PTO 93 | Growth Accelerator

 

Christina Panetta, PT learned fairly early on in her clinic ownership that she needed to outsource in order to grow and improve. When she needed some time and space after having a baby, she hired a PT and came back to part-time work. When she recognized that she needed more business training, she hired a business consultant. Now, decades later, when she needed some support on social media to drive patients into her clinic, she hired a social media marketing company. Too many times, in order to save money, owners will take it upon themselves or leave it to their staff to work in areas that are not their specialty (business ownership and social marketing are two examples). This inevitably leads to poor outcomes, distractions, wasted energy, and little return on the investment. Moral of the story—hire them on or hire it out.

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Listen to the podcast here:

Growth Accelerator: Hire Them On Or Hire It Out With Christina Panetta, PT

I have Christina Panetta out of New York who not only brings and shares a great story about her growth from a single room clinic to multiple practices, but I'm excited to share this because Christina recognized fairly early on and as a firm believer in either hiring them on or hiring it out. What I mean by that is either hire on another physical therapist if I need more time and space or hire on a coach or consultant to teach me what I need to look for and do that I don't know how to do or also hire it out. Find the resources, find the vendors to do the things that you're not an expert at, which could be many things. Social media marketing and billing come to mind. All these things that sometimes we try to do and we're not trained to do it. We don't know the ins and outs where we could hire an expert and get it done much more efficiently. Christina is a huge believer in that and her story reflects that because she's hired on and hired out. She has grown significantly and continues to grow and continues to look for other resources to help her grow and she's been successful at doing it.

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I've got Christina Panetta, Founder and CEO of Panetta Physical Therapy in New York. I've met Christina through Hands-on Diagnostic Services, which we’re both owners of diagnostic treatment centers. I've always been excited about talking with her because she has plenty of wisdom. She's been around for a while. First of all, thanks for coming on, Christina. 

Thank you for having me.

I consider you a great part of my network because every time I've interacted with you a lot, you've had the wisdom to share. I don't know if you remember those instances, but they were important to me. I'm excited to bring you on. Did we meet a few years ago for the first time?

Yes. When we were training, learning how to do EMGs and diagnostic testing.

I always liked our conversations as we were going to lunch and whatnot, but for us in the audience, would you go back and share with us a little bit about your professional story of what got you to where you are? I know you started small, now you're up to four clinics. I want to share what your path was like with the audience. 

I wouldn't consider myself a business person. I went to physical therapy school because I wanted to help people clinically. I never thought about having a business. My husband was a business guy. He had his insurance office and I was working for a big medical group. I had at that point one child, I had my son, he was maybe two years old and we joined a gym. This is back in the time where free weights, we were moving into Nautilus, it's the '80s. We wanted to get back in shape. We joined a gym and we were walking around the gym and they were telling us about how they're going to move some walls down and put in a Nautilus center. My husband says to the sales guy, "Did you ever consider having a physical therapist here?" This was before anybody did things like that. He's like, "No, what would you need?" He looks at me and I'm like, "Room for two tables." The next thing you know, that's how I got into the business. I didn't quit my other job. I got 500 square feet maybe, I don't even know if it was that big. We put two tables in there. My father in law made the sign and it said, "Physical Therapy Office: Christina Panetta, PT." I sat down.

I didn't even have a telephone. I use the club's phone number and my marketing when I would get a phone call, they would go, "Christina Panetta, you have a call on line two." I would run out of the office through the club and answer the phone. I legitimately didn't know anything about anything. The first patient was a gym member and he walked in and he was like, "Who are you?" I'm like, "Physical Therapists." He's like, "I’ve got back pain." He was a landscaper. That was my first patient. I remember his name. I even went in on Sunday mornings to treat him. I started small.

What were the first couple of years like? Did you ramp up quite quickly? How soon thereafter did you get out of your full-time job and recognize that maybe you needed your phone and your space?

PTO 93 | Growth Accelerator
Growth Accelerator: You can't treat everybody yourself, so you have to learn how to delegate.

 

It was a slow ramp-up. The cool thing was I got to know the doctors in the medical group and the medical group, what would happen is they would have patients. People that were injured at work and in car accidents, which could be treated in or outside of the group. It was a weird situation. Even when I was working there, I was allowed to bill privately anytime anybody was injured at work or in a car accident. They didn't have inside the group all the access. I had access, a pool, and I had access to this new Nautilus equipment and treadmills. I could use anything in the gym. I started two nights and then eventually, I tweaked my hours in the medical group.

I was working three days and then I would work two long days in the health club. The owners of the club, I'm not even exaggerating, my rent was $50. This is the '80s. Therapists were making $10 an hour. My dad was in awe. It's different in the '80s and they were always like, "Are you doing okay?" They love the prestige of having a physical therapist. I was full-time with two nights, then three days a week in the medical group and then two days a week. Eventually, I got pregnant again with my second child. After I had the baby, I switched to two days in the medical group and three days in the main office. Once I was three days full-time with my patients, I bit the bullet and left the medical group.

At that point, you were probably looking for new space. At what point did you finally establish your clinic had set up a lease? I'm sure that was a huge jump for you at the time, but to have your place or jump out of treating full-time and going to your thing.

It was a big jump. I feel like in some ways I was lucky because my main office is still in this health club. What happened was the health club kept expanding. Every time the health club expanded, first of all, they would've given me any amount of space when I first said, "How much do you need?" I was kicking myself because I'm like, "Why did I only say two tables? I need four tables." I eventually did get my phone. In the early '90s, I got a computer. The '80s is pre-computer. I got a dot matrix printer. In the beginning, I had an aide receptionist because I use all their exercise equipment. I always needed an aide in the gym, that was my big plus point. Everybody got to like, "That's got me the whole body concept, come in for your back but I'll treat your whole body." The club liked it because anybody that became a patient often would become a gym member. It was a nice give and take in that period.

It's not uncommon to have a physical therapy combo like that in a gym. One of my good friends, Aaron Williams with OSR in Arizona, worked closely with a gym down there. One of my previous episodes was with Paul Wright. He's in Australia, but the same thing connected with the gym and was able to establish something big with them, especially with that crossover.

It's an easy way because I didn't have to have a big layout of equipment. My most expensive equipment, the same thing, the early '90s. Electric stim units, it was big. We hardly ever use it, but in the '90s you needed electric stim and ultrasound. I remember my electric stim unit cost the same as my Camry, which was my first car. I didn't have to take care of the bathrooms. I kept growing and I was lucky in that the club kept growing. They put a second floor on and I'm like, "I need four tables," and then I was like, "Four tables is not enough. You're not using that conference space. Can I take over that?" I was like, "I need eight tables." As I grew, first, there was me and then Karen Eckardt. She was my first employee. Her father-in-law was one of the owners of the gym. It's convoluted.

Her husband was an insurance agent. Her husband was walking by my office and he was like, "Who are you?" I'm like, "I'm a physical therapist." He's like, "My wife too." I'm like, "I need to meet her." Karen comes and meets me in that summer. I was working. I worked three twelve-hour days and that was my schedule. The other two days, I was a mother. I had two young children. That summer, all I remember is I hired Karen and I said, "This is fantastic. Here are your patients." I was only working three days a week and I gave her the whole schedule and I said, "I'll work on building my schedule in the fall." I took the summer off and enjoyed it. I know it sounds insane, but I was trying to balance being a mother and being an owner of a business.

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Many times I come up with people that I interview that eventually become successful or coaching clients that I have, and they keep thinking, "I'm treating full-time. I need to bring on this other provider and build up their schedule." I try to tell them my coaching clients at least or who aren't at that point, "No, you give them your patients and you worry about building up your schedule or scale back so that you can work on your business." Looking at it from a different perspective, how can I financially afford to bring on somebody else and not treat patients myself? What am I going to do to become productive? You found that because you were essentially living a higher purpose and that being a mother and spending time with your family, especially as young as they were and concerned about building up your patient load afterward. For you to give that to Karen was not only insightful, but it's an example of what people could do. If they have the focus of themselves and their business first. When you bring someone on, it’s investment. It might've been a scary situation for you at the time to take on another salary like that. To invest in bringing on a provider that you can scale back and work on the things that you need to work on, whatever that might be.

My husband, his degree was in marketing. Come the fall, he was like, "We’ve got to go out and visit doctors." That was not easy for me. Because he was insurance, I used to help him. They used to call this X dating where you would call people and say, "When does your insurance expire?" I hate it, but I would do it. I'd be like, "Please don't make me do that." When I had to go and visit doctors, I was like, "No way, this is terrifying." He was like, "I don't understand." He couldn't understand that. I was terrified. I did it, I would go out, but I had a lot of awkward experience.

You learn it over time and you're probably pretty good, I'm sure. 

I feel comfortable. I had a lot of help along the way. For me, I had people that helped teach me how to go and make a relationship with a physician.

Things seemed relatively smooth. When did you hit a point where you're like, "I'm in trouble?" Did you ever hit a point like that? 

What happened was, a lot of my referrals came from the medical group. The doctors wanted their patients to have what I had at the gym. They were referring their patients to me and everything was great until one of them, the leader of the pack, the orthopedic, and then probably hundreds of people have been through the same story. My biggest referral source, way more than 50% of my patients. What does he do? He wants me to open a business with him, but I don’t want to open a business with him. He opens his own PT clinic. The interesting thing is I had an office manager at that time. That was Karen and myself, an office manager and a trainer. Karen and I worked opposite schedules that we could fill up our table, and we only had a certain amount of tables. This is how I got introduced to a survival strategy. The office manager sent us a postcard. It said, "Do you need more patients? Are you afraid of visiting doctors?" I'm like, "Yes." I didn't answer it. I throw them in the garbage. She filled out the postcard and she was like, "We need help." Way back in the '90s, me and the office manager, we fly out to California and then that's when I learned how to make a relationship with positions that I didn't already know. That was either sink or swim. Either I was going to do something to handle the situation or I was going to think.

Was that difficult for you to sacrifice the time, energy, money that it takes to have some consulting through survival? 

The first program I did with them, we doubled our business. Karen and I being together to four full-time therapists. It was a big thing because I remember saying that I always had this target that we wanted to do $1 million. Being able to double the business, that was our big target. I have four full-time physical therapists, I could do $1 million, which is pretty much what we did. That was huge. That was where the club added a second floor and we were able to double our space. I could have gone anywhere, but I've been lucky in the club that I got to stay in the same place because they kept expanding as we expanded. That was huge for us.

PTO 93 | Growth Accelerator
Growth Accelerator: The best patients you can have are people searching for answers.

 

It took more time going to a weekend course and then coming back and all of a sudden you have four therapists. How much time did that take for you to build up? 

We doubled our referrals in one year. It was probably one year that we've doubled the amount of new business coming in. I did a marketing program with them and then the following year, I didn't know how to manage anything then I did a management program. For us, that’s the basis and it put the organization in the company. The first step is you have to be able to go out and then form relationships, find the patient's people are out there suffering. You have to be able to find those people, bring them into your place but then you can't treat everybody yourself. You have to learn how to delegate. I always say my type of management I call it household management. When I was little, I was treating, but I could hear my office manager and front desk receptionist. She was everything. I was treating and I would be like, "No." My management was like family-style. To me, you could get yourself maybe one therapist. If you want to expand out, we're open from 7:00 AM to 9:00 PM and that's two completely different staff. You have to have a management system in place and an organization. That's what Survival Strategies helped me a lot with setting up, having an organization in place, having systems. Everything even that we do has come from what we learned with them.

The way that my business partner and I looked at it as we were going from mom-and-pop to an enterprise. If you envision what a mom-and-pop place looks like, everything is dependent upon mom-and-pop being there and running everything to an enterprise. The idea of what an enterprise looks like means that there's a structure in place, there are policies and procedures about how you do things. You might never see the owners on site. We recognize that it took some investment in capital, energy and time to make that transition. It’s necessary if you want to grow and if you want to avoid burnout for the individual. The one thing I'm confident I can say this about you is that when you did get that consulting you were adamant about implementing it quickly. You didn't come across and be like, "That's a good idea. Maybe I'll do that someday." I'm certain that you came back and you put a plan in place quickly to get this stuff implemented. A lot of us might read a book or hear some good things at a conference and think, "That's great. Someday I'll implement it maybe, maybe not." You were pretty determined about that.

The big thing is that it wasn't a course that I took. The way that Survival Strategies works is a consultant works with you every single week. More than anything, they were guiding me. I would have assignments every week. There are those people that always get the assignment and they do it right away. I'm the opposite. There's the student that they get the assignment and they're like, "I work good off a deadline." I don't do it when I get it, but I never miss a deadline. I need the deadline to fire me. Every week I would say, "I'm going to talk to this person. I am supposed to have visited five physicians and ask them these questions or I'm supposed to have met with four of my staff and written up their job descriptions." I always had somebody. They were cheering me on and motivating me. To me, I needed that. I was motivated but I needed maybe more than anything the person to hold me accountable.

That's the beauty of having a coach or a consultant, especially one that meets with you regularly, whether that's weekly, biweekly, whatever it is. They hold you accountable. They provide deadlines simply by the meeting. You don't want to let that person down. You want to show them that you're capable and competent. That's the beauty of having that because who else would hold you accountable? You're left to your devices and there's not necessarily a deadline. Essentially outside of the household is the head of the business. You don't have any one individual to answer to when you're at your founder/CEO stage. That's the beauty of having a consultant that meets with you regularly, is to hold you accountable, guide you and teach you. What I find is a lot of them are helping you fulfill your goals and what you want to learn and what you want to figure out. Is that what you found as well?

Yes.

You've expanded out of four clinics. You've got the policies and procedures in place. You're no longer the household business. You've got the structure, you are an enterprise. What are some of the successful actions that you're handling to overcome the problems that you have?

The biggest thing is keeping my eyes open and being willing to change. In the beginning if you want new patients, you had to make more relationships with physicians. I love that because in New York, we have direct access. People can come right to us. Everybody that works for me other than me has a doctorate. They're all doctors of physical therapy. We have social media. Social media to me has been the game-changer. Think of this, who is on Facebook? People like me. Who makes the decisions about healthcare? Women age 40 to 65 years old and they live on Facebook. They make the decisions for themselves, their husbands, their children and their parents.

Keep your eyes open. Be willing to change. Click To Tweet

Just like Survival Strategies, there are companies like Breakthrough PT with Chad Madden. They specialize in helping you reach the people that are looking for help. What I've learned is that people are out there. There are more patients than all the private physical therapists in the world could ever handle. Many people want help. Still, when they go to their doctor, even despite all the educating. Thirty years I'm educating doctors and I have educated a lot of them, but they still don't always prefer them first to physical therapy. They're looking for answers and people aren't trusting. They don't trust people. They're skeptical. They don't trust their doctors. They do their research. We can use social media, we can use Facebook. This has been for me the biggest thing, our newest clinic.

I did the numbers, only 25% of my patients come from a physician. 30% are coming because they were past patients but everybody else are direct people, just public. People are searching for answers. To me, they're the best patients you can have because it isn't the doctor who said, "Get some therapy." They're looking and saying, "I have back pain. I'm an active person. I want to get back to doing what I want to do. I want to get back to doing what I love. I don't want to take medication. I don't want surgery. I don't want injections. I've tried all that." They're doing their research and then they come across our educational videos about knee pain, shoulder pain or back pain and they sign up for our workshop. I'm 100% in control of who do I want to see. I can turn it on, turn it off. The fun thing is I can say, "Let's decide what we want." We want shoulder patients. I can go and I can work with all of my staff and say, "Let's make sure we're all doing the same thing." That's a lot of what I spend my time doing because I don't treat it all. I don't have any patient load. Even Karen, she is still with me.

She doesn't have a patient load. We spend all of our time keeping our systems in, but also looking out there and saying, "What's new?" You do the diagnostic testing. It's like, "We should be doing that." We’re researching what's out there. "Therapists can do EMGs, NCVs and Musculoskeletal ultrasound." Does that fit into the practice? Doesn't it fit in? Does it bring the type of patient in? What I find is when you bring that type of patient in and you have to make sure all the staff is capable of delivering the same outcome that you're promising when you deliver the workshop. Our workshops are all about, you have a pain in an area, most likely the cause of it is somewhere else. It's always that message of, "You have a herniated disc. You're bone-on-bone. Yes, you have a torn meniscus." What's causing it? If you never fix what's causing it even after you get the shoulder decompression, you're still going to wear out the other tendons in your shoulder if you don't fix your ribs.

I love the experience that you share because it shows what you would be doing if you're not treating essentially. That question comes up from physical therapists all the time. “If I'm not treating, how am I being productive? If I'm not treating, what am I doing with my time?” You've established that. You're keeping your structures in place. You're still monitoring all the key stats. You've got your KPIs, you're probably graphing them or at least looking at them week-to-week. If you're not, then Karen is doing it for you, reporting up. You're looking ahead and that's what a true leader should be doing. It’s not heading in the ground or buried in patients, but rather looking up forward and saying, "We've got direct access. How can we take advantage? What is our demographic that we're hitting at?" We're getting into marketing strategies. Knowing what your true demographic is and how to message to them is the first step.

I love how you said, "It's like a spigot." You've got two systems in place where you can turn on the patients, turn off the patients or tweak things enough to say, "We're doing this and this is the message that we need to do. We're going to focus on this body part. We need to train the therapists appropriately." Everyone's using the same narrative, the same vernacular, the same vocabulary, they hear these patients hear the same story to build on that foundation. That's what you should be doing as a leader, developing that over and over again, tweaking the marketing and doing the training. It's great that you shared what you're doing as a leader. 

PTO 93 | Growth Accelerator
Growth Accelerator: You have to make sure all the staff is capable of delivering the same outcome that you're promising when you deliver the workshop.

 

If you know what it is, it's much fun meeting with the therapist. We have thirteen therapists. Every quarter, we meet with every single therapist for 30 minutes. If I do look at their production, I'll usually have a question. I'm always looking for, what's their passion? When you learn things about people, how do I pull that passion out? What do they want? What I see is that most of my therapists other than Karen, myself and Mary Jane, they're all 40 and under.

You guys are 41, 42? 

I'm more in that other demographic of the Facebook people where my staff is the Instagram generation. They will balance in their lives. They want the family and they want the profession. They want to have an impact. I'm reading this book called Impact Imperative. They care about the world. They care about people. They want to treat people who want to get better. I talked to them all the time at the workshop, people are suffering. We have the answers, but there's this big disconnect. They don't know it. When you can take a person, we always do success stories, testimonials, complete a plan of care. We take a picture. The patient talks about the before and the after. You take that person that thought they'd never run again or they'd never be able to walk them all with their grandchildren or go to Disney. That's what's great about being a physical therapist. You can help a person that wants to do that passionately.

We spend a lot of time teaching new therapist, how do you pull that out? I spend a lot of time talking to the therapists about who is it that you love to work with? Why do you love to work with that patient? Let's get down to the bottom of it. I'll find out some crazy things like, "This person loves to work with people that are grandparent’s age that can't walk." You would never think of this. He’s a young guy and he's like, "That's my favorite patient." How do you create a story and how do you find those patients? You can get so good at working with that patient. That's what I'm having. I spend my time and I'm having fun. That's helping me have my therapists have more enjoyment and getting more out of work because they think they're having a bigger impact on their community.

It sounds like what you're doing intentionally, you're creating a culture that is focused on purpose and you're getting to the heart of what the therapists want to do and fulfill that purpose that they had in going to physical therapy school and helping them define that. I saw you're reading The Coaching Habit or Change Your Questions, Change Your Life. Which coaching book was it?

It was one of those, The Five Questions.

It was The Coaching Habit. I highlighted that in a show because that was one of my top books. I know you're probably following that agenda a little bit to help them get in becoming a coach. That's what a coach does. What else do you want to do? There are some books that have been influential as you look back.

The last book I read, believe it or not, was Impact Imperative. It was all about having an impact because I do all the work in Haiti. It was looking at, is what you're doing having the impact that you thought it was going to have? It has a lot of research of sometimes what you think could have a good impact and sometimes have a negative impact. That's why it's called Impact Imperative. Making sure that you look forward and you also look backward to say, "This is the impact I was trying to have. What impact did it have and was it all good? Could some of it have been bad?"

With the knowledge that you have and the wisdom that you gained over the years, what would you tell your past self about what you know now?

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I would say don't be afraid to challenge yourself. Most of the time, people don't give themselves enough credit to have the confidence to move forward. Give yourself more credit. When I would go to visit a physician, I was the one that was afraid and I felt uncomfortable, but my husband was like, "Christina, every time you come back here, every conversation you're like, the one is good." Some of it is your demons, hold yourself back. The other thing I would say is to get help and reach out. Open your eyes, read all the magazines that we have. There are a lot of people out there that can help you. If I had reached out and worked with Survival Strategies years earlier, what would that have done? I would have been twice big in the hay day of physical therapy. Not that I'm not, I've achieved a lot. I've moved through it, but some people can help us. What I'm finding, go on the other extreme, I'm like, "Who's the expert in diagnostic testing?" That's E-stim. You’d go to HODs. I had issues with getting patients to arrive. "Who's out there?" It's much easier. It pays itself off much faster. If you're having difficulty in an area, look out there and don't be afraid of the changing environment. I look at it and say like, "Social media." Even for me, I have an Instagram account too. I know Facebook because I'm that perfect demographic, but when I want to hire a PT, they're not on Facebook, they're on Instagram. A lot of it is being willing to study up a little bit and research.

I love that you've gotten to that point and that surprised me. It took you several years to get to Survival Strategies from when you started?

It was 1996.

It was about the same thing for me. We got coaches earlier than that, but it took me several years before I was willing to invest in getting some coaching and consulting. Frugal as I am, it's hard for me to part with money. Like you, once that I found the benefits of it and how it not only increased my volume and my profits, my revenue, you name it, all that stuff, it also improves my life. The freedom that I had in my life. Fulfilling a greater purpose and helping me achieve that. There was all that stuff that was helpful that came from having coaches and consultants and I would do the same thing. I would tell my earlier self to get a coach much earlier, get some consultants. The same thing I had this accident. 

For me, the big thing is, I am in the second generation in the practice. Transition planning, even Karen and I had talked about that. There's a lot of consolidation going on in the industry. You work hard to create something that I feel is unique in the marketplace. How do you transition? That's I'm exploring not much selling the business but looking at, “How can I offer to my employees to become perhaps owners in a company?” That's the next step, how do I make sure that it lives on? Even for my staff, you have this environment, if you sell out, half of them could lose their jobs and life may not be the same as the way that it is. It's like, "How do you have it live on?" I'm not there every day anymore, so less and less.

Good luck with that but it goes back to you being the leader and looking forward to seeing what's coming down the road. Not for you individually, but also you're noticing what's going on around you and how are we going to survive this? How can we structure it? What do we need to do to survive and do what's best for our team members? You brought up something. Tell us a little bit about what you're doing in Haiti. Do you mind sharing? 

Haiti had an earthquake in 2010. Another 300,000 injured and maybe twelve physical therapists that were all trained in the Dominican Republic. For a country, there are ten million people that live in Haiti, the poorest country in the Western hemisphere. It didn't have a good, stable system to start with. You know the story. I had gone there during the earthquake. I brought back a woman and a baby and I have continued to work at Stony Brook University there, maybe after four years, I brought them down there to help establish a PT program at a university. The cool thing, our first students graduated and 22 of them. The two are my scholarship students from rural, I'm talking rural mountain, no electricity, running water. They live in banana huts, they ride mules. I sponsored two kids and they're graduating. Everyone has a passion. My passion is to help that country together to help grow the physical therapy profession in Haiti. They have 50 something physical therapists in the country. They are all young, smart professionals. There was another school. There are two physical therapy schools in Haiti.

PTO 93 | Growth Accelerator
Impact Imperative: Innovation, Entrepreneurship, and Investing to Transform the Future

You don't have to go to the Dominican Republic and learn to speak Spanish to become a physical therapist. They're at the point of being forming licensure. If they're at those early stages of having physical therapy be a recognized part of a medical program that every hospital would have a physical therapy program. All therapists would be registered by the government. They're trying to set up, they have a legitimate association and they are recognized by The World Confederation for Physical Therapy. They just got that.

That's great and kudos to you for taking on such a massive project like that, but your influence has been felt. Congratulations and thanks for your work with that. 

The cool thing is all the physical therapists that I know, people in private practice, they have helped me with that project. Anytime I've reached out and said, "Can you donate money for a laptop or a table?" People are amazing and that they've helped and they've also brought their talents. Many people have come with me to Haiti. That's where you get to see how good people can be.

If people were interested in what you're doing or wanted to donate, do you have ways to take their money or take their time or help?

I haven't asked much for the money but the talent they can email me Christina@Panetta.com. We haven't set up a 501(c) officially yet.

I'm sure there are people out there who are like, "I would love to join a trip sometime or if there's any way I can help out, let me know." I want to make sure that's available and to do that, they need to reach out to you?

Reach out to me. Even if you go through my Panetta PT website, there are links and find me on Facebook.

I'm sure you've posted some of the pictures on Facebook or Instagram or both? 

It’s on Facebook.

You've gone from a point of success and you're making significance in the world, and even in the PT industry in regards to Haiti, at least. You're at the forefront it seems like. Congratulations on that.

I feel like I wake up every day, I go to sleep thinking about, “What can I do?” It drives me. It is my passion. I try to share as much as I can with the therapists in Haiti because they have such a thirst for knowledge and know-how. Being able to share, not just me, but that's where you realize how many cool, great people I know that I can bring those talents together to help in ways that make such a big difference.

Thanks for your efforts there. Is there anything else you want to share with us?

Most of the time, people don't give themselves enough credit to have the confidence to move forward. Click To Tweet

It makes me realize, why I do what I do and how much physical therapy touches many lives. The biggest thing I see is that I don't think any of us know the effect that you have on the person. I came in, I couldn't do this and now I can do it. You don't always fully know. I thought it would be cool to follow-up with people and say, "You've got this person back to anything." It could be walking or running or work or helping their grandchildren in turn. Think about physical therapy in general, you get that active person who's involved in their community back to doing what they love, what do they, in turn, accomplish in the community? That's where I feel like physical therapy has such an impact. I can't think of anything, honestly, that has a bigger impact on not just life, but it's the trickle effect into society. Anything we can do to promote that. If we always keep that in mind, that's why we do what we do because it makes the difference.

Thanks much for sharing your story and your wisdom. I appreciate it. 

You're welcome. Thanks for having me. It was fun.

Have a good day. 

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About Christina Panetta

PTO 93 | Growth AcceleratorChristina graduated from Stony Brook University with a Bachelor’s of Science in Physical Therapy in 1985. When it comes to helping those in critical circumstances, Christina wastes very little time – in fact, just after graduating from Stony Brook, Christina began working at the Brunswick Rehabilitation Center. During her tour at the Rehabilitation Center, Christina worked closely with patients that were recovering from extreme physical injuries; these injuries include patients with spinal cord injuries, traumatic brain injuries, amputees and burn victims. Christina eventually went on to open her own Physical Therapy clinic, and never strayed from her calling to help those in need.
In 2005, after Hurricane Katrina left many parishes throughout Louisiana and Mississippi in ruins, Christina immediately took action working with local Law Enforcement to provide medical care and aid. Hurricane Katrina, as devastating as it was, is only the beginning of Christina Panetta’s dedication and unyielding commitment to others.
After the 2011 earthquake in Haiti, Christina felt compelled to help those that were injured, and went to assist distraught families at the state hospital in Port Au Prince. One of Christina’s most fulfilling acts of aide to humanity was when she successfully cared for and brought home to the U.S. a young woman who had sustained a double amputation due to the earthquake and her eleven-month old baby who was suffering from malnutrition.
During the course of the next three years, Christina continued to provide medical care and aide to the people of Haiti. Recognizing the overwhelming need for Physical Therapists in this region, Christina turned to her Alma-Ata, Stony Brook University. She went to Richard Johnson, PT, EdD, Chairperson, Department of Physical Therapy and through his strong leadership and the stellar reputation of Stony Brook University a successful collaboration between Christina, Stony Brook University and UNIFA ensued. On October 6, 2014 the first University Program in Physical Therapy opened in Haiti.
Christina lives in Oakdale, NY with her husband Richard Panetta; Mana and Wolf continue to reside in the Panetta household. Wolf is 10 years old.

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PTO 15 | How to Hire "A" Players

 

Contrary to the belief of less is more, in business, having more people means getting many of the tasks done in no time. This was my constant refrain in the beginning stages of PT business ownership, "I love doing the PT, I just hate running the business!" That all changed when I started hiring the right people. In this episode, Dr. Jamey Schrier shares how to hire "A" players onto your team, because when you do that, you will obtain stability and freedom. The right people in the right positions will take your business to levels that you cannot take it by yourself. As Jamey shares through his process, by hiring the right people and empowering them, your business will grow and be positively affected for years. He also talks about the importance of coaching and networking when it comes to figuring out your business while giving a peek into his book, The Practice Freedom Method.

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Listen to the podcast here:

How to Hire "A" Players with Jamey Schrier

I’m interviewing Dr. Jamey Schrier. He’s the Founder and CEO of The Practice Freedom Method, a business training for physical therapists. After Jamey grew and sold his multi-location PT business, for a price often reserved for businesses quadruple in size, he began teaching other PT owners of all clinic sizes how to grow and scale their practices while improving their quality of life.

PTO 15 | How to Hire "A" Players
The Practice Freedom Method: The Practice Owner's Guide to Work Less, Earn More, and Live Your Passion

Jamey shares his proven methodology with other PT owners using timeless business principles combined with his best practices that he has learned in over twenty years of business. He has personally coached over 70 private practice physical therapists to create their dream practices. He has a book called The Practice Freedom Method. Along with signature programs, he has helped hundreds, if not thousands of physical therapists achieve their dreams.

I’m excited about presenting this interview with Jamey to you because of a couple of things. I love a quote that he shared and that is, “Different is better than better.” You can take that into almost any aspect of your business, whether it's marketing, hiring, getting the right people on the bus. Many times, different is simply better than better. We'll talk about his five-step hiring process. It's part of his Practice Freedom Method that we delved into. The five-step hiring process goes through figuring out what your ideal person is, the values, attracting those people, interviewing and qualifying them, onboarding them and training/empowering them. I’m excited to bring you the interview with Jamey Schrier.

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We're talking to Jamey Schrier in Maryland. Jamey's a successful physical therapist and current consultant and coach. I’m excited to bring him on simply because of his success story and also some of the insight that he has in working with physical therapy owners. Jamey, do you want to give us a little bit of your backstory? What got you into physical therapy and ownership in particular? Bring us up to speed as to what you're doing.

I appreciate you having me on. I appreciate being here. This is always fun for me. It’s always fun to connect and try to impart a little bit of all my mistakes that I’ve made over the years. I try to help someone to avoid some of those time, emotional and financial mistakes.

Thanks for being here.

My story is one that like most people I wanted to have a business. I always thought of myself as a business owner. I had that entrepreneurial spirit as they say. Several years after outside of school, I finally was able to muster up enough guts to say, “I can make this happen.” Like many people I’ve talked to and spoken to, it's just me. I put out my shingle, Schrier Physical Therapy. My fiancé, my wife now, Colleen, she was at the front desk. It was just us two. I had a couple of people feel sorry for me, like family and friends. They would come in and see me even though I was out of network with most of their insurances. People started to refer other people. The number one marketing strategy we all have at that point is word of mouth. In a short period of time, probably around six months, I was making good money. I was above from what I was making at my previous job.

That lasted for probably two more years. I started to experience what I know a lot of people experience and it was heavy into me. I started to experience some anxiety. I started to experience some angst towards this business. It wasn't that I stopped loving treatment because that wasn't the issue. I started to dive into areas that I wasn't comfortable or familiar with. I started to hire people because we needed help. My wife was pregnant, or we ended up getting married and then she is pregnant. We had our son coming, so she wanted to take some time off. I started hiring people. Insurances all of a sudden started denying payments, whereas before it was fine. Patients were not necessarily paying their copays and deductibles. All these areas of the business started to emerge as the company started to grow. I wasn't prepared for that.

You have to let go to get to the next level. Click To Tweet

I started to get anxious around that. I started to become less than happy the situation I was in. The only solution I had at the time was to work more. Instead of being home more with my wife, I was at the office a lot. I got up at 6 AM. I was at the office by 7 AM. I was home by about 8:15 PM. It was a lot of hours. I wasn't off on the weekends, I was doing some notes and thinking about the business. There was no clear time away. It was a combination. Some crazy thing happened. We had a fire in our place and the place literally burned down. It was wild. I saw it as a sign. I saw it as, “If I couldn't make a decision to do something about it, I guess someone made a decision for me. What am I going to do now? Am I going to stay in this business? Stay in this whole field? Am I going to maybe do something else because I was that unhappy?”

I bet somebody has had their fire, whether it was a fire, whether it was something else that made you like, “What am I doing here? What am I going to do moving forward?” To me, it was the fire and this forethought of, “Where do I see my life ten years from now?” All I saw was working just as much, if not more, not being with my family and not making the money I wanted to with declining reimbursements. I started to realize that these are all the reasons that I wanted to get into business. I’m saying, “I’m not going to get any of this stuff.” I took all the risk. I put all the time in.

I’m like, “This is ridiculous. This is not what I wanted.” To fast forward, I made a decision. I talked to my wife and said, “I know I can do this. I know I can make this into business. I just have no idea what to do.” I started searching around for programs, for people, for coaching and mentorship, everything. I was willing to invest. Prior to that, I literally read a couple books. That was my entire investment in the business. I was like, “I don't care what it takes. I’ll either do it or I’ll fail trying. I don't care. I’m going to find out how to make this happen.”

I didn't see anybody doing what I wanted to do. I didn't want twenty clinics or 50 clinics. I know how you can build a business with 50 clinics. How do you do it with one or two? How do you create where you have time, be with your family, do the things you love to do in your business and still make money and have an amazing quality of life? To fast forward that, when I made that decision, it took me nine years and a lot of money. I invested $300,000 of my own money into all these different types of people. Most of it outside of PT, because there wasn't anybody inside the PT who was doing it the way I thought it should be done.

In January 2013, I completely removed myself from the schedule. I did not see any patients. I had a great team in place. My business shot up 18% in that year. I didn't treat one person and took 137 days off. I went, “This is a big deal.” That's when I moved into what I’m doing with business training and coaching other people. I hired a coach to say, “Can you help me capture what I did? I know what I did. If I don't capture it now, I’m going to forget. I bet there are a lot of other people want help, who wants to know how to do this, who wants that freedom, that money, control and all that in their business.” Since 2013, that's what I’ve done. I wrote a book, The Practice Freedom Method. Now, I teach and coach all kinds of business owners from all over the country. That's my story.

PTO 15 | How to Hire "A" Players
How to Hire "A" Players: I had a great team in place and my business shot up.

Your story is not uncommon. It takes some flexion point, a bottoming out if you will. In your case, it was your fire for you to recognize, “I don't have the stability and freedom that I was looking for.” That's why you opened up your clinic or branched out on your own. In my experience, I saw other family members who own their own practices while they were outside of physical therapy. These were the guys who had financial stability in their lives, the time to do things with their family, freedom to be with their family and to pursue the things they wanted to do.

In the same boat and a lot of my interviewees experienced the same thing, we get to a point where, “I don't have any of that that I dreamed of when I opened up my clinic. I’m at this point where I’m hating the ownership. I’m questioning what I’m doing. I don't know what I’m doing because I don't have any business knowledge, “How do I get out of this rut?” Your story’s in line with many other independent practitioners and I feel that there are many more out there that aren't at that flexion point yet. I want to scream at them. I’m sure you talk to them on a regular basis as a consultant coach that you want to say, “You don't have to go through that. There's a better way.”

You don't have to go through it. Never tell someone business is easy, but it's a heck of a lot easier when you know what things to avoid and you know what things to focus on. You still got to put the work in. It's not like business is work. What I’ve figured out, what I determined in my own experience of making a million mistakes, I feel sharing a mistake is a lot better than sharing like everything went perfect, because it certainly didn’t. It's a whole lot easier when you have a plan, when you have a path and you have somebody that's been there before.

A lot of times we realize we're not in the position we want. We look around and see everyone else struggling, so we think that's the way it is. We've tried something in the past and we're like, “I tried hiring people, that doesn't work,” and we start telling ourselves these crazy stories that puts us in a place of acceptance. That’s the worst place in the world to ever be in is a place of acceptance, a place of comfort.

We're business owners. We're entrepreneurs. We are here to make a difference in our communities. We're here to help people. We can’t help them if we don't continue to strive to be better and everyone can be better. I made a bazillion mistakes. I did everything wrong. No one will do it as bad as I did. I’m fortunate to work and meet some incredible people that are doing it in a heck of a lot less than nine years. I talked to people and it was twelve months from going into overwhelming craziness to, “I’ve got good financial stability. I’ve got time. I’m not in the clinic 24/7. I have a work-life balance.” What I want to get across to your audience is, it is possible, and it is possible for you, regardless of your current situation.

You said you're talking to people that have made that successful switch. I know you have a number of things in your Practice Freedom Method that you speak to. There are seven steps, is that right?

PTO 15 | How to Hire "A" Players
How to Hire "A" Players: The Practice Freedom Method

Yes. Our success path or the Seven Steps to Practice Freedom follows a clear path. When I developed these seven steps, when I uncovered them, I realized that when you start a business, these are the seven things you have to know and in relatively this order. The first step is understanding what the principles are for a successful practice. Every successful practice out there, and every successful business out there, there are certain principles they have. Regardless of the type of business, regardless of what they sell, their product or their service. We call this mindset. Really getting your mind around what these principles are. These are the foundation principles, that’s step one.

Step two is once you understand this, once you’ve identified your ideal client, your target audience and understand some of the core things of where you want to go, it's all about referrals. Without referrals, you're literally twiddling your thumbs in your office doing nothing. There are plenty of people out there. I don't care if it’s competitions in your area. I don't care where you are. We have people in the middle of seemingly nowhere in Nebraska, in Iowa and in New York. It doesn't matter. There are plenty of people. Referrals are one.

Step three is once you have the referrals, you’ve got to make sure that the people come on the schedule, the plan of care is addressed. The cancellations are low, the dropouts are low, and all that stuff is there. That's patient engagement, step number three. After patient engagement, chances are you're going to need people to help you. Hiring is step number four. After you hire people, your time is going to go crazy. You're going to get into that overwhelmness. You're not going to be able to manage your time correctly. People are going to be pulling at you from every direction. Step five is time mastery.

At a similar time when you have this bunch of employees in place, you've got to create a team. It's all about creating a team and team building because the team is what sets you free. You can only do so much. You’ve got to help other people. That's step six. Step seven is financial mastery. Literally understanding and dialing in your metrics. That's probably the only one that we touched on earlier in our program. We want people to get some clarity around their financials, but it is an important one. Those are the seven steps. Even if you do those seven steps poorly, your business will still expand because I’ve done them poorly and it still works. That's what Practice Freedom Method and the Practice Freedom U is all about.

There's a lot of stuff that we can do well. To some extent, even as physical therapists, we can learn to manage when you look at getting referrals, putting yourself out there and doing some salesmanship. Getting patient engagement, those are some things that you can develop in your first few years. The two things that we specifically want to talk about in this method that you have is the hiring process and then what it takes to create a team.

Those are intricately involved. You’ve got to have the right people on the bus. Put them in the right seats to make sure that you're all running in the same direction, that you're aligned and to eventually get to that point where you can experience some freedom. If you don't have the right people in place and you haven't created that team, your hair's going to be on fire essentially. Running around trying to put out the other fires.

Most people will put it out there as, “I need more patients.” The calling card of the typical business owner is, “How do I get more referrals?” I've never met someone that said they needed more referrals that didn't already have referrals. The best way to get referrals when you just started is to use your network, use word of mouth, deliver great care and you're going to get referrals. It's not that hard. The big challenge is when we start hiring people. The reason you need so many referrals is that of the inefficiency of the business. The lack of communication, the lack of clarity within the business and that all starts with hiring.

It's better to be different than better. Click To Tweet

I’m happy to talk about hiring because I believe hiring and team building, empowering your team are the two areas that most, if not all business owners, have the most difficulty in. I would even venture to say that if you had a good team, you’d be able to generate referrals easier. Referrals aren’t about a fancy strategy. You don't need some fancy digital marketing strategy. All that stuff is great, you just don't need that initially. You can do so much without that but you can’t do any of that without a team. Your time is already taken.

What is your secret for hiring A-team players? How do you consult and coach people to find the people that are going to be as interested in the success of your company as you are?

The first mindset thing I'd like to share with everyone is the idea of you have to look in the mirror and say, “I can't do this by myself.” You have to get it in your own head that, “I need help.” That is tough for us to get into our own heads. The reason why is because as physical therapists, as people that have been smart, intelligent their whole lives, successful in the academic world, you didn't have help. You studied your butt off. You sacrificed. You have been literally the top of your class. To go from that, and I know this was one of the biggest challenges I had because I’ve got an ego. PTs have an ego.

It's hard to say, “I don't know how to do this.” It's hard to turn in the same sentence of, “I’m the best. I’m the most talented clinician,” to, “I don't know how to run a business though that delivers quality care. I just know how to deliver quality care.” Having that conversation with yourself and you accepting that is huge. If you don't accept it, no matter what I say it’s not going to matter. When you accept it, the next thing you have to then agree to is, “I will have to let go in order to do this.” You have to let go to get to the next level.

I had a client, Becky, in Nebraska. We were talking about she wanted to reduce her treatment hours. She was treating 40, 50 hours a week. She had a great employee on board. I said, “Seriously, why don't you look at bringing this person on as a Clinical Director? Promote them and then you can immediately reduce your schedule by three days.” She's been trying to do this for two years. She goes, “Jamey, he can't treat as well as I do,” and I said, “You're right and he never will be able to have the chance unless you give him one because you'll always keep him down. Your ego is bigger than what you want.” She said, “You're right. Let's do this.”

Within a few weeks, her schedule went down, his schedule got much more efficient and he started taking over a lot of the administrative things around as a Clinical Director. He was hitting better numbers than she ever did. The clinic was more profitable because they were more efficient, and more utilization, she was treating less and working fewer hours. That didn't happen because of some strategic thing. That was a mindset shift that she was willing to let go. Those are the two big ones. The actual steps involved, there are five of them.

In that example specifically, there was somebody already on her team that was able and willing to take it to the next level if they were given the chance. Sometimes it's hard to find that person to bring them on in the first place. Especially as you're looking at some of your admin staff, you're thinking, “I can hire anybody $10, $12, $14 an hour to sit at the front desk.” How do you get some of those people as well? Let's run through your recommendations.

We call this our right fit hiring process and it starts with identifying your ideal employee, your ideal candidate. Most of us hire out of reaction. We hire out of necessity. In other words, someone quits, we hire someone. We're overwhelmed with treating and answering the phones and dealing with everything else, we just hire someone. It's usually a patient or a patient's son or daughter. Like me, I hired my wife, my fiancé at that time when we first started. That's okay as a Band-Aid but I don't highly recommend doing that. There are a lot of reasons, especially family members. Unfortunately, it rarely works out well. Identify your ideal client. What are the characteristics?

This isn't just who the ideal therapist you want or front desk. Who's the type of person you want working? Many times, we don't dive into those values. We have a value system in our company. I have a value system in which I operate in my life. I want to make sure someone else's value system is in line with mine. My value system is gratitude and appreciation towards others, being on time and doing what I say I’m going to do in someone else's time. I’ll show up when I want to show appreciation. They should be thanking me. If someone has that type of value system, their résumé could be the greatest in the world.

That in-person interview, if I start hearing that, I don't care how great their résumé is. I know this is going to be a disaster. The biggest challenge we have are the people that we work with who already have hires. They’ve already had some people and those people are not on board with what they're doing. Most of those people are good people. If you tightened up some systems in place, it's fine. Hire slow, fire fast. You do not want to mess around because where there's smoke, there's fire. There are tons of things that are happening. If you get wind on some of these things that your gut tells you and all that.

PTO 15 | How to Hire "A" Players
How to Hire "A" Players: You have to look in the mirror and say, “I can't do this by myself. I need help.”

If these people aren't aligned with you, it's important to get them off the board quickly. They're not bad people, you're just not aligned. If we as practice owners recognize that those people, especially if they're the ones handling patient engagement, scheduling, click copays and deductibles, they can lose us a serious amount of money with every patient. If we were able to monetize the amount of money we were losing on those people who aren't aligned with us, we would fire a lot faster than we do.

Think about some of the doctors you go to. We all go to doctors on some level. A lot of those doctors look at their front desk people. Would you want that person working for you? The person that's sitting behind, you're interrupting them because they're talking to somebody. They don't say hello, “What's your name?” They say, “Hello, give me your insurance card.” You’ve got to realize it's not their fault. That is the person who was intentionally hired by whoever their supervisor is.

That's how they were trained or not trained. The doctors are a little bit different. Is that how you want your office to be? You may not know that it might be coming off as a little bit of that. By getting clarity around the values, the characteristics and the qualities you want anyone to be, that becomes a huge qualifier in knowing who the right fit is and who's not, before you even dive into the specific skills. Write down what characteristics, qualities and values of someone who is working for you or someone whom you eventually want to work for you or the ideal person you would want to work for you. Step number one.

Step number two, how are we going to then attract this person? I am a firm believer in the Law of Attraction. Whatever you put out there comes back to you. If you put out certain things out there, certain communication, you're going to attract people who may not be the people you want to attract. The ad you have out there. Is your ad generic? Is your ad saying the same thing that the hospital down the street is? Does your ad say something unique and differentiates you from everyone else? It's better to be different than better.

Being better than your competition isn't better. You want to be different than everyone else. You want to differentiate yourself. The way to do that is to use some of these qualities that you've written down and start crafting your ad in such a way that it brings this up. It brings the quality. This position is right for the person who believes in this and believes in that. You want to start using that in your ad because you're not going to see this in other people's stuff. The hospitals are going to talk about $5,000 sign-on bonuses. That’s great and you're never going to compete with their budget, so let's not try. Although people want to be paid fairly, the right people who come into your practice want to be a part of something more.

Identify your ideal candidate. Attract the right person. Have a qualification process. A qualification is an interview process. Once they're hired, onboard them. Once they're onboard, empower them, another word for training. One of the things you can do to attract this person is picture where this person is. I love doing this exercise with our clients. I’d say, “Close your eyes. Where is this ideal, perfect employee? Where are they right now? Are they just graduating from school? Are they in a corporate setting? Are they in another PT setting like yours, another private practice? Are they in a home health setting? Where are they now? Why would they want to come work for you?”

What it does is help you get your mind out of yourself into their mind. In other words, they might be in a job where there's no upward growth. If your company has an upward growth, then you want to mention that in your ad. If they're unhappy because they're seeing four patients an hour and don't feel they're giving quality care and your company sees one or two an hour, then you want to bring that up. We call those pain points. You want to bring these things up in your ad. The reason you do this because it grabs their attention. With someone looking for a job, what they have is a million opportunities. There are many jobs out there.

How are you going to differentiate your ad? You do that by posing a question, “Tired of seeing four people an hour and ready to deliver quality care to your patients?” Something like that or, “Do you feel there's something more for you and there's a lack of advancement at your current position?” That's someone that maybe you're looking for a senior therapist position or Clinical Director. You want to get into, what are the frustrations and challenges that they're going through right now and how can you craft that into your ad? There's obviously more to it but that's the essence of it. If you can do that, even if you do it poorly, it will be better than the ad you have now.

You are the people that you coach. Click To Tweet

Step three, qualification. This is huge because even if you do a crappy ad, ultimately your qualification process should weed out the bad people and allow the good people to come through. Allow your A-players to come through. What I did over time is I created a three-step process to qualification. I used to just do one. People come in for an interview. I interview them and because I just wanted to hire them and get it over with because I had to do other stuff that would be it. Now, I developed a three-tier process which helps weed out people and it lengthens the hiring process intentionally.

The first one is I do a very quick call interview. On a phone call interview, if you have a question about their résumé or they had a gap in their employment, you want to ask them about that. You want to ask them about, “I see that you are interested in our position here. What attracted you to our ad?” You want to know that they saw your ad. They read the ad. They had an interest in your company versus, especially when you hire administrative people. I can't tell you how many administrative people are literally applying for positions because they're on unemployment. They have to pretend they're trying. I’ve talked to many of those. When I started saying, “What attracted you to our ad?” They went, “What was that ad that you had again?” I went, “Thank you.” They had no idea who I was. They sent their résumé to 50 people.

I found those calls to be valuable and such a time-saver. If they had some qualifications, I'd call him and say, “Let's get you in for an interview.” Instead, I took a little bit more time on that phone call to say, “Tell me a little bit more about this, tell me a little bit more about that.” You get to know their phone voice, you get to know their energy level and you get to know a little bit about their personality. You've already got this idea in mind. A lot of that can be gathered over the phone. If this person is going to be on the phone a lot, especially for those positions, you want them to be engaging on the phone with a kind voice and an interest in a high tone level.

You can filter out and save yourself so much time in the interview process if you can weed those people out initially on that few minutes on a phone call. You can save yourself that hour where you're going to block off the time and you can tell right off the bat that when you bring him back that it's probably not going to work, but you're going through the motions essentially. So many of them are putting ads out there, they don't even show up for that interview and you blocked out an hour. That initial call can be so much of a time-saver.

PTO 15 | How to Hire "A" Players
How to Hire "A" Players: When the resume does it match the phone call, when the phone call doesn't match the interview, when the interview doesn't match the shadowing, there's something wrong.

The reason I created this type of process is that I always like to look at alignment, like the spine. When a spine’s out of alignment, they're going to have pain and problems on the area. When the résumé doesn’t match the phone call, when the phone call doesn't match the interview, when the interview doesn't match the shadowing, when that isn't in alignment, there's something wrong. There's a yellow flag or a red flag going up. If you only have one segment, one thing, you don't know if it's right or wrong because you have nothing to compare it to. That's another thing that this does. This is their best foot forward.

If they don't sound great on the call and you're hiring a front desk, don't think it's going to all of a sudden magically improve. It's what you're going to get. That leopard is not going to change their spots. It is what it is. If they're nice on the phone, if they're engaging on the phone, they show up in person, they're dressed well and they're engaging, you're seeing a pattern. It's who they are. It gives you more confidence that this is the right person and it gives you confidence if it's not the right person. it's a time-saver for both of you.

That's the most that people talk about. What questions do I ask? You can type in interview and get a million questions. Instead of going through all of that and repeating it, I’ll say this. I would definitely include some questions that have to do with the future. There's a lot of psychological research around this. You want to put the person in a future situation and ask them questions about things. For instance, “Nathan, let's say everything worked out. You came onboard here and it was great and a year from now, you left.

From your vantage point, what most likely would be the reason that you would leave?” What that does is A, it forces you to visualize you here. B, it says clearly that you now left. What is coming to your mind of why that would be? “More money,” which I’ve never had someone say, believe it or not. Even though my mindset used to be, people always leave because of money. That's bullshit. They don't always leave because of money. Sometimes they may but there's usually something more to it. Very rarely, unless you're literally paying way below the market. If you're paying fairly, they're not going to leave because of money. There are going to be other factors included.

One of the stories that I want to share is I was looking for a PT for one of my clinics. I asked that question and she said, “Probably within a year, probably nothing. In two years, I'd probably leave because my husband would be relocated to Germany because he's in the military.” I’m like, “Tell me about that.” We went on this whole tangent of her husband in the military and what he does, which connected us even more. The great thing was we ended up hiring her and what happened? Two and a half years later she said, “Jamey, my husband got relocated. We’re leaving.” We put party for her. It wasn't a surprise. It was something we were all prepared for. We had a great relationship. We still talk. We still keep in touch on Facebook. That is a different relationship than if all of a sudden, she goes, “Jamey, my husband, you don't know him. He's in the military. We're leaving in two weeks.” There are many people that are blindsided by that. These few future-based questions are a big one that I ask.

Doing it later is not going to make it easier. You got to get started doing something now and move forward. Click To Tweet

What a great gift you gave to her to allow her to speak into that. That then blessed you because you knew from the get-go that she wasn't going to be there forever. You could plan it. Like you said, you were prepared for her leaving and what a gift that was to you to know that ahead of time, so it wasn't a surprise. If you had it scheduled out, you could start hiring again, soon before she left and work out smoothly. That question alone in your interview was a successful action that paid off for three years, in your case.

I couldn't ask if she was married. I couldn’t ask about her husband, but she brought it up. The moment she brought it up, I asked her questions about it. It connected us on a deeper level than just future boss, owner, PT and staff PT. This was someone who was married, someone who has a husband and the husband was serving in the military. We went down roads that we would never have gone down with my typical questioning, “What are your strengths? What are your weaknesses? Why do you want to join Schrier PT?” Those questions are fine.

The biggest thing that I will take out of this interview process and the ones that I try to hit home to business owners are not the questions that are powerful. It's the nonverbal communication. It's the feelings that are transferred with that. You could say all the questions perfectly and you still wouldn't get as much if someone that was in tune to people. You want to make sure you're in tune to that. The minute she opened up, started answering that and her nonverbal, she opened up her arm. She went, “Hey,” and had started. I was like, “We’ve got ourselves our next person.” It was a done deal and she felt the same way. “I’ve got myself my next job.”

The final one is shadowing or we call it a work interview. I call shadowing when it's clinicians because you can't have them work. I would not have them work because of the insurance and legal reasons. It's more of a shadowing, but if it's a front desk, you want to get them engaging. You want to get them, “We answer the phone like this. Why don't you take the next call?” You want to see them in action. Do they stand behind the counter with their arms crossed? Do they try to jump in and be like, “Ms. Smith, hopefully they'll hire me. I’m here on interview.” That gives you a lot of confidence.

The people that I found I was impressed with were the ones that came with a notepad and pen in hand. Those people are the ones that I saw them come in, I thought, “You're ready to work. This is serious for you. You're ready to take notes and see how we're doing things.” Especially those that were engaging with your patients right off the bat. They didn't sit like a wallflower just biding their time because I’m here. That says a lot about a person.

We even had one interview come in and talk about how she was hung over that day from partying the night before. This person was engaging on the phone with the phone interview and the in-person interview but as soon as she did that, she was off the table. I was glad that we had the working interview for her. It's in those situations where they're talking peer-to-peer and not to a potential suitor or employer. Where they open up a little bit and then your team can tell you things that she wouldn't have told you in an interview.

That's the biggest point of the shadowing. The shadowing isn’t about you. Even if you're the only PT there and you're having a clinician, get someone else in the clinic. Get his friend, get a spouse and get someone there because they bring a different perspective to it. A lot of time we have fixed ideas, we have negative biases. We have filters in what we see. A lot of times it's because we want something to happen so badly. We forget certain things. To add another point, my wife is great at this. She sees quality. She sees things and then says, “Don't hire that person.” I go, “No? He seemed nice.” She would tell me all the signs she saw that said this person's crazy.

When I started listening to her, things worked out. When I went off my own, I was like, “This is not something I’m great at. Maybe I should listen to my team. Listen to my staff.” There's a great saying and it goes with the Law of Attraction that says, “Like attracts like.” If you’ve got even one good person in your company, that person will attract another good person and repel a bad person because they know they're going to have to work with them. The shadowing and the working interview is all about allowing your good team members, maybe not everybody to get a sense and be a part of the interview process.

That contributes a lot of teamwork. The next part is onboarding. I used to put onboarding and training as the same, but they're different. Onboarding is you want to make sure the forms are filled out. They’re all on the payroll. They're credentialing is moving forward. Their taxes, forms, health insurance, the handbook, their email address. Maybe give them a shirt. That's onboarding. If it was a bigger company, this would be what HR does. It's that crap. That’s all it is.

Make a list of the things that you need to do to establish somebody as an employee in your company. You take fifteen to twenty minutes to do that and set up some links to the page if you need to or put it all in one file. Take an hour or two and put it all together and that's your onboarding packet.

PTO 15 | How to Hire "A" Players
How to Hire "A" Players: A right fit person is this last step of empowerment.

That's what we have we have, a checklist, very easy, step-by-step. Here's the beautiful part about the checklist, you don't necessarily have to be the one that does it all. In our checklist, I sat down and shared the vision and the story of how Schrier PT got started and where it's going. That was my role, but someone else did pretty much everything else. Once you have the checklist, it's easier to then delegate. I would say the biggest one of all of them, assuming that you have a good person. A right fit person is this last step of empowerment. I call it empowerment, not training because it's not just training them. It's empowering them, so they could be successful in their position as fast as possible as fast as possible.

You, telling someone to do something are not going to empower them to be successful. Them demonstrating it, being successful and feeling good about it, that is freedom in a nutshell. If you get surrounded by people like that, you'll be like, “Jamey, what am I supposed to do now? They don't need me in there.” That's what happened to me. There was no reason for me to go into the business every single day. The front desk took care of people. The therapist took care of people. The directors took care of it. Billing. What was I supposed to do? All I would do is screw it up. I walked in there, occasionally say hello and I had some meetings with people. I had to go look for something else, which luckily I did because now I’m doing coaching. There's something bigger for you. The key to training is what does this new hire in this particular role? You're talking about a particular role, whether it's front desk, therapist or an aide. What do they need to know or understand? What do they need to be able to do? What do they need to be able to communicate? Know, do and communicate.

The way I break it up initially is what do they need on the first day? What do they need on the second day? What do they need on the third day? What do they need on the first week? What do they need on the second week? What do they need on the first 30 days? What do they need on the first 90 days? Our empowerment program, we call it the onboarding or mentorship period, the empowerment period is no more than 90 days. Ours was two years officially because we wanted people all to be certified in dry needling. At the time, nobody could be certified in less than two years. Now that's all sped up. It didn't stop our people for coming onboard.

Prior to this, if someone hit their target numbers, we ended up having our target at 60 people a week. We saw a person every half hour, so 60 people a week which was about 85% utilization. It would take six months to a year for someone to do that if they did at all. When I implemented an actual training program with a brand-new person who just graduated from school, who barely knows how to do an evaluation, scared to death, the communication skill is like shit. This person in 60 days was our most productive therapist. He's averaging 61 patients. He was getting a bonus. It blew me away. It's because we added training.

We basically gave them exactly how to be successful here. We didn't tell them how to be successful. We showed them and trained them. We had them communicate how to do an evaluation. We showed them the flow of the clinic. We showed them the best practices in billing procedures. We showed them everything we wanted, instead of hoping and praying they would do it and then getting mad when they didn't do it the way we want them to.

I like that you have the structured intervention: the day one, day two, day three, one week to one month and 90 days. Laying it out like that is not only beneficial to the employee that comes onboard but for the person in charge of that. Having that structure provides a lot of mental freedom. When that's laid out ahead of time, then you can say, “I know what I’m going to do with this guy on day one, day two and day three. I’m going to follow up again on week one and week two.” Having that all in place so you're not flying by the seat of your pants. You know exactly what you're going to do. You can then also, if you have that structure, have an expectation for when they should be catching on. You can tell them, “Following our program, you should be able to meet your quota, your goal within this period of time.”

Getting clear on what you want and what you're willing to do to get there makes things easier, and it’s what successful people do. Click To Tweet

How empowering is that to the employee then, giving the power back to them. If you follow these things, you should be able to be at your goal within 60 to 90 days. If you have the right people on board, the exciting ones, they're going to say, “I’m going to crush that. I’m going to do it in 30 days.” Having that structure in place, I love that you call it empowerment instead of training. Not that it has a negative connotation, but empowerment takes that to a different level. This is how you can master your physician. This is how you're going to show well, and this is how you're going to add value to the company.

You’ve got exactly what the whole reasoning behind it is. It's exactly what happened. I’ve done these many times. Many people that have incorporated this way of onboarding people and training people. They’ve gotten the same results, if not better. Our mentorship period was 90 days. The one that happened to do it in 60 and the reason is he didn't know any better. He didn't know it was supposed to take six months to a year. He rose to the level of what we expected. What we said was going to happen. “We're going to help you. You're going to be an amazing PT and you're going to do it within the 60 days. Just follow what we do.” One of our core qualities at Schrier PT, and it's still a core quality in everything I do, even clients we work with is, “Are you coachable?” If you're not coachable, then everything I shared with you will not work. If you're not willing to learn like you were willing to learn in school, it's not going to work no matter how great your program is.

There's a great saying that was from Edwards Deming. He did research and he talked about the biggest challenges in business. It's called the Deming Rule. After all his research he said, “94% of the problems in business is not the people.” We think the people are the problems. I wrote an article called People Versus Processes. He said 94% of his research, it wasn't the people. It was only 6% of the time that people were the problem and why the business wasn't growing and moving forward. He said 94% of the time, it was poor systems. When I learned that, I immediately looked in the mirror and said, “I have the power to change the systems. I have the power to improve my systems.” If 94% of the problems that I’m seeing right now is about the employee I can change this around.

As I started to put in place these systems, these processes, these checklists, the business started to run so much better. Profitability and bottom line, we're better. My sanity was better. Most importantly, the people who worked for me were happier. It was a win-win. There were no non-wins. There was no equal sum game. Some person wins, some person loses. There wasn't that. Everyone won. That's another huge thing to recognize is that there's a reason why I shared with you the seven steps. There's a reason why there's a five-step hiring process because that's what breeds clarity, confidence and moving forward. That's what your staff is thirsty for. That’s leadership.

You're telling the people that you coach, “I can't help you if you're not coachable.” What do you tell the guys that might say, “I'd love to do all this, Jamey, but where do you find the time?” What do you tell those people?

When someone says, “Jamey, it sounds great. I want to do it.” They never say too much about the money. Our core program, our Practice Freedom Mastery Program is $11.97 a month. It's one new patient a month. It's not it's going to break the bank. If we can’t help you generate one new patient a month that was wrong. Luckily, it's not happened and I'd never refunded someone's money that did the program. The biggest thing I get is, “Jamey, I don't know if it's the right timing. I’m still looking at this. We're doing well. We're trying to get out of this problem.” Procrastination is something that all of us have naturally in us as human beings. We are procrastinating human beings. It's never the right time. It's never perfect. Here's the thing, you can get started doing something now and move forward. You can start doing it later.

Doing it later is not going to make it easier. All it's going to do is allow more of the same problems to happen and more frustration. I wish I did this earlier myself. It took a fire, literally, my place burning down for me to do something about it. If that fire didn't happen, honestly, I don't know. It might have taken me another two, three years to kick myself in the rear. What I say to people is everybody has 24 hours a day. Richard Branson, the billionaire that owns Virgin, has 24 hours. The difference between you and Richard Branson comes down to only one thing. What he does in his time and what you do in your time. It's not you don't have time. That's one of the problems you have. You don't know how to master and utilize your time. If you did, you could get results quickly. Chances are, that's not going to change unless you have someone guiding you. A mentor, a coach, somebody being your person to say, “You're doing the same crap.”

It's like Einstein, “Doing the same thing over and over again, expecting different results.” We all know that quote. We don't do anything about it. We're frustrated by the results we're getting in our business. One of the things that we do, it's like, “If there's something that you want and there are challenges preventing you from getting there, in Practice Freedom, we have a solution for that. It may not be the solution you want. It may not be something that you want to do. There are lots of solutions out there. We have one that works. However, if you're not going to do this solution, then do something else. If you're not going to do anything, don't expect anything to radically change.”

That's the real eye test is can you swallow your own ego and your own pride to be willing to learn what to do? I don't care what it is. It's the same thing I tell my patients. Your back pain, maybe your knee-to-chest stretch is not what you need to be doing. Maybe you need something else. When your back pain's bad enough, you'll call me.” I use the same type of communication and language with my patients and it was fantastic. We’ve got great people in there. It makes things easier when you’re clear on what you want and you're willing to do what it takes to get there. That's what successful people do and that's what unsuccessful people don't do.

PTO 15 | How to Hire "A" Players
How to Hire "A" Players: The real test is swallowing your own ego and your own pride to be willing to learn what to do.

I feel we're on the same page in this and one of the reasons why I created the podcast and my slogan, “Reach out, step out and network.” Do something. I’m not telling anything in particular, but I’m telling you because I’m all in on different is better than better and your five-step hiring process is great. All those things are great, but something's going to work. You have to do something. We didn't get business training in physical therapy school, so there's no reason to think that we should be able to run a business well. We need to invest in something, a consultant, a coach, a network. Get some training to know how to run your business. When you reach out to those professionals like you, when you step out and network, do network, step out of treating 40 or 50 hours a week and steer the bus, then things become magical. You start gaining that stability and freedom that you were looking for initially.

It's becoming decisive. When a patient says, “Nathan, I need to come in for my back pain.” There's nothing you can do. They didn't say they were coming in, they're talking. They're saying what we call dirty words. Dirty words are vague words. Obviously, they're dirty like need, should and maybe. Those are all vague words that keep us in an ambiguous place. We haven't decided on one thing or another. The one thing we do in our program, which is why it's easy to determine whether someone's right to work with us. We're going to help you make a decision. The decision might be, “Keep doing what you're doing,” or maybe the decision is go get a book and start there. At least you have something decisive that you can move forward. That sounds like what you're saying with the slogan of your podcast is just get into motion. Get into action because motion and action cure fear and cure stagnation. Just do something.

Jamey, it was great talking to you. Thank you for sharing your insight. If someone wants to reach out to you individually or figure out more about your Practice Freedom Method, how do they get in touch with you? How do they find out about you?

Jamey@JameySchrier.com, that's the best place to reach me. Definitely check out that. I always give something for your audience. They're spending the time, they're reading. When you're able to click on that, I’ll share some cool thing with you. There's a tool that I have called How To Deliver Better Care And Increase Your Bottom Line. It's basically how to generate visits in your practice fairly quickly. It works great. There are five ways I go over. That's going to be a freebie for your audience that they could download and get immediately. It's a thank you. I always enjoy doing this. I want to see people do well. I’m on a mission. I don't want people to have to go through all of the bullshit that I went through, because I know how tough it is emotionally. I know how tough it is on relationships with spouses and families. I know how tough it is especially financially and how much stress that does. I appreciate you having me. It's been great you obviously get it.

Thanks, Jamey, for sharing some of your insight. A lot of what you're sharing was invaluable, especially where we're coming from as physical therapists. No one trained us on how to hire the right people. Having that little bit of insight and having a little bit of structure on the hiring, the training and on the empowerment, I loved it. Thank you much for sharing those nuggets of wisdom.

You're welcome. I appreciate it.

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About Jamey Schrier

PTO 15 | How to Hire "A" Players

Dr. Jamey Schrier is the Founder and CEO of The Practice Freedom Method, business training for physical therapists. After growing and then selling his multi-location PT business, for a price often reserved for businesses quadruple his size, he began teaching other PT owners of all clinic sizes how to grow and scale their practices while improving their quality of life.
Jamey now shares his proven methodology with other PT owners using timeless business principles combined with his “best practices” he has learned in over 20 years in business. He has personally coached over 70 private practice physical therapists create their dream practice, and through his book, The Practice Freedom Method and signature programs, he has helped hundreds if not thousands more.

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