PTO 161 | PT's Biggest Problem

What's the PT's biggest problem? It's finishing documentation. The time and energy it takes to do documentation properly and in a timely manner is a headache that we all must endure. Enter Marc Moore, PT, the owner of Moore Physical Therapy. Marc talks with Nathan Shields about how he found a solution for his clinic. It has changed the lives of his PTs on staff, a benefit that will retain them for a long time. In this episode, he shares the benefits of having a scribe on the team and what that looks like. PT owners would be wise to adopt this practice! Do you want to get rid of your documentation headache? Then you need to tune in to this episode.


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The Solution To The PT's Biggest Problem With Marc Moore, PT

I've got a long-time friend, fellow PT schoolmate, respected friend, and associate, Marc Moore, of Moore Physical Therapy and Owner of Marc, thanks for joining me.

I’m happy to be here, Nathan. It’s been a long time since you've been asking and finally, we got together. We got the guts up to talk on your show, which is awesome.

You were one of the first people I told that I was starting this show, before I even moved up to Alaska several years ago. I knew eventually I'd have you the show but I'm surprised that it took this long run.

I've been running.

I know all about you. We've been physical therapists. We went to Northern Arizona University, graduated in ‘99 as lumberjacks from a physical therapy program there. Tell the audience a little bit about your ownership journey and what you're doing.

In 2002, I opened a private practice in Mesa, Arizona. I named it my last name, Moore Physical Therapy. I might call it a mistake at this point, but at any rate, it's been good. I have loved the journey as a PT and particularly as an owner of a company. We grew steadily over the course of the years but took off in 2015, 2016 when we decided to expand and opened an additional office in 2017 in Gold Canyon, Arizona. In 2019, we opened the third clinic in Tempe, Arizona and we're growing a company out here in the East Valley, Phoenix area.

It's always been awesome to watch your progress and the growth that you've had over time. Marc and I are not only longtime friends and associates, but we're also members of a similar Peer2Peer group inside PPS. We've been able to look at your business specifically and some of the things that you've done to improve it over the years.

One of the reasons I wanted to bring you on, not only because you are a successful physical therapist but one aspect that you brought to the table a few years ago, was that your usage of scribes in the practice. I want to get into that a little bit and talk to you about how did you come upon that idea and how did you integrate that into your program. We can spend a lot of the time during our discussion about scribes and other things, but tell us a little bit about what brought that into play.

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In 2015, I realized I was one of these guys that put it off but finally decided to get some coaching. As Nathan talks about a lot, this is a pivotal moment in a lot of people's journeys. I started to take some coaching and I was in a workshop with Jamey Schrier. He said he was on your show, a well-known great guy. It was interesting, I was in that and I was talking to another participant there. He was a chiropractor because Jamie will have mostly PTs, but also other practitioners in his program. The guy was talking about having a scribe in his chiropractic office.

I can't remember where he was at, somewhere on the East Coast. It stuck. I couldn't get it out of my mind. It was constantly this thought that you've got to do that. I took a lot of things out of that workshop, but that was the one thing that resonated with me. I was staying late after work, doing notes. It's common in the outpatient orthopedic world, with your patients and you're still there hammering out notes. It's miserable and it's the part of the job that you dislike the most. In fact, I always say to people, “When you look at different professions, like a plumber, what's the worst part of his job?” We all can fill in the blank.

What if you're a mailman? That's the dog that bites you. What if you're the school teacher? It's not the kids, it's the stinking parents. In PT, what's the worst part about your job? Everybody's like, “We all know the answer to that.” It's clear. It's finishing documentation. It's the notes. I was fed up and I had decided that I was going to do some things differently now. I was going to eliminate things in my life. One of the things that I got from Jamey’s workshop was I was going to do an activity inventory. Look at all the things in my workplace. What are all the things that I do day to day?

I wasn't answering the phones anymore. I was early in my professional or my ownership and I wasn't scheduling the patients. I'd given away all these things, but certain things I still own that I thought only I could do, but I didn't want to do them anymore. This activity inventory was a list of things that remove your energy, that take energy away from you. List them at the top, start chipping away, and get rid of that stuff that takes energy from you. The top of my list was obvious. It was documentation. I had to do something about reducing the time that I was spending in notes and documentation. That's why when I talked to the chiropractor, and he said that, it wouldn't leave my brain. I'm like, “I've got to get rid of that.”

You're not alone. Documentation is the thing. Even in the web PT surveys that they do have 7,000 to 10,000 different physical therapists, always at the top of the list. It's the headaches that surround the EMR, mainly documentation.

I've asked that question to a lot of people and they all say, “It's easy.” It's outpatient ortho. It's easy. The answer is clear. It's documentation that they like the least. I made a decision. I was going to do something about it. On January 1st, 2016, Heidi arrived at the clinic.

A day that lives in infamy.

PTO 161 | PT's Biggest Problem
Who Not How: The Formula to Achieve Bigger Goals Through Accelerating Teamwork

It's a day that is close to my heart. I said, “I'm going to construct this. I'm going to invent this. I'm going to make it what it is because I didn't have anybody out there to guide me in the process. I didn't have a who.” Nathan, I talk a lot about Dan Sullivan's Who Not How. It's a book that is at the top of my list. I needed a who, someone who would take that load off me. I hired Heidi.

Did you hire her specifically to be a scribe? When you hired her, you said, “You are going to be my scribe?” Did you hire her as a tech with some scribe responsibilities on the side?

I hired her as a scribe and said, “If you have downtime, you'll help out as a tech or other ways. You can answer phones.” I was inventing this. I hired her as a scribe and never looked back. Now we have scribes in all three of our clinics. It's such an advantage in many ways.

We are going to talk a little bit about what you do, maybe how you train them a little bit, what you're willing to share. Do you look for certain people as you're trying to hire for scribes? Do they have a certain skillset or personality? They don't have to have degrees, I'm sure. They just have to know how to run the keyboard, I'm assuming.

Here's what I've found, which is part of the beauty of this, is that people love this job. I've never hired a scribe that didn't come to me within a couple of days and go, “I love this. I love it.” They love it. If you've got somebody who shares the values, that's first and foremost, and is going to be someone who you can work well with and they are interested in being part of a healthcare team which a lot of people do. This is a lot of the same people that you hire to work as your patient care coordinator.

These are people who want to be around patients, want to be helping, but they're right there. They feel their frontline because they're in the initial evaluation. They're gleaning and capturing all of the things that you're learning from your patient in that initial evaluation. They realize what the plan is and what the goals are. They've got some medical terminology that increases their ability and they love all that. I don't know that I could say I figured out the best candidate for that but I've found that it's not hard to find because the job is enjoyable.

As long as their value-aligned, which should be appropriately so for anyone who joins your company, but have some interest in healthcare, it's intriguing to people. In a way, you're pulling back the curtain and letting them see what it's like to be a physical therapist because they're intimately involved in the process, taking all this personal information, writing down the objective data. Do you have to spend a lot of time training them on terminologies and vocabulary? I'm sure they have to spend a significant amount of time doing some training on your EMR.

That is where there's a lot of work and time that needs to be invested like in any job. The moral physical therapy way like we do it in a certain way at our offices. Whoever else out there, they're going to have their ways, too, but this can integrate. They do not necessarily have one way of doing this. It can fold right into a company's purposes and missions and their methods as well. I have 4 or 5 main things that happened when I put a scribe in our company.

One, it reduced my documentation time by 60%. The quality of my documentation went way up, way improved, way better. My plans of care and the buy-in that I got from my patients on plan of care on the first visit and subsequent visits way improved. This one thing we're talking about now, there was uniformity and there is now a fairly uniform methodology across three clinics. Imagine that. You've got all these different providers, PTs and PTAs’ right notes and having different ways that they do things. It doesn't push anybody into a corner, but it allows some uniformity because they're using the same scribes. There is some there that helps in your company.

The last of those five items is maybe the biggest, which is when you go to hire new PTs and you're a total advantage. When someone's competing and saying, “I might go work for this guy. I work for you. Did you say that you're going to reduce my documentation by 60%? I'm going to go with you.”

I can totally see that as an advantage.

Those are the main things that stand out and there are others.

I'm sure it's not a hands-off process and you've got a detailed process as to how you introduce the scribe into the room and any better processes to what verbiage they're going to say. You're also reviewing this documentation after the fact and telling and you might be even giving them certain phrases like, “Write this down word for word.” I'm assuming that, over time, the way you're training and telling them what to do becomes uniform, but also the quality of the documentation improves and their ability to read your mind to an extent. They start throwing out stuff that they know you would say.

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We are creatures of habit. Let's not pretend like we're not. They see patterns quickly. For the most part, they're an observer. They're capturing information. Imagine that in your evaluation and you never take your eyes off your patient, not once. Your eyes are on them unless you're looking at your goniometer. You're looking in their eyes and talking to them about them, goals, purpose, and things that are meaningful. All the while, this is all being captured. It's wonderful that way. You can't predict what the patients are going to say but you can prepare your scribe to be concise and not ruin on every sentence and everything has been said.

That comes with some experience with some training but this is not transcription. It's not an advocation of the role of the PT. It's a trained individual that loves what they're doing to be an extension of you, the provider, and produce what you would produce if you had the time, energy, and wanted to. They'll do even better than you will.

I could see they could get carried away with those patients that spent 30 minutes on their past history, and you don't want them capturing all of that word for word. It takes a little bit of training. Does it also take some training to help them understand what quality documentation is and what is needed by some of the potential auditors and whatnot? Do you send them through some of that training and talk them through that?

That's a component that we need to make sure that we are on the up in every way. There's no certification for this as of yet, but it is something that I'm working on. That would be something that we could create some uniformity over the time so that we can see this as a profession that's recognized, has certifications and whatnot. That's certainly not outside of the realm of possibility. It's still in the works. We want to make sure that this is serving all the interests, the payers, the providers, the owners.

I'm also assuming one of the byproducts is that your initial evaluation times have decreased. It doesn't take an hour to do an initial evaluation. You're doing the most important things, getting the most important information, and moving on.

The biggest thing is your initial evaluations and your progress notes. Those are the notes that typically take us more time during the day. The other thing is that we're busy. Oftentimes, we'll be working with somebody and they'll make a comment about something, “We’re able to walk up five stairs without using the handrail, which is three more than last time we talked.” Some distant part of the day after you've seen other three patients, you're like, “What's that Mrs. Smith said something about the stairs? I can't remember what.” It's going to be captured well accurately because that's the reason the scribe is there. They're going to capture that.

Another thing is because a scribe, for instance, in one of our offices, we'll have as many as four providers at one time and that one scribe is providing the scribing work for four of them. It's not one-on-one. This person can work with everybody in that office. If I'm seeing a patient comes in and I'm talking to this patient, finding out how they've done over the weekend or whatever since we've seen them last and my scribe was working with another one of the providers, that's fine.

You don't have to deal with that second but when that scribe is done and comes over, and I feel her on my right shoulder here and I know she's there, then I'm going to say, “Mrs. Smith, tell me again what you were saying. Did I hear this right?” I can restate to Mrs. Smith what I heard her say. What does that do? It gives her a chance to go, “I am totally heard and understood.”

This PT listens. He understands. If she says, “No, that's not what I meant at all.” “Let's make sure we get this right. What is it that you said?” That's all captured and that's why the quality of our information goes up. Oftentimes, it's not just capturing it right as it comes out, it's asking that patient, and this is what we're trained to do, is let's ask that patient, “Do I understand you correct you're saying the following?” That restatement is validating their concerns, their worries, their thrills, the things they're excited about connects you more deeply with your patient, which we know that connection between provider and patient is as essential as anything to see that patient improve and get better.

They want to feel that connection and maybe it's not a statistic that you measured, but has it changed maybe retention rates or your completed discharge rates?

Plans of care, it's way up. When we opened this clinic in Tempe, we’re starting with a little bit of a skeleton crew because it's a new clinic and you've got a lot of startup expenses and stuff. We went for a while without a scribe. When we got that scribe and added it in, we see those changes and improvements.

I loved one of the benefits that you pointed out, and that was how it improved your plans of care. Tell me about that a little bit. How did it affect your plans of care and the patients buying into it?

When you're sitting there looking at the patient, not looking at your notes, not looking at a computer, laptop, or anything of that sort, you're connecting with them. This is part of the uniformity, we have a way of asking Mrs. Smith. This is the question. This is the question, “Six weeks from now, if you and I are sitting here having this conversation, what is it that you need to happen in between now and then that would make you satisfied with this relationship with you and in our clinic?” That’s, by the way, not my question. That's Dan Sullivan's question. It's called the Dan Sullivan Question. He's my entrepreneurial coach. Chad Johnson is my coach but we asked that question. What you get from that is such a connection between what they want.

When you can restate back to them what they said to you even better than they could have said it to you because you have the ability to articulate it through the lens of somebody who understands their disease, their pathology, and their anatomy, and you put it back to them and they go, “What you said, that's what I want. Buy-in.” Your chance of executing the full plan of care and having that patient become a well patient and having succeeded, goes way up, which also then, in turn, makes your whole experience better.

Your staff loves their jobs better. You're getting into why you're doing this in the first place. You do this to help people. It helps the business, because as a business, we've got to be aware of profits. This is the profitability factor. Completed plans of care and the satisfaction of individuals that both work for you and come through your doors, these are all hard to measure things, but we all know about them and we're working on them all the time.

Was there a concern that you're taking on this additional salary, that there was going to be this additional expense? It's hard to get ROI out of this position, but the trade-off is great, even if it's not fiscal.

It is fiscal.

Tell me.

It's right in front of our faces. You got a PT. What do you pay your PT?

Mid $70,000 per year salary.

Let's say it's $40 an hour or something of that sort. What do you pay a scribe?

I don't know.

Not even half of that.

$12, $15?

There's your answer. You've taken from a $40 an hour person a task and you've given it to $13 an hour person or whatever that is in your region makes sense. It's right in front of your face. That's obvious.

That $40 a person is no longer doing the $13 an hour job. They can focus on doing $40 per hour things.

How could that not help your plan of care become more likely to be executed and have your outcomes skyrocket because they can spend the time like people that are working as physiotherapists? Now, I'm out of the office. I haven't worked seeing patients, which is one of my personal objectives where I've gotten and I'm happy about that. Those who work for me, they're the most amazing people, and they're there. Their whole heart is to help people get better.

That's the reason they're there. If they're not doing it, if they're doing stuff that doesn't move toward that direction, then it’s not happy. That's not why they went to school. That's not why they'd done all this. What does a happy employee cost? What's the value of that? What's the value of somebody who's going to stay with you for a long time and maybe forever because this fits their needs? Eventually, everyone's going to do this. It's a no-brainer.

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I'd imagine you probably noticed this in the Tempe clinic specifically, but once you implemented the scribe, morale probably changed a little bit. The feeling in the clinic was a little bit lighter and happier, would you say?

Who notices this is the providers? They do drive providers. PTs in your office drive the morale of the office. Everybody's speeding off them. They're the ones making decisions. You affect that person, you affect the whole thing. Oftentimes, we do in our office is we ask one of our physical therapists to be a clinic director. They've got additional roles and responsibilities. This frees them more, too, if you can imagine. It can't help.

I love the fact that you have them share between your space for providers. Do you think there's a limit to that? If someone has 15 providers in a clinic that maybe they need 2, 3, or 4.

There's capacity there. We've found a formula that works for us, but then you can also use this individual as part of your team in other ways, too. Let's say, for instance, you've got a single provider clinic and it's not enough work to have a full-time, all-the-time scribe. They're healthcare-minded people that want to provide care. There are places where they can help out in your office. We've experienced this. We've been doing this for several years. We've got a lot of experience.

You find them being a scribe for four providers, it doesn't necessarily keep them busy full time. They should be finding other things to do.

With them of four providers is pushing the limits of an individual scribe. Three is a sweet spot, at least in our format, the way we do it. You can vary that a great deal, for instance. If a person's coming in and it's a daily note that you're doing, you're not doing a progress note or an evaluation of the sort, they're going to be capturing subjectives and helping capture objectives from the provider. That's not a whole lot there.

It depends. There've been periods of time when they can't capture all of those things. They primarily are doing the progress notes or the vows. There's some flexibility there but your providers also understand that, “If the tribe's busy, I can also do my note. I don't need to wait for them.” If it's a quick daily note, you can punch it out and go. You don't have to use the scribe if it doesn't make sense.

If the scribe could even help them 60%, 70%, 80% of the time, that's a huge load off of their plate.

It's much more like 95% that they're capturing.

When that scribe calls in sick, that's a pretty sad day in the clinic, I assume.

It got to the point where they have forgotten what it was like to go without it. They're like, “What’s going on here? The scribes not here.” You're like, “You have to do your own notes.” “What? I didn’t sign up for this.”

Welcome to the rest of the world.

That's a moment where you can say, “There are other offices around town that don't have strategies. It works for them all the time. Never have one.”

Forty hours a week writing notes.

I remembered why I like you so much.

Do you have a hard time filling that position of scribe when it's open?

We never have had. I've realized this when I have friends at other places in the country, like our friend in New Mexico. It's not all like it is here for us. We seem to have plenty of folks that we can draw from and we can find good people.

When you tell them that, “In this position, you're going to be riding a lot, you're going to be following the providers,” do you find that alone weeds some people out or gets them excited?

I'm not looking for just anybody. We're looking for a who. We're looking for the person that says, “I can do this better than you can. I surely can do it better than your PT scan, like type, capture information. I'm better than all the people here.” There are who. There are person that knows how to come in and make it happen. They need to learn a little bit about physical therapy and about the system but they're coming in proud of their abilities to type fast, capture information, be able to glean it, make it concise, and what the providers want to be.

They have their little rolling station and when you're done with an initial evaluation, they roll out and find the next patient that they haven't captured information on yet, ask them how they're doing, talk to the PTs, and work the clinic all day long.

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The patients know them. They're engaged with patients because the patients see them every time they come in. That's Heidi. She comes every time. It gives you that moment as a provider to make sure that you put your thinking brain on with that patient. You're not just going into treatment mode. Heidi is going to come over behind you and you're going to have to go, “Let's capture the pertinent and important information here.” It's good for the provider.

There've been many times when I've been in a particularly challenging evaluation. Usually, I've got patterns of how I do an eval. For whatever reason, this patient threw me curve balls. I was out on some other tangent going, “What's going on here?” Trying to figure it out the scribe will say, “Don't forget, you usually do this assessment with this kind of patient. Did you want to do a straight leg raise test here?” “Yeah.” “Thank you.” I always do that test. I needed to get that neuro attention information, but at that moment, it was lost. They help in a lot of ways and they know that. You turn and look and you say, “Without you, it wouldn't be as good here.” They love what they're doing for you.

We've covered a ton of stuff about scribes. Is there anything else you want to share that maybe we missed?

We are a new company, this Rehab Scribe that we are opening. We are capable of taking on clients across the country because this training can be done virtually. We don't hire. We do give some guidelines and guidance in hiring but we can train your people in your place. Oftentimes, someone in your organization already exists. We can turn that person into the who for you. We're happy to be of help.

I was saying to Nathan before we started this show, I want everybody who's felt my pain, which is the pain of outpatient orthopedic. After the people leave and you're still sitting there, I want you guys to not have that. I want people to start doing this so that they get home to their families and stop doing notes or taking notes home, which we've all done. I've done it. It's a little bit of an investment but financially, it does make sense. It comes back.

Are there any other small things that you've done over the course of your ownership journey? You've been a practice owner for several years. Any other small things that you've done that have impacted your business that you would share?

I’m reading this blog, Nathan. I was prepared for that question or a variation of some sort. I was thinking to myself, “What are some of the things?” I listened to the other successful PT owners come on. I gleaned a lot, I pray, I value that, and I appreciate that. Three things that stood out to me, one was my morning routine. As good as my morning is, it’s as good as my day is going to be. Those first two uninterrupted hours of the day are important. Getting coaching, reaching out to get somebody to help you.

PTO 161 | PT's Biggest Problem
Think and Grow Rich

You need it. Even though all the information I believe that I need is already inside here. Great coaches don't necessarily add stuff in your brain. They just pull it out of what you already got. Mastermind groups. We've been in together through the Peer2Peer program of APTA, and other mastermind groups that I'm in are helpful to me. Those are the things and there are many of others, but those are big. They change things.

I can tell that you've made a difference from an outsider's perspective, that you've made significant changes in your business as you've gotten the coaching, as you've done the networking, and as you've pulled yourself out of treating. You've had more time to work on your business. All those have been influential in your growth and I've seen the growth in your company because you've done those specific steps.

If I go back and I look at my first coaching I took, 2015, a few years later, I opened my second clinic after twelve years of going along. Two years after that, I opened my third clinic. Two years after that, I take myself out of treating patients altogether and doing what I want to do now, which is to be a business owner. I know a lot of people that, that's not a fast movement. They could have done all that in six months and I know that. For me, I like that. That's the progress that I'm thankful for. I don't think I've done all that but it's worked out in that fashion and I'm grateful.

Looking back on where we're at now and because we've had a similar trajectory to our schooling and careers.

We did open our clinics within months with each other and within maybe it's fifteen miles of each other.

We've been tied in a lot of our pursuits. What would you go back and tell the Marc Moore of 2002 when he first opened up his clinic? Is there any advice, 1 or 2 things you'd say “You've got to do this. The sooner you do it, the better?”

Don't have a scarcity mindset as much as I did. I realized that you make decisions based on fear that you're going to run out of stuff, run out of money, time, and whatnot. One of them would be, get coaching much earlier. I read your interview with Adam Robin. That guy's a stud. He jumped in. A year after starting PT clinic or something like that, he’s coaching. I'm like, “Good job.”

How much money would you have saved if you had gotten coaching early on? Instead of learning from the school of hard knocks, you could have saved so much headache, time, money, energy on poor employees, you name it.

To me, it would have been why I have waited long to feel much fulfillment. Money aside, I've wanted certain things for myself like we all do. It's putting it off where I could have started expanding my influence and acting on my desires, goals, and inward wants. That's the loss that I feel. It's like I missed out on some years where I could've been making more progress.

You could have had a greater impact sooner, right?

Yes. To my family, to my employees, to myself.

You could have achieved some fulfillment sooner and maybe be able to be a little bit more clear about it.

I can go and think to myself, “What do I feel my own value is?” My value has to do a lot with do I act on the impressions that come to me? I wanted to open a second clinic within a couple of years of opening my first one, I was always going to do that twelve years later. Why hadn't I? It was because I needed some nudging, I needed to take some time and to act on those impressions that were coming to me and not just listen to the fear that comes right after the message.

One of the most influential books that I've read was one you shared with me called Who Not How. You've already referenced it in our conversation by Dan Sullivan and, who was the guy that wrote it?

Ben Hardy.

It totally changed my thought processes. I'm still filling out impact filters. Any other books that have been influential?

PTO 161 | PT's Biggest Problem
The Road Less Stupid

The Road LessStupid by Keith Cunningham. That is a book that will help you think. What I mean by that is, I don't know how many, maybe 40 different sets of questions that you should be thinking about. You should stop and get a quiet place. You should think and write. Your prompts, if you'd say it that way, but it's accompanied with some background as to why that question is important. It's nice. It's a great book and that one's been helpful. That one's going to be something I'm going to have on my desk for years as I'm working through it.

Is that a small business book? Is that more of a self-help book?

It's a business book. It's specific to your business. We got to always give homage to Covey, 7 Habits was early and it's still powerful. Oftentimes, it’s skipped over. It’s timeless. His son, Sean Covey, with a group of other authors, I feel bad I don't remember the others, wrote something called The 4 Disciplines of Execution, 4DX. I love that book. That's been helpful to me. That's that Marriott, the hotel's method for how they execute their company. That's been good. Those are all books and there are many others.

I want to pick your brain because of what you provided me. I'll have to check out The Road Less Stupid. That came from left field. I hadn't heard that one.

Ben Hardy and Dan Sullivan are authoring another book. It's about to come out. This is Dan's second big market book. Those who know Dan, he produces a book every 90 days. Who Not How was his first widely published book. The other books he produces are for people that are in his workshops. That was a major market book, Who Not How, and it did well. I can’t remember this other one is. It's called The Gap and The Gain. It's an awesome concept. I haven't read the book yet but I know the concept well. I've been benefiting from it for years.

I remember listening to his podcast and he talked about the gap. It's going to be a big elaboration on the gap, I assume.

The same author, Ben Hardy, who's awesome. He’s a stud. He's got other books of his own. Their collaboration is incredible. Dan Sullivan writes zero of the book. He goes to Ben, “Here's the concept,” and trusts him. Ben is his who and steps away. Ben writes the whole book. Not any words in there unless Ben happened to be quoting him. It's not in dense writing. He's a great example of getting people like a scribe, someone who wants to do and loves to do that particular work. The other thing about it is in every job that's out there, there's somebody around you that loves that job. Especially the ones you hate much. Give it to them, let them run with it because they're going to do much better job than you are.

We talked about that a lot in my masterminds, are a number of therapists, some more than others, but most of them dislike marketing. It's because of their dislike of marketing that their marketing efforts are stunted. Numbers get low and they do more marketing. Numbers come up and they stop marketing or they try singular efforts every now and again in that kind of thing, whereas the guys who are successful.

If you're going to take a page out of those successful books, it's to find the who. “You don't like marketing. Let's find someone that does, that loves to visit doctor's offices and play the game and try to get past that front desk person.” People like doing that. Find that person, let them do it. When you get a consistent marketing engine going, even if it's a part-time person, the number significantly improved. In my business, once I found someone to do the job I hated, that area of my business improved. It's awesome that you've taken this concept down to the scribe level.

PTO 161 | PT's Biggest Problem
PT's Biggest Problem: Scribes primarily make the progress notes.

I'm trying to live that concept as much as I can because there are still things in my life. Going back to the activity inventory that I did years ago and wrote on all the little things that I do. There are still items on that list that I might be good at. I might even be the best at more organization but it removes energy from me because I don't like it or it's not keeping me in the areas that I love and bring me energy. I'm still trying to chip away and I will for the rest of my life. Let's be honest, this is a process and I know that.

That’s an impactful exercise for you and it's one that you're still going back to, it sounds like, years later.

It'll be forever. Everything I do every day is only what brings me energy, but then, what's going to happen? My interests will change and then I'll be like, “I don't like that anymore. Now, I want to paraglide or something.”

I got back from a golfing trip and that's something that could give me energy every day. I have no other concerns about how well I'm going to play golf. Thanks for your time again. If people want to reach out to you, how do they get in touch with you?

In regards to the scribe, it is Give me an email. If they're interested in getting some help in developing, describing their clinic, we'll get on the phone. We'll do consultation and find out what their needs are and make a decision.

Thanks for your time, Marc. I appreciate it.

Important Links:

About Marc Moore

PTO 161 | PT's Biggest ProblemMarc Moore is the owner of Moore Physical Therapy. His company has a 19-year history and 3 locations in the East Valley of the Phoenix AZ metropolitan area.

Marc also owns and is passionate about the use of scribes in clinics to elevate the PT experience for patients and providers alike.

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PTO 158 | Let Go Of Someone


Handling a team is challenging, especially when there are members who don't cooperate. So when push comes to shove, how do you let go of someone? Today, James Savas, the Deputy Chief Executive Officer at Hands-On Diagnostics, breaks down the process for us. James talks with Nathan Shields about how business owners should handle termination or resignation. It begins with mindset, clear reasoning, role-playing, and documentation, documentation, documentation! Taking on the role of leader and holding team members accountable can be difficult, yet it is necessary for the growth of your business. Tune in and let go of someone as clean and simple as possible!


Listen to the podcast here:

How To Let Go Of Someone Successfully With James Savas

I've got a returning guest, James Savas, who is an HR and Recruiting Specialist. He's working with Hands-On Diagnostic services as well as other business owners for their HR and recruiting issues. I'm glad to have him on. James, thanks for coming.

It’s great to be back.

If people want to learn a little bit about James, we won't get into it but we did an episode in 2020. What was the topic that we discussed, do you remember?

It was recruitment a little bit but the front end is onboarding staff. We touched on the operating side a little bit.

We had a follow-up episode about getting rid of the dead weight and that stuff. This is apropos that we talked about this topic because we won’t get into how to successfully fire somebody or offboard somebody. We are going to talk not just about firing somebody but also what to do when someone resigns and how to make that successful for you. I would highly recommend that the readers go back and read those two previous episodes because these will all be somewhat sequential in nature.

When this topic came up amongst my mastermind that someone said, “I've got an employee, a physical therapist who's resigning here in the next couple of weeks.” Another member of the mastermind said, “It would be valuable of you. You recommended that you should do an exit survey.” I thought, “Something we haven't talked about on the show before is exit surveys or exit interviews if you will, however you want to call it. Who should I talk to about properly offloading somebody?” and I thought of you.

Thank you. I appreciate it.

Where do you want to start with this? We talked a little bit prior to push and record about the mindset. Maybe that's a good place to start. There's always that inkling, “I need to let this person go.” Can you help us walk through where someone should start considering and how to consider letting someone go in the first place?

The first thing is understanding, acknowledging or re-realizing that you have a partnership with this person and you brought them into your company, right, wrong or indifferent. They are your great hire and deadweight but they are yours. A general statement in the personnel period is to take the viewpoint of responsibility because ultimately, you have them there.

As an employee, take what your management says and apply it. Click To Tweet

I'm not saying it's necessarily the owner's fault that things don't go right. However, if that's the viewpoint the owner has as senior management of like, “Why didn't they make it? Why didn't this employee make it?” That's a great mindset for you because then you go into correction, quality assurance yourself, your processes when they came in, on the training measurement when they were there and on the way out.

It is more enlightening to me when staff is on their way out for any reason. Enlightening yourself in your process because then you will see what you lacked, what you did right, and what you did wrong because again, that's your partner. You brought them in, you cared for them at some point and you pay them some money. Now you’ve got to end it. That's a quick mindset point I wanted to comment on.

That's valuable that you have to recognize where did things fall off. If you are not using it as a learning experience to improve, then you are setting yourself up to have the same issue over and over again. What could we do differently during the hiring process? What did they come with? What could we have vetted better in the recruitment stages, hiring process and interview stages? How could we have seen the red flags, you name it?

As you said, we brought them on, we were excited about them, and we vetted them appropriately but maybe our training processes could improve. How can we set them up for success? Essentially, your job as the leader is to set up your teammates for success. How can we improve that foundation that they can build upon? Did we provide them the appropriate expectations ahead of time so that they weren't surprised by anything that came up? Were they aware of all the policies that were expected of them ahead of time? If we didn't talk, can we do that differently?

No matter what has happened, we are in this position where they have either resigned or we recognize that maybe this is going in the wrong direction and we need to consider firing them. What I’m trying to ask is how do you decide if someone needs to go? It's time to stop all this and it's time to let them go. You, as an Owner, have been on the fence for a long time, how do you finally make the decision it's time to leave?

I don't pretend to give legal counsel. I just want to make sure that that's communicated. Take this from expertise and professionalism and what I have done with these own hands in my years. I want anybody that is on the HR personnel universe will tell you that documentation, the same way when you are treating a patient, reports, emails, and funkiness that have occurred, the good, bad, and the ugly. At this point, you want to go the ugly-ish. It's got to be data-driven like a physical therapist.

If you have an occurrence that on March 5th, X, Y, and Z happened, you have statistics or KPI that point you to where they had these targets to achieve and never have achieved them. For the last six months, they have not achieved them. Three major indicators or evaluators would be reported in their files. I don't have it verbatim but there's an old adage that if you investigate the employee, investigate but you have about an inch thick of a personnel file. We all use electronic stuff these days but you get the idea that if it has been a while and a few reports, let's look into this guy or this gal.

It’s the day-to-day data, reports, statistics, KPIs, trends, and their arrival to current and in between. If you make it non-emotional and no opinions are allowed. You want to get raw on the legal side, it's no opinions and no emotion. “Jack Smith was late these days. He failed to achieve the targets that he knew they had. We had our review and we went over it. He signed that he did it, bye.” That's it. Those for sure are things to evaluate.

It helps as I'm talking coaching clients through this when we can get as objective as possible and that's what we are talking about. Objectivity helps the situation. Subjectivity and emotion are not going to help. It's going to be he said, she said, it's going to get emotional, back and forth. It's not going to be a good learning experience for the person and the employee who is leaving. That's one thing owners don't do enough of is documenting the infractions so to speak. It’s simply writing up, “This is what happened and this is why it's an issue.”

PTO 158 | Let Go Of Someone
Let Go Of Someone: Build a system coming from the top down where everyone freely writes up comments about things.


I would take it a step further, which helped me and my clients in the past to determine and define, which value of the company they are going against by performing this action. If they were late and weren't meeting their productivity measures or the KPIs, those are infractions. Is it professionalism, integrity, accountability or empathy? You name it. What value are they going against? When it's a value-based decision, this person is not upholding this value. That also makes it objective and clear.

I fully agree and it's interesting because we will probably get into what form of documentation do you need or what checklists but on that point, which dovetails the two points. Ideally, reports are written or other reports call them statements. It's happening all the time and there's no particular pressure or no funky viewpoint about it between the staff. If Samantha is late, they write Samantha up. Not because I don't like Samantha.

It’s because she was late. That manager observes, following through with a policy or procedure, and documents it. That’s all. It’s clean, no opinion. It’s just, what happened is, I thought. In the same way, it's the same thing you are doing for patient incidents. When something happened, write down that Mr. Smith felt that he got hurt from that ultrasound. Did he really? Maybe not. Is it your fault? Maybe not but he felt that way, so you write it down.

Ideally, you do have a system that comes from the top down that everyone freely writes up comments about things. I will tell you something. That's not easy to do but if you can pull off at least a management group or your top guys and gals that back that viewpoint up, then what you have is what a sane environment you created. If you see a report occur and the report itself looks opinionated, nasty, and she never, I'd investigate the writer of the report but that itself tells you something.

If you can get your management and up, it could be one person, office manager or the billing manager in smaller offices but if you get their backup on the report writing, you are golden. If that's not possible, you are small or you can’t do it with, which dovetails to your last point, I would say at least every six months or every year, an official evaluation or whatever we call them an employee review.

At least, if the reports can happen for whatever reason under the sun, then the reviews or the evaluations. In those, exactly what you said, there are categories of viewpoints or a backup of overall purposes of the company. How does the employee align with the purposes, good, bad and indifferent? Why? It’s statements that you, Manager or Owner are writing that. If you want to know more about that type of document, it’s official. The employee signs. That review signs that they read what you wrote. It's all handwritten and right there. If not, which is again, you should look to do that if you can, then at least annual and biannual review.

That's where many owners fall short or don't feel comfortable as to, number one, have accountability meetings when issues do arise. As physical therapists, we like to be liked. That's the general personality of physical therapists. If we are going to hold someone accountable, now we are the “bad guy.” We don't want to have that feeling of confrontation in the clinic. However, that's the perfect way to allow people to walk all over you.

To be a leader, you need to hold your ground, set the boundaries, draw the lines if you will, and then have those accountability meetings and have regular meetings, one-on-one meetings with your team. They want that and deserve that. They want to know how they're doing. They want to know what their scorecard looks like. Allowing them to have an assessment and a review is appropriate.

We talked about the purpose. We also consider those value-based assessments. We would list the values and, as you said, “How did they exemplify the values over the past period?” We had to go both ways and they would fill this form out themselves, and then the supervisor would fill it out as well. The assessment interview itself, they would start like, “This is how I have shown these values. This is where I need to show improvement. This is what I'm going to do in the next period.” The supervisor would say, “Thank you. I agree. This is how I think you've shown those values. This is where I think you need improvement and this is what I need to see from you.” As you said, we both sign off on that.

Care about other peoples' success. Click To Tweet

That's just an example of an accountability interview like you talked about, but having those in the employee files as well as, “I'm seeing a trend of you not coming in early. Let's go to productivity statistics specifically. We have an agreement that you need to see 60 visits per week and you have been routinely at 50 visits per week, and I'm not seeing you do anything about it. What do we need to do about it going forward?”

Make sure that's written up and there's an agreement. Depending on the severity, and then maybe they sign off on it or not but you have to have those things to make it easier to let them go if that's the case but it also provides them the foundation to grow, understand, and invite them to, either join the team and say, “This is the team over here and these are the expectations to be part of our team, or you need to find another team to play with.” That accountability means that can be huge. We set up an employee file.

Let me give you this question because this happens more often. They do okay. They don't speak negatively of the business. Their performance is on the border most of the time. You ask for improvement, and maybe they improved for a couple of weeks, but then they go back again. How do you decide if you should keep that person or not?

It's a matter of, are they willing employees or are they something else? Are they an employee that takes what you say and applies it, that takes your direction and changes? When you give them orders, directions, viewpoints, policies, they understand it and do something with it or about it. On a low level, would they be able to go? I used to run a drill on the hiring side with the new employees. If you gave them a specific order at a restaurant, would they understand and duplicate all the little, “Mayo on this side and mustard on this side,” or whatever?

Do they understand your communication and can they operate based on it? Are they willing? Does that happen? Yes or no? “No, they don't listen to me. They do an average volume of work, or whatever their area is.” Are they willing or not? A non-willing employee comes in a few different shades. They can be defiant and be like, “No boss.” They should be out the door. That's just who they are. If not, you don't need that very long.

It's easy to fire them.

Yes, exactly. They let you know that you should fire them or there's a behind-the-back guy. The back-coverty like, “Everything is fine?” Big smiles but intentions are, “What?” In the statistics, you will see a division or area that it's not going well or we can't hold staff here. People are unhappy here or there are complaints. Tracking that down, it’s Peter or Sally. Either you have a willing person that responds to correction, communication, and changes as a result of that can duplicate and understand basic stuff needed by you, by the boss, by the managers or not.

If you can decide that they are willing, if that's assumed, and let's be truthful at the front end, do they have a general IQ and aptitude for the job? Generally, they have to ask to be assessed on it. Assuming those two things are valid that they are willing, they have a fair intelligence for the position, and they are not doing well, then the answer is they should correct with correction. They should change their operating basis. It should be an even keel, peer-to-peer, down to their level of conversation about, “What's going on? What are your future plans? How is it going here?” I wouldn't even necessarily document that at that point. It’s a conversation with your partner that you brought into this group that is not working out well.

If they are a willing person, generally good, emotional state, and so on, they will and you will find out what it is. You will find out that, “It's a rough year. It’s COVID. I just broke up with my girlfriend or my boyfriend.” You might get that stuff, too and you might get something else but that's through communication. That one if not handle the problem, you get the root of it, parts of that roots or pieces of the roots and there you go, “I get it. Things suck for these reasons. Can you do the job that you were hired to do?” “I guess I can, boss.” “If not, I don't think it's cool. Let's look at some other options here like part-time, you are in or goodbye.” You have to first evaluate that you’ve got somebody worth it, the production flow or are they are really not worth it. That's the first point.

PTO 158 | Let Go Of Someone
Let Go Of Someone: Letting someone go comes down to documentation.


What I see in owners oftentimes is they haven't had held somebody accountable in the past and they don't know how to start doing that now because that is a different culture. It's going to be a surprise to those employees that were finally holding them accountable. I did this in the past and you didn't say anything wrong. I'm learning to become a better leader. I decided that I'm finally going to sit down with you and talk to you about it. They have to get comfortable and maybe they don't also know how to hold that conversation.

I like how you brought it up like, “How's everything going? Are you happy here? Is there anything else I need to know about? Now, understanding that we will clear the air. Let's look at your statistics. Things aren't going in the right direction. You are not producing what the expectations are. Are you aware of what the expectations are or you are not? In order for us to be productive, helping our patients, and profitable as a business to sustain our survival, you have to see this many patients per week. Can you do that? Yes or no? If not, let's move forward. If you can't, I don't know if this partnership can work much longer. How are we going to figure this out?”

It doesn't have to be, “You just need to see more patients.” That's not going to go far and as you said, this is a partnership and you have an agreement between each other that you have established but you need to understand that both parties need to hold their end of that agreement. That's what that meeting means. It's valuable to, number one, start having those conversations.

If they still aren't able to come around, still not doing things, other patients are falling off left and right, they can't keep the patients in the door when they come in or they are leaving after the 3rd and 5th visit, it's time to have that conversation. What kind of mindset do they need to have when it’s time to part ways?

The owner?

Whoever it is.

In my experience, PT owners and other professionals as well but they are caring. That's why you’ve got into the field you did, among other reasons. You care about the staff. When you are at the point where you are having those conversations like we just said or get further into it like it's going to go, “Tomorrow you are gone or now you are leaving.” When you do it from the viewpoint of care, the same way you might have a tough conversation with a patient about it doesn't look good.

In PT, we don't have those conversations but you get the idea that it doesn't look good here. It's the same thing that you care about that person and you don't change that. You don't suddenly become a bully or something else. You are still that guy or gal with those purposes and partnerships with those agreements and you care.

Working relationships are all about trust. Click To Tweet

I have even used those words and guided owners to use words like, “I care about your success. I care about your future. I care about what we have done here. You are valuable to me in this way or these ways. You happened to be valuable.” Part of it has to be acknowledging the good, the agreement, and partnership so that care things should never go away. The ax comes down and you have to put your other hat on, and now you are the mean guy. It's not at all. You are the same person that had the same question. It's a viewpoint like you said, shift.

That's exactly what I asked. What mindset should you have going into the firing, per se? I like to avoid the details unless I have to and just say, “We have had some conversations and it seems things aren't going the right way.” Shaun Kirk who is a mentor of mine was like, “It's just not working out.” That was his famous phrase. I like to give them a little bit more and say, “We have had conversations in the past. It's time that we part ways. I care about where you are going to go but honestly, today is going to be your last day,” and go from there. What do you recommend in those conversations? What kind of wording do you use?

That is the phrase. Shaun is right. That is the blandest way to say, “You are out. That's it and it doesn't necessitate any other accountability but we are not a good match. It's not working out.” Those phrases are globally gray and okay. I like those, generally speaking. It's not going to work every time, I get it. I have had people and I'm sure some of your owners had people that go, “But I deserve to know, I want to know,” or whatever it is. Number one, I would always role play, by the way, prior to. Number two, always have somebody in the room with you.

A witness, the good cop or the bad cop, there are a million reasons why that's a good idea. Roleplay with that person and say, “We are going to do this. It's going to be maybe sticky. She's not going to like it.” I would be real with that manager. Ideally, it's the Area Manager and you, the Owner or the two owners, whatever. That is a good bland thing to say.

I had gotten into a conversation where they demand to know or something like that, and I have held my ground that, “I don't have to give you a reason other than what we have gone over in our last talk or other than what we have gone over in your evaluations. I will give you a copy of that if you would like. Its statistical point, I can give you a copy of the graph if you would like. If you went down, that's evidence here.” That's it.

If it gets heated, I have gone that direction where, “I don't have to tell you and I will give you some documentation if you want.” If you are going into it with the idea that it might turn into a legal issue for you like they are leaving, either way but it might get sticky, they might get you for something. Maybe you are not sure or they weren't a good employee but you kept them on because you had nobody else or whatever, it's going to go bad.

Again, I'm not the Owner of your clinic with the money or the lack of money but I would always have available a check on hand. I have done that before, too. If it goes great, maybe no check but you have it there, “I give you a week's pay.” A week's pay is planning for that general employee, maybe a payroll cycle of two weeks max. That's generous. I have done that not just what they worked up to that day because you owe them that, of course, but I would give them a little bit for their troubles and that thing. That's a little ammo, just in case.

I feel this way personally that if I'm going into that conversation and they are surprised like legitimately out of left field surprise, “Where is this coming from,” then I probably did something wrong as an Owner and not having more meetings prior to that point. Would you say that's fair?

Absolutely. I had gotten them in tears. It's rough.

Let Go Of Someone: If you're the one leaving and moving on to a different game, others will ask what's going on.


“Based on our prior conversations, things just aren't changing.” You should be able to say that. They can be in tears and be emotional about but they shouldn't be like, “What? I don't know where this is coming from.” They shouldn't be in that situation. You should have had previous conversations.

If we are talking about the viewpoint of what shoulda, coulda, 100,000,000% that is the case. You are right.

Unless they did something egregious and you said, “That's not appropriate. You are leaving now.” I have done that before. “Don't bother coming back.” You also bring up another point that there are certain people that you need to be careful with letting go. I had an employee, there’s an age discrimination issue that could come up if they are over the age of 45, 55 or something like that and a lawyer let me know about it. If someone is pregnant or has recently had a child and that has affected their work, then you need to be careful about how you let someone go in that situation, and race is always an issue as well. If any of those things could potentially be an issue, it's always good to talk to a lawyer first, especially one specific to your state.

Any good lawyer will tell you as a general statement to wait. If it's a pregnancy or a medical issue but didn’t come back, then decide. There are always exceptions. Again, it's always going to come down to documentation. If they were flagrantly doing things and now, they are pregnant or might get you for age discrimination or something else, then you’ve got the goods.

You still have to have the objective data to back you up. You have to have documented proof of what has gone on in the past. In those situations, there was one situation where their age was a potential issue. I had to provide them paperwork so that they understood that this wasn't an age-related firing. They had to take that home, review it, sign it and get it back to me.

That was an issue that I had to deal with. A lawyer walks me through it and eventually worked it out but you want to cover your bases and make sure you are doing everything legally prior to those situations. I'm glad that you brought that up. I would refer the owners to a lawyer for sure to make sure they cover their bases when they are letting people go.

You brought up another point that there should be a checklist. We call that our offboarding checklist but when you offboard someone, we needed to get the keys. “Did we have all the passwords? Have we removed them from access to all the software? Do we have everything we need? Did they have any access to bank accounts that they need to,” especially if they are in billing? “Have we done all these things? Have we signed all the paperwork? Have we notified the payroll company and make sure you have that checklist?” You make sure everything gets done appropriately.

One thing I would do on that, and you might have done this yourself is, you have to have the backline steps like remove the password. You are not doing that in the room with the guy. Necessarily, I have done that too. It's an interesting thing where if we were 90% sure it was going to happen and that meeting that they were gone or we had to let them go, then as they walk up the stairs literally, we were cutting off passwords and changing passwords.

It's a partnership; it's a team. It's not just employees. Click To Tweet

We would let the Building Manager know that we are talking. I have done that before. I agree with a checklist. You need that but I will make sure that some things are post-firing. Now they are gone and you don't have to do them, the keys, passwords, bank account data, and whenever they change keys and passwords to get locks and keys.

I have had the checklist in the room with me. I would call it two checklists. I had a master checklist of these processes like getting keys back that I control. No one saw that but me or my manager. That’s what I did, and then it went to the file when they were done. I had another final document in that meeting. It was the last meeting. I had that there. It’s interesting results. It was the list that the person has to acknowledge to the best of their ability. If they were not, they were not being let go for reasons like race, sex, age and so on.

That's, again, to the best of their knowledge because they can assume whatever. Is that a legal point or else? No. Imagine what that creates on the other side is you are going to get a little flack like, “What am I signing here?” “This wraps things up and we went over why you were being dismissed because of stats, objective data and so on. I want you to know that it has nothing to do with such and such.” “I guess not.” They won’t all sign it. Let's say that it has been overt about that. However, the idea of that document is that they have to mutually agree that it’s okay. It's a funky area, I know that but we always had that. It’s always nice to see the person has to confront themselves. It's always weird. I thought it was good to help end it.

What your thoughts then when someone resigns and says, “I'm putting in my 2-weeks, 4-week notice. I want to be done at this date?” There are some situations where you might say, “I will take your resignation and you can leave tomorrow.” I'm sure there are those situations. What are your thoughts in general about letting someone stay on for four weeks? Who do you let stay on? Who do you say take off tomorrow?

It's about trust. In my lifetime in the area, medical and HR, both separately and together, maybe 5 or 10 people on the hind side that I have let stay. Very few people stay. This is someone that either I know from prior work before this job, we have some connection prior to it, a PT from school, a buddy from here, my personal assistant or raw employee. I would say of those 10, 2, 3 or an employee I have no relationship with prior, that's few when I do that. If I would do it with a PT, I would say, “It is a standard for a PT, in my opinion, to give you at least four weeks’ notice.”

That should be policy, I believe. When I sign on their employment agreement that there's going to be at least 30 days’ notice for severing the contract or the agreement.

I don’t think they would need more than two. It goes back to this willing employee thing. If they are a good person, you trust them and you don't feel they are going to bad mouth you, call you names, or pull people with you, there is nothing objective there. There is no statistic of, “When you are leaving,” they are leaving but here's the thing. As an Owner-Manager, you have to know that if you keep them on, you cannot be surprised by what you get. Let me just say that.

Be willing to experience the situation, even if they are a good guy or gal. You have no other PT hired. You didn't create your bench of potential recruits. “I’ve got to keep them on.” I would say get rid of them. The general rule is to let them go and say, “At the end of this week or today, I would like to. Thank you.” That’s it. If you keep them on because you need them, they have to write up their job duties first or something else, or they were in the middle of all these notes like, “I finished their notes or whatever,” then don't be surprised that you might get somebody who is on social media, Facebook or texting your people that, “This didn't work out. See you then.” I have seen that happen, too.

All you can do if you think that might happen in that final interview is be upfront about it and go, “I'm going to agree. I’ve got your resignation letter. Thank you very much. I'm sorry. Can we salvage this if we want to or not?” “No, we can't.” “I’ve got four weeks. Thank you for giving me four weeks.” Acknowledge them for that and then, “I need you to do me a favor, John, Jack or Cindy.”

PTO 158 | Let Go Of Someone
Let Go Of Someone: You'll feel better when you get rid of dead weight, unwilling staff.


If you are going to keep them on, you have decided that. When someone is leaving, they can get a little funky because they are leaving. They don't want to be here for whatever reason or moving away for good intentions but it's not working out. I would say these things. You might not see it if you are the one leaving and moving on to a different game but others will ask, “What's going on? Why are you leaving?” the patients, too.

“You have been backing me up for years in this role in whatever, I would appreciate that you do not engage in any communication with any staff at all about your department. This is between me and you, and the Manager. When we hire a therapist, I want you to train them on to the role and train them up a little bit. I want you to introduce your patients to the new therapist, please, out of courtesy but I'm asking you, please don't share this with anybody else. I won't hear a bland nose.” That's it. If I hear about anyone else finding out about this, we are going to talk.” It's more of a casual, “Help me out.” If you decided they are willing, trusted, good, and will stay, that type of conversation is a must.

Even if they were saying moving to another state or something like that, would you ask them not to bring that up?

I would. When I leave a place and when I have resigned from a job, nobody will know. Maybe a day prior. I will give 6 to 8 weeks, even 3 months. That's a different level and things. The staff doesn't know anything because I'm not acting any different. I'm not going to assume they know anything. It's business. We’ve got things to get done. Maybe a day before, “Tomorrow won't be coming in. It's all good. We are doing this.”

I would say, “Go two directions with it.” I would say yes even if they are moving away. This establishes the area, no matter how they say it. They are an established person or a pillar that was there for block time. They are known for that job and those procedures. That smile in the morning, handshake and now they are gone. They are going, “You are going. Why are we losing staff?”

I would ask the person to zip it as long as they can. If their wife works there, their best friend or husband, it might leak, I get that but I would have a conversation every week with the person like, “Are we still good.” Meanwhile, recruitment and move your butt on that side but as a general rule, I keep very few people when they resign more than a week max.

People usually keep those people on because they haven't found the next person or out of fear that they might lose some productivity. If that person is not culturally aligned, not establishing values, and they are not productive in the first place, just let them go and deal with the pain of it for a little bit until you find someone amazing.

In Arizona, I had someone who he was just dealing with for a while and productivity was mad, and then he complained about things every so often. Some patients loved him but his number overall wasn’t the best. When that person was finally held accountable, he didn't like it and put in his resignation, which was a good thing but the client was scared. He has two new physical therapists on board that are amazing and he's like, “I don't know why I dealt with that person for as long as I did. We are going to move in a great direction now that I've got these other great therapists.”

There are better people out there. There are A-players, you can find and it takes some time. Don't be afraid to let them go. When the resignation does come across your desk, be okay with it. I don't want to say there’s plenty of fish in the sea because everyone is looking for a physical therapist now. There are better players out there and people that will work out much better for your clinic, and you will be a happier owner if you've got people who are truly aligned with you.

Part ways as clean and simple as possible. Click To Tweet

You are building a team. Again, it's a partnership and a team, not just employees. That is the illegal word for them or staff. At the same time, if the viewpoint is a bit more along the lines of they are partner, not my friend but they are my partner in crime, we are building this together and we are a team, that takes some of that separation out of the game of like, “Boss and Jr.”

I dealt with somebody and they had to let somebody go. She was an amazing therapist. She had a unique skillset but as you said, she did not align with the purposes, the goals of the group and was snarky. Some patients loved her and some didn't. She had to look at that and go, “Play loser. What happens?” The answer was you’ve got to go treat a little more than you want to. You get some PRN person for a few for as long as you like. In that case, they were gone a little more sanity above the clouds. You will be surprised when you get rid of some of that truly dead weight unwilling staff and you go, “Why do I feel better?”

It's very common that when you let some of those dead weight go, numbers tend to go up all of a sudden, productivity improves and you are like, “I have never seen numbers like this before. Nothing is different. My marketing hasn't increased but all of a sudden, numbers get better.” It happens so often. We covered a ton of stuff and you shared a ton of time with me. I appreciate that. One thing that we didn't cover and I alluded to it earlier, is the importance of an exit interview. Can you talk to me a little bit about the importance of an exit interview? What that should entail? What does a leader trying to get out of that exit interview?

I have some documents in place, checklists, and so on, as I mentioned. Let's say you exit. They are definitely going to go now if that's the viewpoint you want to get.

It's more than likely amicable. “We have agreed that this is your last day,” or maybe letting them go, you have prepped them enough and held them accountable enough where you say, “This is your last day.” They say, “I understand.” You could maybe go into, “Can I ask you a few questions if you don't mind?” Is that one way to lead into it or how do you lead into that?

It would depend a little bit on when we last spoke about any infractions or problems. Has it been a year since then? It's a bit of a surprise, as you said. Has it been three months back? “I looked at you, you are yesterday funny because you did something.” There's a little dependency on timeframe here. Mindset is care. Why do you want to get out of it? You want the person to understand that it would just be not a match for whatever reason. If they are moving away, that was a non-match, either way, we don't match. We are doing PT and in purposes, you are not living here, you don't agree with this and whatever.

If there's no agreement on basic purposes and values, then that's it. I would communicate it like that. How would you open the conversation if it's a request to leave? “I heard you are resigning. I’ve got your letter. Thank you.” Acknowledge them. If it's more of, “You've got to go now,” then say, “I want to talk to you about a few things.” If you are asked, if they are aware, and they will go, “Am I being fired? Am I being let go?” “I want to talk to you about something.” I would not answer that question. Let me say this as an asterisk.

If it's someone that it's going to be a bit of a fight and a bit of a verbal, you don't know how it's going to go but you need to go and they say that I have done this, “Am I being let go?” “Should you be? Should I let you go?” What does that do? It throws it back. “Maybe yes. What did I do?” If it's a salty individual, I have given them like, “You tell me what's going on, Jack? What have you been doing?” They will pause a little bit. You didn’t say anything you shouldn't say. “Tell me what's happening?” Let them originate, “I took that pen. I'm sorry for that,” or whatever.

Ideally, you want them to acknowledge and agree with what you say. You want to be able to say, “I want to talk to you about something. Since this, why it happened, stats, we have had talks that it’s not working out within reason? What do you say about that?” “You are right. Stats are down but it's Rebecca's fault.” “You are the manager of the area, you are the lead therapist or that's your patient. I'm sorry about this but we have to part ways here.” You would like them to understand.

PTO 158 | Let Go Of Someone
Let Go Of Someone: If there's no agreement on primary purposes and values, then that's the end.


It’s always the great first approach like, “It’s not working out. We don't match up here. Sorry.” 9 out of 10 times, 8 out of 10 times more than that has to happen because that's just not enough. They are assaulting individuals or you didn’t care for them more. It can go both ways. These things occurred. “I have reports, emails, stats, checklist, and all that is my ready to go, so what are you telling me?” “Today is your last day. We are going to pay you for the rest of the day today and I will give you money or not.” That's it. Have it role played, have your head straight how it could go. Run it how it could go, not how it's going to go because you have no idea.

In HR, the rule is you have no idea what’s that distinction. If they are having a bad day, you are getting that bad day. I would drill it two ways, completely the worst firing ever and that was easy because you will say one of those things afterward. That was horrible. That was nothing. I would always role play it both ways and communicate it's just not a match. “We are not matching up on some things. The statistics I gave you are not matching. A lot of that not matchy, and then we are going to part ways here.” That can be as clean and simple as it is but you can get heavier handed, a little more, “Will you tell me what's going on if you need to?” You have to be ready for that and skilled a little bit.

If a parting of ways goes relatively well, it's professional, there's an agreed-upon date, you trusted that person for some time, then moving on to something else, and you understand whatever, I like to have conversations with them not just, “It's your last day and you are packing up your things. You’re here. Cut the cake. See you.” I would like to have what we call an exit survey or exit interview to say, “What went well in our relationship here at the clinic? What recommendations would you have for us to change to do better? What are parts of the company do you think we can improve on? How did you feel about your training? Do you think you have trained appropriately?”

I don't want it to be a bitch session or a lot of griping but you are looking for ways you can constructively grow from the relationship and their parting of ways. Not every firing or resignation is set up to allow you to do that but if you are not looking for that opportunity, you are losing out on that opportunity to get proper feedback and criticism. Some of it could be emotionally charged and you might just forget about that stuff but you could come away with some nuggets for improvement.

I love that idea and I didn't answer that point for you. What I have done differently but that aligned with that exact thing is, when a policy I implement when I'm in a company is that employee reviews or evaluations happen every year or six months number one, as a standard by that manager, and as needed in other words but it's the same basic format.

At the front end on their three-month probation and employees will do both ways, it will be, “I didn't like it. Training has not been good. I'm worried about my job or whatever.” There's your version and their version. On the standard normal evals or reviews, there's more of a generic format we talked about a little bit.

On the exit end, I use the same document. Also, if you have 3 or 4 of those in the file, it's not a mystery. You already heard that it has been going bad, I'm not happy and they have heard that. I love the idea of having an evaluation at the end, of course, but it's going to be skewed for sure. Maybe not every time. Let's say most of the time, it will be skewed. I have no problem with that idea, I love it, especially if you have no system prior. Ideally, it's happening so often that you didn't miss it.

I love your point there that even if you did have the survey at the end, nothing they bring up should be a surprise because you have given them the opportunity to express their concerns all along the way and you have them properly documented, noted and you have made changes to correct those issues along the way. I love your point in that regard. Anything else you want to share about how to successfully let go of somebody? We covered a ton of stuff.

I started up with and I said a couple of times here that these are your team members and prepare for both sides of it, the ugly and the good. Consult an attorney where it might get sticky. You should certainly do that to seek for documents to sign and certain legal points like that. As you said a couple of times, Nathan, as an Owner yourself, our practices and you are not just a PT or a doctor, you are a business owner, it doesn't have to be something like Jekyll and Hyde here. It's not like, “I have to run a business and be a mean guy but I'm your friend.”

When you discipline your team, it's just a matter of changing your tone a little bit. Click To Tweet

You can be the same person.

If you operate standardly and professionally as an Owner with respect for your team, care for your team, and are never too friendly, then when you have to let them go or even discipline them, it's a matter of changing your tone little bit. You don't have to get heated or crazy and go, “What happened yesterday?” “I'm sorry.” That's the reaction you want. If you are a standardly professional, respectful person that cares for their team and they see that, have the systems in place, it will be a lot easier on the back end because it's like, “Sorry, it's not working out. We had a good run.” It's a little bit more like that and a little bit less like, “Sorry.”

I love a lot of the conversations that we have had so we can make that conversation and make that process less emotionally charged. The more you can look at it, you can scrutinize the person and their performance based on what's in the best interest of the business, then it's easy to come up with statistics, incidents, you name it in which they have valued malalignment that you can appropriately let them go without it being emotionally charged. If you can hold them accountable throughout their time with you appropriately, then a firing can be a very easy and simple process.

A lot of times, it's not because we are not the best in the documentation and that kind of thing but the invitation is to start documenting and hold one-on-one meetings where it's appropriate and accountable. If you see someone going the wrong way, love them enough to say, “You are going the wrong way and it needs to get corrected.” Also, recognize that you are not necessarily the best place to work, there might be a better fit for them somewhere else, and you need to help them find that better place.

I can't tell you how many people I have let go. They didn't come back and say, “That was the best thing you did for me. After you let me go, I decide I want to go back to nursing school. I want to do these other things. If that hadn't happened, I wouldn't have changed direction in my life.” Recognize that you are not the end-all-be-all. You are not the final resting place for all employees. You are more than likely 90%-plus of the time a stepping stone to their next place and help them along the path. If people wanted to ask you about HR-related issues, you doing some consulting, how do they get in touch with you?

I have a website if you want to check that out. There are some little tips and media there. My phone number is fine. It is (917) 312-4294. I don't mind a quick text or call, and then

Thanks again for your time, James. I appreciate it.

Anytime and we will do it again whenever you need me.

Thank you.

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About James Savas

PTO 158 | Let Go Of SomeoneI love working with ambitious, driven individuals who have dreams of going big(ger) and just need the right support, backup and capacity to see it accomplished. I help them get that done.

The majority of my professional career has been in the Medical sector with the majority of that time in the Human Capital Management/Recruiting and Business Coaching/Development spaces. Over 20 years I've strategically planned and executed programs and projects for my partner-businesses' expansion from as few as 4 offices to up to 16 offices across 3 states. In my time working directly with various Owners and their staff throughout the boroughs of NYC and down the Rocky Mountains, I've hired well over 500 effective and productive Owners, Executives, Managers and Professionals, as well as created the training regimens for those people and their staff.

In addition to my savviness and acumen as a business expansion professional, I'm a successful soccer director and coach and a very very proud father of 3 amazing beings.

My Mantra is - Keep the create in life and be surprised by nothing!

Additional Points of Interest (some outside PT and some for fun):
* Published article in Impact PPSAPTA magazine (2008) "Hiring & Retention"
* Nationally Licensed Soccer Coach
* Director of Development of several Soccer clubs/groups
* Certified Assistant Teacher
* Co-owner (former) of a small family-owned retail dessert business
* International traveller (school in Italy & worked short-term in Ireland)
* Avid survivalist/camper/outdoorsman
* Humanitarian (as I'm able), directly assisted during 9-11 @ ground zero NYC
* Interned w/ MSNBC out of college (Broadcasting Major)
* Was a celeb-host at the 1996 Grammy's and 1997 ESPN Awards (some good stories not for air)
* Was on HGTV (with my family) in episode of a Montana HouseHunters
* Music composer/Short Story writer (Sci-Fi)
* Best hat I wear - DAD; pays shitty but great rewards!

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