Everyone needs a PT! After all, what is your practice without one? Unfortunately, the current pandemic has made it extra hard to find the right PT. So in this episode, four experts gather together to discuss what PT owners need to do to hire their next PT (when everyone else needs one, too). Nathan Shields is with James Savas of HR Professional, Brian Weidner of Career Tree Network, and Will Humphreys from In The Black Billing & Collections. They take the time to instruct what owners need to say, where they need to be, and how they need to present themselves to snag the next rock star PT. Tune into this episode to learn different strategies that you could implement in your hiring process.
We're doing something completely different. Thanks to my friend, James Savas, for recommending it. We're doing a roundtable. If you are a PT owner anywhere across the country and Canada, more than likely, you need a physical therapist. Inevitably, as I ask people, “Who needs a physical therapist?” Everyone raised their hands. I've asked the question even on the Facebook group but thanks to the wisdom of James. He recommended, “Maybe we do a round table of some PT recruiting experts and talk about what it takes to get a physical therapist nowadays. How do we stand out? Why are we in this situation?”
I've got a number of pre-scripted questions that I'll ask you. First, I want to say thank you, James, Brian and Will for joining us. I've got James, who was an HR professional, deputy CEO at HandsOn Diagnostics. He has a ton of HR experience, including recruiting. Brian Weidner, Founder and CEO of Career Tree Network who solely does mostly PT recruiting and then Will Humphreys recruiter extraordinary Cofounder and CEO of In The Black. He has a ton of experience in recruiting successfully as well. Thank you guys for joining me.
Unless the audience wants to learn more about you, I'm going to forego the typical introductions like who you are, where you come from, why you're so important and then why you're such an amazing recruiter and get straight into the questions. Let's start getting into some things. The first question I want to ask you and I'll start with you, Brian, because you are doing this full-time. Why are we in this state of everyone needing a physical therapist? It didn't seem needy years ago, maybe I'm mistaken but it seems like there's just a huge demand for physical therapists. Why do you think that is?
On some level, PTs have always been in high demand but historically, you can post a job online and then get some responses. The demand wasn't really as apparent but a lot of clinics are posting their job on Indeed and they're not seeing any candidates responding. I think my own personal theory is a lot of people, in the midst of COVID, they decided to retire early. We had a lot of people that were like, “This is a good time for me to do an early retirement.”
Also during COVID, we went through something together, where a lot of people came out on the other side and they're like, “Maybe I don't want to do this anymore. Maybe I want to go somewhere else. Maybe my employer didn't treat me very well when they had to furlough me during the COVID situations so I’m reevaluating what I want to do.” We see in the news the Great Resignation and people leaving their jobs. “Where are they going?” is the question but I don't think they're all going back to full-time. A lot of people are re-evaluating what they're doing and deciding all over again, “Why am I working? What am I hoping to gain from being employed as a PT?”
Do you have anything to add to that, Will or James? What do you guys think?
A lot of it is the psychology of it. We went through what we all went through in the last few years. This is across the nation in different areas. Many PTs happen to be in rural areas but they were from other cities, went to a new location. They were recruited years ago with this expectation. That's going to go great. COVID happened. They probably frankly, got a little bit nervous, wanting to be back in their home. The job became less important.
The family was more important. I have two friends that were their reason for moving back to New York when they were out in Southern California and Oregon because they wanted to be near family and the psychology of the situation we all went through is a big part of it. That's one thing I can add-in. When you're knocked down hard and we all were to some degree, we walked through our version of that, it takes a lot to get back up and get back to normal. It's a funny word the new normal that's raised.Physical therapists have always been in high demand. Click To Tweet
When you were upset with what was going on, you had some personal issues, you want to get back in your home, you didn't want to work. I have three other friends that stopped being PTs. One became a nurse. It was a shift in what they wanted to do like, “Forget it. Because of COVID, I didn't want to deal with the patients.” I don't have the exact reasoning but they shifted a profession to some degree. That's my little version of that.
Do you want to add anything to that, Will?
I love all that they've said and I agree with it. As we look at the facts of the physical therapy industry economy of supply and demand for therapists, it was already deficient. People were struggling, most PTs prior to COVID absolutely said their biggest barrier to growth was finding and retaining talented physical therapists. When the outpouring occurred, it was a good thing for owners for a little while because it flooded.
I remember coaching companies during that timeframe. They were getting rid of relationships that were no longer as aligned. I'm not saying good or bad employees because that's not what it's about. They were finding these individuals that they've struggled with and either they weren't the leader, they needed to be to handle it or the therapist wasn't a good fit and either way they didn't know how to deal with it.
When COVID caused this shrinking across our industry, it was already a hiring deficit, it flooded our industry. For a six-month period, people were letting go of people and seeing their numbers rise, culture was improving but now we're in that stage where there's this huge vacuum. We're trying to get all the PTs back in because people are returning to their normal production. We're not there yet.
As PTs for all the reasons that Brian and James just mentioned, in addition to the fact that when PTs are finding their jobs, they're way less likely to move because maybe they were laid off or they saw someone laid off. There's a lot less movement within the fewer numbers to be physical therapists who are willing to move off that remaining group and it's smaller.
We can't negate the last thing, which is our industry. According to the forecast for physical therapy, we have the highest growth rate and one of the highest in any industry. We have the highest growth rate of any other profession in healthcare. There's all this that's that gap that ravines between supply and demand. It was already going too wide then COVID came in, created this back at home. In the psychology of it, in addition to this overly skewed perspective of who's available.
To piggyback off of this question and your answers, as you're working with some of these physical therapists yourself, Will and helping some of the companies hire physical therapists, what's the difference between what PTs are looking for versus years ago? Is there a difference? Are they looking for something different in their job?
Their subjective reports might indicate but truly, in my opinion, I don't think it is different. We can't suppose that they're not looking for more stability given this climate of change and they might be a little bit pickier like James and Brian were talking about in terms of how they were treated versus how they want to be treated. It all boils down to the same thing that we all want. We want to work at a place that we love, seen, heard and appreciated.
For companies that are successful now, the ones who are able to recruit, there's very few of them but I coach with some of them who were finding their voice in the sea of PT companies that are wanting to recruit, those are the ones who have a clearly defined purpose, vision and values. Those are the ones who, when they finally get the interview, make it so much easier for that PT to say yes.
What do you say to that, Brian? Are you noticing some of the differences and expectations amongst the people who are looking for jobs? They're not many that are out there looking for jobs but amongst the PT population themselves, are they looking for something different nowadays compared to a few years ago?
What they're looking for is the rewards of joining the team. That's translated often into flexibility. That's one thing that came up but rather than just having that default mentality, it's thinking about, “What is this employer going to give me? Is it a practice setting that is of interest to me? Is the clinic hours conducive to my family life?” It's a lot more selfish in terms of the motivation that the PT has, which I don't think when we hear a selfish, a lot of people get turned off by that. It's the reality of the situation like, “Is this job going to match up with exactly what I want because there are so many jobs out there that I no longer have to settle for something? My child has soccer. I'll miss some of the games.”
Now it's like, “What if I found a job that the clinic closed at 5:30 in the evening? I wouldn't have to work evenings.” In the past, there was more flexibility among PTs in terms of being willing to cover. Now I'm definitely seeing more individualistic, “Making sure that my needs are met again. If they're not, I have multiple options.”
Will spoke to it a little bit already about having a clearly defined purpose, vision and values. What what's one successful action that owners need to do in order to attract some resumes? How do we get them to answer the ads? What is one successful action that you can recommend?
Will’s comment is spot on. Obviously, if the owner knows what his purpose, vision and values are then you sell the PT on that if he's on, he's on with you. That's an awesome point. That's what it's about. I would encourage an owner to not get reasonable on what his needs and wants. I see that a lot because I think it's partially correct and I've seen that people are getting, “I'd rather just be home. I can't work on Saturdays anymore. I have kids.” “You had kids before but now your priority shifted.” In my partner in New York, I've seen that. The one thing is the owner sticking to their guns on what they value and pulling in someone that they want not getting a reasonable or slowing down about what they need to have there.
There's an opportunity there to stick to your guns, uphold your values and still provide some flexibility that maybe you weren't providing in the past like to Brian's point, owners might need to find some flexibility that still lies within their practice and how they do things, values and their purpose. Can their purpose and value still be met in a different scenario and have some flexibility within it? Can they compromise? If I turned it back to you, Will, if I asked the same question, I have a pretty good feeling that you would say the same thing. Let’s say someone does had a clearly defined purpose, vision and values, what's one successful action now that they can take to find, recruit and stand out amongst the others?LinkedIn is your best source for contacting PTs. Click To Tweet
It goes down to lead generation. If you're reading this and all you're doing is you have your Indeed ad, you're not going to get results. If you consider what you had before COVID results, you're not going to even get those results post-COVID. That's why great guys like Brian, I recommend clearly and I get nothing from promoting the other panelists in this. Brian does a fantastic job of creating leads. His company does that.
If you're trying to do that internally, what I tell people is to stop hunting and start gathering. For example, if we have a clearly defined purpose, vision, values, I would say, even people who don't have that clearly defined, most PT owners I work with are good at selling their practice. We don't use the word sell in medical businesses but it's enrolling physical therapists into their companies because they ultimately are passionate and can sell the sizzle and the steak at the same time.
People jump on board with them but what they suck at is that they stink at standing out in this lead generation space. It’s because it's a whole different training, it took me a long time working with professionals out of physical therapy to learn what I've learned and Brian as well. That's what Brian brings to the table. He has physical therapy in his home. Your wife is a physical therapist. He has a recruiting background, plus he gets the industry. If you're trying to do this internally, what I'd say is stop hunting and start gathering.
What does that mean? Hunting is like your Indeed ad. The gathering is going to where your PTs, ideal physical therapist, A-players or already congregating and make yourself known. If it's an online group where you can see where they're gathering, you go into there, make yourself known and answer questions. The thing that people forget is that lead generation and recruiting isn't cyclic effort. It's a daily effort.
I advise my clients to do five hours a week on top of their already insane schedule. That's why you need to hire coaches like Nathan Shields because he'll do a yearly strategic plan with you and help you map out your year and build that in as a priority. At the end of the day, if you had a bench of A-players willing and wanting to join your company at any given moment, we've been able to experience that then all of a sudden, there's time to do whatever else we want. This is a top priority.
If you're reading, you are building time every day. You want to go to these watering holes or these PTs are already gathering. Many of them are online. Many of them are in your student's SIGs or university campuses and you just start reaching out to professionals like the people in this room to find out how you should interact with them in a way that produces results. It's a long answer to a simple question. What's the one thing? If they've got their purpose, vision values, the simple answer is to upgrade their lead generation performance.
I love that you said that you have to take the time to do that because I think the default for physical therapists owners in the past has been that we place the ad and we wait when we need somebody. The next step was to always have an ad out. That's where we got to and we were always recruiting. Now you've got to take another step. You can't just have the ad and leave it out there even if you're not necessarily hiring a PT. You've got to actually start doing some active recruiting and take some of the work on yourself. Brian, what do you want to add to that? What's the one successful action can owners do to start gathering some of these resumes and collecting options?
It’s a mindset shift at a high level. Earlier you said answering ads and that's great. If a person applies for the job, certainly we want to jump on it right away and get back to them. It's more about now with the market, shifting the mindset and being vulnerable and going out and talking to people. Instead of talking generally, it's more about being vulnerable about, “Would you like to come to join our team?” The person hasn't expressed any interest. You're on LinkedIn and you saw their profile, you saw them on Facebook or you met them at a conference. It's more about, “Would you be interested in exploring and joining us?” That's a difficult conversation to have because it involves a lot of rejection.
It involves a lot of the clinic owners giving up their control to do the interview process because to a certain extent we're going out and we're initiating that conversation. Obviously, you still want to screen candidates after they've demonstrated some interest but just getting vulnerable around, “Who do I know or see online that I can maybe reach out to?” Having those conversations.
The challenging part is A)There's a lot of rejection to it. B) The most important shift is the person is not applying for your job. They don't have any interest or knowledge about your practice. They're just out there. They're relatively happy in their current position. They have a profile on LinkedIn. As the clinic owner, you want to go out and identify that talent and contact them proactively. Being open to doing that is huge. That's where you get a lot of good results because most PTs are not actively checking Indeed. They're going home and taking their kids to school. They're going about their day. If you're going to wait to have your job ad delivered to your candidates, that's shortsighted.
I love that you brought up LinkedIn because the cool thing about LinkedIn is that you can find certain physical therapists in your demographic, filter those out and find them. When you do message them on LinkedIn, that could be tied to their email. They're like, “I got a message from LinkedIn. I wonder what this is about.” That goes to what Will's point is that you have to be actively involved and engaged in this. What more do you want to add to something like that? James, any thoughts come to mind?
One tool. Will spot them with having to expand it, how you're finding people and where you're looking for people. I have to this day, a lot of success with is I will milk my current staff for prospects that. For a year, I ran a little program for myself just to challenge myself. I put no ads out on Indeed or back then, Monster.com. I said, “Let's stop it.” It’s a heavy promotion internally like a weekly email from the boss, “What's going on? Who do you know? Give me a name.”
In staff meetings, “We're opening up this new clinic. We need somebody. Who do you know?” 9 out of 10 times, there's a guy or girl on your list, on your Facebook page and your phone that you went to school with that's in one of your groups. You're not thinking about them as a candidate. I would always get, “They're already working.” “See if they want something else.” When I ran that, I had about an 85% retention rate on the people that came in that way, far above the retention rate from any other method of recruiting. Milking the heck out of your other owners, co-owners, buddies, that competitors, if you have a good rapport, if they let somebody go, it doesn't mean that game is off. Maybe they're the perfect fit for you. I would look at all these little cracks and crevices, especially with the good staff.
Where are some of those watering holes that you've either seen some success or recommend people go to?
LinkedIn is a big one. This is my personal opinion for what it's worth. I have found with my clients helping them find PTs had a lot more success at the younger PT watering holes. Younger, meaning, in the stage of career, not actual physical age. When people are first coming out of school or have been out for a couple of years, especially if they are younger, they're in a little bit more transition period of life.
They don't have their kids in school and have grandparents nearby. There's no world where those people are going to leave unless it's something more severe versus someone who's no kids and all these different things. That could just be my opinion but what I have happened most successes personally in coaching is where those younger watering holes are.
LinkedIn is more where they live. There are also some Facebook groups that are really big. You can search for those. The number one watering hole is always the university system. That is where, in our experience, we were able to build that bench. When it became empowered physical therapy and I was over those 26 locations and responsible for hiring all the PTs, the reason we never had an open position for long was that I owned a relationship with each of the universities in a way that's different.
You might be taking students from a local university. You might even be attending the job fairs but how much do they see you as the guru of business? There's so much that they're afraid of in that stage of life. They're the most passionate. They're driven by this desire to become a physical therapist. They're paying money to become it.
They're really looking for these value adds. What we used to do was to create a relationship where we speak regularly on a semi-annual basis. I still do it even though I'm not necessarily hiring specifically but we go speak at these things as the physical therapist in private practice, who's going to train you on how to find your ideal dream job. You get in touch in relationships with these class presidents. Once that happens, you get into a cycle, it's a momentum that starts pushing you forward. It gets to a place where they start asking you to speak at the student conclaves and enclaves.
One of my calls to action was that after I would speak about helping you find your dream job, I'd say, “I'm happy to do a free job interview for all of you who want to get some practice of doing your job interviews whether or not you want to work for me or not.” What I'm going to do is we're going to do a 20-minute interview and a 10-minute feedback session. What I learned over time was that the best results yielded with the first-year students because no one's marketing to those guys or girls. They have years before they can even have a license. If you're a typical PT owner, you're too desperate to want, pay attention to them.As an entrepreneur, you have to know how you are hiring people and where you are looking for them. You have to address what needs to be changed in your hiring process. Click To Tweet
Getting in good with those universities early puts you in a position where they know, like and trust you so that when they graduate, this guy will, for example, has been with him since day one. They have so much depth before they even start looking. Guess who goes sets up the rotation at your company? Guess who is telling your friends and family, their friends at the university level, “I'm already meeting and getting help from this individual at this company.” The biggest watering hole is the universities and there are one million different ways to cut that pie. Without a doubt, if PTs would start started treating universities like they treat their patients, seeing their needs, wants, fears and addressing them no matter what that looks like, they would have a bunch of A-players, definitely because no one else is doing it.
How would you address that question there, Brian? Where should some of the PT owners be looking that they're not looking now? There's Indeed. You can get on LinkedIn, they have some good ad programs and you can message people. What else may be stands out to you nowadays?
We have a lot of luck with LinkedIn. There are a few different options that are free as well as the paid version. You could even send requests to get connected to PTs so even if you just have a free profile out there, you can still do some networking like that. We look at it the 80/20 Rule in terms of where are you going to invest your time.
LinkedIn is your best source for contacting PTs because you can view their profile. You can see, “This is outpatient.” PT versus someone that's in a skilled nursing or home health. To Will's point as well, he's right about PTs that are younger in their careers that are going to be more open, more flexible, more willing to explore because when we look at proactive recruitment, there are two different phases to it.
The first phase is, “Are you even open to considering a new position? Regardless of what might be out there, are you even open to talking?” Once the person is open to talk then, “We have this particular opportunity at our practice. I'd love to share details with you. Are you open to chatting with me about it?” You have to have that two-tiered approach. It requires a little bit of drip marketing where you're not just sending out the job ad. You're going back and forth and having those communications that dialogue with the person.
I'm glad that you brought that up because I fear that as we're telling people maybe they should spend some more time on LinkedIn. Maybe they should look for the social media, Facebook pages where physical therapists live on the social media space. They're simply gonna post an ad, “We're looking for great physical therapists,” and think that their job is done. That's where they're going to stub their toes.
If you're getting the crux of it, what Will and Brian are talking about is start developing relationships. Is this what it sounds like? Don't start with, “I'm hiring. Do you want to join?” No. It's more like, “I want to get to know the physical therapists around me.” Try to develop a relationship from there and see if they respond and start developing it. I don't want to put words in your mouth but it sounds like that's what you're talking about. Start developing some relationships.
That's where recruitment happens because this person is not applying for your job. They are not interested. They did not come to you. They're just sitting there and you're contacting them. We can't contact someone who's a cold lead and expect them to jump up and down and come forward. We have to go back and forth, build that relationship and understand what's driving them, what's maybe uncomfortable or unsatisfying about their current position.
That's where it becomes a challenge is because it's very time-consuming but on the flip side, it makes sense because you are interested in that individual person. From the PTs' point of view, feel honored like, “This practice owner contacted me about their job. I don't have to go onto their website. I don't have to enter the address of my high school into their online application.
I can just reply to the text message or the message. That's powerful that the clinic owner would identify me as a possible candidate for their company.” In order to do that, you have to be willing to have those individual conversations. Most practice owners are going to go onto the student Facebook group that has 50,000 members on it and try and post a job ad.
James, as you're knowing some of this, maybe go to some social media groups and whatnot, how does an owner stand out from the crowd? Maybe part of it is developing relationships but what can you recommend maybe in a message or how we go about doing this that's going to make us stand out from the other owners out there?
One thing I'm just going to say prior to that is we're not assuming anything her but there is a lot of work that has to be done. They have to do the work. To build a relationship, that's work. You can't be treated 60 hours a week and build relationships too easily. You're not going to do it. I think everyone knows this but it's good to reiterate it is you have to build in the administrative time, recruitment time or get yourself an admin, lead PT or even use a technician.
Hire a recruiter.
From my side of getting the internal workings, you could definitely just have somebody do it. They're not going to do everything for you but they can post certain things online, send your resumes, respond in your name, work on LinkedIn and be the owner on LinkedIn. You have to make the time rapport.
To go to the point, how do they stand out then in those situations?
I find those salesy messages don't go well because PTs don't like sales. I don't know one physical therapist that likes to sell, even though they have a plan of care to sell, we won't talk about that and I understand that. It can almost cheapen the care. I would not have it be a salesy piece like Will would certainly say, “I would push the values of your practice. What they're going to get from being part of this amazing team?” I would make sure that any employer review sites have amazing reviews by your staff. That's key because I had people literally tell me, when I called them, “Why didn’t you show up?” “I saw the reviews.”
It was having one bad review or something. The backbone of it is in not a very salesy piece, pushing values and integrity of your clinic and the benefits to them not just financially but more ethical, value benefits. Maybe some of that time off stuff that maybe you're a little bit more lenient on time with kids is okay, end early some days a week or flexibility. Those words are fun. People like those words these days. I would make sure that the review is also positive. That has to be a backbone there too.
It would be very shortsighted of owners to think that if these people are interested in us at all, that they're just going to focus on our relationship and not google us. They're going to Google and see what our webpage says. Maybe our purpose and values are listed there, good reviews or we're getting five-star reviews, not from patients but maybe from employees as well. It's important to have some of that backbone structure to back you up for sure. What would you say to this? How is someone going to stand out? I know you're talking to PTs, as well as PT owners. What's the most common thing a PT is looking for that's been out of school between 1 to 5 years?
It was a hard shift for me when you asked that question because I'm so used to like, “What are people looking for coming out of school?” It's always mentorship, number one.
We put that above some student loan repayment.
If you remember being a PT coming out of school, the biggest fear is that you have imposter syndrome. You've got three years of education. You come out and they give you patients. There's no layer difference between you and the PT who has been out twenty years who has an amazing hand. You feel like you're faking it but you aren’t.
A strong mentorship program scratches that concern that itch of like, “You're going to be okay. You have somebody to go to for questions.” They'll take that above the student loan but student loan is number two. That's number one for people out a year. People within seven months coming out of school think they stopped.If we stay fixated on that feeling of invalidation that occurs when people leave us, then we're missing out on what's possible. Click To Tweet
“I just need mentorship. Education is all I care about.” Six months in, it's like, “Where's my raise? I'm doing fine.” They don't care much. They don't even want to do the program. We used to give raises and we have one but the things we did to attract new grads was we gave unlimited connect, “We’ll pay whatever you want. Go into courses.” They never went because they don't really care as much as they think that you're coming out of school.
It's not that they don't here but this passion to be certified in seven different things isn't what happens. The number one thing for any PT after that hands down is student loans. That's a complicated thing because it's easy to say, “You just need to put a student loan program together but it's part of the whole package of how much are they making relative to how much they're seeing.
Thanks to these school systems and that sarcasm, this new generation coming up are so hyper worried that they're going to abuse the system and be taken advantage of if they see more than one patient per hour. It's not every school. It's not every student but I've been in a lot of these discussions. I read all that goes into those student Facebook groups. It's like this constant flow of like, “They're making me do this,” then there are people who are taking advantage of that online.
We're saying, “Don't let these employers take advantage of it. You're worth six figures. Have you run a PT business with crappy margins? Not yet. Have you seen that?” I can find you to work anywhere else where they're not going to have a better balance of these things but these students are coming in. When we talk about student loans, that's the sizzle but that's not the steak.
“We sell sizzle, not the steak.” We sell them on that but what they really want is to feel balanced, seen and heard. It's okay that your visit expectation per week is more than one visit per hour. You can create that and teach them. It's awesome to be more productive because production is the basis of morale. I'm not talking about being a mill, it's not what I'm saying but there's a balance there that when you get the loan repayment piece there and develop this culture of having fun and being productive at changing patients' lives, they’ll never go anywhere else. They're going to answer you like you guys were saying beautifully, James and Brian. They're not going to want to jump into marriage from an app, on social media but they aren't going to click.
If your ad has something to do with like, “Are you sick of the weight of student loans on your shoulders? We've got a solution that I'd love to share with you. Click.” Maybe you give them something that has nothing to do with your company about coming over. Maybe it's something like MacDonald's book stress-free or debt-free PT. You link them to stuff then they remember you. They go, “James was that guy that showed me that connection.” You remember it's the five touch rule. Touch numbers 4 and 5, you reached out then it's like, “You seem pretty awesome. I want to work with you.”
If we compare recruiting to dating, which I do too much, even to the points where it gets inappropriate, I get to the point where it's like, “We all want to be desired. Too soon? Scary.” First, ad, “I want you.” “What the crap? We just met. By the fifth time that we've been in the same communication cycle together, I feel and like you. I look up to you because you've been this leader,” then you go, “You are perfect for us. I've got to talk to you. I know you're probably happy where you are. Can we talk?” That's when we can take advantage of what our competitors aren't doing because they're too busy.
Brian, would you say that the people that are on the move, PTs that might be looking, are they the younger ones that are in this just out of school and onto five years in? Are you willing and open to that?
As you get more experienced in your career as a PT, I found that you're landing your next job based on someone that you met at a conference or someone that you know from the community. We see more experienced PTs finding their jobs more organically through connections. They're not online. Their friend owns a clinic. They decided to come and work for them. I think you get beyond fifteen years of experience and there are very few PTs that are on the open job market with more than fifteen years of experience. Most PTs that are on the open job market have like fourteen or less.
You're going to want to focus your message then on the younger crowd.
Most of our clients as well, when they're looking for a PT, I've never had a clinic owner say, “I want someone that has fifteen years of experience.” It never happens. Most clinic owners say, “I want someone that has 2 to 5 years of experience.” I've never had a clinic owner say that they want some to look more than five years of experience. Most PTs out there have more than five years of experience. It's a strange scenario. When a clinic is looking for jobs and just the market of people searching, it is more of a younger crowd in terms of a newer therapist.
You could tailor your approach to someone that's open. People that are younger in their career tend to be more open and flexible. They don't have their routine figured out. They haven't found their super long-term employer yet. We do see a lot of people that change jobs as well during that 1st and 3rd of their career.
It's important to note that even if you're open to having someone who is more experienced, 5, 10 or 15 years, the important thing is to have a dedicated avatar and a certain demographic so that you can tailor your messaging. We always know that as we're directing our messaging to a certain group, we're going to be more successful number one with that group but we're also going to inspire and treat other people outside of that circle. Even though we're targeting our message to a certain demographic, I think it's important to note that there's strength in that.
Anytime that we're focused on the logistics of the job, that's always my recommendation to our clients is to think about what are the logistics of the job in terms of the work schedule, hours, clinic location. I encourage my clients to focus on those elements. Those are evergreen, regardless of your experience level. Those logistics of the position are always appropriate. I personally don't like to see ads that are saying, “Do you want to work hard and be rewarded? Do you want to join a fast-paced clinic?”
I feel like most PTs want to make it to their kid's soccer game on time. They're not necessarily concerned about being a rock star for someone else. They're working to enjoy the rewards of that employment. They don't want to join your team. They don't want to work for you. They want to work to enjoy the rewards that working for you will provide. It's not that they want to just work for you. They're working for you to enjoy those rewards that they'll receive.
Patrick was mentioning that I was encouraging him to speed up the process because we were losing candidates from a time perspective. I was just encouraging him to keep the process as tight as he possibly can and then extend the job offer as soon as you feel comfortable that you have a candidate worth hiring.
This is something that we'll talk about in our symposium, that speed is vital. You can't keep someone on the line for a few days and not respond to their email texts or whatever message. Within the day, you got to be responding and faster if possible.
I'll read Emil’s here. I’m going to paraphrase, “You have a great interview. The person matches your values and matches the personality you want. The skills are right there, the golden child. He slips and says, ‘By the way, I'm going to be moving out of state in a year.’ What do you do with that?” I worked for a very successful PT up North. I wasn't impressed that he wouldn't look for people that didn't want to own their own practice or didn't want to be the boss. He looks for some people who want to own their own practice. That's quite a span because you're like, “He'll compete with me.”
“It's all above board. What are your ambitions? What are your purposes and goals here?” “I'm going to move. I would love to own it. I'm from Kansas. I'd love to one day on my own practice.” “Why don't we bang this out for a year here? Let's check out what we can pull off together then we'll talk about ownership together. Why not? Let's expand in Kansas.” You'd have to do a lot or research and make sure that makes sense and all that.
Conceptually, being willing to look at somebody who has the ambitions to do that thing, he didn't say ownership here but if that was the case then I would play ball. If he's worth it and it matches everything else you want and he just it might move. “If I don't want to own, I'm going to move,” a different story. Maybe there's a contract for a year. You don't give them certain benefits. Maybe CE use or Continuing Ed, cut down or something. If you need the work now, sign them up. Don't waste them. He's a good candidate.
What would you say in that situation? This guy or girl checks all the boxes and then they say, “My significant other is getting transferred in a year. I don't know where I'm going,” or maybe they do. It doesn't matter. What would you say to them? What is your thought?
I'm with James 100%. I would acknowledge the fact that they were clear. I love the clarity. I love the idea of them coming upfront and saying, “This is my situation.” There are other factors that we have to consider like their previous experience. If they're brand new grads and you don't have to mentor them for three months, that may not be worth it if they're leaving at ten.
If they've been out three years, they've been proven in their previous work experience to be able to see a similar volume that you've done before and you check their references and they're willing to talk to you about it, they can show you a pretty clear match then that's a year of relief. What you can always do in those cases is build that out. I love runways like that. That PT to me, I want to hire them now when I read that message because that's a scary thing for them to bring up. If they're like, “I'm going to be leaving in a year out-of-state,” they're running the risk of not being hired by people who are small-minded.
It still has to check those boxes. If those boxes are checked and they're big thinkers, they can hire them and not just give them immediate relief. Now they've got this runway and they can build it with this person. Think about that. They have an opportunity as an owner to be with this physical therapist in a way to where they leave, they've invested in this PR person who's going to go tell them all about the amazing experience they had their one year at your practice. You're going to stay in touch with them on social media and every time you can, you're going to ask them to send you a positive review. It's a pretty awesome opportunity for sure.
I was thinking the same thing, like what a gift if someone shared that with you. I'm going to be here for a year. You could say, “That is great. That gives me a year to find your replacement and allows you the opportunity to train your replacement instead of me.” What an amazing gift that is to an owner, for someone to give them that foresight and say, “I'll use it for a year. We're on the same page. Let's kill it.” Now you can do all these things that Brian and Will are talking about investing in new grads and the colleges that maybe give you some time to do some of that stuff that'll pay off further down the road. It meets an immediate need. You can also plan and give yourself that much more time to find your next great physical therapist.
One more, which is the opposite, Sarah, “I have had several candidates that join our team. They sign up where they commit on paper or verbally. They like us. We like them. They bail on the first three days. In their first week, they're gone. They never show up for their first day. We are bringing on people that indicate that they will mesh with us. They seem right with our values and then any advice?”
Are they physical therapists? I don’t think it’s common that a physical therapist jumped up in days into the job?
It's not common. Most PTs when they make a decision, they're doing it somewhat scientifically and making that decision to the best of their ability. There's no benefit to the PT to join somewhere and then leave right away. There may be an opportunity to do a job shadow or some realistic job preview. It sounds like the PT is showing up and they're seeing something at the practice that doesn't jive with them. Do a job shadow at least for one hour and let the PT know, “Here's what we have. Here's how many patients per hour. Here's the documentation system. Here's the dress code. Here's the bathroom. Take a look at everything.”
Especially coming from the HR side since you were a professional out of it, James, how do you avoid that situation now? What do you do prior to hire so that the person who is joining you isn't like, “This isn't what I signed up for.”
That's been a rare occurrence especially with a PT, with a professional like that but one thing I wanted you to acknowledge what Brian said is something happened if they weren't truly sold and they were unsold obviously and they saw something, heard something, read a review or kicked in the boat on the way out, they saw something happen, the job shadow was killer. One way to keep them there is just to keep them there and something else we've done when that does happen to keep it from happening again is we call and we survey these people.As leaders in our community, your mindset is the only thing you need to fix. Click To Tweet
It's an odd call sometimes, not all the time. Sometimes they're, “Something else came up. I'm moving or another job.” “Let me ask you something. What was the reason you didn't show up or was there anything that occurred while you were here that you thought was odd or turned you off? You seem interested when you came in. Did something change?” I would be very overt and just be like, “What's up? What happened?”
You need that data because how you're going to correct it if you don't know what you're doing. If they just Willy-nilly go and you'd like, “There's the fourth PT you lose like two weeks.” Number one, change who was hiring people then I probably wouldn't do that because something's up, who's in the room with the hiring person or was at the front desk because there's a gap there. I would immediately change the route lines when they come in and send them to me. I don't want anyone talking to them, send them to me then I would debug with the interview why this happened.
Unfortunately, if you're not doing job shadow during the course of the hiring process, I think you're missing the boat and a great opportunity for both sides to assess each other clearly and also not laying out expectations ahead of time. To not bring up what the productivity standards are in your clinic prior to hire and then bring that up with them within the first couple of days after the hire is a big mistake.
They might come into it thinking, “I thought you cared about patients when the meaning of that to me is that I see one patient an hour and now you're telling me that you book on the half-hour. You obviously don't care about patients.” That conversation should have happened well before hiring, down to, “How many patients you see an hour? What are your billing processes? What is your dress code?” All those things shouldn't be happening after the fact. What would you say to that, Will?
You want to say something like leaning with forwarding hands. Sarah, first of all, we feel your pain. We’ve been there and it sucks. That's just the worst. You think you've got it resolved. You've gone through that whole process and then they fail. The other thing I'd want you to know is that it's not always a reflection on you either. This is because these wonderful gentlemen have already said so many powerful things about it. Sometimes because you're doing the right things, they'll do what they do. You have to remember companies like Google that spend more money on their recruiting and retention programs at any other company in the world, they only get it right 60% to 70% of the time. That means you have a turnover rate of 30% to 35% of who they hire, who they think would be a good fit for them.
Especially if you're dealing with non-PT positions and these are more transitional in nature. It is something that's going to happen as part of the game and it can be a blessing. If people come in and they're gone in a week because maybe they oversold themselves or maybe they came in from a place of these people who aren't even showing up on their first day, huge blessing. You can do an average job recruiting. If they are just a show, I don't think that's your fault.
That's a complete integrity issue on that person's end and you can count it as frustrating, thank you and then move on. The only thing I would add is that those early interviews are to train people on how to end the relationship. One of the things I have found to be very successful in my journey is in the second interview, you don't do it on the first one but before they come on, maybe they've done the working interview.
I just have a conversation of like, “We're really excited about it. I'm going to send you a job offer but I want to talk about what it's going to look like when you're not working for us down the road? What I mean by that is my job is to help you find your next job, wherever that is. I hope it's with me but my job is to serve you to grow. That's the ultimate reason we're together. If you're ever in a place where this isn't going to work and in your first week, you might be shocked because as much as we're trying to be transparent, the reality, it might be different. I want you to come to talk to me. There's nothing wrong with being afraid or feeling overwhelmed. I want you to tell me about it and I can promise you that we're going to do the same with you if anything comes up early.”
“That's why we asked for a four-week notice, not a two week because we have a different relationship here at our company. We were going to be so committed to you like normal companies. If it doesn't start working out so things end within two weeks and it's weird. We want to be a part of your next journey. We're going to help you but we just need time to do that and replace you. Let us know early. If you're going to talk to anyone about concerns, it's not any of your other employees because that's not allowed here. You only talk to your direct report or me if they're getting to a place where you're not sure if this is a fit and will absolutely support you.” That language early does help. Even with that, 30% of the time, it's going to happen.
Did Sarah add any more to the question there or was there simply another question that we can address?
She said that, “These PTs, it's crazy. It happened since COVID.” She explained that then she said, “Thank you. It's definitely not a productivity issue. We are very clear about expectations but the job shadowing and growing mentoring are great. Thanks for that.”
One thing that was really successful for us in the past was we did a lot of emails to the licensed physical therapists in the state. We haven't addressed that. Is that something that you would still recommend? Brian, I don't know if you're doing that as well but maybe you guys can chime into doing some drip campaigns to recruit physical therapists?
The emails are great. Some of the states give you the email address. That's always awesome when you get the emails, otherwise, you can do research using WhitePages.com or other online sources to obtain the emails. You could also purchase lists with email addresses on them. It's a little bit tricky because you don't have permission from the PT to email them. There are some considerations or among that, are you spamming them by emailing them about your job? We look at it as like one-to-one communication. When we do emails, we have it all merged in and we're sending them in large groups but the emails are coming across as like one-to-one communication.
We also do a lot of manual research of email addresses as well because we get a lot of work emails. We try and avoid sending to work emails when possible. Otherwise, you can do some texting as well or some calling. You mostly have to research those phone numbers. That can be a great way as well. Typically, we see about half of our candidates that come through the proactive side like email blasts, cold calling, texting but all of that is somewhat challenging to administer but then also once you get the system set up to do the process, you have to be available to answer the texts. Talk to the people on the phone and respond to the emails. That speed is important. It definitely works but there are certainly some considerations around it.
Definitely time-intensive as well. Will, what did you find as you did the email marketing that seemed to be successful, help or did you find much success yourself?
It was a great secondary thing. It wasn't our main channel for finding leads but it was way better than an Indeed ad. What was cool about that process too is that we would send out an email every 3 to 6 weeks because we're already being bombarded with different emails but the 3 to 6-week thing was the rains that we would do. It wasn't always like recruiting base. It would like if we had a holiday party, would take a picture of it and just be like, “RICE Rehab celebrates the end of this year with it's a most amazing team on Earth. We hope you have happy holidays.”
We try to create value in that but every 3rd to 4th email that would go out, it would be like, “My name is Will Humphreys. I hope you're happy where you are. If you're wondering if the grass is greener, give me a call because we have something really special going on over here.” That would generate a handful of leads every time, just a couple of people to talk to. Over time, there were these highs and lows where sometimes it wasn't really generating a lot of leads but I never let it go because that's how we were coached.
There was one time I was talking to somebody who I met for the first time. He was in this remote area of Arizona, nowhere near our company and he's like, “You're from RICE Rehab?” That was me saying the emails. He didn't remember my name. He's like, “That's a company I've always wondered if it'd be cool to work for. What's it like working for them? I don't want to go down to the Phoenix area but I get these emails. I just keep thinking that looks like a cool company.”
I thought, “There's the magic.” Going back to that recruiting, being a relationship development to marriage, that's what it is. There’s a lot of good PR. It is a good way of putting it to where they can start to have a feeling for your brand. They see that logo. It's a powerful tool. That's a secondary. I wouldn't make it the primary focus but if you don't have a lot of time, that might be better than doing any of that.
James, you were the one that instigated or thought of this idea of doing a roundtable. We covered a ton of stuff. What was one thing that you would want to say to this audience now that we're here about recruiting that people need to know or that you would want to share from your experience?
A couple of key points was you have to make time for it. I can say that 35 times a minute because even myself, there are things that I don't get done and I don't make time for it. Especially with these hands-on owners, you have to make time for it, get an external company to do it for you, get somebody in internal with a quick training, hat to do it for you or something does parts of it for you. Let's talk about current events a little bit, physical therapy assistants. You can live with that a few different ways whether the billables and how that's going to affect the PT industry as a whole.
There will likely be a bunch of PT assistants out there looking for work. If you can make that work in your model, depending on your insurance mix and so on, let's be honest, if you need some hourly work, maybe that's not going to handle a PT load. In some cases, that's not true. Some of them can. I've seen that. Anyway, I would keep an eye on PT assistance. Maybe tweak the ad a little bit, give it a shot and see what comes in because things are going to change. That's just a quick little tip.
Make time for things and keep communication. One thing to add to Will and Brian's last point is I make sure to keep in touch with my former applicants. That's not a frequent thing. People don't always do that but applicants that weren't hired some applicants that were hired and didn't make it but I would put them on that email list. I put them on my little, “How's it going? Open house. Come on back. How have you been?” I keep them there because they had an interest. They were a little hotter than the guy who you've never spoken to.
For those people who don't think they have the time, I would encourage you to think about what could another physical therapist do for you as an owner outside of the productivity that they could provide for your clinic? If you look at it further down the road, another physical therapist could possibly allow you to offload your schedule to find more people find better people, generate policy and procedures. Maybe you're scared to hire somebody because you don't know if you'll be able to fill their schedule.
If they offloaded you a little bit but now you have more time for marketing. There are so many opportunities that you can take with that time and bring on another physical therapist. Maybe the idea of marketing and putting more time into recruiting for a physical therapist can take a little bit higher priority on your list of to-dos.
Remember, there's a magic number there in most outpatient orthopedic clinics if you're somewhere between 1,500 to 3,000 square feet, maybe a little bit more but if you can get to that 4 or 5 physical therapists mark, that's pretty productive. There's a magic sweet spot of profit margin that you don't get when you only have 2 or 3 physical therapists on staff.If you know that you're powerful and have something to offer, then you're going to start showing up like that, and people will be more attracted to it. Click To Tweet
If you're looking at growth, expansion and your goal is to get the 4 to 5 physical and maybe that's an incentive to set aside some more time during the week to recruit for physical therapists. James, thanks for instigating it. I want to give Brian and Will the last chance to speak their mind as to any other things physical therapy owners should know about recruiting. Brian, do you want to go first?
James made a lot of great points there. It doesn't have to be you that does the recruiting. Your time is very valuable and limited, obviously. If you have another person on your team that can do some recruitment activity, it'll still work. You're still going out and planting seeds. It's not rocket science. You would delegate that and have the assistant or someone else on your team handle that.
It does need to be something that you're available to do or that person that you delegate to is available for because when those inquiries do come in, we need to jump on them right away, just the other tipper to reinforce. It's that mindset shift that we need to have where we're not seeing PTs that are applying for jobs. There are still PTs that are out there that are willing to look at positions but we need to approach them and be vulnerable, trying to figure out, “If we have what they want.” Logistically, if it makes sense for the person to come and join us, we are having those conversations proactively.
Will, what do you have to say to the audience?
When you asked that, it made me reflect a little bit. I wanted to remind you of those of you who are taking time out of your day to read this and do other things to improve your practice. I want to remind you how wonderful you are. Physical therapy owners are the ones who make it possible for PTs to be with their patients and to change these millions of lives every day across our country. You're taking on an additional burden.
There's some upside potentially around that but there's definitely the downside. I want to remind you of your power, how influential and how important you are because it doesn't always feel rewarding. If we stay fixated on that feeling of invalidation that occurs when people leave us, quit or don't show then we're missing out on what's possible as leaders in our community.
Your mindset is the only thing you need to fix. Apart from everything that we've shared, which is very valuable, I love what Brian said about the mindset. If you know that you're powerful and you have something to offer people, which you do then you're going to start showing up like that and people will start being more attracted to it.
If you catch yourself using words like, “It's hard to recruit in this rural area. Who would want to come work for an owner?” then you're absolutely going to get what you expect. It's important to validate you and recognize how much all of us appreciate you and all the patients who don't even know you, how grateful they must be if they have known your efforts to help them get the care they need.
The only other thing I would say, if you're a PT owner, apart from working with Brian, you got to meet James. He would be more than willing to take a call from you. This guy is amazing. He is one of the best leaders I know. If you want to know where to start in general, start with a strategic plan. Get with Nathan. He would never promote himself that’s why I’m doing it. He's done a strategic plan for clients of mine In The Black that I kid you not that I've heard quotes that it has changed their lives.
It's a one-day strategic plan that gives you focus and it can incorporate recruiting as well as the many other aspects. That's what you and I did for years. That's how we got where we're going. That's where they should start. If they don't know where to start, start with you. From there, you can guide them to other wonderful people.
Thanks for the plug, Will. I appreciate that. Brian, if they wanted to get in touch with you as a recruiter full-time, how do they do that?
Our website is CareerTreeNetwork.com. If you send an inquiry out there, we'll respond right away.
James, you do all things HR-related. If people have more than just recruiting if they have HR issues and questions, how do they reach and get in touch with you?
Email is probably the easiest way,JSavasJ@Gmail.com.
Will, tell us a little bit about how they can get in touch with you and why someone would want to get in touch with you because you're not completely focused on recruiting.
It's part of this bigger master plan that I have to change the world but for now, if you're interested in learning anything that I do, just hit me up on LinkedIn. I've got three different things that I'm doing now that could help any private practitioner. If you want to say hi, hit me up on LinkedIn @WillHumphreys. You won't miss it. Say, “I read you on the show.” I'll send you over some free information on things that I'm doing, either way, I want to be in your network.
Thank you guys so much for joining the show.
I 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 office 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!
Brian Weidner is the President of Career Tree Network, a recruitment advertising firm based in Milwaukee, Wisconsin that helps Physical Therapists connect with career opportunities.
Since 2007, Brian has helped thousands of Physical Therapists achieve their career goals within a new position.
Outside of the office, you might find Brian playing princess with his daughters, watching heist movies or eating sushi.
I am a father of 4 boys, married 20 years and am passionate about healthcare entrepreneurship.
Teaching entrepreneurs how to maximize their income, profits, and net margin is what I do, but helping them change how they think, reclaim their freedom, and discover what is possible is who I am.
I teach the value of this key phrase: Profitability unlocks possibility.
On this episode, I'm lucky enough to bring back Heidi Jannenga of WebPT. She joined us before and we discussed the State of Rehab Therapy that WebPT does every year. We're bringing her back again because the new State of Rehab Therapy Survey and Report is out again and you can get that at WebPT. Heidi and I sat down to discuss some of the takeaways that she took away from this year's survey. It's a little bit dark on the front or maybe not dark, but somewhat discouraging. We talk a little bit about the burnout issue that is in physical therapy and what might be leading to that. There's still a large amount of student debt out there that the new grads are coming out with and salaries haven't changed all that much and yet reimbursement rates are declining. We talked a little bit about that and we also talked about some of the greater opportunities that are out there for physical therapy as well.
We see a lot of consolidation that could lend it to greater reimbursement rates, as some of those companies are starting to negotiate with insurance companies and gathering their data and outcomes. Also, from what I can see as a possibility that those larger corporations are willing to invest in greater benefits for physical therapists and invest into the cultures that they're creating. There's a further opportunity out there and the needle hasn't changed much in that 90% of the people that need musculoskeletal care are not getting it from physical therapists. In spite of the fact that all 50 states have direct access, still eight out of ten providers are reporting that insurance limitations or their perceived insurance limitations are a barrier for patients to get physical therapy. Simply, it's important that we educate ourselves and start acting like the forerunners and the gatekeepers of musculoskeletal injury.
There's an opportunity to communicate with the public and be on the front lines and not waiting for the referrals. There's an opportunity in regards to the burnout and whatnot. It's an opportunity for you as the owner to sit back and say, “What am I creating here that would make my culture such that people want to stay, that would keep them engaged? How can I align purposes or find people that are aligned with me and our purpose as a company?” To work together as a team, develop a culture max out of the customer experience and make it enjoyable for them and thus, that makes it enjoyable for the patient. There are a lot of opportunities there even though we see some negative signs that came up from the report, but there are also some positive signs and we go into that a little bit.
Heidi is a busy person. I'd love to spend a little bit more time on what WebPT specifically is doing to overcome some of the challenges that physical therapists have in regard to the amount of time it takes to do documentation. Also, to address the regulations that are upon the physical therapy providers themselves on a day-to-day basis. Nevertheless, I'm sure that will come up in WebPT’s business conference called Ascend 2019 in Minneapolis on September 19th to 21st. Check out their website. I’m sure if you Google Ascend WebPT 2019, you’ll get all the information that you need and if you mention that you are a reader of the blog, you will be able to get a discount. Check that out and put it on your calendar. It's one of my mantras, “Step out, reach out, network.” This is an opportunity to network, get some business training, see what's happening out there in the industry and network with other successful physical therapy clinic owners. It will be a great opportunity for you to learn and network and feel like you're not alone in this. Let's cut to the chase and we'll get right to the interview with Heidi.
I've got Heidi Jannenga of WebPT. She's always very busy so I'm excited to bring her on. Heidi, thanks for taking the time to spend a little bit of time with us and talk about The State of Rehab Therapy.
It's honestly my pleasure. We have lots of interesting things that have happened over the year and I'm anxious to share a little bit about some of our new findings that we had from our 2019 State of the Rehab Therapy Industry Survey. I'm excited to be here. Thanks for the opportunity.
It's great that you guys have done this survey and I think this is the third year running, if I'm not mistaken. Looking over it, the amount of data information from it is interesting because I don't see a lot of this data coming forward from other parties and sharing such a broad perspective of The State of Rehab in general. First of all, thank you for doing it because I think it provides a lot of great insight into the profession for all of the professionals. What was your impetus for doing it in the first place?What we don't want to do in PT is lose the best and brightest minds coming into this amazing profession. Click To Tweet
That exactly was the impetus that when we went out looking for data, we couldn't find it. At WebPT, our mission has always been to help therapists achieve greatness in practice. To be able to truly do that effectively, we need to understand the lay of the land, like what is happening and getting direct feedback from therapists themselves. In order to understand the state of our profession, we wanted to be able to see sweeping industry trends. We wanted to understand more about how people are treated and what barriers they're encountering nationwide. We decided to embark on our own survey and we started it. Every year, we've gotten more and more people to be able to give us feedback and take the survey.
Each year, we've dived into a little bit more information based on what we received the previous years. To be able to compare, we ask a lot of the same questions as well. We divided everything up into four categories first of all, which I think is important as you look through the survey. We dove into things like payer mix and therapist productivity, referral sources, utilization of direct access, market consolidation, provider burnout, technology use, growth strategies and salary. A lot of the top of mind things that people are asking about. We get lots of questions around these things that we wanted to have interesting information directly from the sources which we frankly couldn't find elsewhere. We said, “No one else is doing it, we're going to do it.”
You found a hole in the market that was needing to be filled. How has it changed in the last few years? Is there some data that you found that's most valuable now that you didn't expect back before? What are some of the things you're noticing in the information that you want to collect?
We had about 6,500 unique responses to the survey. Just for clarification, 53.2% of those were not WebPT members. This is a clear, very diverse population of respondents and definitely not biased by whether or not they're using WebPT. At the end of the day, 90% of our questions had nothing to do with technology or EMR usage, although we did ask a little bit about that because it's important to us. About 63% of the respondents were therapists. We also had rehab therapy assistants, so 8.5%. The rest were classified as non-clinical, whether that's an executive, a clerical worker or a student. About just shy of 50% of the survey takers were also in outpatient private practice, which we also liked. It gave us a diverse cross-section into the entire industry, not just outpatient where some of us live and breathe most of the time.
Some of the things in the past that have been thought-provoking around salaries and student debt were asked. Despite our information being spread and wide and the American Physical Therapy Association does a great job of making this an important issue, the needle has not moved that much yet in terms of the amount of student debt that students are carrying these days. We might have talked about before that the average is about $70,000 in debt when a therapist graduates from PT school and close to 35% will have over $100,000 or more in debt. You compare that to the average salary is about $65,000 coming out of school. The question mark becomes, “Is the juice worth the squeeze? Am I getting into something that I'm going to be in debt for a long time to be able to pay off those $100,000-plus in debt?” There are also the sentiments of burnouts that we captured quite a bit in the survey.
Is that something that came up? I don't remember it last time the burnout that you're recognizing.
We added that. We now ask very specific questions about burnouts and thoughts about leaving the profession based on the feedback and also the data that we received in 2018. The survey continues to evolve based on information that we're getting and wanting to learn more about the industry as a whole. That was unfortunate but also an important data point. About half the survey respondents are considering a profession change in the next five years and one in five of those respondents would like to move into a non-clinical role.
Some of the reasons that people were giving for that are the immense compliance and regulatory burdens that t they feel like they have to endure and not at the end of the day, why you and I got into this profession. I didn't want to have to fill things out in triplicate and have to substantiate everything that I specifically need to do three times over before I get approved for it. We're getting squeezed on a number of visits. We continue to get reimbursement changes that happen. It's harder and harder to be a physical therapist who wants to affect change and treat patients.
I've noticed the burnout thing a little bit more recently. Someone said you look around our profession, you don't see a lot of 60, 70-year-old physical therapists that are practicing at full-time and loving it, just like you might see a family practice doctor or a general dentist or someone like that who it goes to work every day and loves their job. You don't see that a lot in the physical therapy profession. I don't have any data behind it and maybe you guys do, but there seems to be the burnout, the constant focus on production now that reimbursement rates are declining and the regulatory issues that are on top of us to stay in line. All that squeeze makes you question whether or not it's worth it and that makes it difficult.
The burnout is becoming earlier. In general, we age out because we have such a physical job as a physical therapist. It's in our name. Whether it's transferred or whether it's manual therapy, it's a very physical job. You're getting down and showing people exercises every day. It's not conducive to be doing that into necessarily your 70s. I don't know that's really changed so much. It’s in terms of the earlier burnout and also seeking other professional tracks as a physical therapist, not just being held to, “I'm going to be in clinical care for the rest of my career,” which I thought was interesting. For me, having taken a completely different path outside of clinical care, what I don't want to do and what we also have seen is that there is a decline in students applying to PT schools. Now, the outcome of after PT school and that burden, things like that are starting to become issues to even getting recruits into PT school. What we don't want to do is lose the best and brightest minds coming into this amazing profession.
At the same time, once they're in and once they are starting into clinical care and they find out, “Maybe this isn't necessarily what I thought it was going to be.” We need people to stay in clinical care, that's why we become a physical therapist. I also love the fact that some of the smart and brightest people are doing things representing the physical therapy profession in other ways, whether it's technology, whether it's entrepreneurship, whether it's going into public health or whether it's going into hospital administration. To demonstrate that our profession has a lot of very diverse but brilliant people that are not just ancillary providers. I see it on both sides that it's not great that we have the potential to lose clinicians that can help people and continue to improve the overall brand of who we are. I think that brand can also be accelerated by having more therapists exploiting the value of rehab therapy and PT in different arenas that we're not represented in now.
I interviewed somebody like that, David Self of Keet Health. He was the guy that went through PT school and never treated patients but rather developed his PRM program. It's people like that that you can hopefully say, “There is a track for physical therapy to treat patients and whatever, but there are also other tracks outside of it that can lead you to promising careers as well.” It's tough when you see on some of the social media posts and maybe you've seen them. I've seen them as well. People are saying, “I'm doing this and that and I'm interested in getting to physical therapy. Is it worth it?” I see, just looking forward, some of the respondents are very positive, “It's a great profession.” Some are very negative, “No, it's not worth it. It's tough.” Nowadays with the social media and the capability of people to reach out ahead of time and talk to larger audiences, it's tough if people aren't happy in their positions inviting those bright people into the profession.
There's whole track now of non-clinical PT rise even on social media. Meredith Castin leads a whole podcast and blog post and a group of non-clinical PTs, which I don't necessarily see as a bad thing. They are promoting the profession of physical therapy in such a fantastic way that sometimes I think clinicians who are treating patients all day don't have the opportunity to do. There are a lot of opportunities there but to your point, those that are in clinical care and those that we need to continue to have a pipeline of more amazing clinicians that want to do clinical care. Even those that are getting to the horizon of their career have said that, “I am not as readily willing to tell people, ‘You should become a physical therapist anymore.’” That's the sad part because usually your evangelist of people who love what they do are willing to tell more people and get people excited about the profession.
Did you find that through the survey, some of your hallmark findings were led into the burnout that we're talking about, whether it's some of the challenges that came up consistently that led to the possibility of some of this burnout?The PT profession has a lot of very diverse but brilliant people that are not just ancillary providers. Click To Tweet
The regulatory change, the number of hours that people are working. Of those respondents who I mentioned who are considering a professional change, about one in four of them are doing to decrease the hours that they have to work. I thought that was very interesting. Whether that's based on working more than 40-plus hours in order to make ends meet, you're working your regular full-time job, but you're also doing PRN work on the weekends and things like that. I did that when I was coming out of PT school as well. I don't think that's anything new. In this next generation, work-life balances are even more strongly emphasized and wanting that a component of their life. I think that's reflective of this next generation’s expectations of their professional life. The other thing I would say and part of the reason that we publish this information is for people to use it and take the data and say, “What could I do differently?”
As new grads coming out, they're looking for a great culture in clinics. They're looking for a career passing and mentorship. They're looking to learn. There are a lot of therapists, whether you're new or not, that are wanting those things. As we get busier and busier, sometimes it's hard to find that balance or those great cultures. For leaders to be spending time and money, the bottom lines are not what they used to be. The additional ability to spend more money on benefits and things like that is not as easy, but it's also important. That is a good segue into what we see as far as consolidation in the market. It's been the pendulum that has swung back a little bit through my career.
When I first came out of PT school many years ago, it was very dominated by “corporate PT organizations.” We had the dissolving of a lot of those organizations due to corruption, the Medicare fraud. We saw the rise of entrepreneurship. With that, we see the opportunity now. Private equity money floats into our industry several years ago and now we're seeing the cause and effect of that with many medium-sized organizations being on the quest to grow. I don't always think that's a bad thing. There is a lot to say about economies of scale. I think that people have learned a lot from the past and how they want to do things. There's technology now that helps to make more of the communication and centers run more efficiently. We did see in our survey that larger organizations do have a higher patient volume requirement.
About 40% of our full-time therapists in single providers see six or fewer patients a day, which if you're seeing cash-based patients, I could see that. Still, that's a very small number overall. In organizations with 21 or more full-time providers, they're seeing about nine to twelve patients a day. If you have twenty-plus providers, your patient load can increase from twelve to fifteen patients per day. I think corporate organizations or these large entities get a lot of bad rep for having to churn and burn and see tens of patients a day. Twelve to fifteen patients didn't seem at outrageous to me or outrageous at all to me. I think that there has been a tide change in terms of being more efficient operationally and yet still being able to give great quality care with also that emphasis on outcomes.
You talked about the swing towards more, if you could say corporate care or consolidation. The benefits definitely could be these entities having greater funds, the economies of scale in which they can reinvest into a culture where they can reinvest into providing greater benefits that the entrepreneurs might not be able to provide. Also, coming back to having a seat at the table with the insurance payers to renegotiate those contracts and bring reimbursement rates up. Even though some people might hate to see that coming down the horizon and more mergers and acquisitions occurring, you can see some benefits on one end when they might be willing to reinvest if they're willing and able to do so with maybe a little bit but still maintain high productivity. I think there might be a little give and take on that.
I think one of the downfalls in the past, which we've learned from was that these large organizations try to undercut each other to increase the volume of patients by decreasing the amount that they were willing to take per visit. You don't see that as much. Insurance companies have already done that for themselves because now they also have a lot of data of what they're willing to pay. What we are starting to see and it's low, only 17%, 18% of organizations that collect outcomes data are using it to negotiate with payer contracts. The majority of those are the larger organizations, but they're using those outcomes to increase their payment adjustments, not trying to undercut.
Insurance companies have already that for us because of what we were willing to take in the past. Now, we're negotiating to increase. If I'm going to get better outcomes in improved utilization and less visits, overall that the insurance company pays less, even though the price per visit is higher.” That's the negotiation that's starting to happen now with data. To be honest, that's what it’s all about now. Being able to prove with hard facts and clinical outcome data as well as utilization data, patient-reported outcomes but also patient satisfaction scores as well as the trifecta. What we've talked about in the past of what everybody's focusing on, making sure the patient’s happy, make sure the providers doing what they're saying they're going to be doing and also being cost-effective at doing that.
You talked about some of the things that can link to upset for a provider, whether that's regulations and student debt and satisfaction in the profession. Are there some things that you recognize are challenges within the care of treatments that therapists are regularly reporting? Whether that's pressure from supervisors for production or the documentation time that it takes to get a patient through or time away from patients that don't make them? Are there some of those things that came up?
Those are all part of the challenges and opportunities. The things that we found were most concerning to therapists that were within this policy and regulation area where high co-pays and co-insurances, referrals and certification requirements, then the therapy thresholds or targeted medical review thresholds given by insurance companies. The autonomy of practice is not what it used to be. The burden of the high co-pays and co-insurance is now the pressure to show value and have patient buy-in becomes so much greater because there's so much more out of pocket costs.
That's tough when a physical therapist has to have that financial conversation. It's something that's come on over time, especially in the last several years or so. I didn't have to have those conversations as much earlier on, but it's almost regular now that you see that the patients are having to have some conversation regarding the financial responsibilities of the patient have and displaying the value that we provide as physical therapists. That can be tough for people who aren't used to that situation.
This goes to a bit of a crack in the foundation of ourselves as professionals in terms of the brand of physical therapists in the first place. Of people understanding the doctorate level professionals that they're seeing. That your average consumer understands the education and the value that a physical therapist can deliver but not only that, just the fact that we should be the first provider that people are thinking about for musculoskeletal injury. That's another good segue into one of the biggest items that I'm going to be talking a lot about and have talked about, but emphasizing it now is the direct access issue.
We have now direct access in all 50 states. We have that now. It's not new. Some states like Arizona, where I'm from, we have completely unrestricted access and we've had it for more than twenty years. Yet people are still very intimidated by the ability to take someone off the street, walk into your clinic and have them get treated without a physician referral. The confidence in ourselves as therapists has to be promoted. I don't know how we get past the change in behavior. We have the knowledge and we have the skillset. It puts us in this incredible driver's seat of more level-playing fields with referring physicians because now we become a referring provider as well. Especially in states where you have some limited access where you can only see them for an initial eval and/or maybe a couple of visits or even just the initial eval, let's take the Medicare. To be able to then send that back to a physician and say, “Patient came in. This is what I found. Here are some issues that you might want to look at. Here's how I can help this patient as a physical therapist. You go do your workup and then I'd love to see them back to help them with the issue that they came in with.” Now you become a much higher prominence, if you will in the overall healthcare continuum where people see you as more of an equal.
Where do you think our hesitancy or fear to take the reins in those situations comes from? Is it just from a longstanding history of being, for lack of a better word off the top of my head, subservient to the other medical professionals? Are we not getting proper training beforehand in our schooling? Where do you think that comes from?
Let's face it, we're still a fledgling profession in terms of the grand scheme of things. Where we started was being subservient to physicians and having to rely on referrals from the get-go. It's the longstanding behavior that you have known for most of your career and I don't think that referrals should go away 100%, but I think that it should be a 50/50 split in your clinic. It's going to take a lot from not only ourselves of being willing to take these patients in, which I think is the first stage. Secondly, doing a lot more promotion and education to the consumer as to the value that we deliver and who were good at helping. I will say that I truly believe that the time is now to be 100% emphasizing this. This is why this is my biggest soapbox because of the opioid crisis.In this next generation, work-life balance is even more strongly emphasized as a component of life. Click To Tweet
We know that insurance companies, hospitals and everybody are focused and this is at the highest level of administration of all of these different entities of finding, even at the state level. I was listening to NPR and even in our state level, the top of the conversation in every healthcare arena right now. A significant percentage of the patients that have been given opioids suffer from chronic pain and musculoskeletal pain. Who else is better to be treating these patients for musculoskeletal issues? It's us as therapists. There was a big study that was published by the American Physical Therapy Association and OptumLabs and UnitedHealthcare in which UnitedHealthcare finally came out and said, “We've had this data for a while but now because of this crisis, we understand that physical therapists need to be a primary provider. We need to get them in earlier as an intervention provider for these patients that come in with musculoskeletal issues, specifically low back pain.”
They published in their study that if a physical therapist or I should say conservative care provider, so that includes chiropractic or massage therapy, is the provider that the patient is seen for in the early stages or more acute stages of their injury, they have a 75% to 90% chance that they will never encounter opioids through their episode of care. The data is there to show our value. We just need to scream from the rooftops. I keep threatening that and maybe I should do it. Get a crowdfunding thing to do a Super Bowl commercial or something to make this a known thing, who we are as physical therapists and what we do and how much value we can add to patient's lives.
My next question is part of it is communicating to the public and some of the other healthcare individuals, but how do we change within to have the confidence to stand up and say that we are the masters of musculoskeletal injury care? We are the first line of defense. We are the gatekeepers or whatever you want to call it. It doesn't seem like we've taken that upon our shoulders to be that. From your perspective, what needs to happen? What do we need to do?
First, it comes back to education. Although we've had direct access in all 50 states for quite a long time, in our survey we found that only 13.5% of respondents said patients could directly access PT in their state.
They didn't know.
It baffles me that they don't know, but they don't know. 80% of the organizations said that they still require a physician referral for treatment. Roughly eight in ten respondents claim that payers are the top reasons why. We know that that's not true. It’s a lack of education and lack of understanding of the changes that have happened. Most insurance companies now will allow at least the initial evaluation. If your state practice act says you can see them unrestricted for more visits, it may not be the case based on insurance, but the majority of insurance companies now will pay for an initial evaluation, even Medicare, which is always the one red flag that people throw. The biggest barriers to direct access in which it is perceived are insurance requirements and then the lack of awareness in the patient market. There are not that many patients walking in the door.
This is where this movement for patient retention management, more marketing to the consumer, more of a change in mindset that we are a consumer-facing provider and not just a B2B or a physician to therapist provider where all of your targets in the past and marketing efforts have been much more in terms of getting to know your physicians. Now there's this change, which I'm hoping becomes more of a tidal wave of understanding that we need to go directly to the consumer and get these people to understand that, “You can come in and see me. Here's who I am, I'm an amazing therapist. I can help you in so many different ways.” We just got to get them into the clinic.
Being an owner in the past and I'm assuming that probably a majority of your respondents not only coming from outpatient settings but if they are owners, they've probably been owners for a longer period of time. I'm making a couple of assumptions there.
Only 50% of our respondents were outpatient. It is the broad spectrum of respondents.
From my personal experiences is that you hear that, but you're not sure if you trust it enough to change policy inside the clinic and risk losing so many visits on some patients by not getting that referral or getting the prescription ahead of time. I think it's constant education that needs to be consistently reinforced and then taking action and dipping your foot in the water a little bit more and saying, “It's okay. Come on into the pool. It's all right.” It's a lot of education and showing proof of concept to these people that you don't have to have some of these things. You can be the gatekeeper, you can stand up and you can be the person at the forefront and not need what was needed in the past. That can be difficult when you said we need to shout it from the rooftops in order to get the message across.
Change is always difficult. If you don't have a cash pay schedule now, you need to make one and what do I charge? There's the fear of, “I don't want to charge too much.” All of those unfortunately things that our clinician brain takes over versus the business brain. When we know that people are willing to pay $100 an hour for a personal trainer, why wouldn't they and why shouldn't they pay that for a doctor-level professional who is going to do so much more for them than supervise and provide an exercise program? It's also the mindset and when you said, “How do we make changes?” It does go back to student education in our academic setting of priming the pump early. The confidence in who we are as therapists have to come from the education first and truly believing that this is the norm. This is what you should expect when you go out and if you don't see this, how do you help to make that change as well?
It's a tactic that we've used even from a technology perspective. Introducing electronic health record and electronic medical record in the academic setting and having students use it. When they go out to their clinicals or even when they go out for their first jobs, to then see something that is much less efficient, not as user-friendly or pen and paper, that they are willing to raise their hand and say, “Have you ever tried this? Why are we doing it this way?” It’s the old adage of asking why.
A lot of it is education. Do you see anything else that we need in our tool belt to become more of the front-line defense? Not just to let therapists know that they can be, but from my perspective and because I'm a little bit biased, I'm doing more diagnostics. I do EMGs and I have also been trained in musculoskeletal ultrasound. Do you see diagnostics being a big part of being recognized as that first line of defense for musculoskeletal injuries?
Of course, we have a shortage of primary care physicians. Pushing that line of the scope of practice with these additional certifications and aligning with physicians who are willing to have that information and refer you patients to get that information or that data I think is important. Also, going straight to a patient. The patients’ potential population out there to have them understand, “These are our certifications and value-add activities that we do as physical therapists. It’s part of our scope of practice. It's part of who we are and what we do.” This goes back to the part of our big purpose and mission here at WebPT in the data that we've found and validated with a lot of insurance data as well is that 90% of patients who have diagnoses that a physical therapist could help are not getting into physical therapy. We're fighting over this 10% of people and that number hasn't grown. It comes back to what a lot of people have been talking about for the last several years of the brand of physical therapists.Physical therapists need to be a primary provider and an intervention provider for patients with musculoskeletal issues. Click To Tweet
Tell me what is WebPT working on to help alleviate some of the concerns we talked about or some of the exciting things that are coming forward that WebPT is working on that you'd like to share?
We're continuing to work on efficiency. It's been one of our big mantras here. We’re starting to release our WebPT Documentation 2.0, which has a full new look and feel, but more importantly, much more efficient in terms of getting through your documentation. We're using the data from this survey to make sure that we're hitting all the marks on the biggest barriers. We are working on what we're calling WebPT’s network effect of now working with credit card processing as well as with our outcomes tools. Getting that data and information out there through an analytics platform that can help and empower our clinicians and our owners to use the data. Go and negotiate more with insurance companies to increase those reimbursements or payments that they should be getting.
From the marketing front, we're continuing to improve our PRM or Patient Retention Management platform in which we have so many cool new ways of increasing your HEP, your Home Exercise Program compliance, as well as retaining patients so that you have this constant communication them. Our big thing with that is to hit that 90%, to get more of the marketing component out there. Not only to retain the patients who have come to see you, but how do you increase that by social media likes and email and everything else that you can do to get your clinic more notoriety.
You talked a little bit about analytics and that was always something that I always wanted more for my EMRs, the management statistics so I can have more access to that. Even if it's not for going out and renegotiating contracts, that's a great end goal. Just to manage the day-to-day and make sure that you didn't have holes in your bucket and you could manage it appropriately and manage it by statistics. That's exciting stuff.
We have a whole dashboard of the top nine clinic metrics. You can watch it. All about efficiency where you don't have to do a bunch of spreadsheets and have all this backend work. The data's already in our EMR so how do we then aggregate that and allow you to use that on a day-to-day basis to run your business at the highest efficiency?
That's where the independent practitioner is going to be benefited the most by an EMR like WebPT. Being able to have that as a dashboard and not go looking for it and spend the time on it and thus manage their clinics. Though we're not trained as businessmen, we own businesses. Even though we're not trained as such, it's important that we have those KPIs available to us on a regular basis and managing them and tracking them, even though that's maybe not our forte. It’s exciting that WebPT has that available to us to help us manage appropriately and thus capture what we're supposed to be getting paid for. Like we talked about, maybe reinvesting in culture, reinvesting in benefits and making it a wonderful place for physical therapists to join and be a part of.
This is an area, especially for your small businesses and single provider owners who are wanting to grow or are wanting to make their business more efficient. We have heard you because this is an area that we don't come out of school knowing a lot about, is the business side of physical therapy. What are the KPIs I should be looking at? How do I take those KPIs and make sense to them? What do I do when it goes down? What are the dials that I need to look at to be able to improve those numbers? That's also why we started our annual rehab therapy business summit which is called Ascend. We've been doing this now for years. This 2019, it’s going to be on September 19th through the 21st in Minneapolis, Minnesota. We would love to have you guys come out. If you come to the website and decide to sign up, please let us know that you came from the Physical Therapy Owner's Club show and we'll make sure that we get you a discount code.
Thank you for doing that. I, number one, love the idea that you've got the Ascend conference going and that it's focused on the business aspects, especially like what you talked about. We come out of school, we don't know some of these things and then you hear about, “You need to keep your KPIs.” “I can start keeping my KPIs.” As you said, when they go down, now what? I'm reading the WebPT dashboard that I have and my stats aren't where I want them to be. What do I do? That's where a conference is so invaluable. The networking can be incredible. My mantra is step out, reach out and network. This is how you network. This is how you get information from the other successful business owners. This is how you learn successful actions and take advantage of those who have gone before so you're not reinventing the wheel. It's conferences like this where you'll gain a ton of information and get some of your business acumens.
You learn from people from similar-sized practices to larger practices. We've got speakers from all over the country, the best and brightest minds that we can pull in for an event like this. We’ve got some amazing keynotes from outside of the industry, which we also are big promoters of, to learn from people outside the industry. It's going to be an amazing two full days of super content and lots and lots of learning. Most importantly, lots of networking. We have a lot of time for that very specifically because we know how valuable that can be. Hopefully, we'll see you there. Let us know if you've found us on here and we'll make sure we give a good discount.
Thanks for your time, Heidi. I appreciate your willingness to talk to us, especially about the insight that WebPT has gained from the state of the industry.
You're very welcome, Nathan. Thank you for all that you're doing for the therapy owners out there. The more education that we can get on this business side and more people working together towards the greater cause of helping our profession only makes us stronger. Thank you for everything that you're doing for the industry as well.
Dr. Heidi Jannenga, PT, DPT, ATC, is the President and Co-Founder of WebPT, a six-time Inc. 5000 honoree and the market-leading software solution for outpatient physical, occupational, and speech therapists. Heidi leads WebPT’s product vision and company culture initiatives while advocating for the rehab therapy profession on a national scale. She's an APTA member, belonging to both the private practice and sports medicine sections, and she's on the board of directors for the Institute for Private Practice Physical Therapy.
In 2015, she won the Arizona Physical Therapy Association’s Physical Therapist of the Year Award, and in 2018, she received the APTA’s Marilyn Moffat Leadership Award. Prior to co-founding WebPT, Heidi practiced as a physical therapist for more than 15 years. Today, she regularly speaks as a subject-matter expert at regional, national and international technology, entrepreneurship, and leadership events, as well as at national and international PT industry conferences.
Heidi serves on the boards of numerous organizations, including the Arizona Science Center, Support My Club, the Physical Therapy Political Action Committee (PT-PAC), the Institute for Private Practice Physical Therapy, Conscious Capitalism AZ Chapter, and the Arizona Community Foundation. She also dedicates time to mentorship within WebPT (through her women’s empowerment group PropelHer) and in the broader community (through her work with physical therapy students, entrepreneurs, and women in business).