Enriching the entrepreneurial mindset is a process that involves executing strategies and having the openness for new ideas. A great group of peers that would guide, motivate, and help you develop your skills would be a great way to enhance your skills and learn new things. Stephen Rapposelli, PT has been a long-time listener to the podcast and takes advantage of the opportunity to put Nathan Shields on the hot seat in this episode. They talk about why he likes the podcast, the best books to read, and a few things in-between. They delve into a great mastermind group, how to become a better CEO, the pros and cons of a PT, and a non-PT mastermind group. They also discuss the difference between masterminds and coaching.
In this episode, I've got a frequent flyer. He's been on a number of times and it's been a little while. I've got Stephen Rapposelli, a physical therapist from the great state of Delaware. Delaware is representing on the show. Stephen, thanks for joining me again.
This is excellent. I want to preface this show by letting your readers know ahead of time, Nathan has no idea what I'm going to do. This is a huge experiment where the host does not know what's going to happen and we're just going to see how it goes.
That is true. Stephen is catching me off guard. He says he's got topics in mind, but he has not shared with me those topics that he would like to discuss. We’re going to go off the cuff.
I'll read them off to you if you're ready.
I'm going to essentially turn over the show to you at this point and let it fly. This is Stephen's show at this point.
This is a mishmash of different topics but they're all timely. This is going to be an interesting conversation. Number one, why I like your show. Number two, mastermind groups. Number three, being a better CEO. Number four, the future of orthopedic outpatient physical therapy. Number five, especially, I had a bonus for your readers, some recent books that they would like to read probably. Readers, Nathan has no idea what I'm about to say. I'm watching your reaction very intently. I like your show and I got no dog in this game. I can assure you, I listened to every one of your episodes because I find them valuable and I'm going to tell you why. First of all, you have no idea where this show is going to go and you're okay with that. How cool is that? You're a guy who's pretty comfortable in being flexible, adaptable and letting your guests go where they want to go if that's where they're going to go.
As long as they're presenting value, let’s go ahead.
A lot of shows don't do that. Number two, you have great guests. I have enjoyed every one of your guests. You curate a wonderful set of people, me being top of the list. In general, your guests are great. It's a good mix of theory as well as tactics. As a CEO, there are times when you want to get down into philosophical ideas and that's wonderful. There's a place for that. There are times where you want some tactics and I've seen a good mix in your show of both. Finally, your show with your guests is in general conversational and that is entertaining because there are a lot of things that are vying for our attention as CEOs. If it doesn't have an element of entertainment, you're going to lose people. Consistently, week after week and it continues to get better, you have good conversations with people. Hats off to you. I hope you feel good. Now, let's see if we can knock you off your perch a little bit.
Let's throw some mud on this.
Masterminds, it seems like everyone is in one. It seems like they're everywhere. Nathan, what is the purpose of the mastermind group? I asked you because you have one.
I've got two now. The purpose of the mastermind is essentially an internal concept. When you look at ancient civilizations or go back to the Knights of the Round Table, it was a mastermind. Go back into the Bible, they had what we call the apostles, a mastermind group, you name it. Masterminds have been around forever. Coining the term mastermind, if I'm not mistaken, was done by Napoleon Hill in Think and Grow Rich. I leaned towards his definition. That it is a gathering of individuals who are together to help each other overcome, learn, explore and become better, where one plus one equals three. The accumulation of minds is gathered to affect and improve a single individual. That's the purpose of the mastermind.
Compare and contrast mastermind with coaching.You will get more out of it the more you put into it. Click To Tweet
At least in my mastermind, I'm going to be the moderator per se. I'm not necessarily taking a turn in the conversations, but each person gets their time to talk about their issue, their concern, and where they want help. I'm going to moderate and say, “Joe over here might be able to speak to that,” or take your turns and then I can elaborate from a place of experience as well. The mastermind is going to be a lot of different varying inputs into one individual's issue. Whereas the coaching is going to be singular input based on experience with more guidance.
Where you could see a mastermind coming together sometimes as a brainstorm, sometimes as multiple experience shares where coaching is going to be one-on-one, individually, and it's going to come from, “This is where I'm seeing a weakness and this is what I need you to do next.” It’s like what a coach would do. Let’s say on a basketball team or a personal trainer, “You have a weakness here. We need to strengthen that. Go off and do those exercises and when we come back, I'm going to hold you accountable.” If a mastermind’s working well, then they will hold each other accountable but that can be difficult at times.
Is there a place in the CEOs world for both a coach and a mastermind group?
For sure and there has to be. I haven't referred to it much as I'm looking over the past year of show episodes, but my mantra of reach out, step out and network. The formula for a successful owner in PT practices is number one to reach out and get some training. That could be a coach or consultant. Step out means step stepping out of full-time patient care, and three is to network. Networking, if you're going to get a lot out of your network, you need to be communicating with them on a regular basis and we don't naturally do that. The mastermind is another word for networking in my mantra.
You have two mastermind groups. Why do you have two?
Simply, I had a group of five guys and I had another three that wanted to join a mastermind. I thought it might be a good time to split up and have four and four, so now I have two groups. That makes it easier. With that group of four plus me, we'll spend a couple of hours or a month talking about issues.
Is being in more than one okay in your mind?
For sure. I see no harm in that. I'm coming from a place where I've had multiple coaches over the years. I've been a part of multiple masterminds. I'm doing these masterminds through Physical Therapy Owners Club. I'm also part of one of the peer-to-peer masterminds where I'm not a moderator, I'm just a member of the group. I also have a local mastermind here with some friends where we talk more about personal stuff, and not necessarily business-related stuff. I'm personally in four masterminds at the moment.
That last statement is a perfect segue to my next question for you, which is what are the pros and cons of a PT versus a non-PT mastermind group? What is the value of all PTs forming a mastermind versus non-PTs and you, participating in that mastermind group?
The PT mastermind, the conversations we're going to have are specific to the business. We don't delve into personal issues much. Sometimes we can if that's affecting our business. I've been a part of business masterminds that have spoken to both depending on where the owner is. If they're going through a divorce, we're not talking during his or her segment about his business, we're talking about their divorce." My focus with the Physical Therapy Owners Club is the PT-specific business-related issues and anything else that might be affecting the business outside of that. Whereas the non-PT-related one, honestly, there's a little bit less format to it. It's a little bit more free-flowing. We do have one guy who essentially leads, but we come together as far as what we're going to learn together, the books we're going to read and issues that we're dealing with. Sometimes in that situation, one or two people might dominate a little bit more of the conversation than the others. Whereas in the PT format, I try to keep it a little bit more strict.
You might agree with me, Nathan. In general, we PTs are some weird people as business owners. Sometimes we're our own worst enemy. When we talk business with non-PT business owners, you could be shocked. You can be shocked at the response of other non-PT business owners in how we think. You probably have experienced a non-PT business owner saying to you, “Are you out of your mind,” about certain things. You have to come in with a little bit of humility and openness to be able to think differently because we are, whether it's by our genetic blueprint or training that we see the world a certain way that not everybody else does.
Usually, the reaction I received in those situations was, “Why you are guys doing it that way?” We have been brought up in this industry where we accept some things as truth, and when you talk to other owners outside of PT and they say, “Do you have to do it that way?” My only response was, “That's how we've always done it,” and not necessarily that it's right.
That's part of opening your mind up, which is extraordinarily scary, yet important as you continue to grow as a person both personally and professionally.
That's why it's good to be part of networks that are not PT-specific. Find some more generalized small business networking groups. The first networking group that Will and I joined was Entrepreneurs' Organization, which is a national organization of small business owners and that's the group I'm talking about. I have an electrician, a website designer, a graphic designer, and a dentist in my group. We would share these issues and that's where I get the kickback. Sometimes I would get some bright ideas and from their industries that could be applicable to mine. It opens up your perspective and your mind a little bit.
I came back from a peer-to-peer conference in Alexandria, Virginia and I love my peer-to-peer network. These are PT owners who get together, a subset of the private practice section and a more concentrated experience. It's a great mastermind group and I try to think about what made it great. As a group, we meet every week. It's a commitment. I thought I knew these people because we meet every week and I do, but then we went to the conference and we had 2.5, 3 days together in a room. It was an exponential jump in value.
The reason I say that is you need to make the commitment to get to a level of trust that only comes with sharing a portion of yourself. Rudyard Kipling tells us that that is the only true gift, a portion of yourself. We are called to lay ourselves out. There are very few opportunities for a business owner to get the feedback that is necessary to make them better, because nobody in your organization is going to give you that, they're not because the dynamic is different. If you can get a level of trust and allow yourself to have that 360-degree feedback where people really get to know you and understand what makes you tick, that's mastermind group gold right there.
The hardest thing to do in the mastermind and that can be difficult is to be vulnerable, and also to come in with some humility. Maybe it's a gendered thing. When you have a number of male owners, we guard our weaknesses, we cover them or we put forth our best foot in order to hide the weaker foot. I say that simply because I haven't had any females in my mastermind groups up until this point. In order to get the most out of the mastermind, you have to be more vulnerable. You have to ask more questions and that comes from a place of humility and not knowing and understanding that I don't have all the answers. It's the only way you can get a lot out of it.
Diving a little bit deeper at that and I'm going to reference Patrick Lencioni's book, The Five Dysfunctions of a Team is you have to have a level of trust. If there's no trust, you won't feel safe in being vulnerable. Even that word vulnerable can make some of your readers tense up a little bit like, “Here we go,” but that's where the good stuff is. That's where you need to go as a business owner to improve yourself. That's what a mastermind group when done well, does and it only comes from you making that emotional deposit into that group.
From the surface or at the beginning of the mastermind experience, all the attendees come into it thinking, “What can I get out of it?” If you go into it with that mentality, you're not going to get a lot out of it. I like to make it analogous to a potluck dinner. If everyone comes to the dinner thinking what am I going to eat, then there's not going to be anything to eat. Everyone has to bring something to the table in order for all to benefit. You have to flip that mindset from people who are thinking about the mastermind and what they can get out of it. You will get more out of it, the more you put into it. It's a mindset I have to get people to change.
Your nickname is now Alexa to me because I suspect that you've been listening to me as I'm writing stuff down because I literally wrote down your third thing, which is network. Network with a purpose, which means you go into it giving, you don't go into it getting. When you give, that's when the getting comes back to you automatically and in abundance. What can you give? That's key. Let's keep going forward into topic number three, which is how to become a better CEO.
If you and your readers are interested in becoming a better CEO, I have a couple of tips. Number one is you got to eat the frog. That's the concept that comes from Brian Tracy who says, “Do that least palatable thing first thing in the day.” Nobody wants to eat the frog. If you wait until the end of the day to eat that frog, that frog is not going to get eaten. Eat the frog first thing. You and I both know that there are things in our lives where we would prefer not to do. We can come up with all kinds of ways to delay that inevitable. There are things that you don't want to do. Honestly, the thing that you don't want to do is the thing that you must do. As Ryan Holiday would say, “The Obstacle Is The Way,” another great book.
One of my coaches said something similar. I'll never forget it. He said, “If it looks like death, run to it.” I can say from a coaching perspective and from my own lived experience, the one common thing that is the dread of most owners and maybe this isn't just PT-related. It's a small business thing and there's a reason why The E-Myth Revisited was written. It was because owners don't want to write down the policy and procedures and put systems in place. Many times in my coaching scenario, I can get them to the point but at some point, the owner has to sit down and write or according to Michalowicz even videotape it. Something has to be done in order to put systems and policies and procedures in place for everything that's done in the clinic. It takes time, it's laborious, it's no fun, there's no immediate reward, and no one's going to pay you for it, but that's one of those eat the frog things that has to happen.
That's been one of my annual goals for decades. It's the most unsexy thing you're going to do as a CEO, but it's one of the most valuable. You can have a whole episode on that and I think some of your previous guests have had wonderful tips about doing that.It would be best if you made that commitment to get to a level of trust with your group that only comes with sharing a portion of yourself. Click To Tweet
It's the only way you can replicate yourself. You get to that point in your business growth cycle where you move from a mom-and-pop organization, where you're not only checking people out at the register and stacking inventory and purchasing all the materials for your store to going to an enterprise where other people are doing it for you and there's a level of expectation that needs to be met. In order for that to run well and be successful, they need to follow systems and procedures. It's a tough part.
Here's a controversial statement, and I don't know where you fall on the spectrum, but I've come to the conclusion that I'm either reading too much or I'm reading not enough. It's one of those two. In 2015, I started my personal development journey and I would say, “I'm going to try to read one book a month,” just getting my life in order and my head straight. That year I wound up reading an average of one book a week. I read 54 books that year, a tremendous amount and some of them were great. I kept going for a while. I have a stack of books right next to me. Two of them I’m going to recommend to you, but a lot of us can get caught up in that, “I can't get enough. I have to get that next book that's going to give me that 0.25% edge that I'm looking for,” versus going back to that original 53 books and reread the great ones over again and get that down pat.
For example, every year, I read The 7 Habits of Highly Effective People. You can't read that enough. You really can't. It will take you your lifetime to implement just the concepts in that book. I can give you a dozen other ones, at least, that are just as profound. We need to be careful that the next best thing isn't necessarily around the corner and isn't necessarily in that next book that somebody recommends, although I'm about to recommend two books. We have that schizophrenic thing of, “I'm either reading too much or I'm not reading enough.” Do you ever get that feeling?
Yes. I listened to a podcast about 1 year and 1.5 years maybe. A really smart guy and he said, “I'm not impressed anymore with the number of books that people read. In an ideal world, I would rather recognize someone for the few books that were read and fully implemented.” If I were to turn the tables on you, Stephen, of those 54 books, did you implement at least 54 concepts that year into your business? If someone were to read one that's chockfull of stuff that you could implement, let’s say Traction by Gino Wickman.
I know plenty of people that have read it, but when I go back and say, “Have you considered an organizational chart for your organization? What is the structure of your business?” They're like, “I don't know what you're talking about.” Let's go back to page 96 of Traction, which I know you read and he gives you some examples of organizational charts. A business owner could read Traction and take a full year to implement all that stuff or Clockwork where he talks about making videos. The whole concept behind the book is to get to a four-week vacation where you have no connection to the business. In the end, he gives you guidelines for what you need to do at months 18, 16, 12, 8, as you're getting closer and closer to your vacation. If you took the concepts of that and implemented them, that's the only book you need to read during the year business-wise. You focus on some of those things. Maybe it doesn't take twelve months but if you read less and focus more on implementation, probably it would be better for your business and you as a CEO.
You got to wonder sometimes when you come in with all these fresh new ideas when you come back from reading that course or taking that Tony Robbins thing or whatever, the next thing your know your staff is feeling whipstalled because you're coming in and you're changing everything up. Sometimes, I think you got to stick with your knitting. The next concept, you must do less, in general. As a business owner, you should be doing less. The problem that happens to all of us is because you can do everything, it doesn't mean you should do everything. You remember back in the day, you could do it all. You can document, you can treat, you could clean the bathroom, you could write a policy or you could do that schedule. What happens and what you're doing is you're diluting your focus. The best thing that you can do for everybody is to do less and do those fewer things better. It's a very hard lesson to learn.
What your team members want from you is they want leadership and guidance. They don't want you to come in and clean the bathrooms and treat patients. Even though you might feel like you're not pulling your weight, that's not true at all. What they want is leadership. What does that look like? It means implementing a sound policy, procedure and structure. They might kick back and the people who aren't aligned with your business will kick back against the implementation of structure and procedure. They will self-select and you'll get rid of them and you'll find better people. They want better people around them. They want someone to be the head of culture and generating a culture in their business. They want someone who's looking forward and saying, “We've got vacations coming up in eight weeks. What are we going to do so that's not a hiccup to our business? Let's make this all smooth.”
They want someone who's going to recognize them when they do well, reward them when they do well. They also want someone who's going to hold them accountable when they are falling out of line. Whether they know it or not, they need someone to guide them directly. They want that. If we're doing less, we're doing more of those things that they want. That’s the tough part is as PTs, we've spent how many years through schooling, recognizing that, “I hammer this one nail and I get paid for it. I treat patients and I get paid.”
Even when you start your clinic and you're the alone therapist, “I treat a patient, I get paid.” I'm coming in as a coach and telling you, stop treating patients and you'll get paid more. They're like, “Hold on, I just spent the last twenty-plus years of my schooling and education in my life to learn that I hammer this nail and I get paid. Now, what am I going to do? I'm not a therapist anymore? That's what I've been working the past years trying to do. What am I then? How do I have value and where do I find my worth?” There's a mindset shift that has to change for most owners to get to that point where they recognize that they're more valuable doing what the business needs and not treating patients.
That is excellent and it is a mindset. Sometimes when you feel that you can't pull yourself out of clinical care, there is a mindset there, there's a reason that it happens. Some of it is based on fear, to be honest with you because people are wrapped up in their identity in what they've been doing. They don't realize they have a higher calling and they can help more people if they would train other people to hammer the nail.
The fear is legitimate because part of it is, “What am I going to do with my time now?” Because they don't know what to do. No one's taught them how to be an executive or an administrator, “I'll pay my bills and I'll look at some numbers, but then what?” Once they start recognizing how much the business wants them to work on it, then they start recognizing the plethora of things that they have to work on and then it tips the scales and like, “I've got too much to do. I need to start prioritizing.” There is a fear initial thought like, “If I have all that time, what am I going to do? How am I going to be valuable?”
That goes from a mindset where you exchange your time for money versus when you exchange value for money. If you have a lot of value, the time has nothing to do with the value. The last point about how to be a better CEO is to use the WAIT method, Why Am I Talking? That's what that stands for. As an owner, you walk into that room, you can take a bowl of oxygen into your way or the highway and you can pretty much dictate how things go. Because you like to get things done, GSD, Get Stuff Done, that's at least how I call it, you just go in a bowl in a China shop and you get it done. What happens is you make everybody stop. You keep people from being their personal best and bring a perspective that you need. Start every meeting, write the word WAIT down in front of you on a piece of paper.
This conversation reminded me of a quote from a guy that does something called Mind Your Business Podcast. The quote he said was, “When you value your time more than money, you'll have more of both.”
That's one to meditate on.
Going back to what you initially said that you need to do less or recognize that when you value your time more than money, you'll have more of both. Because you're going to use your time wisely at that point. The American mentality is to work hard, work long, and it pays off. Whereas that's not the society we live in nowadays. It worked well up until 2000 or so, but now in the information age, your value comes more from what you provide as a leader than it does as a worker.
With that said, let's get into the controversial part of the show, the future of orthopedic outpatient PT. I want to start a ground rule with what my dad told me, which is your most important function as a CEO and as an executive is to think. These statements are designed to make you think. It's a little bit controversial. I may believe this stuff, I may not, but it's designed to make you think. In general, we're steadily losing our edge in the marketplace as PTs. We are putting obstacles in our customer's way to use us by our own mindset and the way it's been done in the past. The marketplace is different now. The reality is we all as customers, as consumers, all want a combination of good, fast and cheap. As PTs, we should offer two of those unapologetically. There should be good and fast, good and cheap, cheap and fast.
If you want next-level business smarts, offer your customers to pick what option they want. If somebody walks into my office and they have an acutely sprained ankle, they want a fast. That's all they want. “I got to get in now.” Somebody calls in and says, “I want to be treated by Nathan and only Nathan." "Nathan's first appointment is two weeks from now." They're choosing good over fast. If someone wants cheap, "I don't want any out-of-pocket expense at all." "Here's the list of exercises. See you later." It's not going to be good and it's not going to be fast, but maybe you need to start thinking like a business owner of can you offer people that choice and you do it in a diplomatic way, you have to send the message correctly. We need to start thinking like that as physical therapists in delivering services because we are losing market share. Not a lot of people say this in public but I will. Why not? We're losing market share to pretty people on YouTube and TikTok who look good in a bathing suit because they're telling a better story than we are. They're telling a story better than we are as physical therapists. We don't even know how to tell our own story the right way. That is, “What's your customer wants? Not being able to tell your story well is how a business dies.
We're starting to see that, I believe, in all of the things that make people outraged when they see, “Did you see that guy on YouTube who was telling me how to fix my back pain fast and he wasn't even a PT. He didn't even have any medical background than I do.” Guess what? He removed all obstacles to his customer and he wins, you lose. We need to start thinking differently as PTs. You need to find out what your customer wants and give it to them. I'll tell you a funny story. Back in the day when I was treating people and it will be at the end of the day and they were coming in for a bad neck or whatever.
She would say to me, “When you put me on that heat, my neck, it feels so good. I would pay you just to put that on.” After about twenty years of hearing that, it finally dawned on me what if you did offer then to somebody? What if you said, “You come in here, I'm going to put you on heat. I'm going to put you on the heat for fifteen minutes and we’ll close the lights off. You're going to lie here in a dark room. Your husband can't call you, your kids can't talk to you. You can basically take a nap if you wanted. We thought that was the funniest, goofiest thing until I put a name on it.
We started a napatorium and people paid for it. You might say, “You're crazy, you're unprofessional, you're cheapening this profession.” You know what? That's $15 or $20 cash that we didn't have before. That's how a business adapts and survives. For people who say, “I'm done with physical therapy. I wouldn't get stretched out. I love it when you stretch me out.” We started a Stretch-N-Go program where we charge cash for people to get stretched out. We've doubled that line of business since January because we put a funny name on it, but we gave people what they wanted and we presented it in a very clear way. If physical therapists don't start thinking like that because people don't search for physical therapy, they search for, “I want my back pain to go away. Who can help me make my back pain go away?”
No one wants to go to physical therapy.
I don't even know how to describe physical therapy and I'm a physical therapist.
They may still mistake us with chiropractors and massage therapists after how many decades. What's interesting to your point that came across my mind this week as I read the Impact Magazine and recalled something that a mentor of ours said 6, 8 years ago. This is a guy who owns large multiple practices. He's a chiropractor that owns large medical practices that include chiro and diagnostics, all the bells and whistles under one roof and has done very well. In fact, he even owns an insurance company. He said, “FYI, do you guys know that physical therapy as you know is not going to exist in another couple of decades?” I'm like, “What?” He said, “It takes too long to take that time out of someone's day and you have to come too often and people want it done quicker, faster and cheaper.” I thought he was silly but I could see what he was saying.
Lo and behold, I read something in June '21 Impact Magazine. Someone referred to Telehealth and referenced, and I'm counting this to be true, but studies are showing that some of the TelePT services are getting similar results to physical therapy services. Why would insurance companies pay for someone to go to a clinic anymore? If they had a slew of physical therapists in a call center during TelePT, why bother sending someone to a brick and mortar?It’s okay to ask questions because you don’t have all the answers in the world. Click To Tweet
That hurts your feelings, doesn't it, as a physical therapist? Honestly, the marketplace doesn't care.
It's going to go that way. It also had a great article about concierge PT and it provides some concierge services. It blew my mind. I thought, “Why aren't we offering discharge patients a monthly subscription to have access to ask us a question 24/7 to our clinics? Say, pay us $20, $25, $50 $100 a month and you'll get 24/7 physical therapy advice consult. You can call about your sprained ankle and you don't have to come into the clinic, we'll FaceTime. You can call about your exercise equipment or, “This flared up, what exercise should I do?” If it goes beyond that, then you say, “I need you to come into the clinic or let's set up a Telehealth evaluation,” and bill their insurance. Outside of that, just have that accessibility. Those concepts came to my mind as I read the magazine this week, and I thought, “Maybe my mentor did have something there.”
That is mind-blowing. For example, I'm assuming that you go to the dentist for regular checkups twice a year. Why do you do that, Nathan? You don't want your teeth to fall out. Why don't physical therapists give twice-a-year checkups for the musculoskeletal system and charge people $200 to do that? Not everybody cares about that but that's okay. You don't have to have everybody. You just have that segment that values what you're offering. At my age, I will definitely value that. If you can look me over twice a year and tell me the things that I need to work on because my right shoulder and internal rotation are getting tighter. My left gluteus medius is weak and you're going to give me a specific exercise, I'm going to pay you $200 for that. That's something that we should be thinking of.
In addition, cash-based services. There is nothing wrong with that. It was drilled into my head that as a PT, you do not make recommendations on equipment, you do not sell equipment, you do not sell anything for cash, it's all through insurance. Honest to goodness, that is like walking into McDonald's buying a hamburger and then refusing to sell you the French fries. That's like, “I'm going to take a big Mac.” They're going to go, “You can get French fries, but why don't you go down the street to get those, because they're a little bit cheaper.” You’re like, “What?” That's what we do as physical therapists all the time. Shouldn't I know what the best pillow is for your neck? Shouldn't I know what bed is good for your back versus the MyPillow guy? We're going to get out of control if we keep going. Let's finish this with a couple of good books that I think are good. Are you ready?
I want to know.
Who Not How by Dan Sullivan and Benjamin Hardy.
Most influential book I've read in years. There's my impact filter. I've never shared books before. I've shared at least fifteen copies of that book.
That book is super good because it changes your mindset from thinking not how am I going to do it, but who am I going to get to do this. Because you don't do your taxes, do you? You get your accountant to do it because they're better at that than you. You're paying him for a result and that's not going to jail. That's painful. That's the book in a nutshell, but you should read it. Everybody should read it, I think.
I've even thought about doing a whole show about it.
You should. That's excellent. The other one that I like lately is Business Made Simple by Donald Miller. You might say to yourself, “You've been in business for 30 years, what the heck you reading a book called business made simple?” Even after 30 years, you should be open to learning some things. The thing that I love about Business Made Simple is this other book, Building a StoryBrand. It is making your customer the hero of the story, not you. You're the guy. There's a separate show. That book really puts your thinking upside down and you look at all your marketing a different way after you read that and you understand the concept of how customers respond to that message.
I love both of those books. The one I'm excited about right now is called Effortless by Greg McKeown. He had a bestseller called Essentialism a few years ago and then I heard him on Tim Ferriss’ podcasts. It’s a great book, great ideas. He's not going to give you a lot of nuts and bolts like the Who Not How but, I love Effortless and the importance of finding those things that are easier for you and letting go of some of the other things. For example, starting from ground zero and building up instead of saying, “Look at this complex issue, how can we simplify it?” Start with, “What is the minimum viable product we've got to achieve and how do we get from point A to point B with the least amount of steps?” Essentially, that's Effortless in a nutshell.
It's a great non-trivial exercise when you recommend a book to be able to synthesize the major points because it forces you to distill out of that. What was it about that book? That's a great exercise for somebody to do. It’s to say, “Why am I recommending this book Effortless? What's so good about it?” Also, trying to verbalize that.
It solidifies that in your head.
I hope that you weren't uncomfortable in this show. I think you did very well.
I'm not uncomfortable at all. It's always great having you on. You're always going to throw me for a curve somehow.
Seriously, you had no idea what I was going to talk about. That was real, authentic interaction and that's super valuable. As someone who values their time, that's why you tune in to a show like yours because you know it’s going to be authentic and you're going to get genuine value out of it.
The last question I have for you is how do I title this episode? You left me in a lurch. We covered a ton of stuff.
You'll come up with something. Don't miss this episode no matter what. I hope this discussion spurred some thoughts in your readers and they will reach out to you, either on your Facebook page or the email, and start a dialogue. That's what we as PT owners need more of. That is some cutting-edge thought to open up our minds.
I always love it when the audience emails me simple questions, business questions, maybe we'll hop on a call if necessary via email. I love seeing the interactions that people have had on the Facebook group, people coming from different backgrounds, but also with different questions that aren't necessarily for me like, “What do you do about this?” To see other people in the group respond to them gives me some fulfillment.
You're definitely doing what you should be doing. This is your ministry.
Stephen, thanks so much for your time. If people wanted to make you part of their network, how would they do that? Are you willing to share your contact info?
They can search for me on LinkedIn, they can email me directly. I'm one of those crazy Italians, so I have a long last name. It's SRapposelli@PPTAndFitness.com. I'm hoping nobody wrote that down correctly, but if they do, they can reach me that way. I'm always happy to help anybody. I've got nothing to sell, but I'm hoping we can move the profession forward. That's what it's all about.
Thanks for your time. I appreciate you taking the time.
I'm always a better man after I speak to you, Nathan.
Stephen opened his private practice in Delaware in 1992, at the tender age of 26, because he was told by his former employer that he couldn’t afford to buy into that existing business. He has since grown to 3 clinics and has been voted best PT business in his state for numerous years.
He also serves as Vice President of the Delaware PT Association, as well as sitting on the IMPACT editorial board. Stephen plans on devoting the rest of his career to promoting independent practices across the country.
Love the show? Subscribe, rate, review, and share!
Join the Physical Therapy Owners Club today:
Many people have given up or temporarily set aside their formula for success when the pandemic hit, putting a halt to their professional growth. But even with such a huge obstacle in front of you, should you really stop moving forward? Adam Robin, PT, DPT is proof that you can achieve your goals even when faced with a pandemic that threatens to derail your business. Adam recognized early in his ownership that he needed help and guidance to become a better owner, and so he focused on getting a coach and implementing the things he read about in business books. Since then, he's moved out of treating, hired more people to implement his procedure, and looking forward to expansion. In this discussion with Nathan Shields, learn how Adam's constant desire for progress allowed him to make a successful career transition.
My guest is Adam Robin, physical therapist, Owner of Southern Physical Therapy in Picayune, Mississippi. Thanks for joining me, Adam. I appreciate it.
Thanks a lot, Nathan. I’m super excited to be here. I’m looking forward to the conversation.
I brought you on because you've had a ton of success over 2020, especially in spite of the pandemic, you've been able to achieve a number of goals. Not necessarily because in your area you haven't had been hit by the pandemic, but in spite of being hit by the pandemic, you've been able to still do what you wanted to achieve in 2020. I want to pick your brain a little bit about it. What are some of the successful actions that you had, some items you can share because the whole idea behind the show is to be a resource for other PT owners? Maybe you can be an inspiration and support for the readers. Before we get into that, Adam, go ahead and share with us a little bit about what got you to this point in your professional history? How long have you been an owner?
I’m thankful to be here, Nathan. I don't know if you remember, but the first few weeks in our coaching relationship, I remember telling you, “I'm going to be on your show one day.” I put it out in the atmosphere. Here we are. I live in Picayune, Mississippi. I'm from New Orleans, Louisiana. I love to work. I'm a hard-working guy and graduated from PT school in 2017 through my passions for health and fitness. After PT school, I hit the ground running. I wanted to do more than the average bear. I didn't know what that meant at the time. It meant work harder.
That's what I did. I worked harder. I had a full-time job. I picked up a home-health job on the side, working as many hours a week as I possibly could. That work ethic carried me through to eventually opening up Southern Physical Therapy Clinic in late 2019. It was two years after graduation. After about a year into that, I quickly realized that I didn't know how to run a business. I had to work hard, but I didn't know how to gain control over the chaos that is business. A lot of my fears and insecurities built up to a place where I didn't have an option. I had to reach out and get some help. I found you through the show and the rest is history.
You've been a coaching client of mine. What was interesting about you is number one, you started early. There are very few owners that I've come across that get coaching as soon as you did into your ownership lifespan. Usually, it takes a number of years for people to get their feet underneath them and they're working hard or maybe they get to the point of burnout, a decade or two into ownership or they say, “I can't keep doing this. I want to do something else.” The cool thing about your story is that you reached out for a coach early on. Maybe you knew it from reading the show before, but that is the formula for success.
You recognizing that number one, you need to reach out and get some help. Number two, you need to get step out of treating full-time in order to run your business and number three, start networking. Since you started that path, that's when things started to align for you and you could achieve your goals. Reaching out and getting a coach, was that something that you had thought about even before getting into ownership that, “At some point, I'm going to need some guidance,” or did it take some rough patches in your ownership to recognize that you needed help?
Definitely, some rough patches. I wouldn't say they were rougher in my head than they were because everything's rough and you don't know what you're doing. You're wandering around like a chicken with your head cut off, don't know what's going on. Everything's overly dramatized. You don't have that clarity and focus that control that you need to stay composed and make strategic decisions. I was an anxious mess and I knew that I couldn't sustain it. I have a good friend of mine who is a nutrition coach. I reached out to him initially. I got his perspective on coaching, and this and that. His mentorship on that subject along with my understanding that I needed to learn more, those two things combined led me to give you the call. I called several coaches and lead to our relationship.The growth of any company is directly related to personal growth and understanding. Click To Tweet
What are some of the most successful things you've done to help you achieve your goals?
My goals have changed in 2020. I used to think that money equals success and that has been a huge mind shift for me, but I can boil it down to two things. Number one, stepping out of treatment to have a little bit of quiet time to be able to think and work on the business was helpful, and being willing to trust that process. Also, embracing the understanding that the growth of the company was going to be directly related to my personal growth and understanding. Diving into learning more about business, leadership, and developing a team, those were the two biggest things if I had to break it down.
Let's back up a little bit because I want to delve into the mindset there. What was it that changed? I’m cut from the same cloth as you are that the money is what equals success. What helped you change that mindset that you had thinking, “If I had more money then I will be successful,” and where are you now along that?
A lot of books, a lot of reading. When you and I first started, I wasn’t into reading. I listened to a lot of podcasts, watched a lot of YouTube, but I didn't grasp the power that reading books could have on your mindset. That is the biggest influencer and being intentional about placing quality information like that in front of me on a consistent basis. Over time, shifted my mindset in a way that gave me a lot of peace, clarity, focus, and understanding. Reading books was the big one.
Were there 1 or 2 books in particular that you recall being impactful?
Getting control of my team was a big one. Leadership and Self-Deception was a huge leadership book for me. Crucial Conversations was a huge leadership book for me. The Five Dysfunctions of a Team, The E-Myth Revisited. I can go on and on. I've read all these books. Those were huge.
Think and Grow Rich, was that on the list? Did you read that one too?
That was an older one that I've read before. Those other books helped me tie it together.
It gave you some things and tools to work with, and recognize that leads into where your personal growth equaled company growth. The episode prior to this one is a conversation with Jenna Gourlay about how to have hard conversations with your team. That's not something that we typically learn anywhere. You don't necessarily learn how to have hard conversations in college. You have to read the books, you have to find the coaches to help you have those hard conversations. Having hard conversations can be one of those things that if you improve on that personally, as a leader, then your company is going to improve within. You're addressing the important aspects of the company that needs to be addressed.
People need to be held accountable, need to be taught, need to be buy-in. You have to align purposes and values with those conversations. Your conversation here reminds me of that conversation there because as we grow as leaders and having important conversations is one example of that. Our company will grow as well as we have those hard conversations. Was that something that you had to learn how to be a leader? Is that what you gleaned from a lot of these books and how to act better or did you think that was something that came naturally?
You could call it naturally, but it wouldn't have happened without the reading. You mentioned conversations with other people, but those books also teach you how to have conversations with yourself. Those internal conversations and conflicts that you have with yourself help you organize them, prioritize them and enter your day with a level head, cool, calm, collected, and with an understanding of what you need to accomplish. Having those relationships with your team further develops the culture of your organization. It's a powerful thing.When you start to implement change, not everybody on your team will be on board with it. Click To Tweet
You said one of the other things that you realize is pulling away from treating so that you had the time to work and think about your business. That quiet time became important to you and something that you recognized that you needed. What there something that you noticed that was dramatically different in your thought processes when you weren't treating full-time? I’m wondering if there was a light bulb moment where you said, “Now that I'm not treating it. I'm thinking about these things or I have the time and energy to consider blank.” Did you have any of those light bulb moments?
It was a series of light bulb moments. Being comfortable, stepping out of treatment and quiet time takes practice. The first time you step out and you're sitting in front of your computer with a blank piece of paper, you don't know what to do. You're like, “Now what? I'm sitting in here by myself and what do I do?” Developing that skill takes practice and like anything, the more practice that you have, if you want to be a great PT, you have to practice. You have to go in front of patients, you have to fail, and you have to learn from that, stepping away from treatment and being strategic with your admin time. You have to get in there. You have to be unproductive at first. As you start to learn and develop new skills, you become exponentially better over time, especially when you use that time to learn how to leverage your team. A series of light bulbs. I still have light bulbs. Every week I'm having light bulbs.
Was there ever a time that when you were going into patient care, “Thinking this is a waste of my time?”
I wouldn't say a complete waste of my time, but I did feel that it wasn't quite aligned with my true purpose at times. I love treating and I love helping people. That is why I ultimately decided to go into business for myself. I do know that if you want to be a business owner and your purpose is to truly make a large impact, something that's larger than yourself, that you can have a sense of burnout and mental fatigue when you have too much treatment time on your plate. You're not fulfilling your purpose when you're sitting there one on one with somebody. It's fun. It's not something you want to lose contact with, but you can't truly make the impact that you want if you're stuck in that bubble.
What were some of the hardest things you had to deal with in achieving your goals in 2020?
I had to go through a few things. A lot of change in the way that I led and the way that we organized our efforts as a team. One lesson that I had to learn is that when you start to implement change, that not everybody on your team is going to be on board with it. You're going to lose people and that's a hard thing to do. I had to go through that about 2 or 3 times over the course of six months, but like everything, the more you do it, the better you get at it.
It reminds me of the old adage, “The people that got you here are not the people that are going to get you there.” The people that you have at this time served a great purpose and you appreciate them, but as you change and implement you grow and as you start implementing policy and procedures, I've seen it time and time again, it weeds people out for one reason or another. Either they act up or you find out that they're not a fit and they have to move on. As you get more clear about how you do things, and as you start creating that culture and refining it, and becoming clear about your purpose and living to the values, some people start getting weeded out, but you start attracting the right people.
Those people are the ones that are going to get you to the next level and who's to say, if they're going to get you to the next level beyond that? They're going to get you to the next level of where your company needs to go. It's an inevitable part of changes that you're simply going to lose people. Some people don't like the structure that might be put into place. They want to say, “We're becoming too corporate. You're too focused on the numbers if you start bringing up data and looking at your statistics,” but it's in the best interest of the business. Therefore, you have to remember that and move forward. I've seen it time and time again. It happens all the time. Once you become clear on your purpose and values, and you start pushing that, once you started implementing procedure, implementing structure and statistics, inevitably people start falling off that wagon. You've noticed, as you becoming a better interviewer and a better recruiter, you start finding the right people.
You found understanding and whatever it is that you're working on at a time, whether it be numbers or whatever, then you can immediately implement that in your new hire. They become exponentially better than the one that left you.
That's their normal, they don't know any different. Is there anything that you would have done differently in 2020? You achieved all these goals. You did some great things and we didn't even allude to the goals that you have achieved in 2021, but what would you have done differently?
I hadn't sat back and thought in-depth about that. Stepping out of treatment sooner is always good. “Get out of treatment. You got to.” I was a little bit resistant in that regard, finding a coach sooner.It is a huge thing to identify your biggest problems and create systems that solve them instantaneously. Click To Tweet
You can do it quickly, to begin with.
It's been such a transformation in 2021 for me and in the business that it's hard to imagine me doing anything different because it's been so rewarding. All I can say is that I wish that it would have been sooner.
You stepped out of patient care. Before we started the show, you started telling me some of the issues that you're having, pandemic related, and people falling off the wagon. Without your issues, it's not blue sky, easy sailing, but what is your focus on where you're at?
To paint a quick picture of where I was before, I was treating in the clinic full-time with a PTA. I was completely overloaded with treatment, overwhelmed, and didn't have much. I am not even on the schedule anymore. I have hired 2 PTs full-time, 3 PTA's in the clinic, 2 front office admin staff, and we're looking to hire a third. It’s a huge transformation. I work from home a lot. I work remotely. I meet with my team and my focus is on empowering them in whatever it is that they're trying to accomplish. I help them understand some of the things that I've learned to understand so that they can be better at what they do.
What does that mean to empower them? What exactly are you doing to empower your team? I agree, the next step to most people's growth as they're stepping out, developing policy and procedure, and developing leadership teams is the next step, if that's where you want to go. If you want to expand, if you want a bigger clinic, that's not dependent upon you, or if you want another clinic outside of the place where you exist, you have to get the right people in place. What are some of the tools that you're using to empower them?
Policy and procedure are huge, dialing that in and becoming obsessed with your policy and procedure to understand that's your problem-solving template, period. Identifying the biggest problems that there are in the company, the ones that give you the biggest headache, and creating systems that solve that instantaneously, is huge. Also, instilling that understanding into your team that this is the policy and why it's the policy, and then providing tools, whether that be checklists or systems or reports that they can utilize to hold themselves accountable. All the while, you’re helping them understand the purpose of why we're doing what we're doing. That is empowering the team. They become more efficient and more effective. They have a fulfilling place to work and they enjoy their work more. Results come.
I still remember that from an episode with Roland Cochrun. He is a guy in Oregon who travels the world, still checks in with his physical therapy clinics, and they are successful because his sole mindset is to create a foundation for which his employees can succeed. Whatever he does is for that purpose. That is policy and procedure, reports, statistics to monitor and what to do when they're going up, what to do when they're going down. He's got this all dialed in. It is all meant to empower his team.
That’s exactly what you said there, empower other people to do it, and the effect you can have in doing that becomes multiplied exponentially. Your effectiveness as a provider is one-on-one and it's that one patient that you work with every 30 minutes, but now if you empower a number of providers, now you've multiplied your effect. You've multiplied your purpose beyond yourself doing the work. That's the next step. Do you have them reading some of your same books as well or are you sharing YouTube snippets and inspirational things like that?
With some of the members of the leadership team, we talk about books and ideals, some of that we want to hold true to the company that is from the books. I do a lot of teaching and coaching, especially when there's a problem that I helped them solve. I use the principles that I've learned in the books. I don't necessarily reference that directly to them, but that's my understanding.
That's part of it. Empowering them is coaching them like you needed a coach, they need coaches as well. Younger and older business, the team members, the employees on your team value that. They look for someone who's going to be a mentor in one way or another, whether that's a mentor from a physical therapy standpoint or a mentor from a leadership standpoint. They want someone who's going to help them learn and grow. No one wants to stay still and continue to do the same thing they were doing, hoping that someone recognizes what they're doing and no place to go if there were any issues or concerns. That's one of our jobs as leaders is then is to focus on coaching our team underneath us. Looking forward, are there any books now that you're reading?
It makes it easier. It gives you a step-by-step process. You can into any meeting and you can ask this set of questions, almost resolving any problem that comes up against you by using that little template. The Coaching Habit is great. Thanks for sharing your time with us. Anything else you want to share with the audience?
If you're not just a physical therapist, but a young business owner, if you're feeling overwhelmed or there's something that you're missing, I would highly recommend a coach. I would highly recommend investing in your education, find somebody who has done what you want to do, and that knows more than you do, and seek their guidance, and you will come away a much happier and fulfilled business owner.
Reach out, step out, network. That's the formula. If you got it done, you would achieve some great things in 2020. Congratulations. I look forward to seeing what you're able to achieve in 2021 too because I know you have big plans. I see great things from Southern Physical Therapy. Thanks for your time, Adam. I appreciate it.
Love the show? Subscribe, rate, review, and share!
The COVID-19 pandemic has turned the world upside down, forcing many of us to leave behind our old ways and adapt to the new norm. Speaking for those in the PT industry as we are in the thick of it, Nathan Shields takes us into his follow-up episode with Avi Zinn, PT, DPT, OCS, the owner of Druid Hills PT. Here, we get the chance to see how Avi worked through the COVID-19 pandemic, how his coach helped him through it, what dramatic changes he made, and what he's looking forward to now that they're scaling back up. Don't miss out on this conversation as it leaves great insights into navigating through these uncertain times without being left behind.
This is episode three of my reality series with Avi Zinn, the Owner of Druid Hills PT. We're following along the course with Avi, as he has decided to take on coaching in this practice. Not particularly with me, but we want to follow along and see how coaches helped him as an owner so you can get an idea of what a coach or consultant might do for you as an owner as well. It is cool to see the growth of a relatively new owner. You've been an owner for how long now, Avi?
This is for a few years now, Nathan. I’m pretty new.
I usually recommend people get their feet underneath them maybe for a year or so, and then maybe reach out to a coach or consultant at that time after they've gotten someone established. They can start earlier, but I thought it might be interesting to follow along on your journey here as you're doing the coaching. Thanks for joining us again, Avi. We have time to catch up on. I looked at our notes and the last time we spoke was March 6th, 2020, and the episode released on March 24th, 2020. We all know that March was like the hailstorm of the COVID-19 pandemic. I don't think we even touched base on it. It might not have even been thought of in our minds last time we spoke.
I don't think it was at all.
We didn't even make reference to it. One of the previous episodes was about telehealth and COVID-19 if you need to do that. The one right after you was how to save your business financially with Eric Miller, which had a ton of views on my show. We were right in the thick of it. Tell us a little bit about what happened with your clinic, with COVID, and the surrounding area with your business.
First of all, thanks for having me back. It's always fun doing this. When we did our last episode, it was before anything happened in the States. Right around that time, I was speaking with someone, a friend, a chiropractor, she was anticipating closing down because of Coronavirus. I thought that she was crazy. Why would it even be a thing? Three weeks later, it all went down. In the middle of March, probably right after our episode, when things were starting to get intense, I made the decision to close the office to in-person visits.
Lots of people stayed open. Some people didn't. For me, it felt like that was the thing that we needed to do. We’ve pushed over to telehealth. I believe I listened, if not before, at least after to that interview you did with Daniel. I did reach out to him and talked to him a little bit to see if he could give me some advice on it. We did switch over to telehealth probably from March through sometime in June, we were doing mostly telehealth. We did have a few patients stay on. Even from the beginning, we didn't close 100% because there were like four patients that were post-op. We made the decision that we would keep them in the office, but no one else. There were four patients coming and the rest of the visits were telehealth. We had to pivot and figure it all out.
Out of curiosity, how did telehealth do for you? I know some people tried it. Some people had some success, some people didn't.
Honestly, to the credit of my team, the PTs, and the front desk, they made it work. They were able to transition to it quickly and got it going. Our caseload, for sure, dropped probably like 50% or so, maybe a little less even. For March through sometime in June 2020, we were full with telehealth and we were treating and the PTs were figuring it out as we went along how to treat differently because it's not the same. They were seeing results and people were continuing to make follow-up visits. Even a lot of the patients that were right before COVID continued until their plan of care and they were discharged through telehealth. It was all to the credit of my team. I pretty much removed myself from treating and they did it all. They figured it out and it was impressive to watch them do that.
That's super cool because what I came up against, as I've talked to clients who are trying to implement telehealth, is that they had a hard time convincing the patients that it was going to be beneficial. The patients lost that connection or were skeptical about its capabilities and the results that they would get with telehealth. What were your people able to say to convince patients that this was okay and they were going to still get results?
I think it was more of like, “This is what we've got. This is what we're working with. This is what the world is now.”
This is better than nothing.
Yes, but in a more positive spin on it. Not better than nothing, it's almost as good. It just doesn't have a few components. If you have to think of it differently, most of the stuff we can still get accomplished. Maybe a little bit we can't because we can't do some of the manual stuff, but we can still do this. A lot of PT anyway is trying to talk through a lot of these problems with our patients. You're a PT and most of the time are simple as far as what to do, but it's how to figure out to get them to understand, be committed, and know that they have to commit and they have to do these things. A lot of times, it's not the manual treatment that's going to get them better. It's talking them through things.
You can do that with telehealth. I don't know why that worked better than some other people had. I know some other people didn't have luck with telehealth, but at least, we were able to get people to stay. Who knows? Maybe they liked the practice because a lot of them were continued on patients from before it started. Maybe they were like, “I already got some results from my therapist. I'm already seeing it. Why not continue? If they're telling me it's going to continue to get better, then I believe them because they've already shown me. I've gotten a little bit better already.”
Are you still doing some telehealth?
We are, but very little. We're back to probably 90% or something in-person. There still are some telehealth visits. What's nice though and that's something that moving forward after all this goes back to some kind of normal. I would love to be able to keep telehealth as part of the practice. Forget about Coronavirus, let's say someone has got to stay home with their kids because they're sick or something. It's a good option for people to have like, “This week, I'm not going to be able to make it into the office, but at least, we can still touch base and do some of the treatment through telehealth.” Hopefully, we can keep that.
If someone's on vacation or something like that, they could still call-in. They don't want to on vacation, but there are extenuating circumstances in which you can continue to use telehealth and not miss that visit.
Hopefully, we can continue to have that as part of our practice and the whole world will continue. There are many opportunities now that we all can take and we all are. Besides PT, this is for everyone. I've got kids. Our kids had to do remote learning and everyone and my wife is working from home. This whole world is figuring out how to do this stuff remotely and hopefully, we'll all see that. Some of this could be more of a benefit than not and we hope to use that to make things more effective or more efficient.
I think telehealth can change a part of our practice if we are intentional about using it. You mentioned that you transitioned out of patient care. Were you still seeing patients a little bit back around that time and were transitioning out fully or had you been out of patient care by that time?
I had been treating still. I've always been trying to reduce my treating hours. That was one of the first goals of coaching was to reduce. I don't know if I ever thought I would have to completely take myself out, but I always knew I had to do less treating. Once this all started, it was like, “There is so much that I need to deal with now, I cannot be treating.” Almost overnight with Coronavirus, I was treating and then I was down to no treating. It was good for me because if it wasn't for something like this, maybe I would have always reduced my hours a little bit, but maybe I would never go fully out to zero treatings. That force me out, which I'm not saying I won't go back ever, but it's clear to me that I need to not be treating and focus on all the other stuff of the business.
It's interesting that you pivoted in that direction because I've talked to plenty of clients who didn't have the telehealth success that you had, but they let go of a number of their team members to the point where they had to treat. I love the fact that you saw it not as the owner and as a leader that, “I can't afford to treat. I need to focus on the business and pivoting us to a point where we can stay afloat until things get back to normal.” Whereas, a lot of owners have the mentality that I need to let everybody go and do this all myself. It's interesting that you gained that mentality that your ownership and leadership in the business is more important than you treating patients. That's a cool mindset that you had. Over the course of time, you gradually pulled yourself out of treatment. Did you start with half days or full days here and there to gradually work your way down to the point where you were before COVID?
I don't remember exactly, but it was reducing hours. There would be half days because I was also doing billing. At some point, I also had not to treat certain hours so that I could take care of the billing. Once I was more proactively reducing my treating hours, I was maybe chunking time every Monday, Wednesday, and Friday morning. The rest of the time I'll do billing and other business stuff and slowly reducing to maybe just Tuesday and Thursday. When I was treating, I was trying to at least have two days a week so that if someone needed to come in more than once a week, I can still see them. I was slowly reducing hours and trying to make it an efficient way to do that. I would chunk times where I'd be treating some, but the rest of the time would be more business stuff.
There's a concern with some owners that I talked to that the team around them is going to look at them oddly or think differently of them if they're not treating and they're pulling themselves out to work on the business. Did you have any pushback from your team or did you have to explain yourself to them very much?
I did not get any pushback from my team. I didn't have to explain myself, but I often felt like I should. That might be a common experience that owners have when they start pulling themselves out that they have to justify what they're doing. I think I'm lucky that I believe my team knows that I'm still working even if I'm not treating or at the office. It's clear that I'm still doing a lot of stuff. I don't think that they feel that way but I could be wrong.
I know that's a fear that comes up often. Maybe it's an unrealized fear, but it's something that within the owners that I talked to. I went through it myself. “What are they going to think about me when I'm sitting back in my office? What if I'm not here for hours at a time between 7:00 AM and 6:00 PM, what are they going to think about me? I need to at least show my face and step foot in the clinic.” I think those are fears that often go unrealized. I'm glad to hear that you had a similar experience that it wasn't all that difficult and there wasn't a lot of pushback at all. They understand. Tell us a little bit about what your coach has done with you during the course of the pandemic? How did your coach help you through those few months?
I'll give a little bit of background on the coach. It's part of a group. There's coaching. I get one coach and we have bi-monthly calls. In addition to that, there are quarterly workshops. There was a workshop on March 18th and that got switched over to a virtual workshop. I think we closed our doors the day before or something and there was a workshop which was good timing because we all got together. We were able to talk about all the issues. I would say the first thing that we talked about was to focus on yourself. Focus on making sure you're safe. Not necessarily safe from Coronavirus, but safe financially, knowing that you have some type of a line of credit or emergency fund. First, look over the numbers and make sure you know what's going on.
You had Eric Miller on a while back and he was talking about profit first and money management system. I started reading and implementing some of the practices. Even before this all happened, I was already creating some small type of emergency fund. When this all happened, I didn't have to stress immediately. It wasn't like it was stress-free, but I had a little bit of reserve that I was setting aside. You need that because of something like this. That was very helpful. The second thing that we talked about at that workshop was after you first look at yourself and your finances and the business, and make sure you're safe, then make your team feel safe.
I talk to them about, “I've got this emergency fund. I'm applying to the PPP. This is how I think we're going to do things,” to make sure that they know that their job is secure or how we're going to proceed with that. Those two were big because I wouldn't have known to do that. Having that guidance and the ability to talk it through with other people in the same situation was huge. There was one other thing that I can't remember. There was another main point that I remember from that initial workshop. After that, moving forward, I still had my calls with my coach. Before Coronavirus, we'd probably talk more about strategic stuff and how to fix operating procedures. Now is more of like, “Let's take this week by week and figure out what we need to deal with.” If there's something that comes up and how to do anything, how to feel you’re not so overwhelmed that the business needs to close down.
It was interesting talking to clients because no longer were we talking about KPIs and your stats so much that we normally would have. Those were out the window or implementing new programs and stuff like that. Things change week to week. You weren't quite sure what was up and what was down. You handled it as it came up very much more reactive to the situation. You would talk about, how are you doing with the funds? How are you doing yourself? I also stressed more with my clients, maybe considering what are you going to do differently when you open up? What are the things you would consider changing? Are you going to bring all your team back or just those who are well aligned with you? Over that time, did you work on your business quite a bit, thinking forward, like, “When I open up, I'm going to do things differently,” or were you so ingrained that you had to deal with the day-to-day?
That was the third thing and you’ve been saying that in the show. It was like, “Take this time as a reboot and focus on your business and think about what you could be different and what you could improve.” Thankfully, I got the PPP funds early on. Once I got that, it made everything a lot less stressful. We're able to focus on the business. I did focus on the business a lot. One of the things I wanted to do for a long time was to get a billing company or hire someone to do billing.
It didn't make sense to do an in-house and train them. It didn't seem appropriate anymore. I reached out to Will Humphreys after hearing him on your show about how he was starting a billing company. I reached out to him and it seemed like a good fit. I also got in touch with you about it and you said it could be a good fit. We went ahead and that was one of the big changes for me, but also for the business because there were many things that we were doing that probably were inefficient. Having an experienced billing company take over was much better for the business. That was certainly one of the things we did. The other thing since we had a little more time, their caseload was down, we switched to EMR software. That was also a big thing to take over.
Can I ask you what you switched to and from?
We switched from WebPT to Prompt. It is a newer company. They are a young company, but I can see that they're going to continue to develop their software to potentially be the best or one of the best. In full disclosure, I don't think they are the best yet, but I think that they will be or at least better than a lot. I felt it was a good time to change because things were a little slow. Honestly, we had a little bit of time because we've had PPP funds and that's what it's for. I paid my staff and we had a little extra time to learn about our new system. Whereas if it was regular time, it would be overwhelming. You have a full caseload, and to try to switch over to a new EMR software is not a fun thing to do.
It is a huge transition. It is time-consuming, energy-consuming, emotional, and all that kind of stuff. I have to give you kudos for taking the opportunity to make some significant changes in your business. I know you are personally doing the billing, but making that billing decision is huge in and of itself. Maybe we can talk to your mindset as you went through that a little bit, but also changing EMR. Most of us probably know what painstaking process that is. For Prompt, I've had the owners on before. I liked their platform and they're going to do great things because they are quite capable of responding to the needs of the owners. I think it's going to bear fruit and become a great system.
As a side note, I liked the fact that they're focusing on project management or company management in obtaining the data that you need and the KPIs that you're looking for and the reports that you need to manage your business. I like that part because a lot of EMR are lacking when it comes to providing the owners the reports that they need. To go back, what was your mindset? Why didn't you simply hire on an experienced biller and instead bring on a billing company? Even in my experience, I'd usually recommend people have their own billing departments so they can manage it and oversee it immediately and have people that are aligned with them. In your situation, I thought maybe that was a better move for you to hire out. What was your thought process in going with a billing company over hiring someone?
I had a few different thoughts. One was the nature of the global pandemic. I didn't want to take on more risks of hiring someone, take the time to train them, who knows if they get sick, who knows if they're going to be good. I didn't want to add another stress. If I could find an experienced billing company that I know that they're going to do a good job from the beginning and I don't need to train them, it would make it a lot less stressful. I think this helped persuade me a little bit to go with Will and Katie. It’s that Will offered some coaching along with the billing company. Obviously, I'm into the coaching aspect of things. I thought that was cool to get an additional coach out of it.
I think that could have been the thing that tipped the scale. At this point, one of my main reasons is I don't want to have to worry about training, what if they do a bad job, and then I have to start over. The third thing was I just started with them and there's no way to know. I believe from what they showed me, they were going to provide reports, check-in, and tell me all the things that they were working on and what they're collecting. That's what they were all about. “We want to communicate with you as much as possible and perhaps overly communicate to let you know what we're looking at and what we're collecting.” Those are some of the reasons why one would want an in-house so that you can better manage and know what your biller is doing. I got the sense from them that they were going to provide that and stay accountable for what they said they were going to do.
I can see the dilemma that you have there. When you consider bringing on a billing person for the first time, you're taking a big leap of faith that that person has the experience that they can do the things that they say they can do. Add that to your payroll and benefits that you might have to provide and trusting in them to honestly provide you the reports that you need. That's not necessarily even in our wheelhouse. Most owners don't know how to tell if their billing person is doing well. They're relying on the billing person telling them, “We're doing well.” There's always that question in the back of your mind, “How do I know?” You have to go on faith.
In your situation, especially as a small business owner to bring on that one person is a big leap of faith. Whereas if you have the opportunity to go with someone that you can trust, at least you know that they have a ton of experience coming in behind them with billing and PT-specific billing, you don't have to go through the hiring process. You can trust that they know the language, that they know physical therapy, that they know what they're looking at when they're looking at your EMR system, and the financial reports that it pushes out. You don't have to train them on the EMR system at all. All those things can be to your favor, especially as a small clinic owner like you are instead of bringing somebody on. I'm interested to follow along and see how that works out for you, but I'm confident that it will.
I think you would probably know more than anyone else.
I can trust Will and Katie, especially Katie did great things for us in our billing. She was our billing department head. I'm sure they'll do well. It's important that you also take the time and effort like you did to sit down and weigh the pros and cons before you make that decision. You have to put so much emphasis on that money line and make sure that you have full control of it.
The truth is for months, I was putting out job posts for billers. Hiring is hard in general for all the reasons. I was putting it out on Indeed and I was getting thousands of applicants. It was hard to even weed out any of them to determine if they're good or not. Half of them didn't even have any billing experience. I also got burned out from that process too. It was the part where I was like, “I need to hire someone. Here's someone who's going to do a good job.” If it wasn't for me feeling confident that they were going to do a good job, obviously that would be a different story, but I got the sense that they were going to do a good job. They were going to report and communicate. Those are the things that I would want. Maybe it's cheaper, maybe it's not. That wasn't the biggest concern because as much as every dollar matters, especially during these times, I needed to have certain things work well. I needed it to work so that it was worth spending a little bit more. It may not even be a little bit more. It depends.
You've opened up since June 2020 and we're in the middle of July. How have things gone ramping back up? Have you had any hiccups in opening back up or things that have maybe changes that you've made that have worked out well?
Some of the changes were by the very nature of us already being a small clinic. When Coronavirus started, we only had two PTs plus myself. When I removed myself, we had two therapists. The office is set up that we can basically have two areas. We have one PT and their patients on one side of the office and one in a completely separate area, a different room. We tried to follow CDC guidelines and make it safe, clean, and try to set up protocols to prevent as much overlap of patients. Telling them to wear masks, to not come in and wait in the waiting room, all that type of stuff.
Those were the logistical things that we had to figure out. The nature of us, the size of our clinic, it worked to our advantage that it was seamless. Other than that, we were already treating one patient at a time. We didn't have to change our model or anything. For the most part, things were okay with that. It was more trying to come up with protocols. We had someone who called in and said they want to be a patient, but they had a positive Coronavirus test. The question is, at what point are we allowed to let them in? We don't know these things and we have to figure them out as they come along.
Someone calls and said they had Coronavirus. They did test positive, but they're not showing symptoms. Are we okay with that or not? Honestly, I don't think there's the best guidance out there from anywhere. We come up with these policies. We're trying to figure it out. We're consulting with other medical professionals and trying to do the best we can. We're trying to be as safe as possible. We are trying to figure out all those things, but the biggest challenge moving forward is knowing that it's probably going to keep coming up.
Are you getting a lot of your new patients from doctor referrals or our doctors back in your area and treating and referring patients or have you had to change some of your marketing strategies?
Most of our patient referrals are not from doctors. It's hard to say, but I would guess at least half of our patients come new referrals come from direct marketing through Google Ads. To answer your question about the doctors, we don't have very many doctors that consistently send, but a few of them, once they started doing surgeries again, started sending patients. The Google Ads was interesting because from March 2020 through June 2020, the ads were not performing like they used to. That was something we were having to figure out if it was because of Coronavirus. Did Google change something with their analytics? Google did change stuff. Even with getting Google reviews, they weren't posting your reviews right away. If a patient wrote a review, I don't know why they did it exactly. They did some extra process of screening the reviews for whatever reason or maybe they had fewer steps.
We all rely on those reviews. That was interesting to see, but I wonder if they changed something with the ads as well. Whatever it was, we went through this process of testing ads, changing the website, and tracking things differently. Eventually, I think once, people became a little bit less scared to go out in public things, it became a little bit back to normal on the ad side of the thing. It could have been that people weren't wanting to come anymore because no one knew what was going on and people wanted to stay home.
Did you have to change your message much on your Google Ads?
No. Even throughout the time when the ads were running, most of the conversions were coming from the regular ads and not the ones promoting virtual therapy. Even if they were calling to make an appointment through telehealth, they were still clicking on the original ad.
What are your plans going forward as you're looking forward to the end of 2020 and the beginning of 2021? How have your goals changed? What are your projections? What are you thinking is going to happen here towards the end of 2020?
To be honest, my answer is probably the same as it was at the end of the last interview. I'm focusing on my team because I realized more even now than ever how important it is to have such a strong foundation. Foundation doesn't mean that your systems are in place. It means that your team is there and that they're able to function and take the business where it needs to go. Just like I saw, they were able to step up, be super proactive, do the things that we needed to do for our business to survive this. Interestingly enough, we had another workshop at the beginning of July. Before that workshop, I had my first coaching call with Will.
Will recommended that I start reading the book, Start With Why. On the workshop, they started talking about Start With Why, which was cool because then it's a little bit of reassuring that different coaches are talking about the same thing. That's nice to see. Ultimately, coming up with the why and my purpose statement, trying to differentiate that with my vision, our mission statement, and our values. I've been focusing on that because I want to get my team involved. I want to have them help with creating that vision and us all figuring out not just what I want from the visits, but I want to know what they want to get out of it. How are they? Could they be doing more? Do they want to be doing more? What do they want?
That will help us all be even more of a team because we all know exactly with the end in mind, what we're trying to achieve. I want to focus more on my team. Now, I don't know if it's the right time to hire or not. That's the biggest challenge I have. I don't know how to figure that out because who knows, you hire someone and two weeks from now, there's a second wave and everyone shuts down. You have to furlough or lay off and you just hired someone. That might be another stress that I don’t want to deal with. At the same time, I want the business to continue to grow. It's a hard thing to figure out but I do recognize that with the team that I have, they're a great team. I feel that the best thing I could do is invest in them so we all become even stronger. On the other side of this, everything has to be easy after this.
I love that both of your coaches started talking about purpose. Simon Sinek’s TED Talk is one of the more popular ones for a reason. That was many years ago and it’s about Start With Why and he has a book from it. It's super popular as well, but it all comes back to your purpose and making sure you're aligned. That's one of the first things I do then with my clients is to make sure that they have a purpose professionally and recommend that they find one personally as well. Also, incorporate values and getting the team involved with that. In that way, you're aligned and you start working with team members who are value-aligned. You start bringing on more people who are value-aligned and the growth can then accelerate exponentially.
I think you recognize what people who are in alignment with you do for you when troubled times come up. Those people who aren't aligned with you, they would have been the people who were like, “I'm just going to hang out. I'm not going to do as much. There's nothing to do. I can't get these patients to respond.” Whereas your team, thankfully, you've got some great team members who were focused on, “No, we're going to push through this. We're going to get the patients the care that they need. We're going to make this telehealth service thing work.” I think it's a great place to start and focus on your team and making sure you have a firm foundation to build off of. It's awesome to hear that you're heading in that direction. Going forward, what are your goals then for 2021? Are you keeping things at bay for a little bit until you see that we're out of the woods here?
Yes, keeping things at bay, but the next goal is hiring to grow. With some of the things that I've been able to accomplish when it's time to hire, I think we'll be ready. Getting myself out of treating, getting the billing taken care of, we've got the new EMR that we're working on, that we're getting more comfortable with. Personally, without the team, I'm working on the purpose and the vision. The next step would be to do that and try to develop that with them as a team. I think our foundation is going to be super strong.
We can grow exponentially from that. When that happens and also when it feels a little bit, maybe more certain or safer to hire on someone else and take it to the next level. One caveat though, it's also a little bit hard to figure out how to bring on more people. If we're trying to figure out safety protocols and keeping distance, it's hard with the space that you have. If I bring on another PT, where do we put them so that we can still maintain that space between the patients and the other therapist? That's also another hard challenge to figure out. Moving forward, when things slow down a little bit, become a little bit safer, more certain, my next goal is to hire and develop those senior PTs and clinical directors. To give them a little bit more not responsibility, but more overcharge on what they're doing at work and allowing them to also grow the business. Not just for the business, but for themselves professionally as well.
I see the same for you. I think your next step is to gradually get to the point where you're bringing on other people and starting to develop a leadership team. You're doing all the leadership, but for you to move up, you need to start building up people who can take on responsibilities on your behalf and start managing and being responsible for more than treating patients. That's when you start developing the leadership team. A lot of PTs are looking for that opportunity. You're going to be able to provide that for your team and they'll be excited about it. That's a cool next step. It takes some time and some effort, but it looks like that's where you're going.
I'm excited about it. It seems like that's where we're heading almost not just naturally, but also putting in a lot of work to get it there and the coaching and everything. I feel like what you just said, I think that my team wants it too. They want to be doing more and they'll thrive at it.
Congratulations on the changes that you made. What's cool about your story is that looking back, the time that you were shut down sucks, but you took advantage of the opportunity to make some positive changes in your business and going forward, you're optimistic. You can look forward to more changes in the future now that things were somewhat normalized. Also, you seem to be prepared if things don't go back the other direction. You've been through it. You're even better established now. You know what you would need to do if another shutdown occurred. Congratulations on better establishing your business and making some positive moves forward in light of the pandemic. It's cool to catch up with you.
It's always fun talking to you.
We'll catch up again. I’ll talk to you later.
Thank you, Nathan.
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.
Love the show? Subscribe, rate, review, and share!
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.
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.
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.
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.
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.
Love the show? Subscribe, rate, review, and share!
I've got physical therapist Stephen Rapposelli out of Delaware. Stephen owns a number of PT clinics. He is also the Vice President of the Delaware Physical Therapists Association. I came across Stephen because he wrote an article in July 2019’s Impact Magazine about team building via identifying core values. I've talked a number of times about values here and there in the show, in parts of discussions but never had an episode dedicated specifically to that and more specifically how to create and maintain/work-by values that we have in our company. Stephen was awesome in his article in that he broke down exactly what he did to create values for his company.
He and I might agree that it’s probably many years too late. He and I would agree that we should have identified values in our companies much earlier than we did and start hiring, firing, promoting and developing a culture around those values. The transformation that can take place after implementing them and living by your values is transformational and empowering to the employees. You get people who are aligned with you and your purpose. You also weed out those people who aren't aligned. There's nothing wrong with that. That's okay if they don't align. Let's just make sure they are not on our bus and they move on. To be able to select like that can be powerful and puts you in a powerful position, nonetheless, we talk about some of the details of what he did to create the values.
I'll share a little bit about what I did to create values for our company and also how we maintain those values going forward so that it wasn't just a one-time talking piece or once in a while we throw value out or painted on our walls but never discuss it. How do we live and breathe the values is something that was cool that we got into during the course of the interview. Let's get to the interview and talk to Stephen about values and the importance of them.
I've got Stephen Rapposelli, CEO of Performance PT and Fitness out of Delaware. He’s also the VP of the Delaware Physical Therapy Association. I’ve read his article in Impact Magazine regarding values as it pertains to our physical therapy clinics. I thought this was invaluable. I needed to have him on to share his story and also talk a little bit about values and the importance of them in our clinics. Stephen, thanks for joining me. I appreciate it.
It's a pleasure to be on your show. I've listened to your podcast already and I love what you're doing so far.
Thank you. I appreciate that. If you don't mind sharing with the audience a little bit about yourself, your professional experience, what got you to where you are at this point? I'm sure along the way, we're going to hit heavy into values and the importance of them.
Back in the Middle Ages, I was working for a private practice in Delaware. I was 25 years old at the time and I was working hard and I said, “I'm ambitious and I'd like to maybe one day buy into your practice.” He looked at me and he said, “That's not going to happen. The owners are not going to sell to you and you can't afford it anyway.” That's one of those times where you realized that your life is going to go in a different direction. A few months later, I had my own business. It didn't take long. At that point, I remember talking to the guy who's building an office and I said, “I want you to build me the smallest possible office because I am out of business and bankrupt.” The guy knew what he was doing. He chuckled and he knew that I didn't know anything about anything. He was kind enough to build me a little 1,100 square foot office. That's how I started at the age of 26. My first employee was my mother. She was my receptionist and biller. She brought me lunch and she provided motivational speeches when needed. That's how we got started.
That's awesome because one of my first employees was my mom as well.
You can't mess with a mother because nobody is going to rip off their babies. She was an advocate for me in the beginning and a good person to have and also all mothers.
They got your back and they want to see you succeed. She would go around and talk to my patients. She would walk around motherly like, “How are you doing?” She brought a great atmosphere to the environment.
I'm surprised in the beginning she didn't run over people to get patients because mothers will do that.
How long ago was this?
That was a long time and you’re going strong. That's amazing.
One of the takeaways that I tell people is every phase in the physical therapy industry, there are storm clouds on the horizon whether it's DRGs or this is going to happen or this is going to spell the end. You survive it. If you treat everybody special, there will always be a place for you. Whether you go cash-based or not, whether you do this model or not, whether you do that or not, it doesn't matter. It comes down to as a profession, how we treat people. That was one of the main takeaways for being in the business for almost many years.
You started with a 1,100 square-foot clinic. Where are you at now? Do you still have one clinic or do you have multiple clinics? What are you doing now?
We have three offices. We’ll probably be going to have a fourth. Part of the reason we grew, because most PTs who start out you can have one office and have a great job for the rest of your life. We added offices primarily because we had great staff members who said, “I want to be a clinic manager one day.” For years I'm like, “I'm the clinic manager so that's all you can go.” To provide an upside of a career ladder and an opportunity for growth is one of the reasons why we added offices.
You definitely had the opportunity maybe more so in the staff that you employed. The Jim Collins principle in Good to Great, “First who then what.” You had someone who was aligned with your values and provide an opportunity.
I was lucky enough to hire as a partner a guy who went to high school. We're like an old married couple. We know what each other is thinking without having to say it. Every now and then you can hook up with somebody truly special and this guy certainly is. He's better than me. If you can surround yourself with people that are better than you, you're going to be successful. I was lucky enough to be able to do that almost every step of the way.
What's his name, your partner?
John Bradley, the best guy I've ever met. He's almost Christ-like. I'm surprised three sheep aren't following him because he can have a following.
What would you tell your younger owner self many years ago? What would you tell him about now with the experience that you have?
I wish I had a mentor. I didn't have a mentor and I didn't go out to find them. I remember I lived in a community that has these giant corporate businesses. In Delaware, there's DuPont, whichever is a household name. I remember a guy who was a consultant for them and who was a patient of mine. He said, “Tell me about your business.” I said, “I've got this one office and I'm happy the way I am. I don't want to get bigger. I'm going to stay the way I am for the next many years.” He goes, “That's not going to happen.” I'm like, “No, it will be fine. I will stay the way I am.” That is God's honest truth. In any business, you're either going to get bigger or smaller whether you wanted to or not. Hooking up with a good mentor that can help you grow professionally and personally is the number-one success tactic that a younger PT should and must do. They are out there.
How do you recommend they go about doing that? I've heard the same thing and I've heard Tim Ferriss recommend it and how he recommended going about doing it. How did you go about it? How do you recommend people go about finding a mentor?
I didn't have a mentor. I didn't have anybody to bounce any ideas off of. I stunted my own growth significantly because I was happy doing what I was doing. I didn't force myself because I was truly ignorant to look ahead and beyond myself. Mentors come in many different forms. I do think if you're talking specifically for physical therapists, you need a physical therapist mentor and you need a business coach mentor. Those can be two different things because I now surround myself with coaches and mentors. It's okay to have more than one and you should have more than one because if you're a physical therapist, you quickly realize that there are people out there who don't think like you. That's a good thing. As physical therapists, we think in a certain way and sometimes that's not good.
It can definitely be to our detriment.
Have you ever met someone who's in business that's not yours and you speak to them in a mastermind group and you're like, “I did not even think like that, I didn't even know that type of thought process existed?” As you're doing that and coming to that realization, you're expanding your skills and your abilities and that's what it comes down to.
Sometimes I'd be in a mastermind group and I recommend the same thing, a mentor, a coach, a mastermind group. That's why my mantra is, “Step out, reach out and network.” Reach out means reach out to someone else, whether that's a coach or consultant or mentor in this case. Networking definitely needs to be part of a mastermind group of some others so you can have a different perspective. I would sit in mastermind groups and tell them the issues that I'm having with physical therapy. As I'm describing the issues and recognizing they're coming from a different perspective, I’m thinking, “This is a stupid mindset.” It is a mindset or it's a story that I was telling myself and was so ingrained that I believe it. I could tell from their faces and the way they were looking at me like, “Why do you do that way? Why are you thinking like that? There's no reason you have to do it like that.” It's something that becomes ingrained.
Those are limiting beliefs that you don't even realize. You talked to a guy who's a dry cleaner or does home repairs. He's like, “This is how we acquire customers A, B, C and D.” You're like, “We could never do it that way.” Maybe you should do it that way. Maybe it's okay to do it that way. You need to have your mind expanded. You probably need a coach and a mentor and it's okay to have one for one specific thing. Maybe I don't know anything about Facebook ads. Go with a coach who does Facebook ads and teaches you all you need to know about that or business processes that are different or contracts that's different. It's okay to cut and paste and get different coaches and mentors so that single piece of advice would push people forward much more than you can do yourself. I found mentors in books and I'm a firm believer that reading books is probably the gold standard for all of us. Any question that you want to have answers is in a book. Someone wrote a book for it, whether it's how to think better, how to invest better, how to open up a business, how to close a business. Anything you want to do, someone's written a book on it.
I'm huge into books. The one thing that I would say about books, they have a ton of knowledge. There are people out there though that will gain knowledge without converting that to action. That's where the benefit of a mentor and a coach comes from. Now you're personally accountable if the mentor or coach is doing their job. You need someone to hold your hand.
Books provide us with ideas and then you have to execute. One of the tips that I give people is I have the Amazon app on my phone. Whenever I'm out networking with people, I will ask them the same question, “Tell me a book that you absolutely love.” Whenever they tell me, I open up that app and I buy it right there without question. You slowly add that to your own personal library, which your personal library should only be filled with books that you have already read. I threw out my entire Encyclopedia Britannica that I had never read. I decided to throw them all out and go with books that I've read. You can buy those books used.
It's $10 to $20.
If you get one idea out of that book, wasn't the $10 worth it?
To go back to where we’re focusing on in values, is that something that you got out of a book? You had your clinic for many years. Where along the process did you decide, “I need to install some values in my clinic and the way we do things?”
A few years ago, my partner and I were like, “We're busy. We're seeing all these patients but we're not making money. What's wrong with this?” That was the same time that my then office manager said to me, “I looked at the Department of Labor statistics and you're underpaying me by about $15,000 a year.” I said, “We're doing the best we can, but my income went down by 50%.” She looked at me with a straight face and said, “That's not my problem.” That's the other day that changes your life. I went, “I am no longer going to live this way.” I hired a consultant who came out. I paid him a lot of money and besides him saying, “You have to fire your office manager,” which I did, he started making me look at processes.
I realized all the things that I was doing wrong as a business owner or things that I wasn't doing. When you're a physical therapist, you figure, “I'm great at physical therapy. If I treat people, everything's going to be a success afterward.” That's not necessarily the case. I picked up a book called Traction by Gino Wickman, which I recommend everybody to buy. It talked about establishing values. I'm like, “Let's skip that part. Let's go into the tactics. What can I do to make more money than I did last year?” I force myself to go through the boring hard work of creating the foundation for my business, which starts with values. It sounds boring and stupid. Why do I have to identify what my values are? I know my values. My values are great. My values are my values. “Tell me what they are.” “Do good work, that's not it.”
We decided to get the staff together and have a staff meeting. I put a whiteboard up at the front of the office and I said, “In your mind, think of the best employee that you've ever seen here. You don't have to tell me who it is. I don't care if that's not me. Think of who is the best person that is the heart of this business. When you got that person in your mind, I want you to tell me some words that you describe that person.” For the first three minutes, everybody just sat there. In my mind I'm going, “I don't care how long it takes. I don't care how uncomfortable the silence is. Someone is going to say something.” You give people the eye-roll, you give people a look and sooner or later somebody says, “She was friendly.” “What else?” “She was good with patients.” “What does that mean she was good with patients?” “She treated them like family.” “What does that mean?” “When people come in, she was always honest.” “Tell me more.” We came up with sixteen words. I said, “We have sixteen words, now we're going to come up with four.” We start eliminating words. What is truly the non-negotiable must-have quality of that person that says they are the Performance Physical Therapy or they are our brand? We came up with six values: honesty, integrity, respect, treat people like family, treat people with enthusiasm and teamwork.
Now we have these six words. What are we supposed to do with that? As it turns out, you do everything with those words. Everything you do comes from those words. It means that I can't be everywhere. I can't be in all three offices. I can't be there from 6:30 in the morning to 8:00 at night. Somebody is going to be there without me and they're going to have to make a decision. How do they know if they're doing the right thing? Whatever decision is in front of them, if they say, “Am I being honest? Am I respectful? Am I treating somebody with integrity? Am I treating somebody like family? Am I treating them enthusiastically?” Whatever decision is in front of that employee, if they run it through that filter and it comes up yes, 99 times out of 100, they're doing the right thing. The opposite is also true. If they're about to make a decision and it's against one of those values, they're probably not doing the right thing.
When you have to hire somebody, you hire them through those values. When you fire somebody because there's somebody, “I’ve got to let Jane go. I’ve got to fire Jane. Jane does not fit in here.” You can't just say that. You have to be able to come up with some reason why. When they don't embody one of those values that helps you as a manager to say, “This time you did this and it wasn't honest. This time you did this, it was disrespectful. This time you didn't work as a team and here are the examples.” It allows you to make all these decisions for the betterment of your company and make sure that you're course-correcting. It's almost infallible.
It's fundamental and it gives you so much power to be able to fire somebody according to the values, to hold people accountable according to the values, to do performance evaluations according to the values. Probably the most important is to be able to hire according to the values. As you're sitting there, sometimes we would do group interviews and we would talk about our values. We'd ask them what they thought about those words and you watch the body language. The people who weren't comfortable in that space talking about values, those were the people that we weren't too excited about hiring in the first place. As we would evaluate people, we'd evaluate them according to the values and how well they were representing those values.
Have you ever made a mistake hiring somebody, Nathan?
Yes, of course.
In retrospect, you try to evaluate that and say, “How did this person fool me? How did they get through? How did they get here with me not knowing it?” People can fool you in the hiring process. That's probably one of the single most important things that a business can do is hire the right people. Those values allow you a clear, common, easily reproducible set of metrics to evaluate a potential employee. You and your staff are called to develop an assessment tool to evaluate that. How do you assess whether someone's honest? How do you assess if somebody has integrity? How do you assess if someone's a team player? How can you assess that objectively? One way we assess if someone's a team player is if they've played on a team. In your entrance exam for your business, do you play sports? What sports have you played? Do you volunteer? Those are simple questions that can help filter out the people that that need to sit for the face-to-face interview and those who should self-delete out of the mix.
We should have done it so much earlier in our careers, especially as owners. It would have made things so much easier. Sometimes you think you're so small that you're like, “What does it matter?” You've got to take the long view there, get a little bit bigger perspective. As you're developing your foundation, it would make things so much easier if you hired according to your values, even if it was yourself. Maybe it's you and your mom back in the day.
The exercise that my business partner and I did was very similar to yours. We didn't bring in our whole company and reading your experience, maybe we should have but anyway, that's here or there. We did the same thing. We said, “What characteristics do we highly value in people that we revere and respect? What are some of those characteristics that we expect out of ourselves or out of our company?” We made a list of twenty. Some of them were very similar and so they eliminated each other. Maybe you could use a different word to describe them better and started narrowing them down. It’s the same thing. It’s a cool process. We enjoyed it.
We came up with Professionalism, Accountability, Growth and Empathy. That was an easy acronym to remember, PAGE was our acronym. Eventually as we rebranded along the way, we came up with some cultural values as well. We wanted our company to be known for family, fun and freedom, the three F's. A lot of the things that we did around developing the culture revolved around those three things about family, fun and freedom. We took this but didn't ingrain it into our company until we started using them more. We talked about using the values to hire, fire and evaluate employees. Do you bring up values at other times during the weeks or months in between all those activities? Tell me about those.
You think that's gimmicky, the three F’s. The value of that is you are setting very clearly and simply the expectation in your company. You should promote that to customers as well. Your customers, your patients should know what you stand for and that guides all our actions after that.
What are some of the things that you're doing to incorporate values into the discussions between those events?
We have weekly and quarterly leadership meetings as well as staff meetings. We identify what those values are. We take one of those values and talk about it and we give examples. That's huge. What you do is you reinforce it every single time. One of my morning rituals as a CEO is I go onto Google and I look for Google reviews. When someone writes a Google review, that instantly gets copied and pasted and goes company-wide. The subject line is, “A great way to start my Monday or guess who got a five-star review? See who got a shout out.” That reinforces those values as well. It comes up time and time again. The more you talk about those values, the more it becomes part of your company's cultural dialogue and vocabulary almost to the point where it's like an inside joke to people, where you can look at another staff member and go, “You people like family.” They get that and they dig it. It only happens with repetition like anything else. That's true personally as well because you can't talk about professional development unless you talk about personal development. That's part of that personal ritual that we all go through. Atomic Habits is a great book by James Clear about how to develop these personal and professional habits on a day-to-day basis to get more out of your day productivity-wise.
We got a lot of traction out of the values when we started talking about them weekly in our team meetings at each clinic. We would highlight one maybe and then ask if someone had exemplified that during the course of the week or recently. We brought that up significantly in our quarterly events. We would shut down the clinics one Friday afternoon a quarter. We would have a subject that we wanted to talk about that pertains to everybody. What everyone loved the most was when it’s almost like a religious meeting where people were standing up and we'd ask them to share who exemplified what value sometime during the course. People were emotional and they were in tears. They were excited and proud of their coworkers. They were excited to be part of such a team.
We call those shout-outs. We carve out time in that staff meeting. A staff member stands up and gives a shout-out to somebody else, “I noticed that Anthony went outside last week in the rain and picked up our flags so they didn't get ruined. His pants got all wet. Thanks, Anthony. That's great.” You’d think that's dumb. That is some of the best use of the time you can do because it tells the employees what you value and that they're being recognized by not just me but by each other. That's a big deal. Going back to values, when you go to our website and you go to the staff page, we have each physical therapist do a video on one of our values. We've got an extraordinary amount of feedback, not only from patients but also from potential employees who said, “I saw those videos and that resonated with me, that spoke to me. I appreciate that,” or from a patient that said, “All physical therapy places are not the same. You feel like family to me because I watched you.” That's a tip for your audience. If you do that one thing, that will 10X your results.
How engaging that is to have video posted on each value. You've ingrained it into your company. What has changed in your company since you had cemented values a few years ago?
That next year after starting that process, our profits went up 96% in one year. It's that difference. It’s that much of a change because what you find is that the people who do not belong on your bus, get the idea fast that, “This is probably not the place for me.” It also makes those conversations easier if it gets down to it. If they don't get it, if they don't want it, if they don't have the capacity for it, they realize it and they take themselves out. They find it uncomfortable to be around that environment where they're not congruent and they take themselves out and they leave.
I would imagine a year later the ease at which you obtained that 96% profit growth was significantly greater. It was so much easier and the environment and culture changed.
What happens is then you're like a forced coupler. Everybody knows what they're supposed to be doing when they're supposed to be doing it. As the owner, you wind up having to talk less. You now can concentrate on shoring up your processes, being more efficient, being more effective and documenting things, which none of us does.
We all need to get down to the dirty work and do that because it's an ongoing process. What the values did for you is exactly what you're talking about. It gave you some freedom and independence. It allowed the employees to take on more responsibility, to be sovereign and give you the freedom to then work on those things. It allowed you to be the leader of your own ship, to be up at the helm looking forward instead of looking backward.
My late father who was a very smart man but I didn't realize it at the time. One of the things he said to me is, “Your biggest job as an executive is to think.” I'm like, “Dad, that's stupid. I don't have time to think. I’ve got to do all this stuff. I’ve got patients to see, I’ve got to write checks, I’ve got to meet doctors.” My dad was right, the most valuable thing that we can all do as executives is think. You take uninterrupted time to think, give me two hours to think and I will come up with something good. What most of us do is you're running and gunning, you're hacking and chocking, you're bobbing and weaving. You don't have time to do anything and you wind up doing crisis management all day versus being the smith of your own fortune, planning ahead and then executing on it. That's the difference between having a job and growing your business.
It makes all the difference when you can have a bedrock of shared purpose and values and with those people come in alignment as to how things get done, then it's an unstoppable force. The weeding-out process can be painful but in the end, it’s so amazingly better once you go through all that. Things become easier.
Identifying those values does it for you. You should always stress testing, meaning that in January when we have our two-day leadership retreat, you say, “Is this what we value? Let's take each one of those. Are we about being honest with ourselves, our employees, our physicians and our patients? Do we want to be honest? Is that a value?” We stress test it. We argue about it and we'd go back and forth. If it needs to change, then we change it. If it stays the same, then we're on board.
What a great exercise for you. I'd be surprised if your values change all that often, but what I'd imagine happens is how are we not being honest and what do we need to do to correct it? Is it picking one value?
Yes, that's exactly right. You have to have the fortitude to be able to test your beliefs. One of the other powerful things that we do and it's emotionally exhausting to do this, but we go around the room with each leader and say, “What do I need to do more of and what do I need to do less of?” That is one heck of an exercise. Even if you only have two people in your leadership, even if it's just you and your mom, “Mom, what should I be doing more of? What should I be doing less of?” You have to be able to trust each other. My leadership team, I'm sure they were sweating bullets but they let me have it when they went around the room. One of the things they said was, “You've got to be less distracted. You're being pulled in all different directions. You're going after the next shiny thing. You're checking your phone. You've got to be less distracted.” That was embarrassing to hear that. I was the CEO. I was supposed to be the knower of everything, the perfect one. They're telling me what I needed to hear, not what I wanted to hear. It changed my behavior. That is the mark of a real awake executive to be able to have that feedback and then to try to implement it.
In that setting, you're becoming vulnerable. Initially, when you described the exercise, I thought like, “I'm coming up with it myself. This is what I need to do better at,” but they're telling you. You can get in an uncomfortable position. You set yourself up for a lot of vulnerability and emotion to come up but what does that do for your team? I can't imagine the trust and the cohesiveness that comes after a hard exercise like that.
That’s the prerequisite for that exercise is to be able to establish that there's trust and then there’s safety in this group. It doesn't matter that there's are fifteen or there are five or there are three. You carved time out of your day off to get together and better yourselves personally in the profession. Once you set that stage, then you can be vulnerable and say, “What is the number one thing I can do to help myself this year coming up? What do I need to do more of? What do I need to do less of?” It’s those two simple questions. It's almost not as valuable if you do it to yourself in your own head because I can fool myself easily. I can tell myself anything I want to hear but getting that feedback and as a CEO or as an executive, you don't get that very often. They’re not going to tell you.
I love what you're doing with values. You've got to be proud of the company that you’ve built after going through the structuring process, the hard times and also this focus that you've put on the last few years.
It's never over.
It’s much more enjoyable.
You think, “What else can we do? What else can we tear apart and rebuild and make it better?” It's also very easy to look back and be like, “Was I a dope?” You're right. You were a dope. Everybody's a dope. My only competition is the man that I was yesterday. Don't worry, that person's not even here anymore, just keep moving forward. How’s that for advice?
This is a great conversation. We've covered a ton and we nailed some of the important topics that I think of when it comes to values. Is there anything else you want to share?
Try to always better what you're doing no matter what. Nobody has the answers. I know that I don't and I'm always looking for the next teacher. Everybody has something to teach you. Be open, be willing, do it without ego, do it with humility. You're a better person for it because time is short. None of us has as much time as we think we do.
That’s great advice. I'm shaking my head because I agree with everything that you went through and felt like we've gone down a similar path.
You should also probably tell your audience more of your story because you have an incredible story to aspire to, from having a practice in Arizona, selling it and moving to Alaska. That's pretty bold and it's very impressive that you do that.
It's hard for me to self-promote. It's difficult to do that. I know I need to get that story out there, that's for sure. I'm sure I will here in the coming months.
I told you that I think somebody should interview you for your own podcast.
I will have to do that. I did it with my business partner, Will Humphreys, a few episodes ago. It didn't get into our story. I'm glad you said that because I think I'm going to try to get Will on again and talk about our story a little bit and how we got to where we’re at. It's an intriguing story and worthy of note.
Some of those lessons, you've got some gold in there. You’ve got some nuggets that are valuable to people that they can benefit because as a PT owner, especially if you're a one-man show or one-office show, you think you're the only person. You think you're out on an island somewhere. For years and years, I’ve felt that way. I didn't realize that there’s a whole community out there of people that you can connect with and resonate with and say, “When this happens, then I feel like this. Do you ever feel that way?” They're like, “Yeah,” and then we all get better for it. That collaboration with peers is vital. The private practice section is doing a great job. They have the peer-to-peer network that they promote that I'm part of that is very valuable. I benefit from it and about every practice owner can benefit from it as well. There are resources out there, you just have to reach out and ask for it.
That's why my mantra is, “Step out, reach out and network,” because it's out there. As independent business owners, we can get stuck in our little bubble, our 1,100 square-foot space or 2,500 square-foot space and think that's our world. Our thoughts become realities and we get self-limiting beliefs. It's important that we got to step out of that. We’ve got to stop treating full-time. You've got to reach out to get a coach and mentor as we discussed and you've got to network. That's where growth occurs. There are resources out there to help you.
Another common problem is you go to these networking events or you go to a conference and you think, “Everybody is more successful than me. Everybody knows more than me. Everybody has gone down to that path and I don't. I'm just a mess.” That's probably not the case. Everybody has wisdom inside them. It's a matter of having the opportunity to share ideas. You have an incredible amount of knowledge that you should be spreading to other practice owners and I look forward to hearing more of your show because that's very good.
Thank you. I appreciate the comments. Thanks for coming on. Thanks for taking the time. I appreciate you sharing your experience, Stephen. It's a great resource and I hope more and more PT owners take this specific lesson to heart. It's invaluable and I appreciate it.
Rock on with your mission because you're doing great work and it's a pleasure to be here. You've got nothing to sell but everything to give.
I appreciate it, Stephen.