was like, “Yes, come in today at such and such time and we'll help.” That's huge. She came in and talks about what was happening with her wrists and the other.

We ended up doing an MSK or Musculoskeletal Ultrasound to look at her wrist. We're super concerned. I didn't do the MSK. It was my husband’s ball. I can't remember exactly what his major concern was, but he had one and he said, “You need to hang on a second. We're going to get you to the orthopod. You do need to be screened by an orthopedic before we go any further because I'm concerned about it.” He text messages in orthopod that we have a great rapport with, “I have an athlete here needs to see you.” He’s like, “Send them over at whatever time.” We fed the orthopod the patient versus buying the $700 lunch and begging for patients. The patient went to the orthopod and was cleared. Everything looked good. She came back to us and did rehab a couple of visits. We had her right back to doing CrossFit and she was super grateful and blessed. Her turnaround was within two weeks that we had this whole process wrapped up, had her back doing her thing. That is the power of that social media connection because she follows us on Instagram.

That goes to show the value and the power behind a direct to consumer marketing. It's something that I was pushing for during the shutdowns of the pandemic is we can't rely on referrals sources anymore. This is an opportunity for us to change our marketing patterns and go direct to the consumer because that's where more of the people are. What is often the touted stat? That only 10% to 15% of the people that have musculoskeletal injuries get to physical therapy. That means we're fighting for 10% as we're going to physicians when there are 90% of the people out there who need us. As you've changed your marketing, has it significantly changed your numbers in terms of the types of patients that you see? You said you were 70% Medicare. Are you still at 70%?

No, which is fantastic. In the beginning, I complain about having the risk in Southwest Florida of a Medicare audit. That was a basket that we didn't want to put all of our eggs in. In the heart of our busy season, we do have where all of our snowbirds come down from January to April. We ride about 60% to 65% Medicare. Outside of the season, those numbers dropped significantly to maybe 40% to 50% at the most. We've been able to change that demographic and diversify that payer mix.

You've been purposeful about it. Thus, where do you get a majority of your patients from? I don't know if you knew your numbers beforehand, maybe 95% of your patients came from physician referral. How has that changed by using social media and whatever else you're using? How many patients do you get from physician referral now compared prior to the hurricane?

I'm going to say pre-COVID because a lot of things changed with that. I would say that from a physician referrals standpoint and in just that small percentage of massaging those relationships, those things didn't change all that much. Friends and family have always been a huge referral pattern for us. That has always been above 50% of our referrals that has held there significantly. Between social media and us going to actual PR events and going straight to the consumer marketing directly to them, whether that be at a gym, a CrossFit box, community events. Before when you could have a race or a CrossFit competition that has boosted up into close to 20% of getting that specific that people are coming into our practice.

This is an additional revenue on top of what you are already getting.

We have to not think about what happened with that, but pre that, we were on a tear. I'm grateful to where we've bounced back. We're in a good place but we were going into that season.

PTO 117 | Grow Using Social Media
Grow Using Social Media: What will make you successful is by giving people much value. Think about what they want and entertain them.

I think there might be a fear out there that if an owner is going to start niching down, that they are going to do so at the sacrifice of the other patients that know, like and trust them. Did you find some of that or did you find that this is simply expanded your scope by niching down?

That was my worry in the beginning. I thought the same way. I thought I only niche and market to this specific 30 to 40-year-old female CrossFit athletes like, “What the heck am I doing?” It expanded my practice. I realized number one, we did have a strong foundation of friends and family, to begin with. That foundation was key. I also think that in doing that and being able to serve that avatar person and serve them so well, they will still recommend their brother, sister, mom, dad, their grandma or grandpa, the other person at the gym. They're going to become your ambassador even more so. The CrossFit athlete has been my avatar, but I would say my schedule, I have with school season and track season starting, half of my schedule is full of cross-country runners.

You might not have seen these people before in the past.

My entire schedule would have been 65 and older Medicare.

Has that also affected your recruiting and the PTs that you've brought on board? Do you have a different type of PT that works with you now?

One of the taglines or hashtags that we use is #AthletesTreatingAthletes. Putting somebody in that space and recruiting a PT or a PTA to treat that caseload, they need to be like me from the standpoint of they live in that world. They talk that talk, they are an athlete, they understand injury, the pain and the mental of, “I'm injured and I can't play. I can't perform.” They've been there. That's hugely important.

You not only niched your patient load, but you also niched your team members.

That's true.

Some of the successful PTs I know out there like Sturdy McKee, he's got a practice in San Francisco. They won't hire a PT that hasn't played a team sport before. He thinks and their philosophy is that, “If you played a team sport, then you know how to work well with other people to be productive and achieve a goal.” That's one of their criteria. You might not necessarily have people on there that do CrossFit, but they need to be athletes. Is there anything else you want to share about niching down and how it's benefited you and your practice? You have shared a ton of great information already.

Coming from my story in 2015, it was the PPS Conference. I don't know if you were there Nathan, but we did the PPS Conference in Orlando. Gary Vaynerchuk was one of our keynotes. At that point, he asked everybody to raise their hand if they have Facebook. I was one of the five people in the room that didn't raise their hand because everybody had Facebook. I looked around and I was like, “I'm proud of this. I don't need that stupid Facebook. That's a waste of time.” To go from being that person to now seeing how powerful and utilizing this tool, it goes to show that if I can do it and use it to niche and build my practice, anybody can. Anybody that wants to do it and has the intention to do it, you can do it.

It takes work and you have to set aside time specifically for it. If you don't, it's going to easily fall through the cracks of your “busyness.” I'm sure you schedule the time, make sure you hit it every day. It's about consistency when you're talking about social media.

It is my habit.

When you're putting stuff online, just give value and entertain people. Click To Tweet

Do you post every day or do you post three times a week? What's your schedule?

If I count Instagram, Facebook and LinkedIn separately, including posts and stories, we do close to 100 posts in a week. I would like to even do more, but we didn't start that way by any means. This is building. We started with one post a day to multiple and multiple people doing it and posting stories and all of that.

It is cool to see how you've grown and used social media to your advantage as an owner, especially among physical therapy owners. I don't think that's utilized as much. Our profession is usually about a decade behind everyone else, so it's cool to see how you've used it, and thanks for sharing. If people wanted to follow you, what are some of your social media addresses?

Instagram is @ApexPhysicalTherapySWFL and Facebook is Apex Physical Therapy. Those are the two places that are the best to find us. It's Apex Physical Therapy on LinkedIn or me as Angie McGilvrey on LinkedIn as well. Thank you.

Is there anything else you want to share with us, Angie, before we sign off?

When you're putting stuff on there, give value and entertain people. That's what I try to do is give them as much value, think about what they want and entertain them. That's what has made it successful on my end.

It doesn't seem like they necessarily want to know all about physical therapy and every injury. I've had clients who have posted pictures of sunsets and I've gotten more engagement from the picture of a sunset than they did about anything else they posted. It's funny how it works. Thanks for your time and for sharing. Congratulations on the growth and all the great things that you do. I love seeing your posts on LinkedIn. They've been motivational and inspirational. It's awesome to see how you're using it to your advantage.

Thank you, Nathan. It was such a pleasure to be on. I appreciate you.

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About Angie McGilvrey

PTO 117 | Grow Using Social MediaPhysical therapy and fitness is my passion! Leading my team at Apex, we empower athletes of all ages and levels to move better, feel better, and live better!

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