James Savas is a Senior HR Professional who has worked in the healthcare (and PT-specific) industries for decades, and there is one common issue that he sees PT owners make. It usually looks something like this: the owner hires someone to fill a position, turns around to work on patients and put out other fires, cross their fingers hoping they've made the right hire, leave the new hire to their own devices, and expect them to come up to speed in a week or two. Most of the time, this process doesn't work well for either party, and frustration mounts to the point where the owner throws their arms up in the air and laments, "if only I could find good people." What most owners don't recognize - or take the time to detail - is that there are a number of steps they've missed between recruiting and getting an employee up to full speed. If they take the time to organize the process, the whole system can be a powerful foundation for establishing a rock-star team. In today's episode, James joins Nathan Shields to list a number of simple things that owners can do to create the team of their dreams.
I've got James Savas. He is the Deputy CEO at Hands-On Diagnostics, and that's how I got to know him. James is an expert in many things related to HR, but specifically, he's a senior HR professional with a specialty in Business Development. He's also a certified educator and executive coach. He brings a lot to the table from past experience and PT specific experience. Not just PTs, he worked in other healthcare settings as well. I'm excited to bring him on so we can talk about HR-related issues and depending on our discussion, how these things go, we're looking at making this a two-part episode where we talk about a lot of things related to HR. I want to do that because James has a ton of experience. James, thanks for coming on.
It's good to be here. Thanks for your time.
Share with everybody a little bit. You’ve got a ton of letters behind your name. You've got a ton of good experience. Give us the breakdown. What are some of the professional experience that you have in regards to PT in the healthcare settings and what you've done and brought to the table for PT owners in the past?
I’ve been in the game for many years on some smaller projects. I worked for dentists and chiros a little bit, but mainly the PT sector. Most of my time happens to be with private practice owners and orthopedic clinics generally. What I'll do is depends on what discussion I have. I have to work with an individual that has a good intention to do something with their game that they want to expand either they're too much in the game to expand. They don't have time to think about the administrative side or that HR side or whatever you want to call it. They want to get out of the game and own and let that machine roll.
I am dealing with guys on my track here on those two different sides. I've worked with guys up and down the Rockies, New York, Southern Florida, Central Florida, a little bit in Texas. Mainly the PT side. I'll go in as an HR professional, as a recruiter, depending on the gig. Business development is a big part of what I do because a lot of the owners out there help that can be of service to you guys. They don't have that guy, that ear or that outlet for, “Can I put something on your shoulders? It's all on my shoulders. Can someone else share the burden?”
I generally had been that guy. I'll be the figure out, organize brain, they know that they can do it but they don't have time for it or they don't want to do it. That's a nutshell, but I've seen the chiro practice game overseas in Ireland and all over the parts of the US. I'm dealing with a national company that has a whole bunch of owners all over, I think 26, 27 states. I like what I've done. I worked in Rural Montana and I've worked in the Story of Queens. I've seen both sides of the game pretty much. I can talk to an Alaskan up there if you might have some troubles and the guy in Miami who’s working.
That's good because a lot of owners that I'm supposing are reading, they're like, “I wish I could afford a guy like you to come in.” I know in my situation, people would ask me all the time, “How's the business going? How are things coming along?” Almost to a tee for about ten years, I was like, “I love treating the patients and I enjoy that, but I can't stand the HR stuff.” Having to deal with the employees, the person who gives me no notice and says, “I'm out of here.” Maybe doesn't show up or someone who does give me notice, but they happened to be a PT. I know it's going to be 2 or 3 months before I find another PT even though this PT only gives me two-week notice.
It's like, “Stabbed me in the heart.” Those things kill me and holding people accountable, all those things were hard. Hopefully, we can get into some of that to give some owners some ideas on what they can do to improve that HR side by spending a little bit of time in there. As you worked across the country, we want to talk a little bit about recruiting, hiring, and onboarding. Before we hit those three things, what are some things that you came across in your experiences with PT clinics, in particular, that seems to be an ongoing trend? It’s like you'd come across and say, “This is how you guys think,” or “This is how you guys work.” There's some kind of trend going on here that you need to correct typically when you walk into a PT practice. Anything like that?
I lean into it a little bit before, but what I'll see is that normally the owner has a bunch of ideas for expansion, things he’d like to do, what people he likes to fire, people he or she like to bring on, and he or she got time for not as much evaluation of that data. They have ideas statements all locked in this idea stage. Some of the fixed ideas that they can't afford an employee to do that. Often a debate I get for them is they need to hire, they can’t afford to hire they bring the guy or girl on, they are no good. They have to let them go. They wasted all this time training them.
It is that the attention on those things is not there and their ideas of when they should build up their staffing, how often they should then let go of the dead weight. You have both sides, you have that spot. It's a manager's function that they don't always do that they're busy in treatment or they're busy in other things. That executive manager role where they should be observing the employee going, “That's no good. Why is she still here? Why is he still here?” It's both sides. It's keeping staff that should be there and dumping the dead weight and no time to evaluate that. On the front end, “When do I need staff? Can I afford the staff? How do we get them productive?” Because I'll bring them in and I'll let them go and then I'm busy when they get it done.
I think I know exactly what you're talking about. You've got an idea and you say the solution is to hire blank. Maybe it's to get rid of blank, but you haven't taken the time to work through the process of how to bring that person on and onboard them successfully. I think that's what you're talking about. You were missing steps in between. We've got this idea. We think we see the solution, but there are a lot of steps in between that make that solution successful. We jumped from idea to solution and then go and work on our patients 40 hours a week without lifting our head up to observe, “How are they doing? Did they get any training whatsoever?” I remember many times sitting in interviews saying, “You have this title, but your job is to do whatever needs to get taken care of.”
It was much less delegation and much more of abdication of any responsibility not knowing that the ultimate responsibility always fell on me if they didn't do their job. Poor job at training, onboarding someone, and having some processes in place. It sounds like then as PTs, maybe healthcare practitioners in general that are independent owners failed to take the time to lay out those steps and bring someone on successfully and train them up.
The other side of that went, “They're not doing good. See you later.”
The idea is this person's bad. The solution is to let them go. There might be more steps in between that make that successful that could help us along the way if we do it right. You've been across the country with PT clinics. I'm assuming your role as an HR professional was to do some recruiting. We can never talk enough about how to recruit PTs and get them on board. What were some of your successful actions to recruit PTs and bring them to even some of the rural settings?
The first thing I do when I got to the recruitment part of the HR cycle is to get communication at schools in my zone. In parts of Alaska, there's no PT school maybe around up there. I would get communication with the PTs in the area and what schools are in the area.
Even if there aren’t any local schools, those PTs can reach out to their alumni or their alma maters.
Getting that line is the first thing I'll do because I want to be well thought of by those schools. I want them to see my name, PT, and go, “We had an intern over there.” “I've heard that.” “He graduated from this school.” I want that PR is done well. As a comment, there's this element of the recruitment side. It is a marketing PR action in bulk, especially the recruitment side of it. The PR value of letting the schools know who you are is one of the first things.
Looking at the current good staff you have, who's been there 5, 10 years, or 2, 3 years, the owner's included. Even the front desk girl, the marketing individual or whatever it is. “Who do you know?” One of the biggest successes I've had in recruitment. I ran it as a pilot for myself to see to test myself years ago when I said, “I'm going to put no recruitment ads out.” I'm not recommending this. We had about a hundred staff, some satellite clinics. It was a big company. I said, “I'm going to only promote to my staff. I'm going to send out a weekly email to my staff, a few bucks ahead for a referral bonus internally for other staff. I'm going to bang it out and I'm going to run it like a campaign.”
Every week, there was a newsletter or a promotion from recruitment HR guy going, “Who do you know?” I get at least a name a week, if not 5 or 10. At one point, I had an 87% retention rate, only dealing with strictly my staff's referrals. That's how I got a guy from the UPS man. His daughter, his friend was in school for PT and we got her. The value of those lines and people never think of those things. They don't think of their staff, the mailman, or even the schools, but those two routes, they keep the new students come in and beat you on this side and they keep your current active good people that you’ve got in your business thinking. Those are two of them.
I love what you said about recruiting through your current team. If they're A-players, they're more than likely going to hang out with other A-players and bring you on. It’s the same thing with the students. If you can get a few of those students from certain classes who are in alignment with your company, and they toot your horn, then they're going to bring on their other awesome PT friends. They're not going to bring on a friend who's no good and more than likely they're not hanging out with those types of people. They're going to recruit for you and tout the benefits of working at your company and bring you on. I know that those are huge successful actions. I know, especially in rural communities.
I've had Dr. Sabrina Starling. She lived in Rural Wyoming and would help people recruit simply by using your network. Go to Christmas parties, “How's the business going?” “The business is going great.” During the course of conversation with anybody, maximize your network and say, “We're looking for someone like you. You're an awesome person. You're productive. You're a rock star. You've achieved many goals. Is there anybody like you that would want to work for me?” Take advantage of your network and leverage it.
To add to what you're saying is generally, they’ll refer people like themselves to some degree. They roll with that crowd, but also, they're not going to refer other people because they don't want to be felt bad of themselves.
It's great to leverage your local schools and alma mater. I know my business partner leveraged local PT schools down in Phoenix. To the point where we had PTs who said, “At any given time, if you have an opening in your clinics, let us know.” We had people “on the bench” and that was our goal. It took about 2 to 3 years to get to that point. He did an amazing job recruiting to the local schools, such that if any PT were to leave at any time, no fears, we would call up people and say, “Put in your four weeks’ notice, we're ready to go whenever you are.” We had 2 or 3 people that we could call at any given time to come on. It puts you in a different position altogether, minimizes the fear and puts you in a power position for sure.Most small PT practice owners hire to fill a position without taking the time to considering what a new hire needs to be successful. Taking a little time on that process would save both parties many headaches. Click To Tweet
The big thing is constantly promoting. Most owners I've seen goes, “The law's leaving. We're expanding. We need only one PT.” They’ll recruit for one PT or they'll lose one and get one back. They'll sit on their laurels and go, “We're good because I have the number of equivalents working for me now.” It's got to be constant action. Owners that are single-handing the business are not going to spend 5, 8, 10 hours a day recruiting. Any constant flowing and constant thought about it. Maybe an Ad, an email to your staff, that takes minutes and email to the school, “How is it going director?” It’s been a while. It's little effort, but it keeps that PR communications live. It's in there. It’s got to be constant. If you guys built it up where you had a waiting list, that's what you’ve got to do. We used to interview for the heck of it when we didn't need an interview 1 or 2 a day. “We don't need anybody yet, but we're here. They can shake, hug, love what you got here. I'll be back.” If they don't come back, I gave them a call and said, “Who do you know?” “You're not looking.”
I tell my coaching clients because we got to a point where we always have the ad out whether we were hiring or not for any position on our team. We were doing interviews for the tech positions, the front desk positions that were a little higher turnover. We were doing monthly group interviews for that and sometimes we were able to pull some gems out of that. Sometimes we didn't. We always had a PT ad out. Never let that strap off. We always had it going, always collecting resumes because you never know, especially where we were in Arizona. It's notoriously hard to recruit, but you were in a similar situation in Rural Montana. Just a little bit of time each week, it shouldn't take too much. If you can set aside 30 minutes to an hour, send out some emails, send out a text, promote, make a phone call. That's all you need to do. We get to that point where then as we are hiring, what are some of the things you recommend that owners establish as a “hiring process?” We had certain phases that we would take potential candidates through or potential employees through, but what do you recommend?
What’s completely underplayed by most is what’s next? We can talk about Rural Montana when I was up working for a client, a handshake, look them in the eyes, and maybe a pump on the back. That was your application. “I like you. You're a stand-up guy or girl, let's do this together.” There's something to that. That should happen appropriately every time again. I look at the recruitment onboarding that part is a bit off, where it stops and starts its own thing. It can be a technical subject because evaluating an employee both current inside but also coming in. I find that tantamount to you seeing a patient and seeing what's wrong with them.
You're going to evaluate them all over the place every which way you can to get to the bottom of what the problem is. I evaluate the heck out of these people coming in. There is the interview process. I have a testing regimen. We always would do. There’s a resume review, application review, a testing regimen. I have a couple that I've used a lot and then interview questions and then reference calls too. After all, that, when they're coming in, if that's what you're talking about, what does day one look like? Employee manual review policy, but let me know what piece we're talking about.
Let's talk initially about the hiring phase prior to offering the job or the day one of being on the team. Our steps taken were, collect the resumes. We do a phone call, but that wasn't much of an interview we wanted to screen for. What was their phone voice like? What was their tone level? Were they an excited person or they sound down? If they could simply pass a couple of those things and as I said, we also did some group interviews, but if we could get to a one-on-one interview, then we were doing some intelligence test. We would focus heavily on values. Make sure we were talking about our values and what those mean to people.
Making sure people were attentive when we talked about values and not swung back in their chairs and not caring any body language, assessing that stuff. There’s time to also talk about the job description and what your productivity expectations would be and what you're required to do. After the one-on-one was then a job shadow, preferably not with the interviewer, but with somebody else. After everyone agreed and they'd gone through all the processes, then we offer them the job. That was ours. What do you recommend on top of some of those things or different from some of those things?
A phone screening and a reference check. There’s like the normal systematic things you do. You do reference checks. If I got only one of the three, I got at least one, but try to get at least two.
Something successful for us in regards to the reference checks in which email was always the easiest. I don't know what it was. If I tried to get them on the phone, inevitably, they didn't have “time” to call me back. If I could say, “I'm interviewing this person. They put you down as a reference. Could you either give me a call or email me back your thoughts about them?” That made my reference checks much more successful and timelier.
For time, that’s a great idea. I liked the opposite of myself. I had time to do this. I had to speak to the person on the phone because I wanted to ask some questions. I wanted to hear what they said. I wanted to hear them go, “Lag, do you have an answer?” I did do that because if I'm doing a reference check, then the applicant knows there are some interests. I'm even going to that point. After the phone call with the candidate and I liked them, I'm probably going to have you come in. What I'm going to do is I schedule them to come in and before they would come in, I do the reference check. If I liked them enough after the testing, “I'll see you tomorrow at 2:00,” but I didn’t hire them yet. When I could do that, I could leverage the applicant. I could say, “I called three people. I couldn't get through to Cindy, Joanne, or Mark because they're hot.”
That's been successful. After the initial little phone thing and then the reference checks and now they're coming in for the interview, what you asked them to interview? You could strip that thing out 50 pages. I think the role and the expectations, the bonus structure, what all of that needs to go. I generally do that at the end. I like to start it off personal, “Tell me about yourself. What do you do?” I love the question along the lines of, “What do you do on your time off?” I don't want someone who’s good at watching television.
They have a whole lot of favorites, no offense, a bunch of favorite podcasts, TV, and that's all they know, all they do or that's a lot of what they do. I'm out there, I'm hiking, especially for the rural parts. I want to be out there. I want someone who skis in the winter and likes the summer. That's a big part of it. Once you get to know them and it's a fluid or it's garbage because you'll know that quick. I want someone to interview me in the interview. I want someone to go, “Let me ask you.” They either go, “I have questions for you.” They have a pen and that’s fine. It’s formal. They’re going to be organized. They interview me, “Why are you here? How long have you been here? Why did the owner do this?” I love those questions.
I look for a great personal character and they're involved in life outside of my business. We looked at PTs in one of my practices, I worked for who wanted to own. It might be off-putting to an undergoing. I don't want someone that wants to take over, kick me out, or open next door. At the same time, I don't fully agree with that because as long as they were qualified, good applicants and everything that you do qualify them under. Once you get them in, if their purpose is like, “Down the road, 5, 10 years, I want to have my place, move back to where I come from.” Why not facilitate that? I think that's a misstep too sometimes. I don’t want someone that's, “I’m just going to live here in two years, at least so I can pay for it.” Think bigger.
There were some things over time that I got used to asking. I started steering away from, “What are some of your strengths? What are some of your weaknesses?” It was surprisingly common. I'd ask them what their weaknesses are and they'd say, “I care too much.” I steered away from that and started asking more like, “What books have you read recently?” I want these people who are intrigued. If they're honest, they're like, “I don't read books.” “What do you do? How are you growing?” Maybe they could be listening to a self-improvement podcast instead of an entertaining one.
Secondly, “What is your five-year plan?” Even with texts, with the front desk and older people who I would interview for positions, I want to know that they've got some goals in place. “I'm not sure.” I enjoyed asking some of those more specific, deeper questions. I enjoy talking about values. A friend of mine who I interviewed a couple of times, Sturdy McKee out of San Francisco, wouldn't hire anybody that hadn't played a team sport in the past. You can understand why, because you are working much like a team in a PT clinic that people maybe they're doing individual sports might not be used to the team concept much. That was one of their filters. I love those kinds of things that filter people out and you find a certain candidate when you start narrowing things down.
I love that idea and you reminded me that we used them at one point. You can be the passive indeed goer where you put an ad and that's all you do, or you can pay a month, which was reasonable at the time and see resumes. What was nice about that is you can search for keywords like NCAA or soccer, football. There’s a word bully in searching a certain criteria. I worked for an agency for a while too. I have a recruitment agency side. I've seen both universities. They're different universities. To be able to search, you're talking about a tool. I can search for football, Montana, and hiking.
What was your experience in the past? We've had some good experiences with on the job interviews. We'd tell them, “We expect you to come in for two hours.” Sometimes we'd pay, sometimes we didn't. I don't remember if we had a policy in regards to it, but either way, there was an expectation that they would come for two hours and sit with the person in that position. Even maybe come in and do some of the work but there was a definite expectation that they would be engaged. You want to see how they interact with patients, how they interact with other employees. Even though they're new to space. If it was a front desk or a tech person, two gold stars if they brought a notebook and took notes. What are your thoughts on the job shadow?
I love that. That's what we call it, a job shadow or a working interview. We didn't use them frequently. I would say it wasn't for every employee equal working interview, but there were somewhere I was especially questioning the fit or their background. What do they know? If I had a billing person come in, I'm going to want to a little bit more, “Sit next to Joanne. Let's see you talk to Joanne about your job. I want to see you at the desk with her. Look at some claims, tell me what these fixes mean.” I want a little more live stuff. For certain technical positions, I loved it. Certain receptionists, what we wanted to see, like we had a girl who was in there for years. She was the boss, a reception manager. We stick girls next to her and let her feel them out for half a day, 4 or 5 hours.
On the PT side too, I had one of my first employee way back was a chiro. She had PTs and she'd hire a massage therapist. She asked him to treat her in the interview. “Can you go back here?” “I'm not a clinician.” “X, Y and Z aren't feeling too good. Can you get back there?” She judged them on their ability to do it and understand your language and stuff. I love the hands-on idea. Every PT we hired, we would have them shadow our clinical director or our lead PT. Any technical clinical position, I'd have her do a little walk around. I do a little intro to the space but then I go, “This is what we do.” She looked for indicators like eye contact stuff. Are they involved? Are they asking questions? I would tell her what I wanted her to do and she does it. That was invaluable. I can work half day or something.
A lot of these people, for 30 minutes to 60 minutes, they can snow you over. They can talk a good game, they can show some personality, but when you get them with peers and not with the “boss” or the head guy, and maybe they'll let their guard down a little bit more. For two hours, they start showing their true colors. How often are they bringing up their phones and checking their text messages? How often are they off to the side? I had a coaching client who was interviewing a PT and she had been working in the home health setting for some time and she said, “You've been working in the home health setting for long, how would you help somebody? How would you screen if they came in for low back pain?” She says, “I would do this and that.” “Why don't you show me?” She's like, “I would do this, that and the other.” “No. Imagine I'm the patient and tell me what you want me to do.” She couldn't do it.Most good applicants that wind up being hires want to know that someone's going to be watching out for them. Click To Tweet
Imagine if she had gone off of the interview, the face-to-face talking portion, and not asked her for some specifics and hired her on. Those kinds of screens are important. They were talking game talk. Maybe they were able to go through that portion, but then they would do a job shadow with a PT in the clinic and you wouldn't see any engagement between the candidate, the PT and the patient. They weren't asking questions. They were simply standing there against the wall, watching what they were doing and I'm like, “You don't have any soft skills. I understand you can technically do what you need to do, but you don't know how to talk to people.” That would simply write them off. Otherwise, we were ready to bring that person on that desperate, but I'm thankful we didn't.
One of the clinics they worked for not too long ago, they had a home health piece and then the clinic and brick and mortar in-clinic services. What was nice is even to some PTs and you didn't want them in the clinic. You want a clinic PT to be a certain individual. You want high communication. You want the comradery there and you want the ability to handle a bit busy-ness. You're wasting 18, 20 plus a day to be productive. In the home, they're saying 2, 4, 6, 8 hours a day, maybe different games. They were even different hires there. I liked them, but he's not a go-getter. Stick him in the home.
That made sense for that guy, because maybe he can on his own terms. Let him take his time with six patients to enjoy, but he's not going to work in my clinic and mess me up in there. One thing to add to what you said too. I wasn't sure about the person's honesty level and I wasn't sure about their real intentions. I would give my clinical director or the other manager questions. I would give them things to say in front of us. It’s almost like a private investigator. Have them talk about their last job or the last employer. The face I get in 60 minutes is handshakes, big smiles, hugs. When they're in front of this peer, not their boss, they could have a different conversation. I'll say it's their scenario, but I definitely will use that too. Even once or twice a patient who I knew was in the clinic, “I'm getting the new PT coming in for their shadow. With legal restraints, give them a hard time.” They roll with it or not. I'll play that side too.
I can't overstate the importance of those job shadows, because like I said, there were plenty of times where people pass through the interview phases with flying colors. They got to the job shadow and we're like, “Red flags done.” It's important to have those. The next step is important because we don't know how to onboard people. I wonder if business schools teach that at all. How do you onboard somebody day one? You would think that it takes much hand-holding and much time and effort. I know that there's a difference between the PTs and PTA and the rest of the team. What are your recommendations to establish an onboarding process for those two different groups?
Behind that, you need general policy stuff. State by state if you have to legally have a handbook or not. I know that depends, but you need to have something to provide. I think most good applicants that wind up being hires want a regimen of some kind. They want to know that someone's going to be on them, not micromanaging. All the people I've hired over the years, they want someone that's going to be watching out for them. They want to be disciplined when they need to be. These are the good people that you hire. I think if you have a regimen of, “Here's the checklist we're going to do here. I’m open with my communication and direct. We're going to do this checklist of steps here.” I always included in my onboarding day one is some kind of orientation. You can look at that from the viewpoint of, “This is where the front desk is and go meet your boss.” That's what a lot of people will do. Shake your hand, “I’m your boss, come to me with problems, I’ll see you later.”
Having the formality there, the regimen, I like to have almost like a scavenger hunt. That’s what I create because I want them to come in for any position. It’s a PT, a trained professional, a little more sideways by that or an administrative person. I literally will have them find out where you're going to work. “Go and see what your cubicle is. Go meet your boss. Go shake the owner's hand. Count the number of chairs at the lunch table. Find out if we have a microwave.” It sounds completely goofy maybe what that does is it orients the person in the environment. I'll have to go out the front door and come back. “Do we have a signup?” “You don't have.” “What does it say?” “It's an old business.” It works as an investigation for me because then, “We have no computers. I forgot that.”
It gets them out of their comfort zone. It throws them a little bit off, gets them comfortable. I have to meet five people at least that first day. “I'm doing this weird checklist thing that HR guy said. Let me shake your hands.” That's a big part of it because it gets them a little comfier. People know who the heck they are to some degree and then I'll give them a buddy. I’ll say, “This receptionist is your buddy. Questions about where the lunchroom is, ask her.” “Betty, here’s your buddy,” shake hands and I'll leave him alone.
They're all for about 30 minutes-plus digging around the office. People are seeing them interact and they're doing whatever and I'm getting the packet ready. I'm getting the onboarding process. There's your checklist. You have to review the purpose of the company. The owner wants everyone to know this, because like you said before, even going through the interview stage. If your purpose and theirs don't align, they should not be there. I had noticed this part, I had an owner that would meet with every PT two weeks every month and go over, “How's it going in life?” The owner would meet directly, 30 minutes to an hour, and go over there like, “What do you want to achieve with 5, 10-year plan? How does it align with us and does it align with us?” I think the formality of a checklist, I like that orientation thing.
An employee handbook, review, simple policies, the dress code, the piercings and tattoo code, and voting policy. If you want to take days off, this is the form that you use. We use an HR professional, it was a onetime shot to develop that employee handbook for us and they are out there. I don't know how I found her, but she sat down with me 2 or 3 times and we'd go back and forth on email. She'd give me the standardized stuff that was required by our state. The policies that we had to provide and federally had to provide. She said, “What is your time off policy? Let's put that in there and what do you want?” She would guide me through the creation of that employee handbook and there are independent people out there that can do that for you.
I think even companies like Paychex also have an element that they can do that too. I fully agree that that needs to be there, whether your state legally needed to have it there or not because you don't know how many times an employee who leaves under unfortunately bad circumstances. “I want my last paycheck. I want my bonuses. I want my unused paid time off.” “You signed this. It said we don't do that.” How many times does it save your butt? Fifteen to thirty policies about functionality in the clinic written down. One thing I would say is that the owner needs to spend the time to know them, that's the thing too. Having an HR company do it. It can't just be in your email and you went, “Did I?” Many times not for bad reasons, but you have to know them because if you don't know those and you're going to be the effect of what you don't know.
I know the APTA can help. I think Rick Gawenda was promoting some policy and procedure manuals that can help you with compliance. That's a different thing, separate from the employee handbook, but you’ve got to make sure that's on your checklist. What's your HIPAA policy? Are they going to do some video training? There's a lot of video training on HIPAA that qualify. Maybe your state requires some OSHA training and Medicare Fraud & Abuse. Making sure you check these boxes, not waiting for the next team meeting, that's maybe scheduled in the next eight months to do those compliance things, doing them at the front end. That's why I like some YouTube videos that can support you in that regard. MedBridge has some of those compliance videos. Sit them down here, “Watch this for the next 30 minutes. If you have any questions or concerns, let me know. Scan over our written policy so we can sign you off on the compliance portion of that onboarding.” I think a lot of people miss that, especially as small clinicians, we don't even think about it.
I think you hit something too. When we have a robust onboarding, I’ll put that in an ad. I'll tell you the truth because we've talked much about the recruitment, the ad side of things, which we can do separately or whatever. When you're advertising for a PT and all that stuff, when I put a robust onboarding process or rigorous, they get the idea that, “They don't mess around.” You're this much more apt to get an employee that, “They have a robust whatever.”
Someone professional or looking for an organized structure. That makes the difference between a mom-and-pop shop and an enterprise. I think that's where a lot of PT owners want to get to. A mom-and-pop shop are at the front of the store. They're greeting every customer. They're taking a reorder and that's what a lot of individual clinic owners are when it's them and maybe one other PT. If they want to truly get some freedom, they want to move over to an enterprise. An enterprise has the structure of a hiring process and an onboarding process to ensure the success of those people that come on board and that they're fully “trained.” I know you can take that to many levels. Our onboarding process was towards the end, there was offsite.
They would have almost likely a full day of onboarding training at a different place. I know even in Blaine Stimac’s case in Montana, I interviewed him. I think his onboarding process was spread out over the course of six months or even a year. They'd have a few days and then they meet up again 30 days later and again, 60 days later, 90 days later. Meet up again at the six-month mark and review some of those principles as they needed to and hold them accountable. You can go crazy with it, but at least having some structure for that onboarding can establish a foundation for the team.
I know Blaine is a basic structure. That is a lot to be said about. You can call it ongoing training. You can call whatever you want to call it. There’s this onboarding element where week one is a whole different game plan than month six, I think you should. There needs to be a 60, 90-day, whatever your terms on your employee manual. Review how they're doing in 3 months, 6 months. It has to be there for sure. That's part of that thing at the beginning, I mentioned where you need to know what this person is doing in your clinic. How has it been going? Spend the time to build out the policies, the regimen, and build out the basics. Spend time now so it’s done. Because once it's done, it's done. Once you have the manuals, it’s done.
Once you get that signature, if they have a question regarding the paid time off policy, go check the handbook, “You don't have to ask me anymore, you know where the handbook is. Go look for it.” That helps the trainer. Initially, it's probably the owner but in the future, hopefully it's not, but if you have an organized checklist, that's something that you can hand over to someone else. That's where you start gaining some freedom is when someone else, not the boss starts espousing the purpose and the values. “This is what we do.” When that goes peer-to-peer, that means a lot more than from the boss talking down. It helps out a lot and it also ingrains in the trainer, those same values and expectations, and helps them along the course of it. If something is written out if there's a “curriculum” to it.If your purpose and your prospective hire’s purpose don't align, they should not be there. Click To Tweet
Even in a small clinic, where you have an owner and a couple of staff, letting a peer having one person. I had a receptionist do it. I've had the lead PT do it but having somebody else responsible for that basic administration. Make sure that this new employee does this and this and report back to me that they've done this. It's off your plate as an owner a little bit. Maybe you give them a little money on the side appropriately for doing that. Maybe they have a little bonus, but you have to give up some of those hats.
I'm going to cut off our discussion here because I want to transition into how to get people out the other end of the business. That is getting rid of dead weight, disciplinary procedures, developing that HR. Not just from the beginning like we talked about, but through the course of the life cycle of an employee. It might be going out the door in good or bad circumstances. Before we move on to that, if people wanted to get in touch with you, James, how would they do that? Are you willing to share?
(917) 312-4294 is my phone number. I love helping people. I worked for the company because I'm helping multiple owners in multiple states at the same time. I couldn't do that years ago. My email is JamesSavas@Hotmail.com.
If people have some questions, they can reach out to you at JamesSavas@Hotmail.com, that makes it easy. Readers, watch out for the second part of our conversation. If you won’t, just move on to the next part and we'll start talking more about the life cycle of an employee.
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!
Additional Points of Interest (some outside PT and some for fun):
* Published article in Impact PPSAPTA magazine (2008) "Hiring & Retention"
* Nationally Licensed Soccer Coach
* Director of Development of several Soccer clubs/groups
* Certified Assistant Teacher
* Co-owner (former) of a small family-owned retail dessert business
* International traveller (school in Italy & worked short-term in Ireland)
* Avid survivalist/camper/outdoorsman
* Humanitarian (as I'm able), directly assisted during 9-11 @ ground zero NYC
* Interned w/ MSNBC out of college (Broadcasting Major)
* Was a celeb-host at the 1996 Grammy's and 1997 ESPN Awards (some good stories not for air)
* Was on HGTV (with my family) in episode of a Montana HouseHunters
* Music composer/Short Story writer (Sci-Fi)
* Best hat I wear - DAD; pays shitty but great rewards!
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In 2019, Ben Larsen, PT, DPT, co-owner of the Teton Therapy Cheyenne Location, had great goals of increasing his number of total visits per week by year-end to well over 200. Little did he know that by making appropriate, time-honored decisions he would hit well over 300 visits per month come 2020! His path to success wasn't based on a new treatment technique or referral source. Rather, as Nathan Shields and Ben discuss in the interview, Ben hired people that were in alignment and he implemented what he knew he should be implementing (things he learned from his consultants and coaches in the past), and started tracking stats and training his team (future leaders). Suddenly, patients started coming in greater numbers than he had ever seen before and he wasn’t treating most the time! A great story of small and simple actions generating great results.
I'm bringing on one of my friends and coaching clients. I hope it doesn't come across self-serving but I had to bring this guy on because he has made incredible gains. I wanted to talk to him about what he's done and what were some of the specific actions that he took that got him to see such significant gains. From what I recall from the discussion is that nothing new came up. We talk about hiring the right people, having the right mindset, figuring out your purpose, stepping out of patient care, taking control of your environment, all things that can be seen in Ben's growth. My guest is Ben Larsen. He's out of Cheyenne, Wyoming, and making great strides and looking to grow and expand. Hopefully, I'm along the ride with him as a coach but he's implemented many great things and made all the right choices so they can see significant growth and hopefully continue to see it going forward. Hopefully, Ben's story is an inspiration to you as well and it gives you some ideas about the next steps that you need to take to see your goals and dreams come to fruition.
I'm excited to bring on a friend of mine that I’ve known for some time and has become a coaching client, but he's had such tremendous growth. I wanted to share his story and talk about some of the things, especially the successful actions that he's done to double his growth in his clinic. First of all, the guest is Ben Larsen, Co-owner of Teton Therapy in Cheyenne, Wyoming. Ben, thanks for joining me. I appreciate it.
Thanks for having me. I’m excited to share our story and how we've grown this.
I know your story and I’ve had the opportunity to watch you from a distance. If people have checked the previous episodes where I interviewed the Co-owner of your company, Teton Therapy, Jeff McMenamy. He's got a great story starting from working in a racket ball court and starting his physical therapy clinic way back in the day, but he's grown, expanded and brought you on as co-owner in Teton Therapy in Cheyenne but you've done a lot. I want to highlight you and your story and your successful actions. Let's go back a little bit. Do you mind sharing with us a little bit about your professional path?
I went to PT school just like everybody else. I went to a school in North Dakota, the University of Mary. Jeff McMenamy who's my business partner, is an occupational therapist. He's from North Dakota. He was there at a career fair. We talked and it's a funny story. He tells it better than I do. I show up in a full suit and tie and he says, "What do you want to accomplish as being a physical therapist?" I was naive when I looked at him and said, "I want to own my own practice." This is the first time we've talked. At that point, he mentioned how impressed he was with my drive and my determination to expand as a professional. I signed up with him to go ahead and work for him.
I move my way up within two years as a clinical director and then as vice president of operations. In the meantime, I did a lot of training on business techniques and different management techniques through measurable solutions. I got trained in how to run the company from a vice president of operations standpoint. I'd been doing that for several years and he approached me. We had an option to move the clinic down to Cheyenne. He asked me what I thought about doing that and moving my family to a new area. I took my wife and kids down here and decided that this would be a good move for us. We moved down here and opened up the clinic with not knowing anyone in Cheyenne at all.
I put up a sign out by the door that says, “Please call for information and consultations,” a couple of months before we opened. We did a little basic type of stuff to tell people we are coming in town. We opened the door with zero patients on the books. When it hit the pavement hard, it all started with a Parkinson's support group. I met my first patient there. She brought her in. We did a couple of treatments with her. She told her doctor. The doctor was having some issues. She came in for me to treat her because we're getting such good results with her patient. She told her friend, who was another doctor who was having some elbow pain. She came in and I treated her. It expanded from there of initially first treating physicians and then getting the word of mouth out and then expanding the practice.
You've got a nice connection there.
Over the past several years, every year, we've had substantial growth, but 2019 has been a big growth for us. Like most practice owners, when you first start out, you make a lot of stupid decisions and you're trying to fill spots. Your hiring is okay as you're first learning it and then it gets better and better. We've had a complete staff turnover at least once. Within a couple of years, we've brought on some real key players that as we started transitioning people. We've seen significant improvement within the quality of care we're giving first off and then second off in our business growth because of that quality of care. That's been our biggest thing.If your goal is to be completely autonomous, you got to be able to handle everything. You can't just handle the basic things. Click To Tweet
Finding the right people, hiring the right people, and then helping them to expand in their position in and what they want to accomplish as well. As I sat down with you, we looked and it was more than doubled. We almost tripled based upon having the right staff members in place, expanding the right way, following the right systems, and implementing things that have helped. The basis of my story is starting from about nothing, to where we're getting ready to hopefully get into a new space. It’s finalizing some things on that, to where we'll be able to double our space and hopefully continue to expand our practice and provide good quality care for the city of Cheyenne.
I don't want to go gloss over it too quickly. I do want to get to what some of the specific steps that you've taken that tripled your number of total visits per week. Can you share with us a couple of your bad decisions that when you look back on, you’re like, “That was bad, I should not have done that,” or “I would have done things differently?”
When I started out, I had done all this management training. When I first did the management training, it was more like, "I'm doing this for the company." Most people are going to have executives out there who they bring them on, they do the training, and those people are doing the training because they want to expand the business for that particular owner. When you become your own owner, you get this mindset of, "I’ve done that training. How do I want to do this?" You start thinking about how you'd want to do things and trying things that haven't necessarily been tried or tested.
Are you doing things differently than what you're trained to do?
Yes, because you're trying to make your own way. For me particularly, I’ve had this owner that has developed me into who he thought to be that good physical therapy owner. I had some ideas, some preconceived notions that there were some things I wanted to do differently than what we were doing at the other clinic. I stopped implementing some things that are successful in other clinics that bit me hard. I needed to get back to the basics. That was the one thing that if I could go back, I would stick with the basics of the training and implementing the statistics. The things that we use in our business to make sure we're producing and doing what we need to do. That would be the one thing that I go back on that I would stick with the training that I had and move forward with that. The second thing is sometimes we hire out of desperation instead of hiring out of what we need. Everyone's had it where they want a position filled with someone that can fog up a mirror. They walk in and they've got the proper license and you hire them, but they're not necessarily the right person for your company. There's a couple of times where I wish I would have taken the time and done better with the hiring process like we do now and found that key quality person that fits with our group, team, dream, and purpose, all those things. Those two things are the biggest things. One is sticking with the basic technology of managing the clinic. The second one is to hire based upon what we need not just to fill a position.
You looked back on some of those decisions in terms of hiring out of need and I wonder how much time did I lose by finding a person instead of waiting for the right person. We've had instances where it would have been better for us if we had simply let go of the entire team in a poisonous clinic and started from scratch all over again. It would have saved us a year of headaches if we started from scratch. Sometimes it's that distinct in my head that sometimes you have to wait for the right people. I also want to congratulate you. You said you're going to expand. You're looking at a new 6,000 square foot facility that you're going into. I misspoke. You're not only doubled, but you tripled in productivity. Of course, things didn't happen all of a sudden and I know it wasn't like one new provider started sending to you. You didn't necessarily niche out and do anything in particular. As you look back along the timeline, what started this process of growth if you look back a year and a half ago to lead you to the point where you had such dramatic changes?
Looking back, there is a key event that happened that sucked. It was the worst experience of my life. I had an employee that totally went ballistic on me. He was upset about things. It wasn't a good situation. He reported me to the board saying we were doing an insurance fraud, claims that made me decide what type of a team do I want to have and how do I want to foster this team to do what's best for patient care. It changed the way that I hired after that point because, initially, our HR person would contact them. This is particularly with physical therapists. I would say, "Once we get down to the top five, give me their names and I’ll set up some time to interview them."
This time I said, "Who's your top ten? I want to make personal phone calls to each one of them before I even bring them in and talk to them." I laid out everything on the line. I was very open within these interviews and talk to these individuals to try to find the right people for our team. We looked at is this person the right person for what we need? I got down to one particular candidate where there were two that I liked. I sat down and thought this process out. I didn't make a quick decision. I thought about it and what we needed. There was one thing in particular with the one that made me think, "This one is the one we need. She's going to take our clinic to where it needs to go based upon our conversations and what I saw."
With this particular one, I had some hard times with it because the HR person, our VPA, she was leaning towards another candidate. She's great and I totally trust her completely, but I didn't feel right about that other candidate. We were about ready to pull the cord on the other candidate when I said, "No, I feel there's something with this other candidate." I talked to my business partner. I told him what I thought and he called both of them. He felt the same way with this other candidate that we hired. We pulled the trigger on this. She's been one of our best producers because we followed that gut feeling of what's best for the business and for the clinic. That's been the biggest thing for me, looking at things in terms of what's best for the clinic. Sometimes it's not necessarily what's best for me personally, but it's what's best to expand the business and make things work for the team as a whole. When I started doing this and adding additional therapists, I was very upfront with my expectations.
It's a funny story. I have this PTA. We were sitting down at lunch and we were super busy and I said, "I need somebody but I don't know if this is going to be a full-time position. Would you be interested in coming on part-time or coming on as a temp position and then it could go into a full-time position depending on how you do?" During the conversation, I don't remember saying this but she said, "If there is someone who doesn't fit in with this team, I'm going to straight-up fire them." She tells me that. It struck a chord with there that I'm serious about this team needs to be working hard together to get to our purpose, which is taking care of patients.
That's what we need. The biggest key to our success is finding the right team. You've probably seen this as well that when you find that right team, the patients seem to come. When you have that right flow, the patients show up because there's something about it. That's what we've got. In times when we're going to slow down, all of a sudden, we get these boom of patients coming in. It's from word of mouth and it's from people seeing what we're doing. They're happy with the results and sharing it with everybody else. It all starts from that team having that same purpose, working together and working for what is best for the clinic.
It sounds like what you did and unknowingly is try to find people who were in alignment with you. You had the best interest of the company in mind and that goes to show how important it is to have that filter. The company comes first. The owner comes second and then the employees come third. It seems like from your story that you focused on finding people who were in alignment with you. It was cool that you could call Jeff, the co-owner and have him also phone interview these people because you and Jeff are aligned. You two can find the right person who was in alignment with you and that starts creating a culture of like-minded people who share the same purpose, vision and goals. It starts to accelerate the growth process. I've seen it hundreds of times and it happens all the time with people I have on the show.
As you start finding those right people, you start developing a culture. Culture is simply the way you do things at Teton Therapy in your case. People do things the same way. They're saying the right thing, they show the same values, and they treat patients the same way. Not to say that they're the same, but the culture is similar and there's a feeling there that starts to gravitate like-minded individuals to the practice to work with you. That's a sense that patients can get when they come to your clinic. They'll start coming. They'll start returning, they'll start referring friends and telling their doctors. It's almost like you can't stop that as long as you continue to hire the right people.
On top of that is I got to a point where we were doing well in the last part of 2019. We were getting things in but then the next step is that network out. That's when I approached you about coaching because I needed the next step, which was to help somebody get me to the next step. I'm talking about phase one versus phase two. Being an owner is phase one, you're that clinician, you're in there. You’re handling all the day-to-day stuff. Phase two, you're transitioning out and you're handling the business side of it. It comes down to as a therapist, you have to decide. With my two hands, I can only do much to help people.
I can only see many patients, but if I take my skills and my two hands and teach others how to do the same thing I'm doing, the amount of people I can help is unlimited based upon the amount of people I can train. Those people can then expand their hands to help more people. The whole goal of a therapy clinic is to help as many people as you can possibly. You can't do that if you're doing treatment all the time and you have to make that decision of, "It's time for me to transition to do a greater good." Therapist is a great good, but there's a greater good of training others to do it that you can help more individuals. You can help more people.
To go back into your story a little bit, and I don't want to gloss over this because it's important. When we talked, I was excited to work with you because you said, "I've learned all this stuff. I've learned the management technique. I've read the books. I’ve got the training. I know what I'm supposed to be doing but I need someone to hold me accountable." I remember that sticks out in our conversation that we had back then. As we started training, you recognize that you need to do less treatment on patients and get out of the full-time treating.
I hope you don't mind if I share but then you got Bell's palsy. Physically, you were not capable of seeing patients anymore. Correct me if I'm wrong, that was a turning point where you were able to step back and see what would happen if you physically weren't present and recognizing that, "Now that I’ve got my head out of treating patients because I'm forced to at this point, I can see the things that I can do." Whereas, when you were treating patients, maybe you didn't have a clear vision. It seems like you had to go through that experience to see that.If the game's easy, it's not worth playing. You've got to have a harder game. Click To Tweet
That was a big part too because at that point, we’re almost 100 less visits than what we're doing just within that last time part of starting this process of the coaching and me stepping out. There's part of you that thinks as a therapist that if I step out, this clinic is not going to do as well. You figure you're going to lose visits. You'll never be going to hit an all-time high unless you're sitting out there treating patients. What I found out was my mindset changed of we're not going to hit an all-time high unless I don't see patients. I can't see patients or we're not going to hit it an all-time high. I have to be doing other stuff. I can't be out there on the floor.
If I am, then my time is not being used for more of that working on the business as not working in the business. That's been a big change. That's been something that's been working with you, working with Jeff. Because we all have that sense when we stop treating patients, it's that timeframe of what do I do now? How do I make this productive? How do I continue to grow the business when I'm not the one who's doing everything? It's a big mindset change and you do need somebody to hold you accountable because if you don't have somebody to hold you accountable, you do find yourself very scattered. What do I do? You find yourself gravitating towards getting back on the treatment floor again, which is not where you need to be.
That's the easiest path and that's what you know. You spent the last 30 years studying to become a physical therapist. Naturally, if you have some free time, you're going to go with what you know and treat patients, but you've got to pull yourself back. It takes a mindset shift. I see this with my coaching clients. There has to be a change in the mind and it doesn't happen immediately. It usually happens over time to the point where they recognize that, “I can do more for the business and for my team, my other providers, my front desk members by not treating patients and focusing on the business to give myself freedom, the bandwidth, the mental freedom and the energy to work on it and make it a better place for my team. Make it a better place for the patients that come in the door and be a greater influence in the community.” It's that mindset shift.
I look at this with my kids. I don't want them to be as good as me. I want them to be better. I want them to do things better. I want them to not have to deal with all the mistakes I have and had to deal with. I don't want it to stay the same. Within the physical therapy profession, I don't think we understand what physical therapy is going to be like in 10 to 15 years. It's going to be different in the way we approach things, the way we do things because we are constantly growing and improving this profession. As business owners and private practice owners, we've got to be at the forefront of training our therapists to be better than we were as therapists. Giving them our basic knowledge and then letting them expand that so that we can continue to expand this field. If our goal is to be completely autonomous, we got to be able to handle everything.
We can't just handle the basic things. We've got to be able to handle everything within the musculoskeletal system and the realm of physical therapy but always pushing those boundaries. That's why, you and I, both involved within hands-on diagnostics because that's what they're doing in Measurable Solutions and another company I'm part of because that's what they're doing. You network with those peoples who are pushing those boundaries because that's what we have to do in this profession if we want to see it succeed. That's what you have to do within your business is pushing the boundaries, not stick in that cookie-cutter box that we have been in the past. The past isn't going to get us to the future. It's the present of working and improving our goals, improving ourselves, improving what we do as professionals.
Did you find it was hard to make that mindset shift? I mentioned that it usually doesn't happen overnight but take some time. What made that switch for you? When did you recognize that, I can't keep seeing patients? I want to go back and reiterate what you said since you stepped out of treating full-time your business has increased 100 visits per week since you stepped out. It did it without you. What was the shift that helped you change your mindset?
It's deciding where do you get the most gratification. For me initially, it was treating patients but then as I'm treating patients and as most of us know, when you've been treating patients for a long time, it becomes second nature that you're not thinking about. You're doing a good job treating the patient but you can tell that it's not challenging you. You get to a point where treating patients becomes this easy thing. Some people reading this may say, "I don't think it will ever get that way." It gets to a point where it's not the easiest. It's the easier thing to treat. The more gratifying thing for me was bringing on new therapists and watching them succeed. That's where I get my joy from. When I see my therapist totally handle a difficult case and they come out like, "I’ve got this guy better." That's what excites me.
Watching them do that and giving them tools to do that. We brought on an OT and she's got her caseload up to where she's seeing exactly what she needs to do. She's built this amazing caseload and seeing that was huge for me. That was a happy moment for me of seeing somebody push it and work hard to obtain something that a goal she had. That's where it comes from. You step out to work on a higher purpose of helping others, helping your staff see success, seeing them help people. You're in the background going, "This is amazing what these people are doing and these clinicians." Even your front desk staff and other things and other positions you have. Seeing them expand their positions and helping people, that's what's brings you greater joy for me, particularly. Anytime I’ve had treating a patient, that's a huge success.
You came to a point where simply treating patients didn't meet your purpose. My coaching clients who experienced this are people who are like, "I’ve got other things on my mind." They're stressed and torn. They're like, "I need to see patients full-time but I know there's the stuff that I'm learning from Nathan in which I need to implement in the clinic that I'm not getting to. I'm thinking about the business while I'm treating my patients." It's an internal struggle. For me, looking at it from the outside perspective, it's that internal struggle. The purpose that you had up into that point in treating patients had changed. Even without you’re knowing or you recognize, “I have a different purpose in mind now.” It's that transition from one purpose that got you to where you were to a different purpose that's going to get you further. You have to figure out what that greater purpose is like you mentioned.
For you, it's to create an environment in which other people can flourish and grow either as providers and hopefully in the future leaders within your own company. Be a greater influence not only in their lives but in their family's lives and in the community that you serve. I see that. We talk about a mindset shift, that's part of it. It's also a change in purpose that you have to come to grips with that as you grow, your purpose isn't being met by treating patients but your purpose is different. For you, it was to grow people. For other people, that greater purpose is meant by having more clinics and growing that way. It can be individual. That shift has to happen and you have to find that greater purpose to go to in order to do let yourself stop treating patients.
It's finding your greater purpose, playing a different game. That's another concept that is part of it as well. The game gets to a point where it’s easy and you need a harder game. If the game is easy, it's not worth playing. You've got to have a harder game. You've got to challenge yourself or you don't want to get up in the morning and do what you need to do. It's constantly keeping yourself up to playing a bigger game. Maybe you add more clinics and that maybe our next step is we're adding more clinics. I've got some big goals and we've talked about some of those things. Some of them I look and go, "I don't know how I'm going to accomplish this but we're going to try other things." It seems goals that I’ve had in the past that are coming to pass and seeing greater good throughout the community. We all do this profession because we want to help people. It's not a money thing. It's a helping thing.
That's why we put all this time and energy into this. I learned this from Jeff, my business partner that I can only do so much with my two hands but when I train others, I can do so much more. I can see more good done through my company because of that. Because of me not being the one who has to touch everything, I can now step out. The nice thing too is it's a different game because you can step in whenever you want. You can help out your employees. You can help them with handling difficult situations in the clinic, but you can also step out. You're not the main guy anymore but you're that teacher. You're that leader that helps them to develop how they need to develop to be the high-quality clinicians and the high-quality people they're capable of being.
Looking back on your timeline, much of it is similar to what we see in the other physical therapy owners. The successful ones. You started hiring the right people, people who were in alignment with you. I know your timeline as well. Go over it and you can correct me if I'm wrong. You also brought on a marketing person to help you out and take that off your shoulders. You also had some consulting and training. You've also done some networking. You already did two of the three steps that I always promote in that is you already reached out and got some training because that was part of your leadership development. You were also part of networks. You reached out and network. When I started working with you, we started focusing on that third piece, the stepping out process and getting out of treating full-time.
We started working together. You brought on another front desk person and based on my experience, and you can share yours as well. Around 120 to 150 visits per week, you need a second front desk person. They can only handle so much. You're bringing on other providers. You've gone from visits that were in the hundreds per week to over 300 visits per week. You've got great goals to get even busier. It's important to note that timeline that you started hiring other people. A marketing person was beneficial and other front desk person was beneficial. You might say that I helped out a little bit as well, but you made that you made those important decisions after hiring the right people and then you exploded after that.
The biggest thing is we're constantly looking at what's the next hire we need to do because it is growing so fast. This might make some therapists, especially owners on this show a little like, “This guy's nuts, how was he able to do this?” We saw a need. I got to travel to try my caseload by having that intention, having those feelers out within recruiting, traveling agencies, to get somebody on immediately to handle those needs. We're in the process of filling that position with somebody more permanent and then adding more part-time help to offset our schedule. Our biggest issue is space. We don't have space until we get into the new building to expand what we want to. We're expanding hours and looking at other options. That takes into account of, we need to add some part-time help to help with this. It's constantly keeping that mindset of what's the next hire? What's the next step? What do we need to do before we get into this new building? How do we handle that? That's where a lot of my time is spent, being that vision of where we are taking this thing.
The time that you spend is much more intentional looking forward. Instead of fixing what was wrong in the past, you can look forward and look, "At this current growth rate, we need to hire another person. We need to find this person." Looking ahead, you can do that simply because you're not treating much if not at all. You're able to intentionally find those right people and take the time it takes to find the right people. There's so much value in that. As you were treating patients full-time, did you foresee that you could fill up your schedule with all of this administrative/executive work? Were you at the point where you're like, “I don't know what I would do with my time if I wasn't seeing patients?”
Initially, you think that the concept of “What am I going to do with my time if I'm not seeing patients?” Once you step out and you start filling it in with executive functions, you think, “How did I even run this company by treating patients because I’ve got some stuff to do?” What it comes down to is once you stop treating patients and you see all the balls that you're trying to juggle that you weren't juggling. You claimed you were juggling but you're not. You can't because you're so focused on patients or you look in your like, "That visit was okay with that particular patient but I don't feel that my quality is up to par where it needs to be." When you focus on those things, you realize that I can't do things halfway for one thing and be okay doing it halfway for another thing. I've got to be fully focused on one thing. I can't have two things that I'm trying to focus on or I'm not going to be focusing on anything.Help patients start the process, change the things they need to change and stop the things that are preventing them from getting better. Click To Tweet
If you're focused on two, it's going to go all over the place. With that being said, since I have the time to handle the executive stuff, when there's an issue on the floor and I do need to see a patient, I'm focused on that patient. I know I have the time to handle the other stuff later. This is a part-time thing of me helping out as needed. It helps me focus more because I know I'm going to have the time on the back end to handle the business stuff, to handle the administrative stuff. I'm okay to focus on this patient. I can focus on the administrative stuff because I have that time. When you're treating full-time, you don't have that administrative time. It's always in your head, "I'm not handling this." You're swimming trying to make it and you don't. Eventually, you start drowning and you're like, "I got to handle this." It's a big mindset change but once you make it, it's so freeing. You free yourself up a lot.
One thing that the audience doesn't know also is that Ben is good about having weekly team meetings with his providers and the whole team, not just the providers of his clinic every week. One thing that sticks out to me from our past conversations that is a conversation that you had with them about control. You could see that the numbers were slipping a little bit, whether it was arrival rates, the number of billing units they were billing per visit or the efficiency of care and noticing that people were dropping off. I don't know what triggered that but as you're watching the statistics, they had dropped a little bit. You felt like the need to address the providers about control. Tell me a little bit about that story simply because it's important to give owners and leaders some of the verbiage or ideas to talk to their teams about being in control of their positions.
We get very complacent with things and we try to make ourselves okay with issues in the clinic being okay. For example, so-and-so didn't come in because they're sick or we had a downturn of visits because it was snowing. We can always find excuses for why things aren't happening. Not necessarily, my teams are good about taking control and handling things. They do a great job of taking ownership of when things happen and trying to solve issues. We all tend to do this when things start slipping, we start making excuses and we start figuring out, we can't control this and that. It came up to discuss what the term of control meant. We’re discussing with the team saying, "Let's define control as the ability to start change or stop something. Let's stick with that as our definition of control." I said, "What can we start? What can we stop? What can we change within our patients?" Define that and saying, "What we have to do is control the things we can control and then we'll deal with the other things as they come up." When you look at illness, weather, and all those things, those are minimalistic on the ability of a patient to come into treatment. Most of the time, why a patient won't come in is because there's some other internal reason they're not telling you.
They're claiming it's an illness, weather conditions, a work issue, or all these other things, but most of the time, there is something else going on. A patient is not committed to the treatment plan. The therapist doesn't have control over the treatment plan. Pushing that on the therapists of saying, "You need to control these patients. They're coming to you to be able to handle this situation. You need to be able to help them start this process, change the things they need to change and stop the things that are preventing them from getting better." That's what our focus is. If you're not able to do that, sometimes you have to have hard discussions with the patient. Maybe therapy is not the right answer for them at that time. Maybe tweak a couple of things, get them recommitted and then you've got a patient who's making progress with therapy. That was the biggest thing I talk about with them is making sure we're handling the patients. Making sure that we're getting those things done that the patients need so that they can handle their condition. My therapists do a good job. Our percent arrival rates stay above the 90%.
They do a fantastic job of getting their patients in and committing them to their treatment plans to a point where we have them sign a document and that first part of their treatment is saying, "This is what our plan is. We want you to complete this plan. Please sign this if you're in agreement." Most of them are signing, they're excited, and they’re ready to make these changes. That's the biggest thing when those stats come down. It’s looking at what we can control and focus on that and not focus on the things you can't control. You can't control the weather. We'd like to. You can control how you're treating the patient and helping that patient to see the value of physical therapy. You can work with that patient to make sure that physical therapy becomes a top priority. You can also have those discussions when a patient is not doing what they need to do of it's time to have those tough discussions and physical therapy is not right for them at this point. Maybe you need to part ways. There are definitely some difficult conversations you have to have, but you also have to be willing to do that to control your situation.
As you're talking about it, I love how you defined control and you put the patient's plan of care in the provider's hand. They need to follow up but they also have to be bought into what the provider is selling. Would you go so far as to say that if those numbers are coming down, if the arrival rate is poor, the patients are dropping off and not completing their full plans of care, if they're only coming in one time a week, hit and miss that maybe the provider isn't fully in control of the patient care and they're leaving it up to chance?
That's a big thing and that's an issue that we have within our profession. We tend to get complacent and feel that way of, "I can't control this patient, so move on to the next one." That's where we have to stop and say, "What could I do to better sell this patient on treatment? What do we need to do differently? Do we need to do some more testing? Do I need to have a second therapist look at this person and see if there's something I'm missing?" It brings in that whole team approach of what could we do to make this experience good and to help that patient get better. It's funny because we've done surveys.
Most patients say the reason they liked coming here or they like coming to physical therapy, getting better is low on the list. The first ones are experience with the therapist and how much the therapists cared about me. All these things are more important to them than getting better. When you foster those two where you're focusing on the patient experience, that ultimately gets them better than any physical therapy skill you can put on them, it doesn't matter as long as you're giving them that high-quality experience. You're making the time. You're showing them your vested in this and getting them to be vested in their health, that's what gets them better.
I totally believe that's true. Many patients don't know what quality therapy looks like or feels like. They're coming into it as a blank slate. The experience you provide them is going to color so much of what they know about physical therapy and not necessarily the techniques you can provide. There are many different techniques that can get people to the same place. Your skills only add to the experience. The better they are, the faster they're going to get. Fundamentally, it comes down to developing a solid relationship with the patients. Getting that buy-in to the plan of care and providing a positive experience for them, which I would assume is focused on improving their functional capabilities.
As long as you've bought in and in control and not saying, "So and so didn't show up, he's not going to get better. Leave it at that.” A therapist that's in control is going to get on the phone and say, "What happened? We agreed to a plan of care that will get you better. I can't guarantee that you're going to get it better if you don't follow it." Instead of the therapist that forgets that so-and-so fell off and two weeks later says, "What happened to that guy?" Being in control shows up in your statistics as you're measuring them. If the therapists are in more control, then you're going to see a better arrival rate. You're going to see you more completed plans of care, etc.
It's great when a patient gives you cookies and all that stuff. That's great and you know that they liked you. One of my patient was on the final day and this particular patient turned to the front desk and said, "I feel like I'm leaving a family." That's the mentality you want in your clinic. You want them to feel like this is a place that helps them get better. This is family, this is a place they can come to if they have issues. That particular patient would have happily come back if they needed it or they're telling all their friends about it. That's what you want. You want to create that family atmosphere that's light and fun, the patient's getting results, everyone's high toned and well personally. That's what you're trying to foster in your clinic. When you can do that, the success comes.
It was cool that you recognize that based on some of the statistics that you had been tracking and recognize that this is what my providers need to hear. I know that your statistics turned around within the week or two after that in huge uptick because they started to take control. You couldn't have done that if you hadn't been tracking your statistics regularly. Ben, I know we can go on forever but I want to thank you for taking the time, especially as busy as you are. You have more free time to do an interview like this, which is cool. Thanks for sharing your insight. As I said on our coaching call, "I’ve got to have you on." I forgot you tripled your visit totals per week. I was like, "I’ve got to have more people like you on." That's why I interview people like you. It's because there are plenty of successful actions that other owners could gain from. Thanks for coming on. I appreciate it.
You're welcome, it’s a plug for you. Nathan, as a coach, has been extremely helpful for me, giving me that accountability. It's taken my mindset from where it was before is, I got be in training to catching the vision of why I need to be out of treatment. Sometimes you need that outside person looking in versus those people who are involved in the day-to-day. That outside perspective helps. A big part of the reason why we're doing this well is because of the coaching. We talked about the consultations stuff that I’ve had with other companies as well, particularly working one-on-one with you to look at the statistics and decide how do we improve this. We've seen my goals have been met. The first day we talked about getting me out of treatment and doing that over a six-month timeframe and we're already there. It's verbalizing those goals and then having someone to keep you accountable for is important. Someone outside of the business who's not caught up in the day-to-day side of things, that's key. I'll plug you every day because of that because you've helped turn around this business for sure.
I love to hear that and I appreciate it. I get so excited after all of our calls and share it with my wife like, "Ben is killing it. It's exciting to work with him." Thanks for the plug. I appreciate it. If people wanted to reach out to you for whatever reason, are you open to sharing your contact information?
The best way is email because I'm not the best in answering the cell phone. My email is BLarsen@TetonTherapyPC.com.
Thanks for your time, Ben. I appreciate it.
Ben has been a member of Teton Therapy since May of 2010. He graduated with a Doctorate of Physical Therapy from the University of Mary in Bismarck, ND and conducted his field work primarily in out-patient settings while in school. During his time at Teton Therapy, Ben has taken many continuing education courses on topics such as Dry Needling, Kinesiotaping, neuromuscular re-education, running analysis, and injury prevention—a topic which he immediately found a passion for and has since conducted classes to the community. Ben quickly applied this vast amount of knowledge to the practice and sharpened his therapy craft. His general interests include water sports, running, outdoor activities such as camping, competing in triathlons, and most importantly spending quality time with his wife and children.
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Going through the interview or hiring process is much like courtship. When you are really smitten by the right person, you can become a nervous wreck and bumble the job offer process. Brian Weidner of Career Tree Network is back on the podcast to share even more wisdom on successfully recruiting and hiring your next PT. He shares some successful actions that you can take to increase your odds of getting a "Yes!" when you put an offer out there. You've moved the ball this far down the field, be sure you get it across the goal line!
I've got Brian Weidner from Career Tree Network back in the show in order to talk about that last step in the hiring process, the offering of the job letter. Sometimes that can be a nerve-wracking experience to send it out, not knowing exactly if they'll accept it or not. You're putting yourself out there and you want to seal the deal and sometimes we can lose people if we don't handle that correctly. We want to talk about that last step in the process and how to successfully offer and present a job offer to an applicant that we're excited to bring on. If you have read the past episode with Brian, we talked about recruiting physical therapists and some tactics you can use to successfully recruit more physical therapists on your team, but we niche down a little bit more on this interview. Let's get to it and see what we can do to make that last part of the recruiting and hiring process as successful one.
I've got Brian Weidner of Career Tree Network on with me. Brian was a past guest. If you want to know little bit about his story and where he came from, I recommend you look back. We talked about some tips and tools as to recruiting physical therapists and what he does at Career Tree Network to help physical therapy owners and staff their companies with physical therapists. He reached out to me because he's recognizing that there are some holes in our abilities to actually get candidates to accept our offers. We want to talk a little bit about best practices in terms of extending job offers and getting those people that we want, those physical therapists that we want to join our teams. First of all, thanks for joining me, Brian. I appreciate it.
Thank you so much for having me. It's great to be back. I appreciate the service that you provide here.
This is something that you've been noticing with the people that you're working with. What are some of the things you're recognizing? Maybe there are some tips you can give us on how to get that person that we want, that physical therapist that we think aligns with us and taking them through the application process, whatever that is. There's still that nervousness that maybe they won't say yes when I present them the ring on one knee. You’re going into this marriage and not sure what they're going to do. You worry about numbers. You worry about if they're going to accept it or not and how the negotiation processes go. What are some of the things we can do to make sure that goes to our advantage?
I like that example of a courtship process. You are building a relationship with this candidate and especially at a smaller practice, if they are hired onto your team, you're going to potentially see them more often than you'd see your own spouse or family. In a lot of ways, the people that you work with are your relationship, or at least they're part of your interactions with other people for sure. We've all had that time when we extended a job offer and then that candidate that we thought we liked and we wanted to hire, they would not accept our offer and they would go and work for one of our competitors. Losing that good candidate is very painful. It's also sometimes preventable in terms of the process that we're using. In general, we're at a point here where PTs are in very short supply. Whether we like it or not, they hold the control and they're driving the relationship often. That's because they have so many different options not only within private practice, but also in the other practice settings. When a PT is looking for positions, they're often interviewing at multiple organizations and it's important that in on their side that they find the best fit. Through those multiple interviews, they're also receiving multiple job offers. This is a topic that offers process, if you're doing it in a way, you can increase your response rate and you can actually get more candidates to accept that offer.
It does actually go back to like the relationship. What's needed is important. Candidates often lose interest quickly if they don't hear anything back. If you're able to extend that job offer quickly, that's the most important factor. We had one client who had a candidate who they liked, but the candidate was interviewing multiple places and they had multiple interviews scheduled down the road. Our client was waiting to potentially extend the job offer until that candidate had finished all of their interviews. In other words, the candidate was the best person for the job. The intention was to extend the offer, but they wanted to almost wait until they got permission from the candidate to extend that offer.
Like the candidate is going to say, “Now I'm open for offers.”
That's the first piece of advice that I would give is that you don't need to wait until the candidate is ready to receive the offer if you know that the candidate is a good person for the job. If they can do the job well based on your evaluation, go ahead and extend the offer.
We talked about this last time and how speed is so important. I don't know why we want to slow things down. Maybe that's a procrastination technique or maybe there's a fear that we're trying to avoid but think about it from the candidate’s point of view. If they think, “That interview process went well with that particular PT owner, I wonder what they think about me. I wonder if they're going to extend something to me,” and then I don't hear from them for a week. Going back to the courtship idea, usually if you want to go out with somebody, you want to let them know rather quickly and not wait a week and see if they come around to still wanting to go out with you. You want to jump on and as soon as you can. You don't want to let them linger out there waiting if you're actually interested and you're excited about that person. It's okay to show that excitement and extend the offer and say, “I was impressed with you. I'd love to bring you on to our company. Here's our offer. Hopefully you can talk more.”
Showing them the emotions and doing that heart to heart type scenario with the candidate is great. You never know, the PT might accept your offer and cancel the other pending interviews. There's no benefit to waiting. The only downside risk on that, which a person might ask is, “We can't have the job offer open forever. How do we make sure that the candidate gets back to us quickly?” The piece of advice with that would be to have an expiration date on your job offer. You could say something like, “We see you as a great candidate for our opening. We'd love to get this wrapped up as soon as possible. When do you think can you get back to me on the offer?”
Is it too much to say, “This is our offer for the next week?” If you know that they're going to do some interviews over the next two weeks, should you jump the gun and say, “We need to know within the next week,” even though you know that they're going to be interviewing for a little bit longer?
That depends. You might phrase it as, “I know you have a few extra interviews scheduled. Is there anything else that we could do now to enable you to accept our offer at this point?” Maybe there is something else, like a specialty area or a certification they were looking for or something simple that you could go ahead and do and that the candidate might cancel their other interviews. It's more of a case by case basis where you want to be respectful of the person doing their due diligence and making sure that they're exploring all the options on the table. At the same time, if you're open with the person and like, “We want this to work out. What can we do to make it happen?” that's a good approach. You never know what the candidate might say. It might be something we all fear, like if they're going to ask for a sign on bonus or they're going to ask for a corporate jet or a briefcase full of diamonds or something. We don't know what they're going to ask. They might ask for Friday afternoon off at 4:00 PM and you're like, “Let's do that.”
I like what you said about things that you can add because there are some things that maybe as smaller practices that we can add to the pot, if you will, if you're trying to woo a candidate that maybe other larger entities can't provide. That is maybe the ability to pursue a particular niche or treat a certain demographic of patients. Maybe provide time off to work at certain places within the community that you could leverage to then increase the patient volume on their schedule, something like that. Those are things that we can leverage as small practice owners, and you talked about this before we started the interview. It's important for us to play to those strengths, especially going up against larger chain practices or corporate settings that might be offering other things, even larger salaries. Maybe we have to stick within our realm and offer other things that maybe those companies can't provide.
A lot of our private practice clients are quite concerned on the salary side. How am I supposed to compete with the larger hospital systems? They have deeper pockets, they have higher reimbursements, better benefits, things like that. Playing to your strengths is the best approach. Private practices offer a great mentorship opportunity where you can play into that card. We want to be the best physical therapists in this community, and we will work with you and mentor you and you will exponentially grow in your skills here. That's one angle, that professional development piece. Another card would be flexibility as well. Like our company here at Career Tree, we're quite small but we offer a great flexibility. If you want time off any day, any time, go ahead, take it off. That's perfectly fine. A larger company would have policies and hoops to jump through and that is annoying for folks. That’s one other thing on the strength side. Some of the smaller clients that we have, they don't offer like health insurance, for example.
My recommendation on that would be to have a stipend earmarked on the paycheck that has a wellness stipend that can be used for a wellness benefit or health insurance where your employee might be able to purchase health insurance on their own via the exchange. If you don't offer health insurance, I feel like in order to compete apples for apples, you should still do la certain amount of money earmarked for that wellness stipend so that the employee can compare. “They're not offering me health insurance, but they do have this wellness stipend.” It helps equate the two offers. Some clients will say, “We don't offer health insurance, but we try and pay our people a premium rate.” That's fine but that money should be separated out in that separate bucket so that the candidate can see it clearly as a benefit to them.
They recognize the full value of their compensation. Maybe I can get your two cents on this since you're talking about benefits and that can be a huge issue whether or not someone joins you. I've sat in a presentation by the guys from Paychex. They provide payroll but they also provide HR support and they can help you with all your onboarding and your contracts that are reviewed by lawyers. You can also enroll in what they provide health insurance-wise. Because they have a large network of small business owners, their premiums can be lesser. Have you had any experience with a company like ADP or something like that where they provide benefits? I wonder if you've seen anything from your angle.
I know some of our clients are enrolled in similar programs where it's more of like a group plan. My personal preference and maybe from employing people here and maybe from a candidate perspective would be it's a lot cleaner to offer a candidate that money earmarked for the wellness benefit and then they can do whatever they want with it. If they get insurance through their spouse or maybe they're younger and they're still on their parents' plan. Because when you do those interesting health benefits, I don't want to name names, but there are some that they're not that great where the candidate would say, “The health insurance that you're offering me is very low quality versus what the larger hospitals are offering me.” Rather than comparing health insurance plans, it's better to give them money and then they can use that money for whatever they want.
I wasn't planning on going into this too much. If we didn't offer full health benefits, we would also offer what is called Teladoc benefits. We got ours through redirect health and that gives you 24/7 access for a phone call to any physician at any time. You talk to them about your issues and they can also prescribe medications and send the prescription directly to the pharmacy for you to pick up and offer $100 or $150 or something like that per employee per month. You can provide those types of benefits and I believe it falls underneath the Obamacare guidelines if you're greater than 50 full-time employees. It’s something also that's out there that you can utilize and not have to buy a full-blown healthcare plan for each employee that could cost you $500 a person. It’s good to recognize that there's a telehealth option out there. I actually love it because then I don't have to make an appointment with my doctor and take my kids in and all that stuff. I can call them anytime day or night and Facetime me if they need to see, I don't know, a rash or a cut. Nonetheless, we're getting a little bit off topic. Sorry about that. I like what you're talking about as far as working with that person and making sure speed is a part of the process. Would you ever recommend someone have an offer ready to give to the candidate in person?You don't need to wait until the candidate is ready to receive the offer if you know that the candidate is a good person for the job. Click To Tweet
Yes. That's a great option to do it when they're on site at the interview. If you have the interview scheduled and the candidate is coming in, you can have the offer ready to go and give it to them at the end of the interview day while they're there. That impresses a candidate that this practice is interested in me. You're covering the speed basis. They might accept it on the spot based on their positive experience from the interview and the job shadow. The only other piece of advice with that is some organizations will do reference checks or background checks and the fear would be, “If I extend the offer, how am I supposed to do reference checks and background checks?” You can have the offer contingent upon successful completion of the reference checks and background checks. We're extending you this job offer. It is contingent upon your licensure in the state that's contingent on your graduation from PT school. It’s contingent upon whatever else you need, but you're still offering them that position or giving them all the details at that point.
More than likely, extending them an offer in person isn't at the first interview unless you've done a ton of maybe conference calls, video conference calls or multiple calls on the phone. I'm glad you said after their onsite job interview because maybe you want them to work within your facility amongst the other providers and patients for a couple of hours so you get a feel for how they work in the environment and how and what the other people think of them. I could see where this might be completely appropriate after you've had a couple of those types of phases that they've been through in the interview process.
We do recommend doing the onsite interview in one day because it's very difficult to get the PT back and do a second day and oftentimes a candidate will drop out of the process if you say, “I want you to take another half day off of work and come in again next week.” That's not feasible for some candidates where if they're already there, I would say, “Let's do the job shadow,” or do whatever you need to do on the day when the candidate is visiting. You might not fully be interested in a certain candidate, but they can still do the job shadow. You might as well have them do everything on the same day. That way they don't have to try and come back. You don’t have to schedule it.
On the delay side, there will be less delays between the steps because every time that there is a delay, that candidate is considering other employment opportunities. Those delays are very important to minimize in terms of the sending the job offer in person. If that's not possible, the next best option would be doing it over the phone. I would not recommend sending it as a blind email. “Thanks for your time. We'd like to extend you the offer,” because you want to be there either in person or on the phone when the person first learns that they're going to be receiving that offer. Because then you can answer their questions and you can clear some things up right away and maybe get the process through to closure.
A lot of our clients would email the job offer, “We decided to offer the position to the candidate. We didn't call them or bring them back in person. We let them know via email that we were going to offer it to them.” That causes some delays because did the candidate receive your email? Did they open it? Did the attachment work? The candidate can wait and they can reply back at their convenience. Also, candidates are more likely to negotiate. They're more likely to feel empowered to negotiate job offers via email or text message, which could wind up costing a lot more in terms of wages and benefits if you negotiate via email because the candidate is more empowered to ask for things.
I can understand that. If I recall our process, we usually call and say, “We want to offer you this position. Look for an email from us.” You're saying you take it a little bit further and say, “We'd like to offer you the position.” Would you get into the details during the course of that call or would it be sufficient to say, “We're going to send you an offer. If you look in your email right now, it's there.” How quickly do you want that to happen, so we minimize that time distance between the interaction?
I would say the best practice is to extend the offer via the phone and actually go into the details, go into the most important details. “We enjoyed meeting you. I'm calling to offer you our position here. We're excited for the opportunity to work together. For a start date, we're flexible on that based on your preferences. For the hourly rate, we were looking at XX per hour. The benefits would include three weeks of PTO. How does that sound?” and go from there. You can say, “I'm going to follow up with the offer letter via email. It sounds like you need a couple of days to look at it. That's great. let me know as soon as you can because we'd love to work out with you.” Trying to get those questions answered as well right away is important because a candidate might not feel comfortable or might delay the process if there's emails going back and forth on questions and stuff.
If you can knock it out during the course of a phone conversation, then that could save you days of emails.
We’ve seen a lot of candidates that accept the offer right there on the phone. They don't negotiate. They accept. On the negotiation side, I may have talked about this last time, but a lot of newer grads are uncomfortable negotiating. They basically take what offer is given, which is from a business perspective, that's a good thing in some ways. Because PTs are in such high demand, they're not going to necessarily go back and negotiate with you. They're going to accept whatever else is out there that's better fit for their needs. We always recommend to aim high with the offer process rather than trying to low ball and say, “We're open to negotiate. Let's offer what the wages to as much as you can on the initial offer and leave it from there.” We can't risk the candidate not wanting to play ball and do any fancy negotiations. Because then we're going to maybe miss out on that person.
You imagine what you might gain in offering a lower salary. You could potentially lose out on them finding out that they could have gotten $5,000 more if they went over here and that being an issue down the road. What does that cost you to replace that person? If you low-balled and they're more than likely going to get a higher offer somewhere else, you might as well add onto your offer in the first place and thus avoid the possibility of losing that person, especially if they're aligned with you and you see a future with them in your company.
The wage from the employee perspective needs to be competitive. You can certainly play to your strengths like we talked about before, adding in some fun benefits that a larger company might not be able to offer.
That's part of the interview process. I talked about it a little bit with Kim Rondina. You want to find out where they want to go on the future, what do they want to do with their PT? If they're looking at particular things that they want to do specifically, that's maybe also during the course of that job offer where you highlight, “This is what we can do for you. We can provide mentorship via this channel. We can provide continuing education specific to this specialty that you're wanting to do. We can provide some bonuses that can be tied to student loan repayments.” That sounds like a big thing nowadays because every student’s coming out with hundreds of thousands of dollars in debt. As you not only explained the benefits, you also might want to take advantage of taking the time to explain the value add that you provide as a small business owner compared to other facilities they might go to.The people that you work with are your relationship. Click To Tweet
Just one other point that I had on the offers and related to the business owner side is when you're extending the offer, try and remove the emotion from it. We don't know what's going to happen in the future in terms of will that PT stick around? Will they leave and go and work for somewhere else? There's a lot of fear and emotion around that job offer process and that often leads to the hesitation. Should I offer this candidate position? A larger organization, they're able to oftentimes move quickly because they don't have that emotional side. We often see it as well in terms of maybe holding out. We've had a few clients that we've had a lot of people interested in their position, but they're holding out for a rock star unicorn person coming forward. Not every candidate is going to be the next award-winning physical therapist. Not to say that you shouldn't hire a quality person, but if you have a job that's open, you need to evaluate candidates. Can this person do the job? Will they do it well to a certain extent? Will they meet the needs of what we have? That emotional piece sometimes comes into play.
The best way to get around that is to have other input within the hiring process so it's not you as the owner making the decision. You have your administrator or you have other PTs on your staff that are helping you like a panel discussion where the quality of the hire would increase if you have more data points and more people giving their perspective. You remove yourself a little bit. You obviously still make the final decision as the owner but to have more data points. It helps to remove that emotion in the process.
Maybe stepping back and saying, “What I need is a staff physical therapist.” If that person can perform that job and maybe you don't see a higher trajectory for them and you don't project them to be leaders, then maybe that's okay. Not everyone has to be leadership quality. I surprisingly had therapists who I didn't think would do much leadership-wise become clinic directors and killed it. Because not everyone has the personality where they're going to come out and shine and show a ton of charisma and be flamboyant and confident and know exactly what they want to do and how they're going to do it. “This is how I'm going to rule a team.” Not everyone's like that. If you're simply looking to add PTs on staff, you don't have to have the unicorn out there. Maybe you can suffice with a very solid rock star. Maybe not even a rock star. A very solid person who simply aligns with your values and that's okay too. Those people can have places within your company.
As your clinic grows and you're looking to add additional people, there's a business need to have additional staff. That business need, if you need to hire someone at a certain point in time, there's only a certain group of candidates that are potentially interested to join you at that time. When you're recruiting for a position and a given window of time, you're seeing the interest in candidates at this moment who can join your team, fill your position, help with your utilization and etc.
Is it only in that given period of time?
Down the road. If you wait six months, you'll have a different pool of candidates at that point. We need to be more business minded with the hiring process.
That goes back to what was successful for my business partner, Will Humphreys, and I especially as he was doing the recruiting, is that we're always recruiting. We're not going to limit our scope to this period of time. We're always taking candidates. We always have an ad out. We're always open to take resumes for physical therapists. That way, when someone does come along that is the unicorn, it's not only when we have a position available, but it's at any time we're open for that person to come into our clinic.
Not having that networking mentality and being willing to talk to candidates even when you're not actively looking. Are you still willing to you have a PT contact you? Are you still willing to talk to that candidate and maybe help them get connected with another practice area or to save their resume for your future hiring? Maybe they want to come in. Maybe they're a newer grad and they want to come in and do a job shadow. Would you be open to support that student or that recent grad and have them come in and network with you?
That puts you at least in a position of power where we actually had people on the bench waiting to get into our company. People who would tell us, “When you have an opening and a position in your company, I'd like to be considered please.” That puts you in a position of power so that when someone does leave, and inevitably someone does do so with short notice, we have a pool of candidates that we could pull from that had already been vetted. That changes the dynamic and it puts you in a different position altogether to find the next great person to join your company.
Some candidates are not in extreme hurry. We have a situation right now with a client where they do have a candidate waiting to go in basically. The candidate is continuing their current employment, and everything is fine. Once the situation opens and the clinic becomes available, it's intended that they're going to join the team. You never know what's going to happen. At least have a few people on the sidelines. It's great.
It makes a big difference. Thanks for your insight on that. We talked last time a little bit about recruiting the PT. I don't remember us taking it all the way through to how do you get them to accept that offer. These are some important tools and tips to make sure you carry that ball all the way across the goal line.
It's important. Obviously, we know once you have that candidate, you've interviewed them, you see them as being great and how do we seal the deal and actually get it going. Especially when you have larger organizations with more sophisticated HR and recruitment procedures, the PT is going to have multiple job offers as well. Getting out there and getting there first would be ideal.
Thanks for your time again. If people wanted to get in touch with you, Brian, how would they do that especially if they're looking to get some help for hiring PTs?
We still have our website, CareerTreeNetwork.com. We also added HireAPhysicalTherapist.com as our second website, which is more employer-focused. There are blog posts with strategies, information about our service as well. People can actually book a call to chat with me right on the HireAPhysicalTherapist.com website. I'd be happy to talk. I know I'm not a salesman per se, so I'm happy to chat about this for free. Feel free to book a call and we can chat if anybody’s interested.
Thanks again for your time. I appreciate you coming for a second go around.
Thanks a lot. It's a lot of fun.
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 princesses with his daughters, watching heist movies or eating sushi.
I’m interviewing Dr. Jamey Schrier. He’s the Founder and CEO of The Practice Freedom Method, a business training for physical therapists. After Jamey grew and sold his multi-location PT business, for a price often reserved for businesses quadruple in size, he began teaching other PT owners of all clinic sizes how to grow and scale their practices while improving their quality of life.
Jamey shares his proven methodology with other PT owners using timeless business principles combined with his best practices that he has learned in over twenty years of business. He has personally coached over 70 private practice physical therapists to create their dream practices. He has a book called The Practice Freedom Method. Along with signature programs, he has helped hundreds, if not thousands of physical therapists achieve their dreams.
I’m excited about presenting this interview with Jamey to you because of a couple of things. I love a quote that he shared and that is, “Different is better than better.” You can take that into almost any aspect of your business, whether it's marketing, hiring, getting the right people on the bus. Many times, different is simply better than better. We'll talk about his five-step hiring process. It's part of his Practice Freedom Method that we delved into. The five-step hiring process goes through figuring out what your ideal person is, the values, attracting those people, interviewing and qualifying them, onboarding them and training/empowering them. I’m excited to bring you the interview with Jamey Schrier.
We're talking to Jamey Schrier in Maryland. Jamey's a successful physical therapist and current consultant and coach. I’m excited to bring him on simply because of his success story and also some of the insight that he has in working with physical therapy owners. Jamey, do you want to give us a little bit of your backstory? What got you into physical therapy and ownership in particular? Bring us up to speed as to what you're doing.
I appreciate you having me on. I appreciate being here. This is always fun for me. It’s always fun to connect and try to impart a little bit of all my mistakes that I’ve made over the years. I try to help someone to avoid some of those time, emotional and financial mistakes.
Thanks for being here.
My story is one that like most people I wanted to have a business. I always thought of myself as a business owner. I had that entrepreneurial spirit as they say. Several years after outside of school, I finally was able to muster up enough guts to say, “I can make this happen.” Like many people I’ve talked to and spoken to, it's just me. I put out my shingle, Schrier Physical Therapy. My fiancé, my wife now, Colleen, she was at the front desk. It was just us two. I had a couple of people feel sorry for me, like family and friends. They would come in and see me even though I was out of network with most of their insurances. People started to refer other people. The number one marketing strategy we all have at that point is word of mouth. In a short period of time, probably around six months, I was making good money. I was above from what I was making at my previous job.
That lasted for probably two more years. I started to experience what I know a lot of people experience and it was heavy into me. I started to experience some anxiety. I started to experience some angst towards this business. It wasn't that I stopped loving treatment because that wasn't the issue. I started to dive into areas that I wasn't comfortable or familiar with. I started to hire people because we needed help. My wife was pregnant, or we ended up getting married and then she is pregnant. We had our son coming, so she wanted to take some time off. I started hiring people. Insurances all of a sudden started denying payments, whereas before it was fine. Patients were not necessarily paying their copays and deductibles. All these areas of the business started to emerge as the company started to grow. I wasn't prepared for that.You have to let go to get to the next level. Click To Tweet
I started to get anxious around that. I started to become less than happy the situation I was in. The only solution I had at the time was to work more. Instead of being home more with my wife, I was at the office a lot. I got up at 6 AM. I was at the office by 7 AM. I was home by about 8:15 PM. It was a lot of hours. I wasn't off on the weekends, I was doing some notes and thinking about the business. There was no clear time away. It was a combination. Some crazy thing happened. We had a fire in our place and the place literally burned down. It was wild. I saw it as a sign. I saw it as, “If I couldn't make a decision to do something about it, I guess someone made a decision for me. What am I going to do now? Am I going to stay in this business? Stay in this whole field? Am I going to maybe do something else because I was that unhappy?”
I bet somebody has had their fire, whether it was a fire, whether it was something else that made you like, “What am I doing here? What am I going to do moving forward?” To me, it was the fire and this forethought of, “Where do I see my life ten years from now?” All I saw was working just as much, if not more, not being with my family and not making the money I wanted to with declining reimbursements. I started to realize that these are all the reasons that I wanted to get into business. I’m saying, “I’m not going to get any of this stuff.” I took all the risk. I put all the time in.
I’m like, “This is ridiculous. This is not what I wanted.” To fast forward, I made a decision. I talked to my wife and said, “I know I can do this. I know I can make this into business. I just have no idea what to do.” I started searching around for programs, for people, for coaching and mentorship, everything. I was willing to invest. Prior to that, I literally read a couple books. That was my entire investment in the business. I was like, “I don't care what it takes. I’ll either do it or I’ll fail trying. I don't care. I’m going to find out how to make this happen.”
I didn't see anybody doing what I wanted to do. I didn't want twenty clinics or 50 clinics. I know how you can build a business with 50 clinics. How do you do it with one or two? How do you create where you have time, be with your family, do the things you love to do in your business and still make money and have an amazing quality of life? To fast forward that, when I made that decision, it took me nine years and a lot of money. I invested $300,000 of my own money into all these different types of people. Most of it outside of PT, because there wasn't anybody inside the PT who was doing it the way I thought it should be done.
In January 2013, I completely removed myself from the schedule. I did not see any patients. I had a great team in place. My business shot up 18% in that year. I didn't treat one person and took 137 days off. I went, “This is a big deal.” That's when I moved into what I’m doing with business training and coaching other people. I hired a coach to say, “Can you help me capture what I did? I know what I did. If I don't capture it now, I’m going to forget. I bet there are a lot of other people want help, who wants to know how to do this, who wants that freedom, that money, control and all that in their business.” Since 2013, that's what I’ve done. I wrote a book, The Practice Freedom Method. Now, I teach and coach all kinds of business owners from all over the country. That's my story.
Your story is not uncommon. It takes some flexion point, a bottoming out if you will. In your case, it was your fire for you to recognize, “I don't have the stability and freedom that I was looking for.” That's why you opened up your clinic or branched out on your own. In my experience, I saw other family members who own their own practices while they were outside of physical therapy. These were the guys who had financial stability in their lives, the time to do things with their family, freedom to be with their family and to pursue the things they wanted to do.
In the same boat and a lot of my interviewees experienced the same thing, we get to a point where, “I don't have any of that that I dreamed of when I opened up my clinic. I’m at this point where I’m hating the ownership. I’m questioning what I’m doing. I don't know what I’m doing because I don't have any business knowledge, “How do I get out of this rut?” Your story’s in line with many other independent practitioners and I feel that there are many more out there that aren't at that flexion point yet. I want to scream at them. I’m sure you talk to them on a regular basis as a consultant coach that you want to say, “You don't have to go through that. There's a better way.”
You don't have to go through it. Never tell someone business is easy, but it's a heck of a lot easier when you know what things to avoid and you know what things to focus on. You still got to put the work in. It's not like business is work. What I’ve figured out, what I determined in my own experience of making a million mistakes, I feel sharing a mistake is a lot better than sharing like everything went perfect, because it certainly didn’t. It's a whole lot easier when you have a plan, when you have a path and you have somebody that's been there before.
A lot of times we realize we're not in the position we want. We look around and see everyone else struggling, so we think that's the way it is. We've tried something in the past and we're like, “I tried hiring people, that doesn't work,” and we start telling ourselves these crazy stories that puts us in a place of acceptance. That’s the worst place in the world to ever be in is a place of acceptance, a place of comfort.
We're business owners. We're entrepreneurs. We are here to make a difference in our communities. We're here to help people. We can’t help them if we don't continue to strive to be better and everyone can be better. I made a bazillion mistakes. I did everything wrong. No one will do it as bad as I did. I’m fortunate to work and meet some incredible people that are doing it in a heck of a lot less than nine years. I talked to people and it was twelve months from going into overwhelming craziness to, “I’ve got good financial stability. I’ve got time. I’m not in the clinic 24/7. I have a work-life balance.” What I want to get across to your audience is, it is possible, and it is possible for you, regardless of your current situation.
You said you're talking to people that have made that successful switch. I know you have a number of things in your Practice Freedom Method that you speak to. There are seven steps, is that right?
Yes. Our success path or the Seven Steps to Practice Freedom follows a clear path. When I developed these seven steps, when I uncovered them, I realized that when you start a business, these are the seven things you have to know and in relatively this order. The first step is understanding what the principles are for a successful practice. Every successful practice out there, and every successful business out there, there are certain principles they have. Regardless of the type of business, regardless of what they sell, their product or their service. We call this mindset. Really getting your mind around what these principles are. These are the foundation principles, that’s step one.
Step two is once you understand this, once you’ve identified your ideal client, your target audience and understand some of the core things of where you want to go, it's all about referrals. Without referrals, you're literally twiddling your thumbs in your office doing nothing. There are plenty of people out there. I don't care if it’s competitions in your area. I don't care where you are. We have people in the middle of seemingly nowhere in Nebraska, in Iowa and in New York. It doesn't matter. There are plenty of people. Referrals are one.
Step three is once you have the referrals, you’ve got to make sure that the people come on the schedule, the plan of care is addressed. The cancellations are low, the dropouts are low, and all that stuff is there. That's patient engagement, step number three. After patient engagement, chances are you're going to need people to help you. Hiring is step number four. After you hire people, your time is going to go crazy. You're going to get into that overwhelmness. You're not going to be able to manage your time correctly. People are going to be pulling at you from every direction. Step five is time mastery.
At a similar time when you have this bunch of employees in place, you've got to create a team. It's all about creating a team and team building because the team is what sets you free. You can only do so much. You’ve got to help other people. That's step six. Step seven is financial mastery. Literally understanding and dialing in your metrics. That's probably the only one that we touched on earlier in our program. We want people to get some clarity around their financials, but it is an important one. Those are the seven steps. Even if you do those seven steps poorly, your business will still expand because I’ve done them poorly and it still works. That's what Practice Freedom Method and the Practice Freedom U is all about.
There's a lot of stuff that we can do well. To some extent, even as physical therapists, we can learn to manage when you look at getting referrals, putting yourself out there and doing some salesmanship. Getting patient engagement, those are some things that you can develop in your first few years. The two things that we specifically want to talk about in this method that you have is the hiring process and then what it takes to create a team.
Those are intricately involved. You’ve got to have the right people on the bus. Put them in the right seats to make sure that you're all running in the same direction, that you're aligned and to eventually get to that point where you can experience some freedom. If you don't have the right people in place and you haven't created that team, your hair's going to be on fire essentially. Running around trying to put out the other fires.
Most people will put it out there as, “I need more patients.” The calling card of the typical business owner is, “How do I get more referrals?” I've never met someone that said they needed more referrals that didn't already have referrals. The best way to get referrals when you just started is to use your network, use word of mouth, deliver great care and you're going to get referrals. It's not that hard. The big challenge is when we start hiring people. The reason you need so many referrals is that of the inefficiency of the business. The lack of communication, the lack of clarity within the business and that all starts with hiring.It's better to be different than better. Click To Tweet
I’m happy to talk about hiring because I believe hiring and team building, empowering your team are the two areas that most, if not all business owners, have the most difficulty in. I would even venture to say that if you had a good team, you’d be able to generate referrals easier. Referrals aren’t about a fancy strategy. You don't need some fancy digital marketing strategy. All that stuff is great, you just don't need that initially. You can do so much without that but you can’t do any of that without a team. Your time is already taken.
What is your secret for hiring A-team players? How do you consult and coach people to find the people that are going to be as interested in the success of your company as you are?
The first mindset thing I'd like to share with everyone is the idea of you have to look in the mirror and say, “I can't do this by myself.” You have to get it in your own head that, “I need help.” That is tough for us to get into our own heads. The reason why is because as physical therapists, as people that have been smart, intelligent their whole lives, successful in the academic world, you didn't have help. You studied your butt off. You sacrificed. You have been literally the top of your class. To go from that, and I know this was one of the biggest challenges I had because I’ve got an ego. PTs have an ego.
It's hard to say, “I don't know how to do this.” It's hard to turn in the same sentence of, “I’m the best. I’m the most talented clinician,” to, “I don't know how to run a business though that delivers quality care. I just know how to deliver quality care.” Having that conversation with yourself and you accepting that is huge. If you don't accept it, no matter what I say it’s not going to matter. When you accept it, the next thing you have to then agree to is, “I will have to let go in order to do this.” You have to let go to get to the next level.
I had a client, Becky, in Nebraska. We were talking about she wanted to reduce her treatment hours. She was treating 40, 50 hours a week. She had a great employee on board. I said, “Seriously, why don't you look at bringing this person on as a Clinical Director? Promote them and then you can immediately reduce your schedule by three days.” She's been trying to do this for two years. She goes, “Jamey, he can't treat as well as I do,” and I said, “You're right and he never will be able to have the chance unless you give him one because you'll always keep him down. Your ego is bigger than what you want.” She said, “You're right. Let's do this.”
Within a few weeks, her schedule went down, his schedule got much more efficient and he started taking over a lot of the administrative things around as a Clinical Director. He was hitting better numbers than she ever did. The clinic was more profitable because they were more efficient, and more utilization, she was treating less and working fewer hours. That didn't happen because of some strategic thing. That was a mindset shift that she was willing to let go. Those are the two big ones. The actual steps involved, there are five of them.
In that example specifically, there was somebody already on her team that was able and willing to take it to the next level if they were given the chance. Sometimes it's hard to find that person to bring them on in the first place. Especially as you're looking at some of your admin staff, you're thinking, “I can hire anybody $10, $12, $14 an hour to sit at the front desk.” How do you get some of those people as well? Let's run through your recommendations.
We call this our right fit hiring process and it starts with identifying your ideal employee, your ideal candidate. Most of us hire out of reaction. We hire out of necessity. In other words, someone quits, we hire someone. We're overwhelmed with treating and answering the phones and dealing with everything else, we just hire someone. It's usually a patient or a patient's son or daughter. Like me, I hired my wife, my fiancé at that time when we first started. That's okay as a Band-Aid but I don't highly recommend doing that. There are a lot of reasons, especially family members. Unfortunately, it rarely works out well. Identify your ideal client. What are the characteristics?
This isn't just who the ideal therapist you want or front desk. Who's the type of person you want working? Many times, we don't dive into those values. We have a value system in our company. I have a value system in which I operate in my life. I want to make sure someone else's value system is in line with mine. My value system is gratitude and appreciation towards others, being on time and doing what I say I’m going to do in someone else's time. I’ll show up when I want to show appreciation. They should be thanking me. If someone has that type of value system, their résumé could be the greatest in the world.
That in-person interview, if I start hearing that, I don't care how great their résumé is. I know this is going to be a disaster. The biggest challenge we have are the people that we work with who already have hires. They’ve already had some people and those people are not on board with what they're doing. Most of those people are good people. If you tightened up some systems in place, it's fine. Hire slow, fire fast. You do not want to mess around because where there's smoke, there's fire. There are tons of things that are happening. If you get wind on some of these things that your gut tells you and all that.
If these people aren't aligned with you, it's important to get them off the board quickly. They're not bad people, you're just not aligned. If we as practice owners recognize that those people, especially if they're the ones handling patient engagement, scheduling, click copays and deductibles, they can lose us a serious amount of money with every patient. If we were able to monetize the amount of money we were losing on those people who aren't aligned with us, we would fire a lot faster than we do.
Think about some of the doctors you go to. We all go to doctors on some level. A lot of those doctors look at their front desk people. Would you want that person working for you? The person that's sitting behind, you're interrupting them because they're talking to somebody. They don't say hello, “What's your name?” They say, “Hello, give me your insurance card.” You’ve got to realize it's not their fault. That is the person who was intentionally hired by whoever their supervisor is.
That's how they were trained or not trained. The doctors are a little bit different. Is that how you want your office to be? You may not know that it might be coming off as a little bit of that. By getting clarity around the values, the characteristics and the qualities you want anyone to be, that becomes a huge qualifier in knowing who the right fit is and who's not, before you even dive into the specific skills. Write down what characteristics, qualities and values of someone who is working for you or someone whom you eventually want to work for you or the ideal person you would want to work for you. Step number one.
Step number two, how are we going to then attract this person? I am a firm believer in the Law of Attraction. Whatever you put out there comes back to you. If you put out certain things out there, certain communication, you're going to attract people who may not be the people you want to attract. The ad you have out there. Is your ad generic? Is your ad saying the same thing that the hospital down the street is? Does your ad say something unique and differentiates you from everyone else? It's better to be different than better.
Being better than your competition isn't better. You want to be different than everyone else. You want to differentiate yourself. The way to do that is to use some of these qualities that you've written down and start crafting your ad in such a way that it brings this up. It brings the quality. This position is right for the person who believes in this and believes in that. You want to start using that in your ad because you're not going to see this in other people's stuff. The hospitals are going to talk about $5,000 sign-on bonuses. That’s great and you're never going to compete with their budget, so let's not try. Although people want to be paid fairly, the right people who come into your practice want to be a part of something more.
Identify your ideal candidate. Attract the right person. Have a qualification process. A qualification is an interview process. Once they're hired, onboard them. Once they're onboard, empower them, another word for training. One of the things you can do to attract this person is picture where this person is. I love doing this exercise with our clients. I’d say, “Close your eyes. Where is this ideal, perfect employee? Where are they right now? Are they just graduating from school? Are they in a corporate setting? Are they in another PT setting like yours, another private practice? Are they in a home health setting? Where are they now? Why would they want to come work for you?”
What it does is help you get your mind out of yourself into their mind. In other words, they might be in a job where there's no upward growth. If your company has an upward growth, then you want to mention that in your ad. If they're unhappy because they're seeing four patients an hour and don't feel they're giving quality care and your company sees one or two an hour, then you want to bring that up. We call those pain points. You want to bring these things up in your ad. The reason you do this because it grabs their attention. With someone looking for a job, what they have is a million opportunities. There are many jobs out there.
How are you going to differentiate your ad? You do that by posing a question, “Tired of seeing four people an hour and ready to deliver quality care to your patients?” Something like that or, “Do you feel there's something more for you and there's a lack of advancement at your current position?” That's someone that maybe you're looking for a senior therapist position or Clinical Director. You want to get into, what are the frustrations and challenges that they're going through right now and how can you craft that into your ad? There's obviously more to it but that's the essence of it. If you can do that, even if you do it poorly, it will be better than the ad you have now.You are the people that you coach. Click To Tweet
Step three, qualification. This is huge because even if you do a crappy ad, ultimately your qualification process should weed out the bad people and allow the good people to come through. Allow your A-players to come through. What I did over time is I created a three-step process to qualification. I used to just do one. People come in for an interview. I interview them and because I just wanted to hire them and get it over with because I had to do other stuff that would be it. Now, I developed a three-tier process which helps weed out people and it lengthens the hiring process intentionally.
The first one is I do a very quick call interview. On a phone call interview, if you have a question about their résumé or they had a gap in their employment, you want to ask them about that. You want to ask them about, “I see that you are interested in our position here. What attracted you to our ad?” You want to know that they saw your ad. They read the ad. They had an interest in your company versus, especially when you hire administrative people. I can't tell you how many administrative people are literally applying for positions because they're on unemployment. They have to pretend they're trying. I’ve talked to many of those. When I started saying, “What attracted you to our ad?” They went, “What was that ad that you had again?” I went, “Thank you.” They had no idea who I was. They sent their résumé to 50 people.
I found those calls to be valuable and such a time-saver. If they had some qualifications, I'd call him and say, “Let's get you in for an interview.” Instead, I took a little bit more time on that phone call to say, “Tell me a little bit more about this, tell me a little bit more about that.” You get to know their phone voice, you get to know their energy level and you get to know a little bit about their personality. You've already got this idea in mind. A lot of that can be gathered over the phone. If this person is going to be on the phone a lot, especially for those positions, you want them to be engaging on the phone with a kind voice and an interest in a high tone level.
You can filter out and save yourself so much time in the interview process if you can weed those people out initially on that few minutes on a phone call. You can save yourself that hour where you're going to block off the time and you can tell right off the bat that when you bring him back that it's probably not going to work, but you're going through the motions essentially. So many of them are putting ads out there, they don't even show up for that interview and you blocked out an hour. That initial call can be so much of a time-saver.
The reason I created this type of process is that I always like to look at alignment, like the spine. When a spine’s out of alignment, they're going to have pain and problems on the area. When the résumé doesn’t match the phone call, when the phone call doesn't match the interview, when the interview doesn't match the shadowing, when that isn't in alignment, there's something wrong. There's a yellow flag or a red flag going up. If you only have one segment, one thing, you don't know if it's right or wrong because you have nothing to compare it to. That's another thing that this does. This is their best foot forward.
If they don't sound great on the call and you're hiring a front desk, don't think it's going to all of a sudden magically improve. It's what you're going to get. That leopard is not going to change their spots. It is what it is. If they're nice on the phone, if they're engaging on the phone, they show up in person, they're dressed well and they're engaging, you're seeing a pattern. It's who they are. It gives you more confidence that this is the right person and it gives you confidence if it's not the right person. it's a time-saver for both of you.
That's the most that people talk about. What questions do I ask? You can type in interview and get a million questions. Instead of going through all of that and repeating it, I’ll say this. I would definitely include some questions that have to do with the future. There's a lot of psychological research around this. You want to put the person in a future situation and ask them questions about things. For instance, “Nathan, let's say everything worked out. You came onboard here and it was great and a year from now, you left.
From your vantage point, what most likely would be the reason that you would leave?” What that does is A, it forces you to visualize you here. B, it says clearly that you now left. What is coming to your mind of why that would be? “More money,” which I’ve never had someone say, believe it or not. Even though my mindset used to be, people always leave because of money. That's bullshit. They don't always leave because of money. Sometimes they may but there's usually something more to it. Very rarely, unless you're literally paying way below the market. If you're paying fairly, they're not going to leave because of money. There are going to be other factors included.
One of the stories that I want to share is I was looking for a PT for one of my clinics. I asked that question and she said, “Probably within a year, probably nothing. In two years, I'd probably leave because my husband would be relocated to Germany because he's in the military.” I’m like, “Tell me about that.” We went on this whole tangent of her husband in the military and what he does, which connected us even more. The great thing was we ended up hiring her and what happened? Two and a half years later she said, “Jamey, my husband got relocated. We’re leaving.” We put party for her. It wasn't a surprise. It was something we were all prepared for. We had a great relationship. We still talk. We still keep in touch on Facebook. That is a different relationship than if all of a sudden, she goes, “Jamey, my husband, you don't know him. He's in the military. We're leaving in two weeks.” There are many people that are blindsided by that. These few future-based questions are a big one that I ask.Doing it later is not going to make it easier. You got to get started doing something now and move forward. Click To Tweet
What a great gift you gave to her to allow her to speak into that. That then blessed you because you knew from the get-go that she wasn't going to be there forever. You could plan it. Like you said, you were prepared for her leaving and what a gift that was to you to know that ahead of time, so it wasn't a surprise. If you had it scheduled out, you could start hiring again, soon before she left and work out smoothly. That question alone in your interview was a successful action that paid off for three years, in your case.
I couldn't ask if she was married. I couldn’t ask about her husband, but she brought it up. The moment she brought it up, I asked her questions about it. It connected us on a deeper level than just future boss, owner, PT and staff PT. This was someone who was married, someone who has a husband and the husband was serving in the military. We went down roads that we would never have gone down with my typical questioning, “What are your strengths? What are your weaknesses? Why do you want to join Schrier PT?” Those questions are fine.
The biggest thing that I will take out of this interview process and the ones that I try to hit home to business owners are not the questions that are powerful. It's the nonverbal communication. It's the feelings that are transferred with that. You could say all the questions perfectly and you still wouldn't get as much if someone that was in tune to people. You want to make sure you're in tune to that. The minute she opened up, started answering that and her nonverbal, she opened up her arm. She went, “Hey,” and had started. I was like, “We’ve got ourselves our next person.” It was a done deal and she felt the same way. “I’ve got myself my next job.”
The final one is shadowing or we call it a work interview. I call shadowing when it's clinicians because you can't have them work. I would not have them work because of the insurance and legal reasons. It's more of a shadowing, but if it's a front desk, you want to get them engaging. You want to get them, “We answer the phone like this. Why don't you take the next call?” You want to see them in action. Do they stand behind the counter with their arms crossed? Do they try to jump in and be like, “Ms. Smith, hopefully they'll hire me. I’m here on interview.” That gives you a lot of confidence.
The people that I found I was impressed with were the ones that came with a notepad and pen in hand. Those people are the ones that I saw them come in, I thought, “You're ready to work. This is serious for you. You're ready to take notes and see how we're doing things.” Especially those that were engaging with your patients right off the bat. They didn't sit like a wallflower just biding their time because I’m here. That says a lot about a person.
We even had one interview come in and talk about how she was hung over that day from partying the night before. This person was engaging on the phone with the phone interview and the in-person interview but as soon as she did that, she was off the table. I was glad that we had the working interview for her. It's in those situations where they're talking peer-to-peer and not to a potential suitor or employer. Where they open up a little bit and then your team can tell you things that she wouldn't have told you in an interview.
That's the biggest point of the shadowing. The shadowing isn’t about you. Even if you're the only PT there and you're having a clinician, get someone else in the clinic. Get his friend, get a spouse and get someone there because they bring a different perspective to it. A lot of time we have fixed ideas, we have negative biases. We have filters in what we see. A lot of times it's because we want something to happen so badly. We forget certain things. To add another point, my wife is great at this. She sees quality. She sees things and then says, “Don't hire that person.” I go, “No? He seemed nice.” She would tell me all the signs she saw that said this person's crazy.
When I started listening to her, things worked out. When I went off my own, I was like, “This is not something I’m great at. Maybe I should listen to my team. Listen to my staff.” There's a great saying and it goes with the Law of Attraction that says, “Like attracts like.” If you’ve got even one good person in your company, that person will attract another good person and repel a bad person because they know they're going to have to work with them. The shadowing and the working interview is all about allowing your good team members, maybe not everybody to get a sense and be a part of the interview process.
That contributes a lot of teamwork. The next part is onboarding. I used to put onboarding and training as the same, but they're different. Onboarding is you want to make sure the forms are filled out. They’re all on the payroll. They're credentialing is moving forward. Their taxes, forms, health insurance, the handbook, their email address. Maybe give them a shirt. That's onboarding. If it was a bigger company, this would be what HR does. It's that crap. That’s all it is.
Make a list of the things that you need to do to establish somebody as an employee in your company. You take fifteen to twenty minutes to do that and set up some links to the page if you need to or put it all in one file. Take an hour or two and put it all together and that's your onboarding packet.
That's what we have we have, a checklist, very easy, step-by-step. Here's the beautiful part about the checklist, you don't necessarily have to be the one that does it all. In our checklist, I sat down and shared the vision and the story of how Schrier PT got started and where it's going. That was my role, but someone else did pretty much everything else. Once you have the checklist, it's easier to then delegate. I would say the biggest one of all of them, assuming that you have a good person. A right fit person is this last step of empowerment. I call it empowerment, not training because it's not just training them. It's empowering them, so they could be successful in their position as fast as possible as fast as possible.
You, telling someone to do something are not going to empower them to be successful. Them demonstrating it, being successful and feeling good about it, that is freedom in a nutshell. If you get surrounded by people like that, you'll be like, “Jamey, what am I supposed to do now? They don't need me in there.” That's what happened to me. There was no reason for me to go into the business every single day. The front desk took care of people. The therapist took care of people. The directors took care of it. Billing. What was I supposed to do? All I would do is screw it up. I walked in there, occasionally say hello and I had some meetings with people. I had to go look for something else, which luckily I did because now I’m doing coaching. There's something bigger for you. The key to training is what does this new hire in this particular role? You're talking about a particular role, whether it's front desk, therapist or an aide. What do they need to know or understand? What do they need to be able to do? What do they need to be able to communicate? Know, do and communicate.
The way I break it up initially is what do they need on the first day? What do they need on the second day? What do they need on the third day? What do they need on the first week? What do they need on the second week? What do they need on the first 30 days? What do they need on the first 90 days? Our empowerment program, we call it the onboarding or mentorship period, the empowerment period is no more than 90 days. Ours was two years officially because we wanted people all to be certified in dry needling. At the time, nobody could be certified in less than two years. Now that's all sped up. It didn't stop our people for coming onboard.
Prior to this, if someone hit their target numbers, we ended up having our target at 60 people a week. We saw a person every half hour, so 60 people a week which was about 85% utilization. It would take six months to a year for someone to do that if they did at all. When I implemented an actual training program with a brand-new person who just graduated from school, who barely knows how to do an evaluation, scared to death, the communication skill is like shit. This person in 60 days was our most productive therapist. He's averaging 61 patients. He was getting a bonus. It blew me away. It's because we added training.
We basically gave them exactly how to be successful here. We didn't tell them how to be successful. We showed them and trained them. We had them communicate how to do an evaluation. We showed them the flow of the clinic. We showed them the best practices in billing procedures. We showed them everything we wanted, instead of hoping and praying they would do it and then getting mad when they didn't do it the way we want them to.
I like that you have the structured intervention: the day one, day two, day three, one week to one month and 90 days. Laying it out like that is not only beneficial to the employee that comes onboard but for the person in charge of that. Having that structure provides a lot of mental freedom. When that's laid out ahead of time, then you can say, “I know what I’m going to do with this guy on day one, day two and day three. I’m going to follow up again on week one and week two.” Having that all in place so you're not flying by the seat of your pants. You know exactly what you're going to do. You can then also, if you have that structure, have an expectation for when they should be catching on. You can tell them, “Following our program, you should be able to meet your quota, your goal within this period of time.”Getting clear on what you want and what you're willing to do to get there makes things easier, and it’s what successful people do. Click To Tweet
How empowering is that to the employee then, giving the power back to them. If you follow these things, you should be able to be at your goal within 60 to 90 days. If you have the right people on board, the exciting ones, they're going to say, “I’m going to crush that. I’m going to do it in 30 days.” Having that structure in place, I love that you call it empowerment instead of training. Not that it has a negative connotation, but empowerment takes that to a different level. This is how you can master your physician. This is how you're going to show well, and this is how you're going to add value to the company.
You’ve got exactly what the whole reasoning behind it is. It's exactly what happened. I’ve done these many times. Many people that have incorporated this way of onboarding people and training people. They’ve gotten the same results, if not better. Our mentorship period was 90 days. The one that happened to do it in 60 and the reason is he didn't know any better. He didn't know it was supposed to take six months to a year. He rose to the level of what we expected. What we said was going to happen. “We're going to help you. You're going to be an amazing PT and you're going to do it within the 60 days. Just follow what we do.” One of our core qualities at Schrier PT, and it's still a core quality in everything I do, even clients we work with is, “Are you coachable?” If you're not coachable, then everything I shared with you will not work. If you're not willing to learn like you were willing to learn in school, it's not going to work no matter how great your program is.
There's a great saying that was from Edwards Deming. He did research and he talked about the biggest challenges in business. It's called the Deming Rule. After all his research he said, “94% of the problems in business is not the people.” We think the people are the problems. I wrote an article called People Versus Processes. He said 94% of his research, it wasn't the people. It was only 6% of the time that people were the problem and why the business wasn't growing and moving forward. He said 94% of the time, it was poor systems. When I learned that, I immediately looked in the mirror and said, “I have the power to change the systems. I have the power to improve my systems.” If 94% of the problems that I’m seeing right now is about the employee I can change this around.
As I started to put in place these systems, these processes, these checklists, the business started to run so much better. Profitability and bottom line, we're better. My sanity was better. Most importantly, the people who worked for me were happier. It was a win-win. There were no non-wins. There was no equal sum game. Some person wins, some person loses. There wasn't that. Everyone won. That's another huge thing to recognize is that there's a reason why I shared with you the seven steps. There's a reason why there's a five-step hiring process because that's what breeds clarity, confidence and moving forward. That's what your staff is thirsty for. That’s leadership.
You're telling the people that you coach, “I can't help you if you're not coachable.” What do you tell the guys that might say, “I'd love to do all this, Jamey, but where do you find the time?” What do you tell those people?
When someone says, “Jamey, it sounds great. I want to do it.” They never say too much about the money. Our core program, our Practice Freedom Mastery Program is $11.97 a month. It's one new patient a month. It's not it's going to break the bank. If we can’t help you generate one new patient a month that was wrong. Luckily, it's not happened and I'd never refunded someone's money that did the program. The biggest thing I get is, “Jamey, I don't know if it's the right timing. I’m still looking at this. We're doing well. We're trying to get out of this problem.” Procrastination is something that all of us have naturally in us as human beings. We are procrastinating human beings. It's never the right time. It's never perfect. Here's the thing, you can get started doing something now and move forward. You can start doing it later.
Doing it later is not going to make it easier. All it's going to do is allow more of the same problems to happen and more frustration. I wish I did this earlier myself. It took a fire, literally, my place burning down for me to do something about it. If that fire didn't happen, honestly, I don't know. It might have taken me another two, three years to kick myself in the rear. What I say to people is everybody has 24 hours a day. Richard Branson, the billionaire that owns Virgin, has 24 hours. The difference between you and Richard Branson comes down to only one thing. What he does in his time and what you do in your time. It's not you don't have time. That's one of the problems you have. You don't know how to master and utilize your time. If you did, you could get results quickly. Chances are, that's not going to change unless you have someone guiding you. A mentor, a coach, somebody being your person to say, “You're doing the same crap.”
It's like Einstein, “Doing the same thing over and over again, expecting different results.” We all know that quote. We don't do anything about it. We're frustrated by the results we're getting in our business. One of the things that we do, it's like, “If there's something that you want and there are challenges preventing you from getting there, in Practice Freedom, we have a solution for that. It may not be the solution you want. It may not be something that you want to do. There are lots of solutions out there. We have one that works. However, if you're not going to do this solution, then do something else. If you're not going to do anything, don't expect anything to radically change.”
That's the real eye test is can you swallow your own ego and your own pride to be willing to learn what to do? I don't care what it is. It's the same thing I tell my patients. Your back pain, maybe your knee-to-chest stretch is not what you need to be doing. Maybe you need something else. When your back pain's bad enough, you'll call me.” I use the same type of communication and language with my patients and it was fantastic. We’ve got great people in there. It makes things easier when you’re clear on what you want and you're willing to do what it takes to get there. That's what successful people do and that's what unsuccessful people don't do.
I feel we're on the same page in this and one of the reasons why I created the podcast and my slogan, “Reach out, step out and network.” Do something. I’m not telling anything in particular, but I’m telling you because I’m all in on different is better than better and your five-step hiring process is great. All those things are great, but something's going to work. You have to do something. We didn't get business training in physical therapy school, so there's no reason to think that we should be able to run a business well. We need to invest in something, a consultant, a coach, a network. Get some training to know how to run your business. When you reach out to those professionals like you, when you step out and network, do network, step out of treating 40 or 50 hours a week and steer the bus, then things become magical. You start gaining that stability and freedom that you were looking for initially.
It's becoming decisive. When a patient says, “Nathan, I need to come in for my back pain.” There's nothing you can do. They didn't say they were coming in, they're talking. They're saying what we call dirty words. Dirty words are vague words. Obviously, they're dirty like need, should and maybe. Those are all vague words that keep us in an ambiguous place. We haven't decided on one thing or another. The one thing we do in our program, which is why it's easy to determine whether someone's right to work with us. We're going to help you make a decision. The decision might be, “Keep doing what you're doing,” or maybe the decision is go get a book and start there. At least you have something decisive that you can move forward. That sounds like what you're saying with the slogan of your podcast is just get into motion. Get into action because motion and action cure fear and cure stagnation. Just do something.
Jamey, it was great talking to you. Thank you for sharing your insight. If someone wants to reach out to you individually or figure out more about your Practice Freedom Method, how do they get in touch with you? How do they find out about you?
Jamey@JameySchrier.com, that's the best place to reach me. Definitely check out that. I always give something for your audience. They're spending the time, they're reading. When you're able to click on that, I’ll share some cool thing with you. There's a tool that I have called How To Deliver Better Care And Increase Your Bottom Line. It's basically how to generate visits in your practice fairly quickly. It works great. There are five ways I go over. That's going to be a freebie for your audience that they could download and get immediately. It's a thank you. I always enjoy doing this. I want to see people do well. I’m on a mission. I don't want people to have to go through all of the bullshit that I went through, because I know how tough it is emotionally. I know how tough it is on relationships with spouses and families. I know how tough it is especially financially and how much stress that does. I appreciate you having me. It's been great you obviously get it.
Thanks, Jamey, for sharing some of your insight. A lot of what you're sharing was invaluable, especially where we're coming from as physical therapists. No one trained us on how to hire the right people. Having that little bit of insight and having a little bit of structure on the hiring, the training and on the empowerment, I loved it. Thank you much for sharing those nuggets of wisdom.
You're welcome. I appreciate it.