PTO 156 | Leadership Development

Leadership development is not a topic commonly discussed within the PT industry. However, just like any business, leadership plays a big role in growing and expanding your business and practice. Dr. Michelle Bambenek is the Regional Vice President of Operations at Empower Physical Therapy Group. She is also a leadership coach and consultant for both PT owners and people outside the PT industry. In this episode, she joins Nathan Shields to break down the critical components of leadership that empower team members to grow and, in turn, your business. Michelle emphasizes the importance of values and imbuing a sense of mutual responsibility within the team. Learn more about the steps and successful patterns to expand your PT practice.


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The 5 Critical Components Of Leadership Development And Business Expansion With Michelle Bambenek, PT, DPT

I have got a special guest, Michelle Bambenek, who I have known for years and worked with Will and I at Empower and Rise Rehabilitation Specialists back in the day. Thank you, Michelle, for joining us. I appreciate it.

It is a pleasure to be here. I’m happy to be on the show with you.

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Thanks for coming on. At this time, Michelle is a Leadership Coach and Consultant for both PT owners and people outside of the PT industry. She did great work for us working with our leaders of the team that we had at Rise at that time. We want to talk a little bit about leadership development. It is something that I haven't touched on a lot on the show and it is something that she is specializing in and invaluable for those therapists and owners who want to grow their practices. Before we get into potatoes of everything, share with us a little bit about you and what got you to where you are at this point.

I appreciate being on with you. I'm excited to talk about this topic. By way of introduction, I am a PT, graduated in 2007. I immediately went into an outpatient orthopedic setting and pretty quickly after that, I was thrown into a clinical directorship position. In 2011, I had the opportunity to transition to working with, at that point, Affinity Physical Therapy, where I met Will. I was the Clinical Director at Affinity Physical Therapy at Coolidge and progressed from there and building as things started to take off or leaving some of the pressure off of Will. He was still treating in Florence so I took on the directorship of Ford's Clinic and then we had the Anthem Clinic. We were fortunate enough to go through the merger with Pinnacle Clinics.

I functioned as a Vice President of Operations for the four clinics at that time, I think. Maricopa, Coolidge, Florence and Ocotillo, the Chandler Clinic. I went in through there. Along the way, I was able to learn a lot from yourself as well as Will and a lot of the expert coaching that we were able to be a part of. I found that I had this natural desire to build, lead teams and offload the owners of the company and help in that capacity. I found that to be invaluable to the overall growth of the company as a whole. I quickly realized the importance of developing leaders, not only of myself but those around me to take that to the next level.

Since that time, you have been strictly in leadership capacities, right?

Soon after I took on the Vice President of Operations and running the four clinics, due to the sprawl of them, it did take a lot of time to be able to work in each one of those clinics, get to know the team and find out what's needed and wanted around what their specific needs were. I was mostly in a capacity of leadership development and training, running meetings and doing accountability sessions and things like that versus the hands-on treating.

It is important to note that for any of you owners looking for opportunities, expansion in the future, or if you are at two clinics looking for a 3rd or 4th at some time along the line, you have to find someone who can manage. Would you consider it middle management, would you say?

Middle management to upper management, depending on the number of clinics. I would say I was in the upper level. It is a necessity for that growth to happen. I would consider the clinical directors that I would have underneath me as the middle management. I was overseeing those and helping in that capacity of a step above them. You always wanted to say, “Everybody is important in that team.” One can’t function without the other. Every single person is an essential team member to make the whole thing move. In terms of an org board or communication line, command line, that is how it functioned for us. I found it very valuable.

Owners can't expect to oversee multiple clinic directors, multiple front offices, the billing, and the marketing. At some point, you have got to offload the oversight of those positions. That is where the value of an upper-level executive like yourself would come into place to take on those responsibilities, a foreign owner, for sure. When you are getting to a third clinic, that position is necessary.

I would have to agree unless you want to burn the candle at both ends because I can see it. It has been done, but it does not last for too long and things start to fall through the cracks. In some of the programs or things that were successful, actions start to drop off because there's not necessarily somebody set up in line to make sure that line is being held. I think it is imperative at that point. It is difficult to run the business and be in the business. There has to be a separation at some point for middle management or upper-level leadership to come in and support in that capacity.

Every single person is an essential team member to make the whole thing move. Click To Tweet

Your growth in the company, your management, and the oversight was essential to our growth in the clinics at the time. Our conversation is a lot about that. How do owners grow leaders, whether that is in the PT industry or outside of it? It is something that takes time, but it also is something I think, because we do not have that training from the past, we do not intuitively know how to do it. Maybe there's not a lot of books on how to develop leaders.

There's a lot of books on how to become a better leader and better owner. Maybe that is the next book you need to write is how to develop leadership teams. We do not have that training in the past. That is what we want to get to is how do owners train their leaders? In saying that, if you want to preface anything, that is fine but where would you start?

I think it is very important. I know that when you are an owner, you go in with a vision of a clinic and we're coming in as PTs. We're PTs, but in PT school, we're not necessarily given the tools or even a course on how to open up a practice. That is something that is missing in our profession as a whole. We do not necessarily come in inherently knowing how to lead a team and be a leader of multiple people outside of treating our patients. Oftentimes, that is what happens.

We have great producers that come in. Immediately, a great producer becomes our leadership because they have the ability to turn out a product and have a high capacity of production for the company. Some people may inherently come in with some tools, but that still needs to be developed. The first thing that I would think of is it does have to start with ourselves. We have to do our own work. We have to develop our own leadership voice that comes from surrounding ourselves with people who know a lot more than you.

PTO 156 | Leadership Development
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It's coaches and mentors and reading the books. I have a myriad of books here that I have gone through, from E-Myth Revisited, Leadership and Self-Deception, Crucial Conversations, and Good to Great. Five Dysfunctions of a Team was pivotal for our team. One of the ones that I'm gravitating to which do not to underestimate the importance of emotional intelligence. I have this book by Marc Brackett, Permission to Feel, which has been mind-blowing to me.

Those are the things that I found were important for us. Not even necessarily one book or one training coach. We've gone through the Gazelle, the Measurable Solutions, Scott Fritz, multiple people surrounding ourselves with thought leaders and people in that space knew how to help us grow to our next level, developing our own way of thinking and knowing the rights and the wrongs on how to approach a conversation and the importance of accountability. All these different things that a lot of us do not inherently come in knowing that I think are important to do. We’re starting with ourselves first.

As I’m thinking about our experience with you, we were sharing and we wanted you to read some of these books. It wasn’t scripted per se, but it was part of our leadership development. We wanted you guys to read the same books that Will and I were reading that we thought was super valuable. Even Good to Great and some of those books.

It was important that we share important books that we had strong beliefs in with those people who we thought were going to be our leaders and who were tagged to be our leaders at that time. We want to make sure that we’re having conversations about those things and get on the same mindset page. There is an assumption you brought it up in your preface there that we assume that good producers inherently become good leaders.

I do not think that is the case all the time. If someone is a great producer, they can see all the patients and get all the results. We inherently think they’re going to be great leaders and that is where they want to go. Sometimes, the conversation needs to start with them to be like, “What is your path? Where did you go?” You were upfront, if I’m not mistaken, with Will that, “I want to be a leader. I want growth.” Those conversations are crucial at the very beginning.

It is one of those things of even finding out what’s needed and wanted with the team going in like, “Is this even something that interests you? Is that something that drives you or is it something that you see yourself doing? Do you find comfort in that? Do you find energy in that?” It doesn’t do us any good to have somebody placed in that position who doesn’t want to own it.

We all have a purpose, a product and a key stat. If you do not even vision yourself in that purpose, then it is hard to turn out a product and the stat just dies. It is one of those things that is an important conversation to have. It goes along with developing that team and earmarking people. Only because they are a great producer doesn’t necessarily mean there are value-aligned, which goes into my second thing. First of all, you have to set a purpose and your values.

PTO 156 | Leadership Development
It starts with us. We have to do our own work. We have to develop a leadership voice, which comes from surrounding ourselves with people who know a lot more than you.

Set up the purpose of values first as a clinic.

Unfortunately, I still witness it in some of my coachings that it is something that is locked away in a cabinet or was developed at the start because people know it is important, but it is not breathed into the environment. It is not living in the clinic. It is not something that people even know. Maybe the executive team knows and not even the executive team knows the purpose and values.

I hear a lot of people when I go in. I’m like, “What is your purpose? What are your values?” They give me a tagline, which is great, but it is a valuable thing you need to build in your company because it is the foundation of how you will ultimately function. I would encourage people to develop those, spend the time, spend the effort, find out what’s important to you, figure out exactly what you value, and the ethical and moral fibers you want to bring into your company and have that happen? That then leads into the development and you are marking who your team players are.

There was a flection point that I noticed during our ownership and developing leaders like yourself in that. Will and I came up with values and purpose, and it was based on coaches pushing us to do so, like talking about those values on a regular basis. All of our weekly meetings started with us verbalizing the purpose and values in unison. For me, that was a little uncomfortable at first, but as we did it, I started recognizing that you and the other team members started taking it on. I thought this is weird that you guys care about this business as much, maybe more than I do.

It was valuable for me to see that other people could care about your purpose in the clinic. I always thought that was something that was here. It was within me and now it is Will and me. This is our thing and we developed it in a secret room in the back of the clinic. When we started sharing it, living it, and talking about it often with our team members, they started buying into it as well. That is where we saw a lot of growth and development of other team members and the growth of our business. There was a direct correlation between the growth of the business and establishing that purpose and values.

That is the basis of the culture that was being developed. Your visibility and sharing that with the team and giving people the opportunity to not only hear it but feel it and be asked, “What does that mean to you? What does that vision or that purpose mean to you? How do you see that?” Taking it even a step further where we were having a regular meeting, rhythms, and getting into a position of like, “How have you demonstrated that? How have you seen your teammates demonstrate that? How do you see that happening in our clinic?” That invites people.

It wasn’t uncomfortable, to begin with, but then everybody was like, “These are my people and they honor and we created a safe place for people to be heard and listened to.” Everybody wants to be part of something bigger than themselves. When you pull them behind the curtain and you share with them those visions, those values, and get to be a part of it, you do want to hear from them. I want to so badly. I do not enjoy standing in front of a team and talking to them. I want a team meeting to be something that is theirs. They are developing and their voices are being heard.

That comes from the development of those values and that purpose and breathing life into that. They become part of something bigger than themselves and immediately have an onus in that company. That is exactly what you want. I loved it or felt it more than you. That is me relieving my primary customer of the responsibility in holding that. I’m doing my job to allow you to do that.

As you start working, breathing the purpose and values, that is when a culture starts getting established. When you start developing that culture, you start recognizing that certain people fit and certain people do not. Either way that is okay, but you want to find those who fit, live, and breathe the same purpose and values you do and have also bought in. That makes it easy then to find the people that do not fit and find the people that do fit, then hiring and firing, holding people accountable becomes much easier at that point, doesn't it?

That is the third facet of what I think we need to talk about and what owners need to gravitate to because sometimes they are going to have a high producer. They may be value-aligned that are very low on the scorecard. You have to evaluate that and see if that is something that you want to carry through. This is hiring and making dismissals and even making business decisions based off of your purpose and your values. Do you fit? Do you align with what we’re trying to accomplish here?

We have the desired impact that we want to create within our team members but also our community. That has to be carried by the entire team. Not one person can do it. Not one leader, rehab coach, tech, aide, PCC or PT. It has to be a shared thing because it is something that is very valuable to the community and to the team.

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One person that doesn’t align can make havoc in your clinic. It can cause A-players, high-value aligned and high production team members to leave your company. When you are breathing it into the clinic like we talked about and talking about it on a day-to-day basis, it makes for an easier accountability conversation because then you can clearly align or delineate where they align and where they do not align like, “This is not necessarily professionalism. Explain to me or help me understand why you did not take accountability for this,” or things like that.

It makes those accountability meetings, the hiring and firing, become so much easier. I guess we’re leaning more towards disciplinary actions and letting go of those people who aren’t value-aligned. When you can do that with a values-based conversation, it almost makes it more objective and less emotional than simply saying, “You went against one of our primary values and we can’t tolerate that. Here’s what we’re going to do next or we’re going to have to let you go if it is severe enough.”

What I also see is not only is it important in helping find those people but those people whose purpose aligned, they want to do more in the business. They want to take on leadership opportunities. You have PTAs that want to become clinic directors and more, like Stacy, not just clinic director but also marketing, supervisor and director of marketing, and did great. She was not only value-aligned, but she was in a company that she could fall in line with and found other ways to live out her desires and what she wants to do. There are opportunities like that come up when you find people who are value-aligned.

All of those things are 100% accurate. Sharing them, to begin with, so that people know those conversations become easier. Also, people start to realize, “I do not fit in here. You guys are drinking the Kool-Aid and have this desire to take this to the next level. I only want a paycheck.” Those people do not fit on our bus. Those aren’t the rock stars that we want. It creates an opportunity for other people outside of it to have that ownership. Even if it is not in marketing, VPO, or clinical director, we found that we had rehab coaches, PCCs, and billers jumping at the first opportunity they could to help like, “I want to be a part of this.”

I remember one time, Savannah came in and she was the rockstar for one of our events. She was going to do an insurance verification right on the spot. We have our rehab coaches, our techs or aides coming in, setting up and taking down for big events. Everybody wanted to be a part of this. I can’t tell you how energizing that was. That even took the pressure off me. It was like, “Am I needed here? What is happening here?”

When you find those people asking for volunteers, doing voluntary events and community events isn't a burden anymore. People are like, "I want to hang out with these people. You are my people. I want to be with you more. How can I do that?” Even if it is outside business hours, right?

That would belt off of our values, too, being in the community and part of that. Having a clear delineation of our expectations, you automatically got those people on the board because those are the people you are hiring, service-oriented, and willing to go above and beyond. I remember during our recruiting process. It is very specific that we're looking for rock stars and do more. We do not want people that are only coming in for a paycheck. That is all fine and good if that is what you want, but it will probably not be a sustainable thing for you and us.

As it pertains to leadership development, another aspect of things that I think is helpful in developing your leaders on the team is giving them some of those responsibilities. When the owner takes it upon himself to have the year-end party, do it all themselves, and figure that all out, you are wasting an opportunity there to develop leaders on your team. Maybe they do not have the title. They do not have to be clinic directors or marketing directors.

What if you had a tech or a front desk person who was in charge of it? Could you be okay with that if you gave them a budget, some parameters and let them go? Those are opportunities to develop leaders on your team to give them small things. Even thinking smaller, give them the opportunity to lead out on your staff meetings or the in-service. Of course, it is one thing to share purpose and values, have them read all the books, talk about them and all that stuff, then you need to give them some responsibility and say, “Here is a little piece of responsibility. Number one, it is an opportunity to do so and show us how you can do it. Number two, it is also an opportunity for us to see how well you do and how well you can coordinate the team.”

I remember being a very young leader and coming in and being like, “I have to hold everything because I want it to go a certain way. I want the pat on the back.” Also, all the successes were mine, but then all of the defeats were also mine. We started off by surrounding ourselves with people that know more than you. I want to constantly look at who’s coming up behind to take my job because that pushes everybody to the next level and pushes me as a leader.

Being that young leader, wanting that praise and accolade but also taking the brunt of everything becomes pretty heavy. Once I started handing things off, having people even write up programs, run the team meeting or do things like that, I realized that there was so much more satisfaction out of that. Now, at the end of something, we were a team like, “Look what we accomplished. Look what we did. We did this together.” I come from sports and a team background, so that is something that gives me a bit of energy.

PTO 156 | Leadership Development
Spend the time and effort finding out what's important to you, figuring out exactly what you value, what your ethical and moral fibers are that you want to bring into your company.

Also, it gave us an opportunity to not point the finger. It was like, “I should have done this. I could have done that.” In our debrief, if something did not quite go wrong, like, “That was my fault. That was something that I could have done better. I could have put a little bit more attention on that.” We’re winning together, but we were also going through some of the mucks together as well. It made you feel like a part of something bigger than yourself again and it wasn’t all of the weight of everything on your shoulders.

I know we’re going into your next point here, but to do that, it is imperative that you write down what is weighing you down. What are you working on that you need to delegate? This is how I abdicated responsibility. When I was a young owner, I would interview people and I’d say, “Your job is to do anything I asked you to do.” I literally said that. I do not know how many times. Of course, they were waiting for me to tell them what to do.

I was upset because they did not like to see a garbage can that was full and not dump it. I told him at the very beginning, “Your job is to do what I tell you to do.” They’re waiting for me to tell them to do that. That was my fault as a young owner. What I learned with coaching and consulting is the dirty work. The grind of an owner or any leader as you are developing a leadership team is to write down what someone else’s responsibilities are going to be, what your expectations are, and have those conversations about, “This is what I expect you to do and here’s a manual on how to do it as well. This is how we do things in your position to obtain your product and to keep stats high.” Writing all that up is imperative but it is a grind and that we do not talk about a lot.

It can be very cumbersome, which is why I think what you said is important. Leverage the team members that are doing something well. This is our job description, coursepacks, training manuals, your playbooks, or your hat packs, owever you want to name them. This is essentially the outline of your company's successful actions, how they’re done, and the steps to get them accomplished. This was something that took us quite a bit of time to develop and it was always in a revision state like, "How can we improve this even better?” It was never fully done.

I remember having a number of different packs that we had not only for the CEO, VPO, PT, or PTA, but we had a leadership hat. It outlined all the books we wanted you to read. It had all of those different ways of doing it. We have what we called our all-rise hat or an all-employee hat that went through the purpose product and key set of every single team member. Not only did I know what my responsibility was, I knew what everybody else’s responsibility was, so then I could support in whatever capacity I could to help them also get their product. Outlining all of that is important because it takes the pressure off of the owner.

I would love to survey your audience like, “How many of you were the primary accountability holders? How many of you are the primary holders of all of the crucial conversations? How many of you are in charge of hiring? Which ones of you are the primary holders of key relationships? How many of you are still out there doing all the marketing?” All these different things initially fall on the owner. When you start, you are it. You are popping upshot if you are doing everything on your own. There has to be a time where you are relinquishing that.

As you are hiring value-aligned team members, they are getting a rhythm. You are marking those that have a desire and a potential to be the leaders, and you see people doing things well. Ask them to write it down. “How do you have a successful day?” “Every single day, I come in, I look at the schedule, and I earmark all of my patients that are going to be either high risk for falls.” You are planning out. That is a successful action that maybe we know how to do for ourselves, but maybe that needs to be written down to be shared and put in those course packs or those playbooks for everybody to now know.

That is crucial in leveraging your team on how they do that like, “Tell me the steps of how you go about as an aid tech. How do you go about cleaning the clinic? What is your process?” All those things can be a little bit cumbersome but are essential because then it is not, “What does Nathan say? What does Michelle say or this owner say? What is the handbook saying?” That is how we do it. Everybody has a uniform way of doing it, especially if you are going to be in multiple clinics. You have to have a uniform way of doing things.

For any owner that has aspirations for multiple clinics, there has to be a common playbook between clinics or there is going to be chaos. It is going to be impossible to manage everything and handle all the things happening at once because everyone is running their own place at the same time. I remember I had a PT student who had spent ten years being attacked at some clinic in the past. I said, “If I paid you $250, would you write up what it takes to be a tech and what do they have to know?” She was like, “Sure. It is $250. I will take that.” I used that for years to train all my techs after that. I was like, “Here’s what you have got to do. Do that. Learn this. I will quiz you on it later, but these are our expectations.” It had exercises, anatomy, cleaning routines, and all that stuff. It is all in there. That was gold for me because I was able to use it over and over again.

As you said, for those owners who are reading who do not have any of this stuff in place, it is going to take some time. If you have anybody on your team, you could say, “They are a rockstar technician, front desk person, and physical therapist on my team.” Asking them how to do what they do and take fifteen minutes if you could. How do you get patient buy-in? How do you get a good arrival rate? How do you collect collections over the counter so well and get 100% every day? What do you have to do to get that done? Having them do some of that will be powerful and is a good place to start. As you take time away from treating patients, you can start writing up some of the things you will eventually want to delegate to somebody else.

Honestly, being that teammate and being like, "You hear me and see me doing good work and you want to leverage what I know. I feel seen, heard, and important. Now, I have more ownership like I'm part of the handbook." That is pretty cool. I'm not only coming to a place of work and being told what to do. I'm being asked what I do well. It is ownership, not only in the company but also validation for that person that you are working with.

Great producers don’t necessarily make great leaders. Click To Tweet

It can be huge. The fallback we have as owners are, “It is going to land on me. I’m going to have to do it all.” Hopefully, what they get out of this conversation is, number one, not only is it valuable to write up all this stuff. Number two, you do not have to do it all. There’s a significant portion that you may have to do. You are going to be ultimately responsible and organizing things initially. Try to find others, if you can, to do some of that work for you.

Have them do some of the write-up and you can put it together in the way that suits you and your company, then continual revision. It takes time. You do not have to do it alone, but it is a valuable way to grow your practice.

This goes to your final point, which is to communicate what your vision is like, “I want to eventually have a 2nd or 3rd clinic. I know that to do that successfully, I'm going to have to have a policy and procedures in place that are replicable over and over again.” While you teach those people who come on board, what were the expectations? Holding that communication line is important.

I think all of these things come together but also the regular communication, daily, weekly, monthly, quarterly, communication rhythm, and a meeting rhythm for the team. They know exactly what’s going on. You are bringing them behind the curtain. After a strategic planning session, now we’re delivering and cascading that information down to the team. They’re not, again, only on marching orders. They’re a part of something. This is your impact on how to move this clinic and these clinics together towards our ultimate goal for the company as a whole. Those are ways that we can bring communication into our team. Get their buy-in. Get their ownership in that as well.

Not only that, they have a uniform time each day, week, month, however you set it up. They know they’re going to go over their values. They’re going to highlight things, present their stats and answer the questions, but they’re also going to be there holding that meeting and being heard. They’re part of the team and part of something bigger. Once you have that regular rhythm, that also breathes into the culture. You have a uniform way of communicating information. You know when you can bring things to the table when you can’t bring things to the table. It also relieves the owner and the leadership as a whole because you do not have like, “Do you got a minute? Can I catch you for a minute?” You know our regular meeting rhythm. Maybe you have office hours, a private conversation, or put that on the parking lot.

That is something that we can bring up to the entire team because if you have that question, there might be other people within the company who have that same question, have that same desire to do something, change something, or work something out. It is a uniform place for everybody to communicate, be heard or be seen. Also, speaking of our values, see the company's greater vision and see how they can be impactful in that.

If there is no consistent communication, people are going to blurt out in the middle of patient care without raising their hand and say, “What is going to happen on Christmas?” That has happened to me in the past. I’m working on somebody, someone comes up to me and asking me about paid time off. “I’m with the patient. Right now is not the best time.” If they know that there’s a consistent communication method and way an oral communication line, they can bring up those questions and concerns, and there is some structure to it. The consistency of communication also provides opportunities for the leaders to shine because you can see them either leading out in discussions when there’s a group discussion as an owner.

The worst feeling in the world is, “How are we going to improve our arrival rate this next week," and then get crickets. You want those leaders to step up and start talking during some of those conversations or if you probe them a little more, they have more depth, have a little more insight, and are also willing to take responsibility. When you have those communication opportunities, that is when some of your leaders are going to step up.

We’ve seen it time and time again. We’re bringing some people on no matter what the position PT, PTA, tech or a PCC sometimes. You are like, “That was a valued well comment.” That is something that I did not consider because sometimes, even as owners and people with big visions and strategic planning, we can get a tunnel vision of something around certain items. To hear perspective from other people that maybe have been new to our industry or not even a part of our industry and coming in, and saying like, “We’ve attacked with something similar to this. I’m not sure if it works.” It is like, “That is gold. I love that.” Seeing that pop up during those team meetings is important but regular consistency is key.

I have also witnessed, unfortunately, in certain times where you set a meeting structure but then the volume of the clinic goes up. All of a sudden, the meetings drop off of the schedule then it becomes something that is not necessarily conducive to building that culture and open line of communication. It is something that wasn’t valuable for somebody to put on our parking lot or wanted to bring up for discussion is now tabled for another week or something like that. It is defeating. You have to stick with them. Sometimes it is difficult because it does.

It could potentially take away from patient care hours, but I will tell you that time will make up for its weight in gold. You will have more streamlined communication. You are not having one-off conversations throughout the week. You have a specific, dedicated time for all team members to hear the same information in the same unit of time. It saves you a lot of work as an owner or as a leader.

PTO 156 | Leadership Development
When you pull them behind the curtain and share those visions and values, they get to be a part of them, and they feel like you want to hear from them.

This is also an opportunity if you are having those meetings for people who are getting training to take responsibility. You are having accountability meetings or maybe they're not necessarily disciplinary in nature, but you are having a monthly or quarterly one-on-one with your team members. If you have someone who's in training, they can sit in on those meetings as long as the other person is comfortable with it. Give them the opportunity to see what that looks like from a leader's perspective. Even though they've been part of that in the past, you can be a part of that planning and assessing after the fact with that person to help them train and communicate how that coaching session went or how that accountability meeting went. There are opportunities galore within that structure to have potential leaders step up and get trained.

I love that you brought that up. It is not always disciplinary. Some people think of accountability as a dirty word. It is like, “I’m going to be held accountable.” It is one of my favorite values and I love it when teams have it as one of their values in their company because I see it as an opportunity for improvement. I care about you enough. I love you enough that I’m not going to let you continue to make the same mistake. I’m going to coach you in a direction that will help you be a better service to the company, but it is also going to improve you personally. That is how I see the accountabilities.

We’ve done that in the past too. If I’m the company's primary owner and holder of all the accountability conversations, you bring your number two in with you and they watch you do it once. The second time, you are still in there and you are seeing them do it, so then you can give some coach points and say, “This is where you could have improved in that or you knocked that out of the park. You are ready to fly on your own.” You are then gradually working yourself out of that picture and maybe you are not in the next one. It depends on the leader and how they’re going, but it is a good rhythm of how to work yourself out of that responsibility.

I can imagine most young owners or newer owners are going to look at those meetings and be like, "How can those happen without me being there?" They still go. There's going to be some trepidation initially, but that is where you develop them. You get them to the point that they have gone through the processes we've talked about. They have worked on themselves, shared that with others, develop strong purpose and values, made the right hires, developed write-ups and hats that these people have followed, trained, done well, and producing well in their positions and responsibilities.

You have given them a little tidbit of responsibility, but that one thing, the one-on-one interaction where the door's closed and you are not present, as the owner, can be one spot where you'd be like, "I hope that goes well." There are opportunities there in training your team and your leaders to do that with you and do it a number of times if you have to so they get it right. You feel comfortable or spontaneously sit in on a few if you want to make sure things are still going well. They can happen without you if you are intentional about the training of the leadership team that is going to take over that responsibility.

Taking all those steps that we talked about makes those conversations a lot less sticky. They’re not emotionally based, value-based, and objectively based. There are so many things that, “This is not in alignment with our purpose, and this is not an alignment with our values.” These metrics are out of whack like, “What’s happening? Let’s take a look at your sub stats.” It makes the conversation far easier. Oftentimes, what I have found in our previous working career together is people are already coming in there knowing exactly what we’re going to have a conversation about. It makes it less like a confrontation or an issue for the owner or the leader to have to do because it is like, “I know my stats are down and XYZ has a reason. This is what I’m going to do to make sure that that is not the case next week.” It is like, “Great. I’m so glad I can count on you. Thanks for coming in prepared,” it makes it a lot easier.

The goal for most owners is to get to a point where they can trust other people to carry out their purpose, vision, growth and goals of the company, so all the burden is not on you. There is some shared lifting. There's so much joy when you can create an environment in which others align with you and work on getting together towards a cause. It is fulfilling in that regard.

It is legit magic.

One question for you. We had a number of consultants and coaches during our time working together and you got some individual coaching from them. I'm sure a lot of that was valuable. Would you say it is imperative to have a third party like that provide you some coaching that is not directly coming from owners?

I personally think so because it is somebody that can see from an outside perspective and maybe look at it from a different angle. They're not fully immersed in the company and all the things that are day-to-day operations. They can help you look at the bigger and wider degree, things and other considerations that can be brought to the table. I thought it is invaluable that people outside of our company were added to our mix.

Did you feel like you could say things to them or talk about things with them that you couldn't talk about with the owners, whatever that might be?

We’re winning together, but we’re also going through some of the mucks together. Click To Tweet

To a certain degree, yes. You felt like you could go a little bit deeper with our relationships and the owners. We created such a safe space that you did not necessarily hold back too much, but maybe there were certain areas that you are like, “This is an expectation and I do not necessarily agree with that. How do I handle that? How do I bring up the point?”

You can talk that out with a coach. It is like, “These are the expectations. I see where they’re coming from, but this is my angle and my view. How can I make that clear to them? How can I have that conversation in an appropriate and respectful manner but come to a position where we’re getting a conversation on the table of something that has currently been a program or a policy?” It is helpful to get that outside perspective of how to even address conversations with your owner or other leadership team members. Not every single day is a rainbow and sunshine. There’s tough stuff that gets done behind the wall.

So much of what I talked about on the show is about owners getting coaching, which is imperative. 99.9% of the people who are successful that I talked to have had some coaching and consulting in the past. After having this conversation, I recognize that I haven't stressed much about having the owners get coaches and consultants for their leadership. That is coming to light to me as we're talking. We provided coaching. Not only we got coaching for ourselves, but we also got coaching for our leadership teams, then thinking about the development of the leadership team that we had. You guys got a ton of value from coaches helping you out and not only straight from the owners.

As we even grew and developed, we had our middle management people involved in our strategic planning. We’re getting directors on our two days off sites together quarterly. We would have directors with us one day and they would go back to their clinics, then the executive team would stay for an additional day. We got insight from the people that are in the clinics doing the work. We had even more and I have gold. Now they are behind those decisions and it is not marching orders. They’re going into the clinic being like, “No, they heard us. They listened to us. They want to do this. We are a part of that. This is what we came to a decision about.” It was important and getting them exposure to those types of thought leaders and people and that way of thinking. Not only like, “I needed to see my new patients.” It was great.

How did it feel then as a leader for us to present to you as owners like, "You are going to get some individualized coaching from someone who coaches us?”

I was giddy. I was like, “Yes, please. Whatever I can do.” It was part of our culture too. We always looked at our primary customers. Every single person on the org board and the communication line had a primary customer. For me, that was our owners. Eventually, I became a partner and people were doing that for me, but my job was to offload my upline. If I had the coaching, I had the capability and I got to service my leaders in that way by having the coaching that you were giving me the opportunity to participate in. I was overjoyed to be able to be a part of that.

PTO 156 | Leadership Development
We have a desired impact that we want to create within our team members and also our community. And that has to be carried by the entire team. Not one person can do it, not one leader, not one rehab coach or tech or aid or PCC or PT.

It is something that I thought about as we were talking about this. It is something that I haven't pushed on the show before or shared a lot. Many owners have leadership teams that could do well to allow their leadership teams to get some one-on-one coaching as well.

It doesn't necessarily have to be at the same rhythm that the owners are doing, especially if we're empowering them to do some of it. I think it is valuable. It should be a part of the path to offloading yourself and getting your leadership some individualized training.

Anything else you want to share about leadership development? At this time, we covered a ton of ground. I want to give you the chance to share anything that you might have thought about during the discussion.

We covered a lot. It is a true passion of mine. I love to see the light bulb click on for leaders, helping go through that coaching process, and see people get to a position where they make decisions and feel confident about it. That is part of that coaching and training process as we go through as coaches and consultants. I’m here to be of service to people just as you are. I hope people found value out of this episode. It is an absolute joy to be on here with you. Thank you.

 If people want to reach out and get in touch with you, how would they do that?

You can reach me on my email. It is I'd be happy to have a conversation around your needs and wants and see where we can meet that.

That would be awesome. Thank you so much for taking the time, Michelle. I appreciate it.

Likewise, it's always a joy.

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About Michelle Bambenek

Michelle Bambenek, PT, DPT has spent years as a successful leader and developer of leaders within the physical therapy space. In this episode she breaks down the critical components of leadership development - granting team members opportunities to grow and live out their purposes. This aspect of ownership is essential for the expansion of the business. The owner can't do it all and must rely on others to follow successful patterns in order to grow. If you're looking to expand your PT practice consider these 5 steps first.


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PTO 47 | PT And Owner Relationship


Kim Rondina, DPT of Wisdom PT Coach, knows what it's like to develop leadership teams and build a thriving practice as she's done both successfully. However, as she coaches and trains PTs and their bosses, she is noticing that there can frequently be a gap between what the PT and owner are wanting from each other. What she notices is that if the owner, the leader, will take the time to really listen to their therapy team and tap into their strengths, dreams, creativity, and desire to succeed, they will get more out of their teams, work together to attain clinical and individual PT’s goals, and develop a team that is dedicated to the vision and mission of the owner. Creating that kind of environment can become a powerful purpose that drives growth, retention, and recruiting.


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Aligning The Mindsets Of Owners And Their PT Teams Equals Retention And Growth with Kim Rondina, DPT

On this episode, I have Kim Rondina of Scottsdale, Arizona, who I've known for many years since working together at a similar facility back in Arizona prior to owning our physical therapy clinics. One thing I know about Kim is she's truly a dedicated physical therapy professional. She’s an endless student and she’s continually seeking knowledge. She has an immense passion for physical therapy especially guiding therapists and accelerating their development and providing the coaching and guidance needed to do that. She is actively involved in teaching throughout numerous professional organizations now and has trained with as well as led study groups to enhance the skills of her local professional physical therapists.

She previously held positions of Director of Clinical Development and Director of Practice Performance for a fifteen-clinic outpatient private practice in Arizona and thus led their growth and development of hundreds of licensed physical therapy professionals and directors. She's engaged in such diverse coaching environments as one-on-one trainings with directors, roundtables, hands-on treat tanks and code treatments. She's also an owner of Transform Manual Physical Therapy which is a thriving cash-based practice without any marketing efforts. Her environment is very unique in that she treats clients on a monthly basis and has a three-month waiting list at any given time representing the raving fans that she's developed through her expert care. The cool thing about her is she provides not only expert care. She's an excellent private practice owner obviously and successful at doing that, but also has transformed herself into an excellent coach for not only the leadership teams but also the staff physical therapist to improve their manual skills.

I'm excited to bring Kim on. We cover stuff that really focuses on connecting the mindsets of PT owners and their therapy teams so that they can get on the same page. When you do that it can be powerful and beneficial for your company in terms of the environment you create, your retention of PT members, your recruitment of PT members and ultimately the growth, stability, freedom and profitability of your PT practice. Although it's something that has to do with culture in a sense, she shies away from that word, but I think it's all about creating an environment and a shared purpose. I'm talking too much. Let's get into the interview here and take a listen to what Kim has to say.


I've got Kim Rondina out of Scottsdale, Arizona. She has been a long-time peer of mine and is the Owner of Wisdom PT Coach. She's also a physical therapy clinic owner named Transform Manual Physical Therapy. Kim, thanks for coming on. We've known each other for a long time and we've had a hard time getting together on this interview. I'm just excited to put you on.

Thanks, Nathan. I'm grateful to be finally joining you and your readers. I wanted to thank you also for providing such a valuable resource for owners in various stages of their discovery and aspiration across being practice owners. It's definitely an appreciation in your direction as well.

Thank you. That's very nice of you. You know how all my podcast start. I want to know your story. In fact, I know a lot of your story because we've been around the same block down in Arizona but you've transformed since then and that's what really gets me excited about bringing you on, is to share with the community where you're at, at this point. Bring it back a little bit and share with us your story.

I had a similar beginning to most. It’s been a little bit of an interesting journey since then. I was exposed to PT as a high school in the intercollegiate athlete. It took me down the path of graduate school at USC where I got my DPT in 2001. Over the years, I worked in a variety of outpatient environments and grew into a role in which a great deal of my work was with leadership development, organizational culture, performance analytics and clinical excellence. I have a curious, analytical personality and over the course of my career, that's provided for some amazing learning experiences and opportunities both as a leader and a mentor. I definitely have a tendency to see things as many little labels outside the box but more importantly, my role is assimilating information to help people make better decisions and choices throughout their careers. A big part of that for me too is developing an appreciation for connecting with people where they're at in their journey. I appreciate this opportunity that you're providing to your readers and creating mindset shifts in how we can transform as therapy professionals doing so.

PTO 47 | PT And Owner Relationship
PT And Owner Relationship: Have the confidence to value yourselves and the services, and patients will respect that, but you do have to differentiate your service.


Just as you're going through what you're talking about, you've seen a ton of growth, and I've seen a lot of professional growth in you as we've come across each other over the years. You went from a traditional staff physical therapist to Clinic Director to being a big part or playing a large role in a large physical therapy group down in Arizona over many different departments. You were there for a number of years.

I was a therapist. When I first came out of school, I had a lot of ambition and ideas of what employment opportunities were going to provide me and I failed along the way because I had three jobs in four years. I never felt like I found a place that really connected with what was important to me, which was patient care, quality experience and outcomes for patients. I settled into a larger organization, a private practice down in the Scottsdale, Arizona area and was with that organization for ten years. I went from being a staff therapist to actually creating two jobs. The first of which was professional development, meaning there was an absence of mentorship within our four walls in our clinics.

Our directors had a lot of responsibility. At the time that I was with this organization, we had fifteen clinics and over 70 therapists. You can see the scale of operation wasn't a simple one but the absence of having time to commit to the growth of our therapists and our professional staff was definitely a need. We created some opportunities for that. That evolved into a little bit involving outcomes and performance analytics and looking at how our industry was changing and how to help our therapists be successful within those changes. It was a big part and that was an absolutely amazing learning experience and one which has shaped where I am now.

You were with that group for ten years but you all of a sudden decided to quit. Give us a snapshot of what that was like and what you've done since then.

It was definitely an unexpected moment in my life. I'm not much of a risk taker when it comes to traditional ways of doing things but on a Saturday, I decided that I needed to change my path and my course. I really didn't know what I was going to do but I just basically started to be curious and have an open mindset about what opportunities might lie in front of me. Eventually, not sooner after, I started to take on it a little bit of risk, and I opened a cash-based private practice in Scottsdale. I started that practice about three years ago. There were a lot of unknowns with that, a lot of scrambling to figure out what met the needs of me as an owner, my emphasis on clinical expertise and excellence and then obviously thriving as a financial entity as well. It took me about six months to have a full schedule. At this point, I'm proud to say I don't spend a penny on marketing. I bucked the trend. I don't spend a penny on marketing other than my initial website, and then I have about a two-month wait list. I'm focusing on my passion and my love for the highest level of care for the communities that we serve.

What gave you the confidence to not only break from this company that you've been with for many years but then also decided to go cash-based?

I think the confidence came from knowing that I did have some strong referral basis at the time that with my eighteen years of practice. I get my name on a script and I had worked with physicians over a period of time and I was able to provide a different level of care, service and outcome to our patients. I trusted that and went with it. On the cash-based side of things, I had some peers and I had started to do some training in a group that majority of the patients that had trained for this group were cashed-based. I built a network of individuals that could help steer me and give me guidance and direction and worked through those moments that you have and the things that you put up as walls or barriers. They helped me see through them and see the opportunity. I flipped the switch on the mindset and be curious about what could this look like.

The #1 Factor of Job Satisfaction: Good human relationships between boss and employee. Thus, aligning the mindsets of owners and their therapy teams will lead to growth as well as improved environments, retention, and recruiting efforts. Click To Tweet

You had some kind of coaching/consulting at about that time when you got started.

Informally, the more peer aspect of things. I have a few mentors that are more on the clinical side of things. One mentor is a little bit on the coaching side and probably less so on the formal side. My mentorship and consulting came from the growth and development within that organization that I was with for many years. It’s definitely a wide spectrum of exposure and understanding the variables that influenced my ability to be successful.

Kudos to you. That takes a tremendous amount of courage to not only step out on your own but also go against the grant and go cash-based. I know it's trending that direction in a lot of our clinics or companies but to do that right out the gate, it’s really impressive. That’s great.

It’s definitely an exciting opportunity. I worked with a lot of individuals now that goes through the same thing. “What gives you confidence? Why me? Is the patient going to be willing?” and all those questions. Unfortunately, it's prevalent in our industry, and I'm glad to see that it’s trending in the opposite direction and people have the confidence to value ourselves and value the services. Patients will respect that but you do have to differentiate your service. It's not just the status quo because our patients are discerning consumers and respecting that in what we offer for sure.

Imagine the audience was a bunch of guys who are considering going cash-based or are thinking about starting a clinic that is strictly cash-based. What kind of encouragement would you give them? What kind of feedback would you give them or things to consider?

Most importantly, be adaptable. You have to meet the needs of your consumer. When we come out of PT school, there's a paradigm in which we think that the application of our services in the scope of our work is what our patients seek, or referral sources were sent to us. In truth, I worked with a variety of practitioners that I never thought I would have relationships with, from people who work in the world of Reiki to Feldenkrais to acupuncture. These guys all create an opportunity to make a difference for a patient and it does differentiate. In the more traditional medical model, it is somewhat self-limiting based off of what directionality and who goes to what doctor, and are they seeing a primary or a specialist? Being adaptable means looking for potential opportunities for a patient's health and well-being regardless of the source. That's the adaptability there and having the confidence to do that and take on any patient that comes to you.

What other advice would you give somebody?

Secondly, you spoke to the confidence element of things. You've endured a lot to graduate with a doctorate level degree and your skill set is more valuable than you believe. We lack confidence when we're early graduates, but you'll find a way to be successful if it's important enough to you. That means you'll probably become more resourceful than you ever thought possible. That means you'll network in ways when you talk to people and think outside the box, having all the mindset and be curious. You start to take on a different role and identity when you're seeking to be able to have that autonomous and autonomous practice and freedom that we all seek in our profession.

Now that you are where you're at, looking back, maybe you’ve established this early on in your clinic ownership or even before you got there. There had to be an inner purpose that made you decide to quit on that Saturday. You eventually decided to open up your own place and go cash-based and work with these other types of medical health care practitioners. What was your purpose? What is your purpose now?

In that moment, it literally was a belief that our therapists deserve better and second and foremost, belief that our patients deserve better. I think we all can attest to some external forces that are influencing our industry between reimbursement issues with referrals, growing issue with retention and recruiting. It truly came down to providing interaction and an opportunity for a patient, for the first physical therapy business I have. It’s to make a difference in clinical excellence and demonstrate the level of which PT can make a difference in a patient's life. On the second side of things, our therapists deserved better and many times someone influenced us to be brave enough to take the leap into becoming an owner. Exploring our relationship with our decisions of becoming either an owner or a therapist with our expectations as either a leader or an employee really dictates our ability to have sustainable success across our careers. That to me is where we start to take control of our future and redefine and evolve where our practices and/or industry are going.

A lot of what you're working on now is either in your own clinic but also with the people that you're coaching. It’s helping them take control of their future and really define what they want to get out of life.

I mentioned that one coach/mentor of mine. She once told me that the best way to get the attention of physical therapists and especially owners is to appeal to pain. There's a little irony in being a physical therapist and saying that but definitely my experience has proven her recommendation accurate many times over. Some of our pain points as owners both internal and external, within our four walls as organizations or businesses, I call them the four Rs. The top challenges for practice owners we're all dealing with, I briefly mentioned that reimbursement. We also have issues with referrals, our retention of employees especially our A players and then recruiting, being able to bring those A players into our organization. I was flipping through some stuff. We transitioned to an entry-level doctorate in the early 2000s. I saw an article published in PT in Motion in April 2018 that was surprising.

For an eleven-year period of time, primary care physician referrals to PT dropped by 50%. Is our dependence or reliance on a referral basis really creating a thriving culture for therapists with that expectation of building a relationship with physician groups, the primary care or specialist space? The reimbursement goes without saying as far as the cost containment emphasis and the impact it's having on our relationship with payers and thus the cash-based environment that I choose to be a part of. Retention is a topic of conversation. I'm hoping it switches more to solutions. The student debt to salary ratio is exploding. There are lots of job hopping for financial gain, high turnover and burnout.

There was also a study demonstrating that from 2016 to 2017, PT saw the highest increase in turnover rate amongst all allied healthcare professions. We feel it, but when you start to see it in objective ways, it starts to magnify and create a focus on our need to maybe bring greater attention to our people, our therapist and our experience as professionals and employees. That's a little bit of a lot of the conversation that I have with aspiring young therapists as well as practice owners. Anybody who knows me knows that I like numbers. Another crazy statistic is the recruiting side, trying to find that player that fits our culture, fits our dynamic and fits our vision as a company.

What drives employee satisfaction is understanding their intentions and their purpose. Click To Tweet

First and foremost, PT is considered the third most difficult job to fill by a very well-respected human resource organization. The APTA also likes to always keep an eye on us and that our workforce and this one is going to blow you away. There's an expected shortage of over 26,000 therapists in the next couple of years. What's our role in that as business owners? Are we pushing people away? Are we eating our young in the sense of burning them out and having that high turnover and not getting them a quality experience as an employee? We're emphasizing it with our clients and with our referrals, but are we doing it with our own therapists that we're bringing in our organizations?

In your experience in the positions that you have with that large organization, this speaks back to your story in that one of your first roles then was the maturation and development of the professional skills of the PTs in your company. You also said on that one of your jobs was with leadership development. If you're really going to retain and keep people from burning out, I think it's a lot of those two things. Am I wrong? What do you think?

At a basic level of leadership development and definitely growing people, clinical expertise is there. The missing link that I hear commonly with the groups that I work within the practice owners that I touch base with is really connecting and relating to one another. The mindset of an owner, we all can respect the demands and what that looks like. The mindset of an owner has somewhat taken a step away from the mindset of a young therapist. This has very little to do about the generational dialogue that's out there.

The Millennial group has some attributes that create some demand for us to be nimble as employers, but they also create a really great opportunity for us to redefine our experience as an owner. Many times, they want and expect exactly the same thing we do. That comes down to purpose and environment. Many of us started a practice basically saying, “I want to be able to treat patients in this certain fashion or I want to be able to provide an environment that allows me to do X.” That's no different than the employees that we're hiring. Here's a little bit of a hard truth. The number one reason employees quit, what's your experience, Nathan?

When they quit, it's usually a better-paying job or malalignment. It just isn't fitting.

It definitely impacts their decisions but here's the truth. The number one reasons employees quit is their boss. People will leave a job not because they don't like their work or because they found a better position but because they don't like their boss.

When you say boss, that doesn't necessarily have to be the owner. It could be just their superior or who they refer to.

PTO 47 | PT And Owner Relationship
PT And Owner Relationship: People will leave a job not because they don't like their work or because they found a better position but because they don't like their boss.


Absolutely but in essence, the owner is still responsible for creating the culture and the expectation of whoever that supervisor relationship is with. The main issue and this alludes to what you were speaking to about why people leave is they don't have a sense of belonging. They can't really relate to what they're being asked to do on a daily basis. A study by Kota in 2018, they looked at job satisfaction in PTs and the number one influence of job satisfaction is better human relations. This gets back to, are we connecting with other people and are we creating a culture that enhances their experience as a therapist? Are we creating a culture of business? If you want to make a difference in recruiting, retention and our ability to thrive as practice owners, we have to ask some hard questions about what we're creating. Those drivers of satisfaction are purpose and environment.

That purpose is what motivates and drives us. We want to connect and relate and as business owners, we can say that's why we started what we're doing. The other element is the environment and this is the experience they have as your employee. The caveat there I'm going to say is there are a lot of times that people go through a checklist of everything they need to do in an organization from a mission to a vision statement to core values, review the checklist of onboarding. That's all great, but it has to be a non-arbitrary engagement. It needs to be genuine. Do you help your employee fulfill their aspirations as a therapist or are they simply a widget within your system that you've built? For me, that's the second aspect of my growth and maturation as a contributor to the therapy profession is to help bridge the gap between the mindset of an owner and the mindset of a therapist. We can stop dealing with some of the things that are potentially internally mediated and driven into some challenges that we have as practice owners.

Pulling back the curtain a little bit. What would you recommend owners do to step back and see if they are connecting with the therapist that they have on staff? What could they do to connect better with the therapist that they work with?

First and foremost, we have to focus inward. I mentioned some of the external things that influence our industry but lots of times as an owner, the first thing we need to do is focusing on ourselves. We need to get clear with our motivations and our intentions. We have to live them, and we have to grow our perspective as far as what our role and our responsibility is. We can't keep getting distracted by the parts of doing our business because we're always chasing. There's always not enough. There's not enough time. There are not enough therapists. There are not enough clinics. There are not enough referrals. There's not enough in the budget. That scarcity mindset really has to be washed out of our mindset as an owner.

Would you recommend they get clear on the company's purpose and then just try to start discussions either in staff meetings or one-on-ones with them and really communicating?

Yes, but no. I'm going to take a step back to that inward on ourselves side of things. Many times, owners will put language to their motivations in objective terms or in material things that they want to accomplish. They really have to get a sense of what they want to feel in their experience as an owner because that will dictate the what of how they approach their employee base and their therapist. If you make it about numbers, many times therapist resist that. If your meaning is, “I want to hit a certain profit margin,” or “I want to grow or create this goal and I want to have this many more new patients in the next six months,” or “I want to add to clinics,” the truth of the matter is it all comes down to what someone hears as more and the never enough and that mindset of scarcity. It’s switching the gears and getting a sense of what you want to feel.

If that profit margin or those goals give you stability and a sense that you're on the right path, those are the type of language skills and the direction of how you engage with your employee. One of the things that I commonly have practice owners, younger therapists go through is I’d have them spend three minutes and I basically say, “Write out your 25 most important wants in life and it's just free for all.” Majority of the time when you get to the end and you ask them, 90% of the things they write out are all material things or data-based like, “Here's a goal,” but it doesn't connect and relate to your experience and experience is a feeling.

The number one reasons employees quit is their boss. Click To Tweet

That relationship that we have with why each of the things that we have a conversation with our employee is important. Let it be a meeting or a performance review or simply having a connection with them. How's your day going? What's making a difference for you and that 360 feedback? There are endless possibilities but it literally comes back to, what is the feeling that you want to have and the experience that you want to have as an owner? How do you bring that into the relationship that you have with your employees?

When you're talking about these things, you haven't used the word culture, but that's what's talking to me.

Buzz words happen. That was part of my responsibility in my prior position. I think culture becomes a concept and it doesn't become the context in which we relate to people. Our therapists, they hear that word and they think it's important to someone else. If you ask them what's important in their culture, they might not be able to answer it. If you ask them what's meaningful to them or what's important in their environment, that's a language that they can relate to and share an experience. For example, environmental aspects. We mentioned a younger generation of workforce, they challenge hierarchy and they don't like the status quo. At the same time, they're absolutely open to change.

The opportunity there is finding the mindset that's open and curious and trying to find and create opportunities to build your dreams together. It’s because you both have the expectation of having a fulfilled career, let it be as an owner or as an employee in coming to work every day, having that job satisfaction and excitement coming to work every day as much as you do driving home. There's always that re-grounding of a question. The how is left up to the creativity of each individual organization. For some people, that's a non-answer but for other people, it gives freedom. That freedom and that autonomy is what allows us to evolve away from the status quo of what hasn't worked over the generations of therapists and so forth. I'm a little bit of an older therapist, but we've got therapists that have been around a little longer than us and they talk about the good old days in the ‘80s. We know we're not going back there.

We've seen a transformation of what influences what physical therapy practice and what physical therapy ownership looks like. Take responsibility for starting with ourselves. Create that intention of what that experience is when we walk in our four walls. How do you want to relate and encourage the people that have basically said, “Yes, you're the person I want to grow my profession with?” Meet their needs. In truth, when you find a willing partner, it's amazing the dynamic nature and the opportunities that will come of simply meeting them where they're at versus trying to get them to see things your way. Our human nature is people should see things our way.

Especially as the owner, you want to say, “These are the stresses that I'm dealing with. I don't know if I really care about your stresses all that much because if I don't make a profit, then both of us have a lot of stress on our head.”

In truth, the most genuine stakeholder we have in our practices are our therapists. It's not our payer sources. It's not a referral basis and it's not our community. Unfortunately, our community is still struggling to figure out who we are, what we do and finding us regardless of direct access and the work we've done in that arena. Our biggest stakeholder is our therapist. Don't look at your budget. Pull that guy out. Ask yourself, “Out of your budget, how much do you spend on marketing versus developing your greatest asset being your therapist?” More times than not people's marketing budget is greater because they're trying to deal with competition. They're trying to differentiate themselves. Now with social media and the ways that we have to get in front of people, it’s more of a financial commitment than ever on the budgeting side.

We also know that therapists on the average generate about three to four times their salary as revenue for your business. Doesn’t it make sense to basically create the investment in our therapists and their ability to maximize that top line revenue that they're generating year over year and create retention and satisfaction? Rather than some of the marketing money that we spend to the people that the entities have shown that they don't value our profession as much as we do. I know it's a scary proposition because we've spent decades focusing externally and giving external people power to define our success. That's not really how we're going to be fulfilled.

I'm just envisioning what it would take for an individual owner to really connect with the PTs that are on your staff and what that would mean. For me, you can correct me if you have a different opinion or idea, but it takes some one-on-one conversations where there is a truly vested interest in what that physical therapist wants and needs in the future. What you can provide them to help them meet their wants and needs as long as it doesn't sacrifice my wants and needs, then we'd come to an understanding. If I can provide you some of the wants and needs and even some of those dreams that you talked about on the top 25 dreams they have for life. If I could buy them experience, if they want to go to Italy for a week, what can it do as an owner to get you to Italy for a week? Is that the kind of stuff you're talking about and at least opening the dialogue between the owner and staff therapist?

I'm definitely coming to work for you if you're going to get me to Italy. That's one of my dreams, but yes.

If you kill it and you've got a two-month waiting list, I’ll send you anywhere you want.

To your point, absolutely. As practice owners, we have to be adaptable in understanding what our role and responsibility is. We can spend time doing, chasing, committing and going through the cycle of business of our professions. We all have those sour points of the things that frustrate us, and we feel like we're in an uphill battle against in the things that we feel like recycling old habits and old conversation points with our peers and so forth. You can get ingrained in that. I understand that, but that's usually the things that don't bring us joy and satisfaction. The aspect of our therapist team is they can relate to us as a therapist. When we sit down and say, “What is it that I can help you attain?”

Stepping back, someone committed to each one of us. We've had people that have influenced us. It might be in an informal way or a formal way where they sat down in front of us or dropped a little message that basically changed the way we saw our profession and how we can be successful and thrive. It's absolutely sitting down. I’ve built performance reviews. I've seen tons of different performance reviews over the years and they can be fantastic tools, but you have to ask yourself, “What is the therapist experience?” We've all had gone to reviews when we were therapists and for the most part, you feel like it's a process because it's a checklist. You have to go through it at the end.

It's basically usually connected as, “Am I getting a raise or not?” The intention there is I have to do this process as a leader or a supervisor. You're going to have the expectation but it doesn't mean that I get greater financial stability in the future. That's not long-term loyalty. As a business owner, you're not going to build loyalty off of that, and that's what we strive for because we want that stability. We want that ability to brand ourselves and have a familiar face for a doctor to refer to. Even if you have to go through an entire performance from you, you have to have an endpoint where it really comes down to the individual therapist.

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This is where the caveat is. Your leadership team has to have the time and the expectation of creating that level of engagement. It’s knowing their staff and truly committing to their future and not being fearful of them leaving, not being fearful of them becoming a competition. In truth, if we elevate each other and one another, the entire profession succeeds. Keeping people down is not working and trying to make sure that we keep our share of the areas in which we have our clinics and so forth. The truth is PT needs a lift up, not just a business or a region of the country. That comes from helping every new graduate and every employee that we have to really elevate the level of impact and growth that they seek to have.

The elevation, it seems like the trajectory of physical therapy in general because back in the day, a lot of it was about numbers, seeing your patients, being the better technician and improving your skill. I don't know if it's just a progression or if it's come with the generation of physical therapists and workers that are coming into the industry nowadays, but it's more than that. It's more of like, “I want to be in a place where I'm in alignment with their purpose,” or “I want to be a part of a group that's got a greater charity that they're involved with,” or “I align with these people because they've niched out into this specialty that I align with,” or “They've allowed me to create a niche within their practice that I really believe in and develop and hone my craft.” There seems to be more of that going on and less of the strict numbers because the numbers then take care of themselves as we invest in purpose and invest in the individuals, the therapy team.

Imagine if you’re changing how you approach your therapist and you start to discover what really motivates them and the gifts that they have to share and how they see themselves making an impact. All those things will start to open up the possibility of how your business grows, how it has different arms of the business, let it be we're going to reach out and do UroGyn or we're going to do CrossFit work or we're going to work with high schools. That comes organically within the people that you're having, but it only happens because they're driven by that meeting and that impact rather than a business owner saying, “Here, this is our next phase.” It's hard to pull people uphill.

The sense of belonging and going back to what drives satisfaction as an employee is the whole essence of everything is. It’s understanding their intentions and their purpose. Maybe this is my bias and my passion but hearing people's excitement about what they can do and what they can offer, my role at that moment is to be curious. It's to be open-minded. It's not to put my foot down and say, “Nope, that won't work. We've tried it before.” What future are we going to have or what type of employee relationship or employee culture are you going to have if they run into walls and you're that wall? Don't be the boss that creates the employee to quit.

Creating an environment like that just lends directly into two of the four hours that you're talking about, retention and recruiting. Your ability to retain at that point goes through the roof because these people have something that they're passionate about and recruiting means, they're not only doing what they love but they're spreading the word, “I work in a place that I really love to work at. You ought to join me.” You can show that to other therapists that you're recruiting. “This is what we're able to provide you. If you have a real passion for something, we can set you up for that.”

It is truly about nurturing and providing their ability to influence their future and your business. I'm sure you've interviewed dozens of people with a variety of different work environments. If we are paying attention around us not just necessarily our local communities but nationally, we see who's making a difference. We see who has raving fans of employees. You get a sense that there's freedom of exploration and there are a true curiosity and interest in how our business can be different, and that doesn't mean that everything has to look dynamically different than where you are now.

It just me not all clinics are going to look alike but it still comes down to your people and how you relate to them and giving them an opportunity rather than saying, “Here's the hierarchy. I've been here, I've done that. I built this. I'm the one with the risk and I know the numbers.” It’s giving an opportunity for someone to open your mind and shift your mindset and make a difference in your business because of retention. We get those A players, but we also squeeze hard to hold on but when we squeeze, we’re really not open. That's when we close off, get guarded and feel a threat and that's usually not when we're most dynamic, creative and adaptable.

PTO 47 | PT And Owner Relationship
PT And Owner Relationship: PT needs to be lifted up, and that comes from helping every new graduate and every employee to elevate the level of impact and growth that they seek to have.


When you say open, you have to really be open to the possibilities that you might not be able to be the best fit for that person. You want to try to create an environment where there's the ability to create and explore and do more but sometimes it’s just not a fit, and that's okay. I understand. How can I get you to the next place?

I have a peer that I worked with at my prior position, and she publicly admits that the best thing that ever happened to her was getting fired because she definitely wasn't a fit. There were a structure and an organization that focused on her weaknesses and dampened her creativity and the uniqueness. She was someone that is an amazing clinician, but it didn't fit into what the culture of the organization was ready for at that moment. She publicly admits, “I wasn't a right fit. I'm glad I got fired. It opened up this whole element.” That's just an example of sometimes the greatest gift that we can offer an employee is to admit we're not the right fit and there are all the sayings about the speed in which we hire and fire. We don't have to go into that. It's never easy to fire someone but in essence, you can do it with the right intention, and you can send the right message. You can still remain a resource for that individual across their career.

The benefit of that is it really speaks to you caring about that person enough to say, “This doesn't work for either of us.” When you're that vulnerable or that open and honest with each other or at least you come to that conclusion together, they’ll bend over backward to help you out. We had a guy that it just didn't fit. We were talking about the programs that we were doing, and we implement this, that and the other and he would improve for a while and then backslide and improve for a while and backslide. Finally, it got to a point where I was like, “Maybe this doesn't work for us,” and my business partner had an open and frank dialogue with him. We came to understand that it's time for us to part ways. I think he gave us two months’ notice and said, “Even if you bring them on, I'll stay around a couple more weeks to train them on what I'm doing.” It was great. It was wonderful and I know he's gone onto another group in town and they absolutely love him, and he's a great fit there. It just didn't work for us and so there's a benefit. I didn't want to go down to this is how to get rid of somebody. It goes to show that when you truly are open and honest with your team and looking out for what's best for them, that things can turn out the right way.

When I have a new graduate or a younger therapist coming and you're asking for career advice, the first thing I ask them is, “What are the top three things you look for in a career opportunity?” It's amazing to me that they can't answer it. When I say, “What are the top three things that you won't tolerate in a professional opportunity?” they know those things right there. They see the bad, and they avoid the bad but don't necessarily look for the right fit. As owners during our interview process or even with our team development side of things is identifying, “What are those three things that are important to you and are the things that we can honestly offer?”

We know the generation coming out right now, they all want mentorship and more learning. Do our business environments, our culture, our workflow and the demand of our day allow for true mentorship in the capacity that they're expecting? As owners, we all think that we're growing our people but what does that look like? Really working through what that expectation is because the last thing you want them to do is to feel that you're not committed to them as a professional because they've just spent over a hundred thousand dollars getting educated. They want you to help further that growth aspect. On the owner side of things, where does that get in our day?

Look for those opportunities, really finding and discovering through conversations, through networking, through seeking people within your own organization that are willing, able and interested to do something that you haven't done before. Allow for it to happen. Sometimes it's okay to try something and get surprised when it actually exceeds your expectation. Sometimes as owners, we always have that cautious tendency where we crawl into things and hope it works out right or we've put up a barrier before because we just don't think it's going to work. Allow yourself to try things and be amazingly surprised at how they thrive and grow organically within your organization.

Is there anything more you want to add? How can people get in touch with you? What speaks to you?

If we elevate each other and one another, the entire profession succeeds. Click To Tweet

As a message of the day, focus inward. As hard as it is not to allow all those external influences on us, encouraging in a culture and society that we have where there's so much business and chaos. Focus inward, ground yourself, get clear on your intentions, live them every day and grow through a perspective. That inward reflection also speaks to who you are as a therapist. Bring that focus on your clinical team, nurture them, influence their professional future and that is going to be vital to your fulfillment as an owner. In doing this, we're going to have an amazing ability to evolve the industry by committing to the people that are true stakeholders and that's our therapists. If there's only one thing that you learn is really differentiating who makes a difference in our profession and in your practice success. Let it be understood that it does come from within those that have dedicated the time, the energy and the passion for serving others.

When you really commit to your therapy team, if you're able to help them achieve some of their visions, goals and aspirations, even the dreams and experiences that they have in life, they'll do whatever they can to make sure that company that they work for succeeds or that you're also achieving your goals at the same time. They take a vested interest in the company that provides them with such wonderful opportunities to thrive, succeed and achieve their dreams. They’ll do whatever it takes.

I'm excited to see it playing out, for sure. As far as getting in contact with me, I am on LinkedIn both under Kim Rondina and Wisdom PT Coach. I do a Monday morning reflection in there just to re-ground us into some amazing thoughts in life in general. Also, through my website, you can contact me through

Thanks for being with me, Kim. This is awesome. I really appreciate it.

Thanks, Nathan.

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About Kim Rondina

PTO 47 | PT And Owner RelationshipKim is a dedicated professional, seeker of knowledge, and endless student. She earned a Doctorate of Physical Therapy from the University of Southern California. Her interests are wide-reaching from discovering skills that will further enhance the lives of her clients, to self-awareness and all things 'why we do what we do'.

She combines an immense passion for guiding therapists and accelerating the development of the highest quality skills in real-world clinical environments, with a style that encourages appreciation of the journey.

Kim is actively involved in teaching throughout numerous professional organizations that she has trained with as well as leading study groups to enhance the skills of local professionals.

Kim previously held the positions of Director of Clinical Development and Director of Practice Performance for a 15 clinic outpatient private practice and has lead the growth and development of hundreds of licensed physical therapist professionals and directors. Kim engaged in diverse coaching environments including a one-on-one with directors, round tables, hands-on 'treat tanks', and co-treatments.

Kim is also currently the Owner of Transform Manual Physical Therapy, PLLC, a thriving cash-based practice WITHOUT any marketing efforts. It offers a unique environment of treating clients on a monthly basis, yet having a 3-month wait list representing the RAVING FANS she has developed through the expert care that she provides and personal mastery skills she embodies.


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