PTO 167 Avi Zinn | Leadership Development

We have been following the journey of Avi Zinn, PT, DPT of Druid Hills PT in Atlanta, GA, for two years, tracking his growth as a newer clinic owner. At this stage, Avi is out of treatment completely and continues to grow his business. Since the last time Avi has been on the show, he's made some changes for the better – hiring another front desk person, implementing weekly team meetings, and planning for a leadership team. In this episode, Avi discusses with Nathan Shields how he's handled these issues and gives us a peek at what he's looking forward to in 2022.

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Reality Episode #6 With Avi Zinn, PT, DPT: Moving Up In Ownership - Meetings, Leadership Development, Marketing Strategies

In this episode, we have returning guest, Avi Zinn. We’re doing Reality Episode #6. Over the past few years, we followed Avi’s progress as a relatively new PT owner and we're on the sixth episode following along in his progress as an owner. Avi, thanks for joining me again.

Thanks. I'm so glad to be back. It has been months since we've done this. I've been waiting to get back in touch with you.

It's good to have you on again. I can't believe it has been that long. It doesn't seem like it was months ago but we've tracked you over time since November 2019. We're almost into 2022 now so we tracked you over two years of your growth. If you haven't read the previous episodes with Avi, you can see what we've been talking about and his growth as an owner starting back in 2019. At the time, how long had you been an owner?

I started in 2017 so that was about two years in when we started talking.

Can you share what kind of growth has your company seen since 2019? Where were you in 2019 to where you are now maybe in terms of weekly visits? Maybe that's a good metric.

We can start with that. 2020 was COVID or at least we're still dealing with that stuff. It’s hard to look at numbers. I would imagine that’s for everyone but for us because we were so new and young, looking at the numbers before 2020, it was sometimes hard to track progress but visits-wise before COVID, around when we started, we were probably on average about 150 more a month than when we were in 2019.

In the last episode, we talked quite a bit about you changing to a new EMR prompt. You had taken on a billing company, In The Black, doing collections with Will Humphreys and you had changed out a front office person. Now, bring us up to speed on maybe what's worked for you over the few months and maybe even more interesting, if you have that experience, what hasn't worked for you over the past couple of months?

The last time we were talking, I was in the process of hiring a new PT. I hired him and he got started in June 2021. We were already pretty integrated with Prompt and the billing company. Both of those, I started around the same time. Prompt was new and the billing company had never used Prompt. We were in the middle of trying to have this three-way communication between all three parties and trying to get our processes and everything down. We've come a long way.

We have some really good communication between all three between our front desk, the billing company and Prompt. We've got that down pretty well. There are still some things that happen here and there but mainly positive things only because Prompt does upgrade and update their software. Every now and then, they do an update and it refines and improves some of the billing stuff so we have to come up with new ways of using that new system. That has been pretty good and has been a great upgrade to the company.

We brought on a new front desk and that was a result of our previous one going off to school. She was able to come on before the other one left so she got some good training with the previous front desk before she left. That was great. She was onboarded pretty smoothly. Since then, we have hired another support front desk to help out. We were getting a little busier and we needed help with some backend stuff like authorizations and following up with patients so we've created a whole back office position for this. Not even back office but support helping out with the front desk.

She's also doing some patient experience stuff where she's following up with certain things with the patients and sending out surveys. We've been sending out postcards after the first visit to welcome them and giving them handwritten, “Welcome to Druid Hills. We can't wait to be a part of your team or be a part of your recovery.” That seems to be going pretty well.

What made you decide that you needed some extra help at the front desk? I think that could be an easy metric to follow for a physical therapist to say, “I know how many appointment slots we have and we're filling up 85, 90 or 95% of those appointments slots. I don't have room to get these patients in at the frequency I want them to. There are no extra spots so we need to hire another PT.” That’s not so obvious sometimes for the front desk. Was there a metric that you followed or what was it that made you decide you need to bring on someone else and I'm assuming you brought this person on part-time or full-time?

It was part-time. There wasn't an exact metric because the front desk was just busy. It wasn't exactly following the metric but she wasn't able to do all the things that she was supposed to do efficiently in calling and following up with authorizations and the lost patients and calling patients to make sure everything is in order for their first visit. Those all do fall into some metrics, like the lost patients. We can get a sense of who's following up with their plans of care or not. We realized that she couldn't do it all so we brought her on to do those other things, which are to make all the callbacks for all the lost patients and to make sure they're scheduled for the next week and to help out with authorizations.

We've developed a whole bunch of other things in that same arena of calling. We made that her responsibility. She does all the calls. She'll call doctors to make sure we get the plan of care signed and to make sure we have all their contact information and the right fax numbers to send to. She's already calling everyone so we threw that into her. That is her responsibility.

It's those kinds of tasks that you don't want the front desk doing and thus, missing an opportunity to reschedule a patient or get them in the frequency that they want to get in because they're on the phone with an insurance company or a doctor's office and not collecting a copay because they're busy or not giving that new patient the proper welcome and explanation of what to expect. You don't want them to miss out on that so I think it's great that you recognized that there was a bottleneck there at the front desk.

You want that to be the best experience possible for the patient because that's the first experience that they have come into your clinic. We recognized it was somewhere around the 125 visits per week that maybe you could stretch them out to 150 before you had to get that second person. I don't know if those were the numbers that you were seeing at that time but when they're getting to that 125 mark, they start to be getting stretched thin, especially if they're doing any insurance verifications and authorizations.

I would say not looking at the numbers in front of me that it probably was about almost like what you are saying. It was once we got around to 125 a week. Knowing our average monthly now, that is probably what it was but that is exactly why we brought someone on. We had that bottleneck and she was missing check copays or missing scheduling someone because she was on the phone and they would walk out of the office because they didn't want to bother her. I think that made a huge difference and then also adding in some of the other patient experience things have upgraded the patient experience.

Meetings are important in any business or organization. Click To Tweet

I think that might be hesitation as to why owners might not bring on that other front desk person is because they're simply looking at the authorizations task and say, “If I just give her authorizations, that's not worthy of a part-time job. That doesn't get her twenty hours a week,” but think greater like you're doing, what more can be added to your business by bringing on this extra person to improve the patient and front desk experience?

What can you do to make them more efficient? What can you do to improve patient arrival rates, decrease cancellations and make sure that no unauthorized visits are seen? There are a lot of things that you can do to add to their plate to fill out part-time and pretty soon probably a full-time position for the support of that front desk.

It happened backwards. The biggest obstacle we were having was the authorizations and when she came on, I think it was right around the Delta spike of COVID so things slowed down quite a bit. There was this month period where we didn't have to have all this extra work for the authorizations, which is when I started focusing on all this patient experience stuff and we figured out other ways to increase that experience and send out the surveys and postcards and then once we started building back up again, it was cool because she already had all that stuff that she had systems for.

She was able to go back to doing all the other front desk authorizations. It was cool how it worked out because I didn’t know that I would've thought to do all that stuff. It was more of a result where I brought her on and then all of a sudden, we have a little extra time and I was thinking, “Now I have this time and I brought her on, what can I use this time for?” That's when I started all this patient experience stuff.

In that regard, it was a blessing.

It was cool. It allowed me to do it. Otherwise, it would have been hard to make that jump. People might have a hard time justifying bringing someone on because they might not think of things that they're going to be able to do and just for authorizations is not worth bringing someone on.

You're not in the office five days a week. You're running the business remotely from what I recall, right?

Yeah. I go in more than I did during 2020 but I'm not there all the time. I’ll do stuff from home. I live close to the office so I'll go back and forth.

What keeps you busy most of these days?

The big thing that we were talking about from what I recall from the last time we spoke is you had asked me if I was developing any leaders. I believe we were talking about that. What keeps me busy is trying to grow the company, strategize and have a vision of where we're taking this and trying to implement it.

To answer that question with also the question you asked before about of what hasn't been going well sometimes efficiencies and communications were not happening the way I thought they should be. One of the things I was working on was establishing a meeting rhythm where we would start implementing our weekly meetings and we hadn't done that.

I don't know if we were doing it yet the last time we had spoken but I have implemented that. Whether or not that was me working on it at home or there, it was about coming up with how we're going to do it and when we were going to implement it. Since then, we've started these weekly meetings which have helped our communication.

It’s creating a team culture where everyone's voice is heard and gives us a space that we can all come together as a team. I think that that's what has allowed the team to realize that their voice is important and so then, they're maybe taking a little bit more of an active role in following up with these communications.

When you're talking about meeting rhythms is the weekly all-staff meeting the meeting rhythm that you're talking about or did you also implement others?

That's the main one. Trying to connect it to the leadership, I've been at the same time trying to find a Clinic Director. The meeting rhythms that we have now is a weekly meeting with the team but what I want ultimately to be able to happen is where the clinic director could probably lead these meetings and then I would have some type of rhythm also where I meet with the director or maybe some of the other PTs so there’s a whole system of meetings.

Let's go back even a little bit. Was there some hesitancy in pulling the team together for 1 hour or 1.5 hours or however long you have? Was there some hesitancy initially to do that on your part?

PTO 167 Avi Zinn | Leadership Development
Leadership and Self-Deception: Getting Out of the Box

Looking back at it, I started looking at the numbers and I was like, “That's four hours with the four PTs every week. Add that up times 52, that's 200 hours that we're sacrificing to not get patients,” and then I realized that first of all, we're not at 100% capacity anyways. Even if we stick the meetings on, there's still going to be those slots somewhere else. That was an easy way for me to realize that we're not using the entire schedule anyways.

That was the first hesitancy and then it was trying to figure out when to do it and does it make sense or how does that mess with the schedule? That was the hesitation but once it started, I realized that this has to be done. I maybe should even be having more meetings. It's so important and so powerful to have this communication with everyone that you can't not have it. At this point, I can't imagine not having these meetings.

I love that you're sharing this because I've had coaching clients that express the same thing that they didn't have weekly meetings or maybe they adjusted them a little bit based on my recommendations. Now as they're having them, they can't imagine not having them. They also are saying things like, “We're getting more done now in the past few months of having weekly meetings than we've done in ten years because we're actually having communication and talking about where the issues are and where things are getting stuck and how to improve workflow. Things that we've been complaining about for years, we're finally addressing those items in our weekly meetings and we're making significant progress. It's great. I can't imagine not having these meetings.” It's cool to hear that you're having that same experience.

Some of them are exactly that. We had a meeting about the plan of care, who faxes them, who's following up with them. That's ultimately where we had the support front, desk person. She became in charge of following up with the unsigned docents but it was because we all came together in the meeting and said, “We have this issue. Some of the plans of care are getting lost, not getting signed and not getting followed up. Sometimes the front desk doesn't know that the plan of care is ready to be faxed out.”

I asked everyone what made the most sense and we came up with the plan. The solution was that the PTs fax it and then we have this other person who then follows up with them from then on. It was a simple and easy process that could have been done but because we all never got together and talked about it, it never happened.

Another cool example of not even necessarily something that we are struggling with but we came together to talk about some of our social media stuff. I think the last time we talked, I was telling you about how I was doing a little bit more social media because we didn’t have a strong presence. We started wanting to have a weekly patient feature where one PT would feature one patient every week and we'd post it on Instagram.

In the meeting we talked about, “Does it make sense? Does everyone think it's realistic that we could get one done?” We all agreed and then we set the expectation right then like, “Everybody, that’s one time a month and Abby who's the support front desk person is going to follow up with you and make sure you get the thing and she's going to post on Instagram.” We all agreed on it and we all set the expectation. It just has happened every week since then and it was because everyone was a part of that decision and created it. It wasn't me coming and saying, “This is what everyone is expected to do,” and there were no questions. It was a joint decision.

You facilitated some discussion and it wasn't you saying, “This is how we're going to do it going forward,” but rather, “Here's the problem. Let's talk about it and come up with a solution.” You probably had some ideas in your head about how things could maybe go best but you were open to having the discussion and letting them come up with the solution. When they do that, they have greater engagement and buy-in.

That's what I'm saying. It's very powerful. That's why I can't imagine not having these meetings.

Did you purposefully go in with that mindset or did you get a little bit of coaching ahead of time to not come in and say, “This is what we're doing going forward.”

I'm working with Will Humphreys. I try to be able to make my own decisions when I can but with most things, I run it by Will to get a sense of, “Maybe this is what I think should be done and it's going with my gut but is there a good, better or best way that I can approach it, how I speak about it, how I get team buy-in and how I get everyone to work with it?” I don't remember exactly if it happened but I would imagine I spoke to the coach and got some good ideas on how to approach it.

It sounds like you're just getting started with these weekly team meetings. You even mentioned it yourself that you're starting to see the formulation of culture coming about like, “This is how we get things done.” Are you starting to get a vibe and a culture around your clinic?

I do. I think that there's a stronger team culture where the team is starting to do things on their own. Not that they wouldn't but because we get together and have the space to talk about things. It's promoting that if I bring something up in a meeting, it can happen at any point and if you have an idea, let's all talk about it. I think that everyone is now comfortable bringing up ideas and trying to act on them and can come together. I think the culture has been greatly upgraded because of these meetings.

Are you starting to see some people stand out a little bit? I say that because we talked in the last episode about developing leaders and you mentioned it now that you’re looking for that next clinic director. Do you see some members of the team stand out a little bit more than others as you do some of these things or were you already going down a path with one of your team members already?

Everyone is standing out in certain ways but not in the way of the clinic director. I did let the entire team know that I was going to start advertising and looking for a clinic director. At the same time, I let everyone know that I'm going to offer it internally as well but based on some of the different situations and schedules, it wasn't something that anyone that was there was wanting.

One of them was not a full-time person and this was a full-time position so it couldn't work out. Whatever the situation was, it didn't work out. As far as the director goes, I did advertise it and I did hire someone. She applied to be a PT but ultimately has the interest in becoming the director. We talked about it and came up with a plan for her to be a director but we are bringing her on just as a PT first to make sure she comes in and gets comfortable. She is a team member first and then looking down the road if it makes sense and everything looks as it should then move her over to the director. That should be happening.

She’ll be our fifth PT and then she's going to essentially become the director. Everyone is stepping up in a lot of ways. Do I think it's from these meetings? I don't know but I can't imagine it's not helping. The team culture is becoming so strong and I think because of that, it's creating this team accountability where people are maybe wanting to do a little bit more for the company than for themselves.

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It's interesting that you hired from the outside to bring a clinic director in. That's not typical but it's not atypical either. Usually, you grow someone from within but what's clear is that as you're developing this leader, they didn't come in and just get the title. The same should be said for anyone that you are bringing up from within the company. They don't get the title and then get some training. They need to show that they're value-aligned.

They maybe do some small leadership tasks to see how well they are able to organize, how to be responsible, how to get other people involved and then if they show competence, especially do a good job in those tasks and are value-aligned, now you can turn over responsibilities related to the clinic directorship and then “give them the title that.” It takes time. You don't ever want to just give them the title and then do the training. You want to do some training. They have to show that they're capable and then you can move them into that position.

What we're trying to do is exactly what you said. We're trying to bring her on, make sure she settles in and first of all, make sure she builds up her caseload and does her roles and responsibilities of a regular PT. You see normally a lot of times people hire from within.

I did hire her with the intention of the director even though we have these stages that we're going to go through but at the same time, what we're going to do is even though she's going to be “just a PT” for the first three months, we're going to start having conversations. I'm going to give her some books to read about leadership and try to at least get some alignment in that so when she enters into the training then she'll already be ready for it.

That was something that we had our leadership team do is read some of the books that Will and I had read that were influential in our thought processes so they could understand why we do some of the things that we do and where that came from. It wasn't us simply thinking up great ideas or coming up with stuff out of the clear blue but rather, here were some of the books that were influential that changed our minds regarding leadership and why we do some of the things that we do. I think it's important to have that library of books to help train other leaders on your team.

I talked to Will about which book he would recommend. The first book he recommended for any director is Leadership and Self-Deception and then the other one was The Five Dysfunctions of a Team.

Those are great. If they want to learn more about leadership and ownership some of those other books are Good to Great and The E-Myth Revisited. Those are all great books that we referenced quite often in our leadership team meetings.

I have not read The Five Dysfunctions of a Team, which apparently is one of those must-reads.

It's a great one, especially with your team. Once you get your leadership team, it's fun to read it together and share thoughts about different aspects of it. It's a great place to start. You've been a PT owner for years. Is there anything that looking back from where you are now you would say, “I would have done something differently?” What would you have told your younger own self?

A lot of things.

Like what?

I always say I got lucky in a lot of ways. I didn't necessarily plan everything or do all the research for some of the important things that you would think you should do as far as looking up what your reimbursement rate might be when you start or if you're going to take insurance. I think the thing that I would have done automatically from what I know now is I would have started with a coach automatically. I think that would have allowed me to skip a lot of the guessing.

I learned and got lucky by doing things and learning as I did it but having a coach probably would have fast-tracked me a little bit more. I say that and then I realized though at the same time, having to make those decisions even if you don't know for sure if it's the right one or wrong one because, without the coach for the first two years, I was just making decisions.

Having to do that was very important for my development as an owner it's hard to make a decision. It's exhausting. It's challenging. It's hard to know if what you're choosing to do is aligning with what your values are and I guess ultimately, what are my values? I think going through all those was important for me but it also could have been done a little bit more efficiently or maybe a little better had I had a coach.

One thing that I was thinking about that if I had done differently and although it hasn't affected me too much I was aware of it during the big decrease in caseload during COVID, was that I've always historically relied a lot on, at least in the beginning, these paid directly to consumer Google ads that have been very successful for me.

We still use them but I would say now, we don't use them as much because we've been around, we've built up a reputation and people are coming back. Our first patient ever back in 2017 came back again this 2021. It's her sixth time that she's come back already. We're having return patients but we're still using the Google ads but what I never did a great job of was relationship marketing and developing doctor's referrals.

I think early on, I tried unsuccessfully and that's when I started looking into these Google ads and I gave up when the ads started working but I realized during COVID that you can't just rely on one thing because there was a time when the ads not performing as well as others. It pointed out that you can't rely on that one thing.

PTO 167 Avi Zinn | Leadership Development
The Five Dysfunctions of a Team: A Leadership Fable

Had I gone back, I would've continued this whole time to try to develop those relationships. We've developed a few relationships with some local docs. None of them are part of hospital systems. They're all independent. It's hard to make those relationships so I think for sure starting from the beginning, I would have kept up with that.

Since you brought it up, do you foresee bringing on even a part-time marketer to help you with some of that stuff?

I've been thinking about it and I don't know. It might be a good idea to bring someone on to do marketing and brand awareness to get a more cohesive marketing strategy. I've thought about it but I don't know who to speak to about that. I think it could be powerful. I can't imagine it would hurt.

The beauty of it is you're doing so much on the organizational side of things yourself. You're the visionary, the leader and you’re holding people accountable that if it's not something that brings you a lot of energy and joy then marketing is something that falls off until the numbers start to dip and then when the numbers dip, you're thinking, “We've got to rev up the marketing machine again.” The beauty of having someone who that is their sole responsibility is that there's the attention paid to marketing all the time so it minimizes the rollercoaster ring and allows someone to pay attention to the entire marketing strategy that you might take your eyes off of every week or two until you go back and say, “We need to redo our Google ad,” or, “We haven't seen that doctor in a while. We need to go see them again,” whereas when you have that person who's dedicated to it, of course, they can concentrate on that effort and make sure the social media is getting taken care of.

They're looking at the four buckets. They're focused on physician relationships, looking past patients and how they can get them back in the office, making sure that everyone's asking for referrals from the current patients and then also talking directly to the community either via social media or the Google ads like you were talking about. Having someone dedicated like that helps maintain the marketing efforts and can increase your numbers in general. That's a conversation that we've had in our masterminds the last couple of months because people are starting to bring on these part-time marketing people and seeing some great results from it.

Everything that you said, I relate to, especially with that roller coaster of like, “The numbers are dipping a little bit. Let me see what doctors I haven't texted in the last three weeks.” That's interesting. As part of the new front desk person, Abby, I also labeled her the patient success manager. She was doing some of the follow-up calls and she's been the one posting stuff on Instagram but I think having someone designated their full responsibility to marketing makes a lot of sense and that's something that I will take away from this episode.

My best marketer was an assistant to a physical therapist. She was a great marketer. Her name’s Stacy Sullivan. She was one of my first employees and she did a great job. She loved it too. It's amazing because I don't know about you but I hate seeing doctors. I hate the marketing stuff and to recognize that there are people out there that love that stuff, if you can find that type of person, use them for sure because that's what they want to do. They want to go see doctors, they want to get new patients in the door, they believe in physical therapy and what you're doing at Druid Hills and they’ll market and promote you all day long. It's great to have that person on your team.

I don't hate going to doctors or at least the ones I already have a relationship with but there are some things that I could see that I just do because I've always done it. I think that’s a lot of the stuff that I'm learning from having a business and with coaching is that if it doesn't bring you a lot of energy then it should be someone else doing it.

You should focus on the things that you like doing and that's where you're going to see the most return on. I could see how that could be something that I'm doing but I'm not giving it my all because it's not something that I love doing or maybe I don't know how to do it either and there are people that are better at it.

You don't have to find a person with a marketing degree or someone that’s going to school for marketing. Some of the people that are getting hired by members of my mastermind are stay-at-home moms whose kids are in school and they want to do something for a few hours since they have the time now. If they've got the personality and the energy and you can show them what to do and tell them what metrics you're expecting them to generate then they can work.

I'll have to add that to my list now, to start hiring a part-time marketer.

As you're looking forward to 2022, when do you start looking forward to the next year and planning for it?

In 2020, I did a budget with my coach and that was the first time I had done that. We probably did it right around now to get ready to start looking at the next year. I haven't done that yet but it was something I'm planning on doing because it was super valuable to do that and to project. We had talked about it in one of the episodes. I don't remember if I said 30% or I used a number and the way I chose that number was based on the actual physical space that we had and then we work backward and that's how we decided how to set the budget. If we were going to fill our space, then we can have six FTEs and then work backward from there.

Even though we didn't end up meeting all of those numbers, we weren't too far off. It was amazing to have a budget where I looked at the numbers for every month or for every quarter and to know ahead of time that if we want to get to this point, I already had it worked out, “This is what we'll need. We need these many visits.” I can look week by week or month by month to see, we can increase our marketing efforts, hold back our marketing efforts or we need to focus on these things so that way, we can hit our numbers. It was super powerful to do that in 2020 and that’s something that I was planning on doing pretty soon getting ready for 2022.

We have to let everyone know that your business coach is also a CPA so it's easy for him to generate these kinds of performance and budgets.

I'm not working with him anymore. I had two coaches that I was working with and it was getting a little too much. They were giving me too much stuff to do. It was all valuable but it was overwhelming sometimes where I would be looking at my homework from the coaches and then I’m like, “This is too much for me to handle. I don't want to do that much. Slow down a little bit.” I took a break from that coach but yes, he was a CPA. That's in his wheelhouse to look at the numbers that way so it was helpful. Now, I think I have a pretty good sense of how to go into QuickBooks, pull out my P&L, look at our numbers and project, look at our metrics and analytics from our EMR and then go from there.

That’s pretty impressive that you're able to read the P&L yourself and maybe even generate a budget yourself if you wanted to in QuickBooks. Is that something that someone had trained you here in the last few years or is that something that you knew how to do beforehand?

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I have no clue how to do that beforehand. I think it was a combination of that coach but from the beginning when I started, I had a bookkeeper where we would meet every week or so and he would send me a PDF of the P&L and we would go over it and we would look at the balance sheet. He would explain it. After the first year of doing that every week, I got a good sense of how to interpret it and then I'm able to now go into QuickBooks and I can pull up a P&L and I know where I can separate it quarterly, do it monthly or select the time. Now, I'm able to go in and generate that.

That's impressive because I went maybe ten years without reading a single P&L for my business. I didn't know how to do it before. I finally recognized that I need to know what's happening with the financials of my company because a patient asked me one time what my cashflow is like and he was also a business owner. I just looked at him blank and staring. I had no clue. He laughed and was like, “I guess things are going fine for you,” and I was like, “Yeah,” but that's embarrassing as a business owner that I don't know my financials well enough so I asked my CPA at the time, I said, “I want to meet with you monthly and you're going to show me how to read a P&L and balance sheet. I need to know what my financials are. I want to do this monthly going forward.”

I highly recommend all of my clients and even the audience who are reading, meet with your CPA monthly and pay him the extra hourly wage to sit with you and show you how to read your financials because it's powerful to know where your money's going. You should know if you're spending more in a certain category this month compared to last month or this year over last year.

You should know what your breakeven points are both in terms of dollar amounts and per visit amounts, which I'm sure you're able to do now that you have Prompt EMR up and at the same time, QuickBooks. You should know how to generate those reports and look through them and review the numbers monthly. That's a fundamental number maybe 3, 4 or 5 in being a small business owner.

Once I got comfortable with it, I can glance at it here and there. It's so helpful to be able to look at it to know where you are and you can see where you're at, at that point. That way, you know what the numbers are. It's like in that situation where the business owner or your patient was like, “What's your cashflow?” To be able to know that you know the answer is powerful.

It is powerful because as you look at those numbers or your management numbers from your EMR, you cannot only see what has happened in the past but you can also project what to expect going forward based on the historical data that you have. It’s powerful to know like, “We saw so many visits in the month of October. That means we can expect this kind of revenue in November. If it's good then that's great. We should expect that number and expect that out of our billing company but if it's not, what do we need to do now in order to cut back expenses or rev up the marketing engine again depending on which way we're going?” We can project going forward and not guess what we're going to do in the coming month. There is a lot of power in that.

It’s also what I was alluding to a little bit earlier about 2019 and then 2020 being COVID. It’s hard to look at our numbers and compare them to 2020 and then to 2019 because of the stage of the business that I was in and then COVID. It's hard for me to do that now to look back and say, “Last November, we were this number,” but last November was also still a little different because it was 2020.

However, it is still the same and not have the budget like I did last 2020 for 2021. It did allow me to do that exact thing which I can look at quarter three and expect that we're going to be here, which means we're going to be bringing in this much and we’re going to be this much profitable. We'll also have this many visits, which means that we'll probably need to be hiring. “I need to start looking for someone and hire them now,” instead of waiting until we see those numbers happen and then say, “Now we need to hire,” which can take an extra three months.

I had some clients who put together a budget going forward and they did it in some Apple spreadsheet. They made targets for when they were going to hire their next physical therapists. I thought, “You guys are pretty ambitious here,” and they're like, “We're just going to put some goals here with the numbers.” Lo and behold, they started hitting those targets, hiring those therapists and the numbers followed suit. It's almost like as you put it out there into the universe, things work in your favor.

PTO 167 Avi Zinn | Leadership Development
Good to Great: Why Some Companies Make the Leap and Others Don't

Before we started recording, we were talking about one of your coaching clients that she stopped treating and she hired some more patients. Because of that, all of a sudden, she was seeing more patients per week than she's ever had before. It's not exactly projecting but she put it out there. She created the space for it and then it happened. I think that's also what I see a lot of times too. You look at these numbers, you think about it, you put it out there and then it happens.

It’s not because you just sit there and let it happen but because you have some intention behind it and your actions follow suit. You're looking at this like, “I want to meet this goal or these are the things that I'm expecting my business to perform and to do.” Your actions along with the help of the universe somehow work in your favor and things go the right way once you put it out there. It's great to see.

I have to acknowledge all the work that I do because a lot of times I just say, “It happened that way. I was lucky,” but it takes a lot of intention. You can set those goals but there are a lot of things that you have to do. Sometimes, it's making a big decision and that can take a lot of time and energy to come up with the right decision to move forward with.

To wrap up this episode, maybe we've already discussed it of the things that we've discussed but is there one thing that stands out that you've learned over the past few months as an owner?

Number one, in terms of the meeting rhythm and communication, I think the more clarity there is around everything, the better it's going to happen. When we can have clarity on the process, why we're doing it, what the expectation is, it's going to happen versus I come out and I send an email saying, “This is what we're doing,” and then it never happens.

When we have a meeting, we all talk about it and everyone lends their voice and everyone agrees on it and it’s clear why we're doing it and how it aligns with our purpose, vision and values then I can see how much more everyone is involved. That has a lot to do with clarity. I think that has been cool to see. Most PTs, I would hope, at this point are coming out of school and are good PTs, if maybe they're not the best. I want our clinic to focus so much on the patient experience that the PTs don't have to worry about any of that and they could just do their job.

I'm so surprised at how much it makes a difference when we give the patients an experience of not even about the actual treatment itself but it's about making sure that we explain every single thing to them before they come in. Make sure that we treat them with respect by explaining the financials and the insurance stuff and then going an extra step and sending out a survey and a postcard. That makes the experience so much better and we're seeing that in our patients’ reviews, in what they say and in their responses. They say that it's an amazing PT experience compared to any of the other places they've been to and it’s because we're putting so much effort into the patient.

It’s not even so much on the actual treatment. Obviously, that's important and that’s why they're coming. It's surprising how that's even almost more important than the PT itself in getting them successful. If they don't have that trust, if they don't love the experience for whatever reason or if they were told the wrong insurance information then it comes back differently, they're going to stop coming, because they feel something is wrong. They're not going to ever be able to finish their PT but if we get them to buy-in and trust from the beginning because we go out of our way to do that, they're going to be so much more successful in finishing their plan of care. It’s so crazy how much it has almost nothing to do with the PT itself.

PTO 167 Avi Zinn | Leadership Development
The E-Myth Revisited: Why Most Small Businesses Don't Work and What to Do About It

I discussed that in length with Jerry Durham. I think he has a podcast now as well but he talks a lot about the patient experience and what he shared on the episode was to sketch out the patient life cycle from the very first point of communication with that patient all the way to the point of their balance is zero with your clinic. At each of those touchpoints, how can we improve the patient experience with our clinic?

If one of the first touchpoints might be your website, how can we make that a better experience for the patient? What would they want to improve that experience with your clinic's website? If it's a phone call, what can we do on our phone calls to make that a better patient experience? As they come into the front office on their very first visit, how can we make the waiting room a better patient experience? You can take each one of those. You could take a full day and talk about your patient's life cycle, how you can improve it and if you did so. I shared this in the previous episode, I think your marketing efforts would significantly increase. They'd probably double or triple.

I completely agree. It's stuff that I'm so surprised at how much it makes a difference and I think because of that, I am being conscious of some of our marketing and trying to think of it through the patient experience. Does it match up to our website? Does it match up to what we're saying and the language we're using when we talk to them? Does it connect to the email that we send them out?

That goes back to what you asked about the marketing person. I think in that patient experience, there could be more cohesive brand awareness or just your marketing and when they're all saying the same message, that's going to completely increase that experience. I think to be able to do that, it's a lot of work but I can understand how that makes a huge difference.

Is there anything else you want to share with us?

I like when I do these with you because it's almost a free coaching session for me because I got to answer these questions and you ask questions that I haven't necessarily thought about, like the marketing person. I think last time, you were asking me if I had an onboarding system and I was like, “Not really but I should probably do that.” I don't have anything else to share other than I do appreciate you keep having me on. I still tune in to your show and I think maybe other than Eric Miller, I might be out there for some of the shows that you’ve had.

That's right. If you've tuned in to my show, you know that Eric Miller has been a frequent flyer. Will Humphreys has been on here a number of times but you're probably second behind Eric. That's for sure.

I wouldn't say that I'm adding as much value as some of the other people but hopefully, the other owners out there or people who are aspiring to be an owner can at least learn from my experiences. Hopefully, it's helping other people.

Thanks for sharing your experience. I appreciate it. We'll be in touch again.

Thank you so much.

Important Links:

About Avi Zinn

PTO 167 Avi Zinn | Leadership Development

Dr. Avi Zinn, PT, DPT, OCS is the owner of Druid Hills Physical Therapy in Atlanta, Georgia. He opened his practice at the end of 2017 and has slowly built it up—transitioning from a staff of one (himself) to a team of administrative staff and treating therapists. He continues to grow the practice gradually. Avi’s main mission for Druid Hills PT is to provide high-quality, personalized care to each and every one of his patients.
Avi has his doctorate in physical therapy from Touro College, and is a Certified Orthopedic Clinical Specialist. He lives with his wife and three children in Atlanta.

PTO 164 | Annual Strategy Session

If there was ONE meeting you should have each year in your business, what would it be? In this episode, Nathan Shields talks about the MOST valuable annual meeting that an owner should have - the Annual Strategy Session. This is the one meeting in which you can step aside from the day-to-day and assess your business as a whole - weak points, strengths, upcoming issues, internal dilemmas, etc. - all at once.

The Annual Strategy Session can invigorate you and your team while coming together to determine what items are essential to achieve our goals this year. It’s a highly valuable meeting and a MUST for clinic owners. Listen to this episode to discover tips on how to have successful annual strategy sessions.

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Coaching Moment: The ONE Meeting You Must Have Each Year

I want to talk about the one meeting that you've got to do every year especially if you have a partner and a leadership team. Even if it's you running solo, the important meeting that you have to have is one of an annual strategy session. The annual strategy session allows you the opportunity, especially with your team, to focus on what's most important over the upcoming new year. Take your heads up out of the muck and the mire of the day-to-day activities that you're performing and focus on the business. Look at the bigger picture. Look at the things that are coming up down the road so you can address them appropriately and in a timely manner so that you're not that you're being proactive and not reactive.

The annual strategy session that I did and most people do, was usually done at the end of the year, looking forward to the next year or at the beginning of the year that they're in, trying to look forward to seeing what they want to accomplish in the upcoming year. The annual strategy session's goal is essentially to get clarity on what are the most important action items that will move your company forward and clarify your goals for the year. It also allows you to recommit to your purpose and values and assess your business from a greater perspective including weak points and potential threats. The beauty behind an annual strategy session is it gets everybody on the same page if there's more than just you. It allows you to focus on the business and what you want to get out of it.

When you're looking at the number of things that you want to do and accomplish over the course of the year, everything can seem like it has high priority. There could be many tasks out there that you're not sure which ones are most important, which ones are most vital to accomplishing what you want to accomplish in your business. It's my recommendation that you do this on an annual basis. You can move your company forward, clarify your goals, reassess your purpose and values. Get a 30,000-foot perspective, reassess business from a greater perspective, including the weak points and the potential threats that are coming up down the road.

One of the recommendations that I have and it's a shameless plug because I offer this as part of my coaching program but it is to utilize a third-party, someone outside of your organization to guide you, challenge you, force you to be clear on what you want to obtain. It will force you to actually put words to the things that you're talking about not just the thoughts that are in your head but words to your concerns or what your goals are. Enforce that clarity to be verbalized.

It's someone you can even be accountable to in the future. It's important in these situations to be most effective, to recognize that there must be a commitment to brutal honesty and recognition of those pink elephants that could be in the room. A lot of you might not have heard of pink elephants before. The pink elephants are the 500-pound gorillas that are sitting in the corner, the sacred cows.

Recommit to your purpose and values and assess your business from a greater perspective yearly. Click To Tweet

A lot of times, especially in a group setting or in a partnership, there could be things that are going unsaid that need to be addressed that are irksome or could be a bone of contention between a partnership or even within a leadership group. The sacred cows are those things where we all believe a certain thing to be true, even though it might not necessarily be that way.

A sacred cow in physical therapy might be something along the lines of we don't treat that way because it's unethical. Maybe it's not unethical but that's just a sacred cow that we've postulated and we need to consider if that's true or not. A 500-pound gorilla could be some serious issues that partners might have between each other and they're just not addressed or haven't been addressed to that point. These are your pink elephants. You need to be brutally honest with each other and amongst the group to recognize that there could be a pink elephant in the room that needs to be addressed.

It's during these annual strategy sessions in which you can address those things if they haven't been addressed to that point. That's a good time to do that to make sure you're all-purpose and value-aligned. Where do you start with an annual strategy session? The first part that I take people through is to envision their ideal scene at the end of the upcoming year. After 3 to 5 years, look and see what you want to accomplish at the end of this year but then also push it forward to see what that looks like 3 to 5 years down the road.

Take that ideal scene and compare it to the current scene. That gives you an understanding of where the gap lies. I want to get to this point but I'm at this point. It helps you understand where you need to get to and where you're starting from. I recommend this be done on both the business and the personal side because more than likely, as an owner at least, your business actions are helping your personal actions and your personal actions, vice versa. It's not something that the personal side of things necessarily needs to be shared if there's a large group of you but it's important to recognize that our personal and our business are significantly intertwined. Starting with the ideal scene working backward, what's our current scene, just to mind of the gap.

Next, reassessment of purpose and values, this is a time to discuss, "Are we living our values and fulfilling our purposes as a business?" This is a perfect time to readdress both the purpose and values as needed and discuss how to better fulfill and exemplify your purpose and values. Sometimes the values can be misconstrued over time. Maybe this is a good time to redefine the values if they're not clear between all the members of the leadership group that's in attendance. Just take some time. It could be a small exercise. It could be longer if these aren't well-stated but it's important to readdress them every year and see how things are going.

PTO 164 | Annual Strategy Session
Annual Strategy Session: Make sure you have measurable goals that can be accomplished within the next year.

The next step is what most people are used to when it comes to an annual strategy session. A lot of people have gone through typical SWOT analysis. SWOT is an acronym that stands for Strengths, Weaknesses, Opportunities and Threats. SWOT analysis allows you to address what are your strengths, weaknesses, opportunities that are afforded to us in the upcoming future? What are the threats that we see on the horizon or currently existing internally?

One of the weaknesses of a SWOT is that it doesn't assess past performance. However, that can be noted and addressed in the weaknesses and threats section of your analysis. Properly recognize we didn't do things right in the past year, this is where it lays currently as a weakness or a threat that still currently exists and needs to be addressed going forward.

Most people do a SWOT analysis and that's about where they start. They do this, they take a few minutes to write down the SWOT and put some goals associated with it. If you're doing this right, I should have said it from the forefront, these annual strategy sessions should be done in about a 3 to 6-hour period depending on what you're assessing and the size of your business.

If you're doing it within a single 30-to-60-minute period then that's not enough time to discuss, analyze and assess. In fact, I did an annual strategy session with a client and took us from 10:00 AM up until 8:00 at night and this was a single practice. It takes some time to hone in on what's happening within your business and in order to do that, you have to take the time and set aside the time to do it.

This is a great opportunity if you have a leadership team, to do a getaway, go someplace off-campus, away from family, away from the business or to go to a business center conference center. Stay overnight at a location and have dinner together after the fact. This is a great opportunity to do one of these getaways and to go through this annual strategy session.

Envisioning your ideal scene at the end of the upcoming year helps you understand where you need to get to and where you're starting from. Click To Tweet

Next, after doing the SWOT analysis, it's important to break all of these down, strengths, weaknesses opportunities and then flip those that are weaknesses and threats into opportunities. It's not that you're just taking those and saying, "That's an opportunity." Rather, just reword it. If you were to say, "One of the weaknesses of our organization is that we don't have a completed policy and procedure manual."

How would you flip that? You would flip that by saying, "We have a completed policy and procedure manual. That's one of our strengths and that's an opportunity we could take advantage of." If you wanted to take it further where if one of your strengths was, "We have a great leadership team," you could say, "We have a strong policy and procedure manual that is supported by a strong leadership team." That would be an opportunity to address in the upcoming year.

You take all these opportunities after getting rid of the weaknesses and threats, rewording them to make them opportunities and you break them down and filter those out until you come down to your 4 or 5 top priorities for the upcoming year. Sometimes it takes some discussion and it's important to recognize that this isn't a top priority for the upcoming year or this is a top priority for next year. It's just not a priority for this year. It takes some discussion after going through the whole SWOT, writing up and switching those weaknesses and threats and rewording them into opportunities.

It takes some real discussion amongst the group to get down to 4 or 5 top priorities for the next year. Maybe some that are super important get left off to the side but you have to sit down. You can't do ten. You have to break it down and get to 4 or 5 top priorities for the year. Break it down, filter it down to 4 to 5 top priorities.

Next, set goals for each of those priorities. Goals that would be accomplished preferably in the next year. Each priority gets a goal associated with it. That is measurable. We still have to remember the smart acronym when it comes to these goals but make sure it's measurable and can be accomplished within the next year. Work backward and set quarterly goals for each priority and goal along with some initial action items.

PTO 164 | Annual Strategy Session
Annual Strategy Session: SWOT analysis allows you to address the strengths and weaknesses of your business.

It's important to make sure these goals are measurable but it's also important to then next assign those action items, assign these priorities to members of your leadership team, if you have one. That's the beauty of doing this whole exercise with a leadership team. Some of your leadership team might be aligned with certain priorities or actually within their department are actually responsible for those priorities and the goals to be met. For example, if you have a marketing goal and you have a marketing person, that person is going to be responsible for that goal and that priority for the next year to get that goal accomplished.

That gives them a lot of inspiration but also accountability to achieve that. It's important to do this with other team members if you're able to. It's important to get their insight, the beauty of doing this with a third person to lead it out is that many times members of the leadership team, if they are present might not feel comfortable addressing certain issues. They might feel like they need to deflect to the owner.

Maybe they feel like their voices aren't quite heard or don't want to speak up because that might be counter to what the owner has said in the past. The beauty of having a third person navigate or moderate this annual strategy session is vital because it helps their voices be heard. It addresses the pink elephants that may need to be addressed. It also holds the entire team accountable for equally shared voices.

I'd highly recommend a third-party doing this especially if you have a leadership team involved so that the owner doesn’t have the loudest voice in the room. After getting all this done, we've gone through ideal scenes, we've done the SWOT analysis, we've assessed our purpose and values and we've got goals and action items in place. Everyone's well aligned for this entire next year. We know what we need to do. We know the goals that we want to accomplish. We have metrics in place to measure them. The last thing we need to do is celebrate.

It's time to celebrate what we've accomplished in this session alone. Gather some excitement going forward as a team. Celebrate with dinner, do a team-building activity, you name it. Go do something together to celebrate being a part of this group that we are aligned within shared purpose and values. The one meeting that you need to have each year to focus yourself and achieve the goals that you want to achieve for the next year and more is going to come down to doing the same version of this annual strategy session to put you on the path for success for the next year. That's my coaching moment.

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PTO 156 | Leadership Development

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

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

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

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

Permission to Feel: Unlocking the Power of Emotions to Help Our Kids, Ourselves, and Our Society Thrive

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

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

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

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

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

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

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

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

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

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

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

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

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

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

PTO 156 | Leadership Development
The E-Myth Revisited: Why Most Small Businesses Don't Work and What to Do About It

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

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

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

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

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

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

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

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

Set up the purpose of values first as a clinic.

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

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

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

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

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

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

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

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

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

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

It’s difficult to run the business and be in the business. Click To Tweet

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It is legit magic.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You can reach me on my email. It is MABambenek9@Gmail.com. I'd be happy to have a conversation around your needs and wants and see where we can meet that.

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

Likewise, it's always a joy.

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About Michelle Bambenek

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

 

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PTO 118 | Tolerating Barriers

What are you willing to tolerate in your business?  Substandard performance, misaligned team members, limited time to focus on your business, sacrificing family time for work, unprofitable company structure - these are all barriers to our goals. But they can only limit us and continue to do so for as long as we tolerate them. Inspired by Jocko Willink's quote in the book, Extreme Ownership: "....there are no bad teams, only bad leaders...." Nathan Shields sees that there is absolutely just one thing that is keeping us from what we want. The fact is our team, the economic crisis, the insurance companies, etc. are not the issue; WE are the issue because of what we tolerate.

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One Thing Keeping You From What You Want

I'll start this episode by apologizing. I haven't been on for a couple of weeks and we're getting back into the swing of things. I went on vacation and contracted COVID thereafter. I've been behind on a few things. Forgive me, we're moving on. This episode is not a guest interview like I typically have. It's a solo podcast episode. I'm flying solo because I want to talk a little about something that I've seen both in my own experience and in the coaching clients that I have. It's related to a concept that Will and I discussed a few episodes ago and was then brought up in a different way and in a different perspective. You know how that is. You're thinking about something and then you read it a different way. It gives you further thoughts and ideas. Maybe it even shines a light on what you were thinking of in the first place.

In my episode with Will, we discussed the five secret actions that PT owners take to make them successful. The fifth one that I brought up was impatience. Not that it's a successful action per se, but it's a characteristic that successful PT owners and small business owners have in general. At the time, I didn't feel comfortable with the word because it's not necessarily patience that the successful PT owners are able to make quick decisions with the data that they have. They're decisive. They recognize that there might be repercussions, but they make the best decisions with the data that they have, and do so in a rather quick fashion.

Extreme Ownership: How U.S. Navy SEALs Lead and Win

This concept was addressed in a book that I'm reading. Our Physical Therapy Millionaires Mastermind read together what’s called Extreme Ownership by Jocko Willink and Leif Babin. In reading that, this is what got my brain thinking a little bit, in page 54, he says, “As a leader, it's not what you preach. It's what you tolerate.” He goes on to take it a little further in page 55. He digs a little deeper and says, “There are no bad teams, only bad leaders.”

What I got from that was that Jocko and Leif are stating a better way of explaining that one of five secrets that I discussed and labeled it as impatience a few episodes ago. Jocko might call it intolerance. The idea being that improvement, growth, attainment require us to look at ourselves and our teams and ask, “What am I tolerating? What negative performance or actions am I tolerating that are keeping me from my goals? In spite of everything I have to say and all the values that I espouse, what am I tolerating that's going against those things?” I believe that answering that question and purposefully addressing it head on is the key to our ongoing growth and fulfillment and our successes honors.

It's not a one and done action. This isn't something that you look at now. Maybe you address a current issue and then move on. It's like that never-ending mountain that doesn't have a summit necessarily. There's never a summit to be reached in this regard. Tolerating marginal or negative behaviors in ourselves and others is the antithesis of growth. We’ll continue to be a stumbling block going forward unless we create or develop characteristics within ourselves to not be okay with those things that we're simply tolerating. We could get into a deeper conversation about integrity and character. For the purposes of this discussion, I'll just say that most of the time, the things we tolerate are counter to our stated and unstated values and purposes.

What are you willing to tolerate to keep you from your goals? Click To Tweet

I want to share some examples from my own experience, the experience of coaching clients that I have to illustrate some of the things that are being tolerated. I'm not going to go through the consequences, but consider what those consequences might be if these scenarios are allowed to persist and continue. Usually we consider that it's a team member. That's the “issue.” Remember, there are no bad teams, only bad leaders. Consider what needs to be done as a leader in order for these issues to be addressed. I'll give 5 or 6 here. The PT that's not following train protocol to get full buy-in for the full plan of care at initial evaluation with a patient. Leaving the front desk and patient then to determine whether the patient should come once a week, twice a week, three times a week, and not taking a stand but saying, “You guys figure it out, whatever works with your schedule. We'll see you whenever you need to come in.” Consider what are you tolerating in that situation? What are the consequences if that continues?

What about the PT owner who finds out that, as I've stated here in my show or maybe found it in a different study, but less than 20% of patients complete their full plans of care? That PT owner does a little digging into their own clinic and individual provider statistics, and finds that most of one particular PT’s patients fall off after 3 to 5 visits and are in that less than 20% completed range. These patients are thus not reaching their goals or completing their full plans of care. When the PT is asked about it by the owner, he or she simply says, “I can't control if the patients are coming in or not. If they're busy, they're busy. I don't know what to do about that.”

PTO 118 | Tolerating Barriers
Tolerating Barriers: Tolerating marginal or negative behaviors in ourselves and others is the antithesis of growth.

What are we tolerating? What is the consequence? In that one, I'll tell you the average outpatient orthopedic clinic loses on average $150,000 a year because patients aren't completing a full plan of care. I'll give you that one. What about this? Front desk is found to be collecting only 50% of over the counter collections. That means only 50% of the copays, deductibles, and coinsurance are being collected at the time of service. Typically, this is struggled off by the front desk and maybe excuses are made that the patients forgot their purse or they don't have their credit card on them at the time or, “We'll just let the billing department handle it.” What are we tolerating? A lot of money and what are the consequences?

How about this? This might be a little bit more relevant to our situations. Six months into this economic downturn, there's a clinic that is overstaffed. Reserves are depleting and there's no immediate increase in new patients on the horizon. How much longer do you tolerate the overstaffing and negative profit margins? These next few are owner-specific. An owner has a team member that complained about their pay, their hours, even asking if meetings are on the clock or not. It's gotten to a point and sour the relationship to a point where this team member now avoids interaction with their supervisors and even the owner. However, they're productive and their patients have no complaints. Is that conduct tolerable? Are we tolerating something? What are the consequences?

The last one I'll share, all of your physician only marketing efforts have led to a stable yet a plateaued number of new patients that come in the door. You, the owner wants to expand, but you don't know what to do and don't have the time and effort to do it because they’re too busy treating patients full-time. You don't have the time to necessarily assess the alternatives because that takes even more time away from hobbies, family, etc. What are we tolerating and what are the consequences?

“There are no bad teams, only bad leaders.” – Jocko Willink & Leif Babin Click To Tweet

Most of these are real situations. Some are mine. Some are clients’ situations, but in each situation, I can promise you that the owner is tolerating the inaction of the employee or of their own that goes against their clinics, values and purposes. It’s going against what they preach. Remember, it's not what you preach, it's what you tolerate. That's where this whole conversation came from. Successful owners who have gained experience and have learned over time, they don't tolerate the affirmation scenarios.

They usually follow up pretty quickly with a four-step process and don't drag things out. Number one, they assess, revise and update any training or protocols that need to take place, and assess the situation to see what was missed in the training, what was missing in the protocols, or if the employee simply didn't follow through. Number two, they commit to change and improve both personally and as a leader of their team. Number three, they commit and expect higher levels of performance of themselves and others. Number four, they follow those commitments up by acting according to a higher standard and tracking the statistics that are related to them to that higher standard, and doing regular assessments either with themselves or with team members or in their leadership teams.

In the book, Jocko Willink says, “When setting expectations, no matter what has been said or written, if substandard performance is accepted and no one is held accountable, if there are no consequences, their poor performance becomes the new standard. Therefore, leaders must enforce standards. Consequences for failing don't need to be immediately severe, but leaders must ensure that tasks are repeated until the higher expected standard is achieved.”

PTO 118 | Tolerating Barriers
Tolerating Barriers: Successful leaders act quickly and decisively and don’t tolerate substandard performance.

What we tolerate leads to poor performance and that poor performance becomes then the new standard. The question is, what can you see in your clinic or in your own personal lives that you're tolerating that needs to be addressed? Simply address that now for immediate improvement. That's the challenge. I can think of a few things myself and they're not easy solutions. Nevertheless, if addressed, I can see the possibility for growth, fulfillment and attainment.

That's obvious if I simply address those things appropriately. I offer you that challenge. Open your eyes, pull your head up as the leader and be honest with yourself. What are you tolerating personally and professionally? Make a plan for immediate correction, including putting on your calendar exactly the hour and the day of when that item will be addressed. This is how successful leaders operate. They act quickly and decisively. They don't tolerate substandard performance.

If you are treating patients full-time, that doesn't give you the opportunity to assess and address your business accordingly to see and act on those things that you're tolerating. I challenge you to do those things. Hopefully, everyone's doing well, especially as we're recovering from the pandemic. I hope to see you here in the near future with another exciting guest, some great resources and content coming up. Stay tuned. I'll see you next time.

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PTO 88 | Tripling Clinic Production

 

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.

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The Path To Tripling Production in 1 Year With Ben Larsen, PT, DPT

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.

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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.

PTO 88 | Tripling Clinic Production
Tripling Clinic Production: If you don't have somebody to hold you accountable, you will find yourself very scattered.

 

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.

PTO 88 | Tripling Clinic Production
Tripling Clinic Production: When things start slipping, we start making excuses and figuring out if the situation can be controlled or not.

 

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.

PTO 88 | Tripling Clinic Production
Tripling Clinic Production: Focus on the things you can control and not those you can’t control.

 

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.

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About Ben Larsen

PTO 88 | TPTO 88 | Tripling Clinic Productionripling Clinic ProductionBen 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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PTO 75 | Private Practice Owner Coach

 

Reaching out for help from coaches helps us gain the needed insights for the development of our practice. In this episode, we are following up on the owner of Druid Hills Physical Therapy in Atlanta, Georgia, Dr. Avi Zinn, PT, DPT, OCS, about how he has developed his business. Although he has been successful in the development of his practice to this point, Avi reaches out because he recognizes that he needs to gain more business knowledge as the CEO of the business. He shares the importance of the stuff they did not teach in PT schools, such as tracking KPIs, leadership development, culture creation, and more. Learn how he is managing as a PT business owner and get a real-life look into what a business coach can do for you and your practice.

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Listen to the podcast here:

Reality Podcast Ep. 1 - Avi Zinn, PT Reaches Out For A Coach

This is the first episode that I have with an individual PT owner in which I'm going to follow along with him as he receives coaching and implement some of the coaching programs into his independent PT practice. Avi Zinn is a Physical Therapist out of Atlanta. He reached out to me to get some coaching and see if maybe we could work together to help him achieve his goals. Full disclosure, he didn't end up going with me as we talked a little bit about what I could provide and if that might fit for him. I actually offered him a couple of friends that he could call and talk to about getting coaching and consulting services with them and he decided to go with a friend of mine, which I'm excited about. Avi’s ready to grow and he needs to take the next step. I wanted to bring Avi in order to not only follow his path but also because Avi is pretty unique. He hasn't followed the typical entrepreneurial path. He didn't go through the burnout, the crash and burn stages that many of us may have gone through before. He did something different. I want to share his story with you.

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I've got Avi Zinn, Owner of Druid Hills PT in Atlanta. I'm excited to bring on Avi because he reached out to me in regards to getting some coaching and we've talked a number of times about his needs and how I could help him out, but things changed a little bit. He is looking for some coaching and consulting help and I want to follow his progress essentially and see what the coach or consultant has done for him to forward his clinic and to achieve his goals. This is the first introduction of that series of interviews because I imagine that down the road I'm going to do some follow-up interviews with Avi. I'm going to show you what it's like and what you can expect out of coaches and consultants and how they can help you as an owner. Let's get to know Avi a little bit and some of his influences and what got him to the point where he was reaching out. First off, thanks for coming on, Avi. I appreciate it.

Thanks a lot, Nathan. I’m happy to be here.

Tell us a little bit about you. Tell us a little bit about your professional path. How long have you been a physical therapist? How long you've been an owner? All that stuff so we can bring everybody up to speed on.

I went to PT school in New York. I finished in 2009. Shortly after finishing school, my wife and I moved to California and we went to the Bay Area. We were in Berkeley. I started my PT journey there. I’m looking for places to work, trying to see what was there. I found a cool PT practice based off their website. They’re more independent. The pictures of the clinic looked personal. They had a good vibe. I reached out to them and they hired me on, which was cool. Starting there was a good experience for me in a lot of ways, which ultimately led me opening up my own clinic.

Did you always have aspirations of having your own clinic?

No, not really at all. When I first started there, they had just done some coaching and consulting. They were in the process of transitioning their whole business model. I soon found out that when I started on, there was a huge turnover right before I came. I didn't realize that at first, but after being there for a few months, the remaining people that were still there were starting to talk about the old days or how things were different and not necessarily bad, but I think the change of the business structure led to other people just didn't agree with what they wanted. From following your show and all the people you've had on, it seems like that's a pretty common thing. You guys talk about your culture and your team. If you're changing your business structure and you're changing your team, then you’ve got to make sure that people are in line with that. I would assume if they're not, then they're going to leave or they're going to get told to leave. That led me to start my own clinic because it was an independent clinic. It wasn't a chain and it was two owners and they had a few locations at the time. I started seeing what it was like from the owner's side of things because they were at the clinic all the time.

You have to take risks in order to have something you desire to create. Click To Tweet

Whereas later on when I started working for chains or hospital systems, you don't see the owners at those clinics. You just see clinic directors or whatever. Being there, I saw that the community and the PT practice had a great reputation. People knew about it but at the same time, the employees, the staff, the PTs weren't saying the same things that the people in the community were saying about the PT practice. It was interesting to see how there could be a different perception that the patients are loving it, but the PTs aren't. That probably happened because of the change in the business structure and however that played out. I started realizing that there could be different ways of going about this business. Clearly, we're providing good service because people were talking about it and people knew about it but the staff wasn't happy. That was interesting to see. That's what really started me thinking about like, "Maybe I could do this." Everyone thinks, "I could do this." I thought, "If I am going to do this, maybe I'd make it so people are happy at their job."

There are a couple of different reasons why people open up their own PT clinics. Either they have an entrepreneurial spirit and they want to own the job and that's something that they have a burning desire to do. I'm sure there are many other reasons, but the two that come to mind are the second one being, "Maybe I can do this better or maybe I can create something that I can fill a need or I can create some value that I don't see in my current position. I can treat the way I want to and expand on that.” There are a number of different reasons in your situation, in particular, you're thinking, "The owners are doing great. They've got a great connection with the community, but the internal structure and culture could be improved. Maybe I could do that myself and create my own thing." Is that about right?

Yes, that's right, Nathan. You have to remember, I was in the Bay Area, that's a hotbed for startups and entrepreneurs. I do think that was a part of it. I remember a good friend at one point. I was talking about a startup and entrepreneurs. He even said something to me that I could be an entrepreneur if I started my own PT clinic. At that time, I didn't know what that meant to be an entrepreneur. I didn't realize that starting a PT clinic would be the same thing. Getting that entrepreneur bug, that's what I'm sure we'll end up talking about pretty soon in The E-Myth what Michael Gerber talks about. I think doing it better though and realizing that maybe I can do this in a way that would provide that service and also have the people that work there happy as well. What I was seeing at that clinic that combined with getting that entrepreneur bug, those two started the process of me thinking about at one point starting my own clinic.

You eventually went to Atlanta and decided to do that?

My wife is from Georgia. She grew up in Savannah and I'm from St. Louis. We were in California and we didn't know totally, but we started thinking that we would want to be closer to family. Atlanta seemed like a pretty good city. My wife did an internship in Atlanta and that was when I stopped that job. We went to for the summer to Atlanta to do the internship, but also see if Atlanta would be a city we'd want to move to. We liked it and when we went back to the Bay Area, we knew we were going to move there. I knew I wanted to open up my own thing or start my own clinic, but also knew we were going to move at some point. I never really wanted to do it in California. At that point, I started doing other jobs and experiencing different types of PT. I did work comp for two years. I started doing home health, which was interesting. I did that for a bunch of years.

Eventually, we did move to Atlanta and started doing home health when we got here to learn the city also. It was a good opportunity that I learned the city, but I was driving around for home health. I was trying to get a sense of where I would want to start a practice. It all happened at a time where I was ready to do it. This location opened up right in my neighborhood. Literally, a four-minute walk from my house. It's on the main street. It's across the street from this big shopping center on this road where they say 50,000 people drive by every day. It was perfect. Everything worked out. That's when I started to get things going because we found this place and I had been thinking about this all these years. It was time when this place opened up.

How long ago was that?

That was the end of 2017.

During this time, had you been reading any books about business ownership or accessing any resources?

When I was doing home health, I was driving all the time and I stumbled upon Paul Gough's podcast. That was really the first one that I started listening to. That was talking about owning a business and how to run it. I don't know if this is exactly what he said, but this stuck. He said, "You don't have to have the best PTs, you just have to have good PTs. You can hire the good PTs and you have to be the one who's working on the business.” The truth is I could be combining that with some of the other, like Michael Gerber, your show, but I believe he did say that stuff and it started making me think about how I was going to set up a practice and what that meant.

The cool thing is that it set up a mindset for you, knowing where you are. You don't have to be the best physical therapist. Soft skills are more important than hard skills. You already had an idea that you were going to bring on some other physical therapists anyways. It wasn't going to be the obvious in a physical therapy clinic and a one-man show. You had aspirations for more right off the bat. You've opened up your clinic and how did you start working in it? How did you start developing it, so that it wasn't obvious in physical therapy clinic? 

PTO 75 | Private Practice Owner Coach
The E-Myth Revisited: Why Most Small Businesses Don't Work and What to Do About It

When I was trying to figure out what to call it, I was really against calling it my last name, Zinn. A little back story. My father-in-law has his professional experience. He opens a lot of businesses. He was able to guide me through a lot of this in the beginning. Helped me set up the LLC. When I was looking at this place to rent and lease it out, he guided me through with creating a pro forma and talking to the landlords about having my financials in order, even though we didn't have the financials in order. Getting that set up and he was set on calling it Zinn PT. He wanted me to do that and I was like, "I don't want to call it Zinn PT. I don't want it to be about me." Maybe because of listening to the podcast and knowing Paul Gough’s podcasts, knowing that I wanted to bring people on and I didn't want it to be about me because maybe had a little foresight knowing that I would have to do the business stuff at some point and not always having people wanting to go to Zinn but to the PT practice.

What did you start doing initially to make it so that it was not Zinn? You ended up developing Druid Hills Physical Therapy, you were the initial physical therapist. How did you start the progress? This is an important part of the introduction of you. You did things a little bit differently and I'll highlight that as we go through the story.

First of all, I was still doing home health, which was a huge help because home health is super flexible and I was able to bring in some income while setting up the practice as a group. There was no other way to do it. I took out a loan. I could've taken out a loan three times the size and lived off of that for a while. That would have been a little overwhelming. Setting it up, I started getting things in order. I don't know if it was from the podcasts or not. I wanted to experience every part of the business at first to know what it was like so that I could start putting people in those places. When I started, I did everything. I was a PT but I was also running back and forth to the front desk to answer phones and schedule. Instead of a front desk person, I had an answering service, which was helpful and they would email and text anytime someone called. I had a doorbell. That was my front desk person. If someone came into the office, I knew someone was there and I could run back and forth to the front to greet them. I started getting things in place. Aside from the business things, I had to start getting patients.

I tried doing all that I thought would have been the normal way to do it, which was called doctors but that didn't work. It started with that. I was lucky that a third-party work comp insurance called me and they were like, "We want to give you a contract and send some people to you.” I was like, "I need people to send patients," which was also cool because work comp authorizes a certain amount of visits, they pay the rate, whatever it's going to be. You don't have to fight with the insurances. They're not going to like deny certain code, which was a great way to start. Because I got those patients, I knew those visitors were coming in and I knew they were going to pay whatever they paid. That was also a little bit of a hard part, to begin with, was the money part. How you charge people. All of it was hard. I didn't know how to do anything.

How long did you go like that before you took on your first hire and eventually before you got your next physical therapist?

I started at the end of 2017. We had our third kid in March of 2018. It was a great idea to start a business and have a kid the same year. Right after that is when I hired on the first PT. The business was growing slowly. Knowing that we were going to do this, I started looking back at the schedule and tracking what was happening. The schedule was pretty light. Looking back, I don't know how I was confident enough to even hire someone on.

That's the question I have for you. How many visits were you at per week before you hired that physical therapist because you went against the grain?

I don't know. At that point, I was doing three days a week at the office and still doing two days a week home health.

You brought on your PT at that point. This is why I wanted to bring you on is that you hired a physical therapist, what most people would consider is too soon. Based on my training experience and if you were to ask me, "When do I bring on my next physical therapist?" I'm going to tell you, you bring on the next physical therapist when you're meeting at least 90% of your slots that are scheduled out in a given week on average. That's the time when you know, I'm working hard or my other PTs are working hard. It's time to bring on someone else where these people are going to get overwhelmed. Maybe you even have a waitlist, but you went against the grain and you don't necessarily know why. You brought on a physical therapist because this is the thing, the typical entrepreneur story is we don't do anything until we get overwhelmed. Sometimes there's a crash and burn element to it. If you read to some of my previous shows and the successful entrepreneurs but you didn't get to that point, so you brought on the next physical therapist. You must've had some faith that things were going to go in the proper direction or maybe you had some real intent out there in the universe that things were going to grow?

It was a little bit of both, Nathan. I was thinking about starting a business, in general, is a huge risk and I've maybe realized that you have to take risks in order to have a business. That was the same move. I saw the trajectory and patients, it was growing slow but it was steady growth. It looked like things were going in that direction. It was time to hire someone on and keep it going.

During this time, were there some resources that you fell back on that might have stoke that faith or inspired you to bring on someone else so that it wasn't on you? Did you also maybe see that there were some aspects of the business that you needed to work on so the PT would take the treatment side of things off of you so you can focus on those things? Was there a combination of some of those?

Because of how busy things got, I realized that I had to do more of the business stuff. That was what it was. It was the beginning of 2019 or it must have been earlier when I started following your show. I remember in January of 2019 is when I started reading The E-Myth. I don't remember exactly when I found your show or how that happened exactly. Even before that, I realized that I had to be able to step away to do from treating, there were only so many hours in the day. I didn't want to be working all day long and then going home and working all night long. I realize that the only way to do it was to step back a little bit. It wasn't a lot, but it was by hiring another PT that I was able to step away and do a little bit more of the business side of things.

You have to take risks in order to have a business. Click To Tweet

The common fear when someone makes that first step is to bring on another PT. The biggest fear is, how am I going to justify that salary? I'm going to be paying somebody $70,000, $80,000. What if they don't work out and they don't produce? Somehow you overcame that fear. How did you do that?

After that first job in California and when we came to Atlanta, I did a traveling PT job. When we went back to California, I started doing PRN. When I learned about what PRN meant, that is ultimately when I hired my first PT, I didn't hire her on full-time. I hired her on PRN and it just happened that I found someone who wanted to do it. She was in a different job and she wanted to switch it up a little bit. She started doing two days a week with me. That is why I was able to not be so overwhelmed because essentially instead of making it five days a week for me, since I was only doing three days a week in the office, I made it a five-day PT but split between two people. I was able to have the patients coming in on all day, every day and then still have two days a week where I wasn't treating and doing some of the business stuff.

You were still running the front desk and taking all the calls and some of that stuff?

I was still doing that stuff and the billing, the front desk. Shortly after that, I got someone two days a week at the front desk. Gradually we started getting more patients, so that part-time PT ultimately wanted to switch all for hours over to this place. It worked out well because I didn't need to look for another person. She was already there. We were organically growing and filling those hours on the schedule without having to hire on a new PT and then have to be scared that you're not filling up their schedule for three months because we did it gradually anyways when she first started by two days and then added on more days.

She started taking on more hours. You started treating less it sounds like and you're working on the business during this time.

I don't think I really started treating less because for the most part, I was still treating the same amount, but it had blocked off certain times from the beginning to do billing, networking, calling people and driving around.

That's a huge part right there and I don't want to overlook that. You blocked off time on your schedule. As I'm talking to PT owners that are treating full-time, that's probably one of the biggest hurdles is to get them to commit to blocking off chunks of time, whether it's four days or 4, 5-hour blocks to work on the business. That is to look over your financials. That is to put together a pro forma like you're talking about. Consider what the future might look like. Do some networking. Even start developing some policy and procedures and hiring the right people to fill the spots that you either have open or are going to have open in the very near future. What you started doing maybe someone told you to or maybe you inherently knew you needed to do was to keep that time sacred for admin work.

Around the beginning of 2019 is when I read The E-Myth. That was transformative. I've heard people say it on your show a million times, working on the business and not working in the business. I think he came up with that. It made so much sense and you can't do it any other way. There's only so much growth you can have if you're working in the business. When I read the part about what a lot of people do is they create a job for themselves. That part was like, “I’m not trying to create a job. I'm sure I didn't try to create a business." I did somehow realized that I needed to keep that time separate to work on the business. Once I read that, it was when I started realizing I need to do more of this and if I want to grow, I need to not just hire more people. It would actually start taking more time to work on the business because once you start getting busier with more and more things going on, you need to have more time to figure out all the things that you had mentioned, which I still have not done yet.

We have to give it proper credit. The book that we're alluding to and referencing is The E- Myth Revisited by Michael Gerber. He does layout a lot of this stuff. When we say you working on the business, what are some of those things that you're doing? I have even some owners say, "If I'm not treating and I'm not catching up on my notes and I'm not paying bills, what am I doing?" What do you do in those admin times?

First of all, I still do the billing. That's part of it.

That's going to change soon. What are you going to do when the billings off your plate?

PTO 75 | Private Practice Owner Coach
Private Practice Owner Coach: The only way to implement your systems is if you take time away from treating and work on the business.

 

We'll find out soon. You did mention about policies and procedures. That's what I started doing was creating systems, which is what The E-Myth is all about. I created an organizational chart, which is another thing that they talk about in the book. Even though every single job in the organizational chart was me, I still was breaking up what created the business, all the different parts and all the different jobs that make up the business. I started writing out what happens under those positions, what one does for that job. Basically, I use Google Drive and Google Docs and I have a nice organized folders system of docs for every one of those job positions. Every time something happened that day that I had to troubleshoot or figure it out, I would put it in that doc and then I would try to create a system to make sure it didn't happen again or t try to delegate some tasks to the front desk person or the PT so that they can do it so that we wouldn't have to keep on going through the same mistake every time. We would know what to do every time. 

You wouldn't have to learn the same lesson twice.

Yes, we don't have to learn the same lesson twice. Also, we wouldn't have to be where someone had to knock on my door and asked me what to do for it.

This is why I love having you on. You're at a place in your ownership that I would say a majority of PT owners are not. I'm including the guys that have been out there for 10 to 20 years. They haven't taken the time to write up their policies and procedures. I can say I was in that boat 10, 12 years after opening up my first clinic. Didn't take the time to write down policy and procedures. I didn't have an organizational chart. It doesn't matter if you are in each position. At least know what the structure of your company is and what it should be and what it will look like when other people start filling those positions is huge. That comes as naturally to some people more so than others, but you're organized enough with your Google Docs to have everything written up underneath each job with a job description, the responsibilities and the tasks that are given to each position. That's huge and that is the reason why you are where you are is because you've done some of those things. How many therapists do you have?

We have three therapists besides me. They're all about 30 hours or so. Part-time but full schedules. One is actually reducing hours the same original one who wanted to take on more but also step out of her first position and try something different. She's going to try something different and reduce her hours, which is fine. Everyone wants to do different things. There's nothing wrong with it. We're about to hire another person and she's going to be my first full-time. We'll have one full-time, two pretty full-times, one part-time and then me.

Being less than a few years into your ownership. That would be unfathomable for some people. I'm talking to some owners who are one-man shows and they're overwhelmed and they're three years into it and they don't see a way out because they're treating 50 hours a week and not working on their business. Whereas you've set yourself up such that you have multiple providers and you're already experiencing some freedom that most PT owners don't have.

Nathan, you probably would agree with this, but for the people that are working crazy hours, I made sure I did this in the beginning, I worked at the office. I did some stuff at night, but for the most part, I was in the office 9:00 to 5:00, and that was it. I made it a point to stop at the end of the day. Of course, you do some stuff at night, you answer emails or you work on the website.

You had some intention behind putting an end to the day.

I think that's what it is. That has allowed me to keep going. It prevented me from burning out and I didn't get so overwhelmed because I was like, “This is the end of the day. We're going to stop, we'll pick it up the next day.” If I work an extra five hours, it's not going to be any different. You need to put a brake on it every once in a while.

There's some power to that. Number one, the time that you do have is limited. There's going to be an urgency to get things done. If you don't have that end stop, you're like, "I can work until 7:00 and I'll take my time getting things done.” Inevitably there’s something called Parkinson's Law that, "The amount of things to do will end up taking up the time that has allotted to do them." If you're available to work until 7:00, you'll have plenty of tasks to keep you busy. If you put that hard stop at 5:00, you've done two things. Number one, you've set a deadline, but also, you were concentrating your efforts on doing the admin work. You can get more done for the benefit of your company by focusing that time on your business than trying to get tasks done. Instead of trying to get payroll down or pay bills. I'm sure you were focusing on what some people call the MIT, the Most Important Thing of the day and that is developed policy and procedures. Get my organizational structure in place. You're doing the billing, but that's a separate chunk of time. The fact that you spent that time on the policy and procedures and the organization of the structure of the company means you've developed solid integrity around that and you've accelerated your growth as an owner and as a business to the point where you are.

There's only so much you know how to do. You need to reach out and ask people for help. Click To Tweet

To be clear, I still have a lot more work to do on the policy procedures and all that stuff. That's ultimately what we're getting at with coaching and consulting. In March of 2019, I hired on the second PT and then that's when I drastically reduced treating time down to twenty hours a week of treating.

Was that a scary transition or something that you're, "I need to do this?"

It wasn't scary at all. It was, "I need to do this." Partially because at that point I had read enough of your blogs and also had probably read to The E-Myth again for the second time or maybe even third time that I realized that it doesn't even matter if it's scary. That's what you have to do. There's no other way around it.

You recognize the need of the company was to go in that direction, right?

Yes and it was my business. If I'm treating, who else is going to work on the business? I have to be working on the business. There's no other way. 

You talked to me about doing some coaching and consulting. What led you to that point?

Where I've gotten myself have been a lot of working on the systems and policies, but at the same time, there's only so much I know. As the business grows and when we're getting more patients in one of the main things that I've noticed is there are cancellations and why are we having 30 new patients in a month. We had eighteen new patients in one week and that was awesome. That was the most we had. The following week the schedule was half empty and it was like, "How is that happening?" I started running analytics, WebPT. I called them up asking, "How do I find out how many times each patient is coming in?" I’m trying to see what their plan of care and how many visits per week? I find that a lot of patients are only coming once a week or they schedule two visits and then they're gone and no one was tracking that. I run this lost patient report from WebPT and then all of a sudden, I look and there are 50 to 100 people on this report of people that came in and we never got them back on the schedule. That was a huge thing.

You recognize that you need to start monitoring your metrics and if you haven't taken the time to do that, then the metrics will control you and sink you.

On the analytics and WebPT, they have their main KPIs. There are six KPIs on there and that was cool. I realized I don't know. I feel like I've done a lot to get myself here, but there are people who know a lot more to take those numbers to who've already gone through this, who can tell you how to use those KPIs, those metrics and what to do with them. How to affect them and also, one of the biggest things through all this realizing that I am not just the owner, but a CEO of the company. I need to learn how to do that. I need to know how to manage my employees, train them and set up different structures and have certain people responsible for different parts of the business. I realized that there's only so much I know how to do. That's when I was time to reach out and ask people to help me along that.

You realize that you are the final word. People are going to come to you because you need to have the answers for the company. I don't think a lot of physical therapy owners who are relatively new don't put on that hat per se. They think that the ownership somehow is not as separate from them. They know that they're the owner, but they don't act like the owner and that they should be monitoring all the metrics and the financials. They should have some idea of what to do when a statistic goes bad and how to look and investigate issues in the clinic. It sounds like you had that realization that you need to take on that hat.

Nathan, that part is hard. I went to PT school, I learned how to become a PT. I didn't go to business school. I don't even know if you learn how to do that in business school either. I don't know how to run a company. 

We're all in the same boat.

To answer your question, that's what it was. I realized that I needed to be the CEO essentially and I needed to learn what that means and how to do it.

You reached out to me and we had a conversation. I actually gave Avi some recommendations of other coaches to also consider outside of me and he has decided on another consulting company and I'm excited because he's going to do amazingly well. You can see that he's already set up the foundation. I want to follow you along this journey. How will you know if you've been successful with a coach or consultant? How will you know that they've met your goals? Is there a statistic that you want to see? Maybe gross revenues and net profits or is it more freedom for you? Is it growth?

PTO 75 | Private Practice Owner Coach
Private Practice Owner Coach: If you're changing your business structure and you're changing your team, then you got to make sure that people are in line with that.

 

I'm starting to understand financials and understanding gross revenue. I'm at the point where I can look at a P&L and understand it and gross revenue, of course. Let's get that up.

You need a return on your investment to the coach. You expect a multiple of your investment on the coach.

Having the patient drop-off, go away or at least get better. Maximize the utilization, which is something you were saying. If there's so many hours that the PT is treating, they should be treating patients that whole time or at least let's say 85% of it and figuring out how we can make sure that happens. Training the front desk also is the best way to take part in the patient's experience. Also, making sure that they're following through with their plan of care when the PT comes and brings them up to schedule. Making sure that they schedule it and making sure that they understand what it means and the cancellations are detrimental not to their progress but to the whole business. Probably a million other things at the front desk can do but hopefully, they'll help me out with all of that.

Are there some particular goals that you have then over the course of the next year or two? I'm sure the coaches will help you along with this, but what are some of your goals that you have?

As far as freedom goes, I don't need to be not in the office 200 days a year, which is great. Maybe one day. I like being in the office. I like working, but I don't want to work all day, every day. First, producing the treatment hours, that was key. I've done that myself, which is talking to you and talking to other coaches. That's what ultimately is going to set me up for success quickly with these coaches is because I've already done what a lot of people have to do initially once they start with the coaches is to back out of the treating.

You're a step ahead already.

That ultimately is going to allow me to focus on some of the goals a lot quicker. In 2020 who knows? Maybe this will happen in two months. If we have twelve hours of the day in the office, 7:00 to 7:00 and we have five PTs, I want to be able to fill up that schedule, which is ultimately going to bring in more revenue.

You're going to have to expand.

Yes, hopefully. These could be long-term goals. I remember early on Paul Gough that he’s talking about how he owns some of his own real estate and some of the practices. That could be a cool goal. I don't know so much about that on the numbers side. I imagine at some point it's beneficial, but maybe it's not always. That could be five years from now. I want to grow this space location that I have to maximize it. If I have to work twenty hours a week still treating patients, that's fine. I like treating, but I also recognize that I have to do other things. If I need to not and I can get someone else to do it, great. Maybe later on, in a few years, I can start treating again. Wherever the business needs, that's what I'm going to do. 

That your decision matrix has to be exactly that. Whatever the business needs. If you're not wanting to set aside time to work on the business and want to treat full-time, then go work for somebody and work full-time. Don't spend the stress and energy to own the business on top of it. If you're going to commit to owning a business, you need to put the business first. That comes first. What a lot of PT owners don't recognize is the clinic needs them to treat less, needs them out of treatment because it's a distraction to treat patients as an owner. You need to set aside times to work on the business and eventually what happens is they work themselves out of treatment because the needs of the business become greater because they were expanding and growing. I'm excited for you and what you're looking. From my perspective, looking at where you're at, you're looking to gain more knowledge so you can confidently and securely wear that CEO hat and become more efficient. You're recognizing that there is a lack of efficiency maybe in your company and you don't necessarily know how to affect it.

That's what I think when I pulled up that last patient report that one time and I realized, that's why our schedule is not full, even though we're getting all these new patients. We need to figure out how to make sure that doesn't happen. 

Work on the business and not work in the business. Click To Tweet

That's a dagger to the heart when you find stuff like that.

That was hard. 

It goes through a couple of things. That is a whole few pages, maybe one or two pages full of lost revenue. More than that, if you're looking at from a higher level, these are patients that didn't get the full complement of care. These are the types of patients that go back and say, "Physical therapy didn't work for me. I've been to Druid Hills Physical Therapy and it didn't help." You don't want that. That can happen unless you're focused on getting them to complete their plan of care. I said this in an interview that I did. I found out about it a couple of years ago when I interviewed Heidi Jannenga of WebPT, and they did their annual survey that most small businesses lose on average $150,000 a year because patients like those on that lost patient report don't complete their full plans of care. That's a detriment to you as a business owner. It's a detriment to them as patients because they're not getting better and the chance of recidivism or the chance that they didn't even get better is significantly higher.

It is a detriment to the profession as well.

We'd become a commodity. They say, “Physical therapy didn't work for me.” They don't say, "I'm going to try a different physical therapist." Like anybody would maybe with a dentist, they say, "Physical therapy didn't work, so I'm going to try something else." It's unfortunate. I'm excited for you and I want to follow along with you and see what you learn along the way and so we can share with the audience essentially the benefits of coaching. I wanted to share your story number one, because it's amazing that you haven't gone through the typical cycle of an entrepreneur that's even spelled out in The E-Myth Revisited. It's not in the physical therapy space, but I think she was a baker of pies and she had that burn out and she's like, "I can't do this anymore. I'm not seeing my family and I hate my job." You never experienced that because you looked ahead and started planning and started acting forward in faith that things were going to continue to grow and it's worked out well for you. You're going to continue to grow that you develop that foundation.

I want to say one funny thing that happened. We're in the process of moving houses. We're going through a bunch of things and I find a box of all my notes from PT school and I open up a folder from my business admin class, the one day that we spent on and pull out the handouts. There was right on the top was The E-Myth Revisited. I don't remember the professor ever talking about that back in the day. If anything, they were doing a good job teaching about business because they talked about The E-Myth. I'm sure there are other ways to look at it, but following that way of setting up systems and organizing the business and working on the business. That is what has allowed me to get to where I am.

What's different about you Avi compared to a lot of entrepreneurs, whether it's physical therapy owners or not, you've had it on the one book and I'm sure you've read other books, but this one's been influential for you. There are people out there that have read the book and I've read hundreds of others and aren't in the position where you are. The differences that you've actually taken action on what you learned. I read The E-Myth Revisited 6, 7, 8 years ago, but I didn't implement it to the level that you did it either. I would submit that people who are reading the business books, if they read The E-Myth Revisited, don't read it as a nice, good story, but to actually implement what he recommends. 

The only way to implement it is if you take time away from treating and work on the business.

You've actually put those principles into practice and that's what I separated you from somebody who is simply read the book. I'm excited to see your growth here as you get some greater insight and knowledge on how to improve your stats and become more efficient. We'll follow up with you and do another interview and see what you've learned and what's been influential for you. Maybe there are some pitfalls, maybe there are some things that happened along the way, who knows? You might experience for yourself what your initial outpatient company did in San Francisco. Maybe not everybody's aligned. That or everything is going to go in a great direction because you have your ducks in a row already. I'm excited to see what happens. Is there anything else that you want to share, Avi?

For anyone, if they are reading for the first time, reading your blog has been helpful also. I talked a lot about The E-Myth, especially because I've set aside some time to work on things. I'll read your blog whatever interview person you have on and then try to implement those things that day or that week. It's been also helpful to know other people's stories.

That makes me feel good. Not only a resource but an inspiration to you. Thank you for that. We will stay in touch and we'll come back around to the story that is Avi’s in Druid Hills PT.

I'm looking forward to it. 

Thanks.

Take care.

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About Avi Zinn

PTO 75 | Private Practice Owner CoachDr. Avi Zinn, PT, DPT, OCS is the owner of Druid Hills Physical Therapy in Atlanta, Georgia. He opened his practice at the end of 2017 and has slowly built it up—transitioning from a staff of one (himself) to a team of administrative staff and treating therapists. He continues to grow the practice gradually. Avi’s main mission for Druid Hills PT is to provide high-quality, personalized care to each and every one of his patients.

Avi has his doctorate in physical therapy from Touro College, and is a Certified Orthopedic Clinical Specialist. He lives with his wife and three children in Atlanta.

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In this episode, host Nathan Shield talks about the people within your company with the CEO of Pure Physical Therapy and Founder of Next Level Physical Therapy, Frank Garza, PT. Frank started seeing growth in his PT clinic once he started weeding out the "bad apples" in his organization and focused on hiring and firing those people who weren't in alignment. How did he do it? He, along with his wife, established the purpose and values of the company and hired and fired accordingly. Now, the people on his team are rowing in the same direction and growth has accelerated. Plus, the energy in his clinic is fresh and exciting, and the culture is drastically changed. Want to establish a culture like Frank? Set the standards, establish purpose and values, and get your team on the same page. Your growth and an exciting culture will immediately follow!

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Listen to the podcast here:

Identifying The Bad Apples In Your Organization With Frank Garza, PT

I have Frank Garza out of Texas, a successful physical therapy owner who recognized that once he had established his purpose and values, he was able to weed out those employees that weren't on the team and we're limiting him. By removing those people, he has been able to achieve significant growth. Based on the book, Tribal Leadership, Frank recognized that there were certain stages of people and certain stages of a team that contribute to your success. As you weed out those people that are in stages one and two, and as you move your team into stages four and five, that's when you make significant growth. That's when you make significant progress and start to achieve the purpose that you set out to achieve. This is great that we can have a personal experience establishing the purpose and vision, hiring accordingly, getting the right people on the team, and then seeing the success that comes from it.

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I've got Frank Garza, a physical therapist out of McAllen, Texas. He is the CEO of Pure Physical Therapy and Pilates and also a Founder of Next Level Physical Therapy mastermind and consulting group. I've interviewed a number of original founders and members of Next Level Physical Therapy. Frank is on to talk about an important topic. Thanks for being with us, Frank. I appreciate it.

Thank you for having me, Nathan. I appreciate it as an NLPT being able to come aboard and talk about all the stuff that us private practice owners wish we knew when we were starting.

Tell us a little bit about you. Where did you start? Tell us about your physical therapy path and especially your ownership and entrepreneurship path and what's led to where you are.

I graduated and I played sports. I think like most physical therapists, they get into it because they got hurt and got exposed to the field and connected with their physical therapy team at the time. That's how I got intrigued about it. I ended up graduating and I coached and taught for a little bit. I liked that, but I knew that I wanted to be my own boss. I knew that I wanted to do something that I could control and that I could lead. In football, that's the position that I held. I liked it and embraced it. Going into physical therapy, I knew that I could have my own business. That's why I got into it too. I went through it and got out. I worked for a private practice clinic for a year. Right after that, I felt I knew enough to go out on my own and do things on my own and get my feet wet. I say sometimes that I rushed it and I say that might have been a mistake, but at the same time it probably could have been the best thing I did because people were there trying to help.

There was a time when there was a lot of work. Private home health companies were picking up PT companies to do their home health visits on the side and paying them a good rate. That's how we got started. We said, “This is an opportunity to go on our own and do something that we can fill our schedules and get other people to work under us.” We did that model for two to three years and then it went south bad. Luckily, we had already planned to do our outpatient clinic and that's how our outpatient clinic got started.

You started doing home health first before you went into it.

We started doing home health first. The reason for that was the people that we were working for said, "There's enough work out there. We'll help you get started.” You build your company name, you get a contract, you start bidding home health agencies for work. There was so much work that you could fill your schedule fairly quickly. It's also something easy to manage. You didn't have all the red tape about credentialing and audits and all that stuff with paperwork because they controlled everything. You were just a contract payer. It was a good way to get that taste of freedom, flexibility and ownership of your own business. At the same time, it was one of those models that you were chasing the profits all the time. You weren't making that much money and you were seeing a lot of patients, you had people that were underneath you seeing a lot of patients and you have to pay them. If they didn't pay you on time, then you couldn't pay them on time. We started learning that it wasn't a great model to grow, to scale and to make the money that we wanted to make. We started saying, "Our ultimate dream was to have an outpatient clinic." We had enough capital to invest in that.

It’s a good thing we did because the home health went south shortly after that. There were a lot of people getting busted for fraud. That model went to hell. We've entered into outpatient and we did what we did and we got started with what we knew. The experience of running the home health, but it was a totally different monster. There were so much things that we had to do before we even saw our first client, our billing and all this other stuff. It was an adventure, to say the least. We knew right away that we needed to hire people to help us. We hired staff. We chugged along for a year, two and three. Have you ever been on a roller coaster ride and sometimes the whole cart shakes on one of the stable tracks? That's how the first three years felt like.

You almost have to fail at everything HR before you understand it. Click To Tweet

Not everybody was a good fit for your team, I'm sure.

That's exactly what I was going to get to. We started realizing quickly that who we hired was like, "It's not going to work out. Who are we going to hire? We don't have anybody to hire." I think our mentality at the time was, “We need people to work for us. Let's pick up whoever is available.”

“If they're breathing and can follow some instructions, then bring them on.”

If it was somebody that somebody referred, that helped. That's even better. There were people that we knew in the home health field and they were like, "I have a cousin, a friend that was looking for a job." We quickly assemble the staff. We also quickly found out that we were in for some trouble if we didn't fix it because it wasn't the ideal staff. We didn't know what the ideal staff was. We learned a lot.

In my situation, I was like, "I don't necessarily have any job descriptions written out, but I'm going to put you in this position. I expect you to do what you're supposed to do." I was so naive to think that I could put him in a position and expect immediate productivity, an immediate buy-in. I found out later on that it was probably good to hire people who have bought into your vision, who share the same values. They're aligned. Maybe it's even better if I actually develop a job description and tell them what productivity looks like and how I'm going to measure them. It all comes over time, but you wish you would learn that sooner rather than later because things change when you start hiring based on that model.

I learned a ton. I learned that if we had concentrated on that department itself early on, on the human resource department for sure, that maybe we have not struggled as much as we did because it was a struggle. I look at my position and I'm learning that it's still a continuous work in progress. There's never HR and building your culture and your team like that. That doesn't stop because it's always evolving, things happen within your team and you’ve got to replace them. There are some things you can't control, but it's a work in progress. I also learned that you almost have to fail at everything HR before you understand it. We're not taught any of this in school. We don't know where to grab all these concepts, stuff and resources early on. It sometimes takes you telling the story of failure to another friend and they're like, "You had to do this and you’ve got to read this. You should go take this class." You learn a lot from failure, but who doesn't? One of the other things that I learned is that you cannot swipe someone else's HR material and expect for you to understand it and then much less for your staff to understand it. It doesn’t happen.

You think that there's a one-size-fits-all HR employee handbook. That's not true. Much of your culture and so much of you is simply how you do things. That's what I consider culture to be. This is the way we do things around blankety-blank physical therapy. That eventually develops your culture and it goes even back to your HR material. This is how we treat patients. This is how we expect you to show up to work. This is how we handle disciplinary actions. All that stuff needs to be broken down and individualized for your own clinic.

The number one thing that I learned early on is that we did not have that company culture that we wanted for the first three years and we have to fix it quick. It started with us, which is exactly what you were saying. We have to make a transformation mentally of what we wanted to instill in our company, what the vision was, what the mission was, how were we going to do it and make sure that everybody understood that, everybody was clear on that message. That was the number one thing that I think if people are out there wondering, "How do I do that? How do I avoid making the same mistakes?" Travis already did a show about this. It starts with us and our vision and our mission. It’s making sure that our staff clearly understands that and making sure that everything they do is working towards that common team goal that you're trying to accomplish. It's something that we realize we didn't have early and we started to change it quick.

It's probably you and your wife that came up with the vision and the mission. Maybe you created values between yourselves and your team. When you finally implemented that after three years, was that rough to implement it and get everybody's buy-in? Did you end up getting rid of a lot of people after establishing and planting the flag like “This is who we are?” Was it an easy transition for you or was that something that got smoothly brought into your company?

PTO 70 | Identifying Bad Apples
Tribal Leadership Revised Edition: Leveraging Natural Groups to Build a Thriving Organization

The transition is never easy when you're trying to get rid of bad culture and create a totally new culture. For us, we identified that we had people already in our organization that we're not going to work out based on the meeting that we had about our mission and vision, all that stuff about what kind of individuals we wanted, what kind of characteristics they needed to have per each individual position? That's key too because you want them in the right position. All of that starts with us. We need to identify the vision and mission and how you are going to do it? It’s on your core values. If you know that you're hiring for the front desk, you're going to go look for certain characteristics for that front desk. That's your expectation. You got to give them an expectation for every position. I looked back and I said, "What did I do in some of my coaching career with my team to get buy-in and culture? What did other coaches do with me when I was playing?” There was one coach that brought out a binder like it’s the beginning of the football season and everything that we were going to live by that season was in that binder.

Our hyped-up a chant before the game is spelled out, everything is written. That was his way of instilling that culture. It was a new coach coming in. He was changing everything. Even before school started, we were reading stuff through that binder and getting to know what his philosophy was, how we were going to do things, and how he expected us to do things. If we didn't abide by-in or if we're doing something different, then there was a consequence to it. The same thing applies to your business. You got to set that standard as a CEO and as a leader. You make sure that they follow it.

That's the important thing to note. A lot of times when you set the mission, vision and values in midstream that you've been practicing for a few years, you decide, "Let's establish a foundation and get down to some fundamentals and talk about vision, mission, and values." Inevitably there are going to be some people who don't like the implementation of that structure and that don't have buy-in. You're more than likely going to lose some people. You have to understand that up front and you've got to be okay with that because the people that you lose are the people that haven't bought into your clinic. Once you shed yourself from those people and you can attest to this, Frank, you will then experience some accelerated growth. Especially as you start replacing those people with people who actually do buy-in to your mission, vision and values. As long as you're establishing that over and over again, you don't stop talking about the mission, vision and values after the initial introduction. Once you plug it in and then start hiring according to those, then you start getting some people who buy-in and the growth then accelerates.

It’s happened to us on two different occasions. One of the things to educate our audience on is how do I identify the bad ones and the good ones? What are some characteristics of some bad culture in your company? I was brought onto this book called Tribal Leadership. It goes through five different cultural stages. After reading that, I started evaluating my staff and listening and observing their body language. You'll find out right away who's on board and who's not. I'll go through those cultural stages to help people identify them for those that are wondering what are they and how do I identify them. Stage one is characteristics and qualities. This is the type of mindset that creates street gangs. We don't want any of this in our company. Their thing is that life sucks. They're despairingly hostile, they band together to get ahead in a violent world. The great example is The Shawshank Redemption. We don't want to hire stage ones, but sometimes you'll get people in your meetings that have that bad body language and in everything you say they’re like, "No, yeah, whatever." There's always something negative to everything you say. There's always a problem to every solution.

Stage two is a little bit different. Instead of, “Life sucks,” they're a little bit more personal, “My life sucks.” They're a little bit more passively antagonistic. They may not say something verbally, but in a meeting, they'll go cross their hands in judgment and not be totally bought in but not be totally against you either. They never get interested enough to spark any passion. These are the ones that sometimes you come in from a mastermind or conference, you've got all these ideas to share with the group and they're like, "I’m not interested." They're not too excited. By the same token, if you say a funny joke to them, the laughter is a sarcastic resigned thing. They’re the whatever type. The talk is that they've seen it all before and watched it all fail.

A person at this stage two will often try to protect his or her people from the intrusion of management. The mood here is that their life sucks. It’s a cluster of apathetic victims is how they characterize that. Stage one and twos are exactly what you don't want to have. If you're looking and coming into meetings and you're seeing these types of behaviors, you want to know that they're not the ones that you want and then they start changing a little bit. They start getting a little bit more positive. Stage three, the theme is, "I am great and you're not.” Knowledge is power so people hoard it. They're the people at this stage they have to win and winning is personal. They're your big competitor people. They will outwork and outthink their competition on an individual basis. The results from this as a collection of lone warriors. These are your hardworking individuals, but not so much team players. They're often seeking help and support, continually disappointed that others don't have their ambition or skills.

If somebody is not trying as hard as they are, they’ll be disappointed. Their complaint is that they do not have enough time or competent support. They’re like, “I’ve got to do this by myself.” It's a bunch of self-described star players. You can't have too many star players. They can't play together as a team. That's basically the theme there. You’ve got your stage four and five. These are the ones that you want all the time. Instead of going from, "I'm great," the stage four theme is "We're great." This is where I think most of your positive company culture is, your great, thriving, growing companies. When they have great culture, they have a great team. They have a lot of stage four characteristics and qualities because it's all about team. Everyone is excited about seeing each other at work. They take the tribe away from the person's sense of self. These are the people that if they take the team away, they feel like, "Where am I?" They feel lost because they feel the team is their second family. At this stage, the culture is effortless. Nobody's trying too hard. Everybody's doing what they’ve got to do and working for each other as opposed to for themselves.

The only one that has influence is the tribal leader. Here in stage four, whoever's at the very top is the only one that actually has influence over this culture because other than that, there are no lone warriors. Everybody's working together as a team. You have your last one, which is, "Life is great." The language revolves around infinite potential and how the group is going to make history. They want to make a global impact. This is where they make an example of Apple where they say that the innovators from Apple and Steve Jobs were at stage five because they did things that made a global impact and they wanted to make life great. The mood is an innocent wonderment. A very small percentage of companies have this type of characteristic. Most have stage four, but you definitely don't want the ones and twos. That's important to understand, to identify what you have.

That's great because you can put this assessment up against each individual within your team very easily. I think it's easy by what you laid out to say, "Who are my stage one players? Who are my stage two players? Who are my stage threes?" What have you learned? Can any of these people change from two to three or three to four? Do you simply hire slowly or fire fast? Do you simply get rid of them?

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The ones and twos, there's no change there. The threes can get into fours and that's definitely what you want.

Just cut your losses.

Especially if you have a big organization and you have this person in a position where they have a lot of people under them. If they're a stage one and two, imagine what they're telling all those people under them. Imagine the mindset and the stuff that they're feeding them. That's what those people think of everybody else on top. That's not necessarily true.

When you have those people in your company, they can be a real poison. It's almost like if they're allowed to linger long enough, everyone that they touch in their immediate circle becomes poisonous as well. We've had that experience before in one of our clinics where one person in particular was poisoned and unfortunately, they were the leader. After that person left, it took at least a year before we got everybody out who they had an influence on before that clinic started turning around. Looking back on it, my partner and I both believe that we should have closed down the clinic, fired everybody that had a connection to that poisonous leader and started from scratch and got some new people. It can be that devastating and that pervasive when that one person has that much influence.

I'll tell you a personal story of my own too. Sometimes you think it was so bad and then you’ve got a new staff and it got better. You're meeting some goals that you'd never met before and you're like, "This is great." It plateaued for me. I was like, "What's going on?" We've got a new hire. This new hire, it was the first time we have put them through a rigorous hiring process and had this funnel built out and had all these triggers that they had to do before they even came into an interview. I was like, "This guy has got it." We hired him and sure enough, he came in and in six months outworked everybody in the front desk so much that we redid all our internal processes at the front desk. That's when I knew, I was like, "We may have another problem." That wasn't his job. He was going to come in and do reception. He ended up coming in with all these things and changes and made things better. The problem was those other two people that were there before him didn't I go through that interview process that you went through. We didn't weed out as much as we thought early on.

Since then, we've hired another one and we ended up tweaking his process more to make it more specific and refined to make sure that we got another person just like him. The other two people are not there anymore and the other two that we hired are now all cross-trained the way he did everything at the front desk. When we brought them on board, we made the onboarding process and the interview process very detailed to everything that he had created and changed up there with my direction. Even when you think you've got it, you probably have to do another thing. That's what happened to me. We went through and we hit some numbers that we had never hit the first time around. We plateaued and we weren't hitting our goals that had after that. He came on and totally changed it. We brought these two other girls on.

As soon as the new staff came on board without the old staff here, because there was a little bit of overlap, they have put in their two weeks. There were several part-timers in training. The very first week when all the old staff was gone and it was just a new staff with the person that we trained up there, we hit our 200 visits a week goal that we haven't hit in a while. It always happens for the better, but I feel it only happens for the better if you put in that work, your blood, your sweat and your tears into making it better. We refined our process, we identified the leaks, we identify leaks again. We tweaked and refined the process and we got a better product out of it. You got to keep tweaking and refine. That's the main thing.

That's the perfect example of the theorem that the people that got you here are not the same people that will get you there. Some people will be good at getting you to a certain point. What's cool about this also is it exemplifies how you were so intentional about the person that you want to hire. In your own words, it was a rigorous process. For someone at the front desk, if you can breathe and say hello, usually that's good enough for us to sit at the front desk, but you took it a step further. What do we exactly want out of this person? How are they going to be the most productive and how are they going to be the face of my clinic? Immediately, as soon as you did that and got rid of the other people, your numbers grew again. That’s a great example. 

Our main focus was we want to create overwhelm for these candidates. That's what I told the guy, Bruce, he helps some of my marketing and all my funnels and stuff. I said, "I want to create overwhelm." He goes, "What do you mean by that?" I said, "I want you to give them everything and all descriptions and tasks that they will be having to handle." Even if they only have to do it once, even if it's not their main task. I said, "I want them to feel overwhelmed." I was like, "Why?" It's because if somebody can come in knowing that they're a little overwhelmed and stick the interview, then they're going to be good because there's a lot of overwhelm at the front desk. Wouldn't you agree? He’s like, “Yes.” That’s what our mentality was when we did that.

PTO 70 | Identifying Bad Apples
Identifying Bad Apples: When you have employees that have great culture, then you have a great team.

Congratulations that you experienced that because that front desk is such an important part. Correct me if I'm wrong, are you paying these newer guys a little bit more than you were previously? 

They're still in the probationary period. It’s equal to what it was for the others but going forward, they're both doing verifications. I already prepped them and have their one-month meeting and say, "This is where I want to be able to get you at, but I want to make sure that you're completely independent with all of these things." They're not quite there yet, but they're helping so much more than the other two were as far as what they're going above and beyond doing.

That's awesome because you're incentivizing them and you're telling them, "If you're going to make more, this is how you're going to do it." That's always awesome that you can incentivize them. There was also a change in the quality of the candidate once we decided to increase our per hour rate that we were willing to pay that front desk person. If we were stuck in the $8 to $10 an hour range, we’ve got $8 to $10 an hour type of people. Once we bumped that up to closer to $12 or $15, then we got $12 to $15 an hour people. I'm not saying that you need to share your numbers, but I'm leaving that as an example that sometimes you should be paying a little bit more for someone who is super productive at the front desk because that person drives so much of the success of your clinic.

I had a conversation with my wife about this. We were going to try to increase base pay across the board for techs and front office going forward, but with these expectations, our next tech coming in is not going to start there. He's going, "You're going to start here and you could get to here once you get to a year-and-a-half experience and you're doing this." Our techs had been with us for about a year and a half, two years. They’re in a little bit more responsibility. One of them is responsible for the cleanliness of all the gym and the other one is responsible for all the equipment. We have to order stuff. He knows my online account where we go order. He just gets it approved. They're a big part of what we do here and they're making more, but if somebody that comes in and starts to do tech work, they’re not going to start there. They're going to have the expectation of, "If you can do this like Alex is doing at some point, this is where you could be.” I do bonus them. Everybody got a bonus. We do a little a profit share at the end of the quarter. Even though their base rate is a little lower, when they get incentivized and bonus, it turns out to good hourly grade. I do feel you on that trying to get those candidates.

We're talking about front desk and tax, but this is correlated with physical therapists and PTAs as well, even the clinic directors. They can have such an influence on your team if they're in stage one and stage twos. You want to have more of the stage fours, people that are bought into the culture. We're talking about your hiring process. Are there other things that you do to cultivate that culture and move those people into stage four types of employees where they're bought into the team and it's all about effortless culture or the things you do to maintain that?

I've been working on that a lot. That's something that we've been changing around here because before, we were tied up with life. We're trying to get their business to where it needed to be. Get the kids in the home life to where it needed to be. It wasn't at the top of my focus at the time, nor did I know it needed to be. I started seeing all the positive effects of that. I read a line by Peter Drucker somewhere in his book, he said, "Culture eats strategy for breakfast. It never stops. It's a 24/7 thing." I said that to my wife and I said, "I'm going to take on this hat and know that I'm going to be coming up with some ideas to hang out as a team. We're going to be celebrating any and all little wins, things that nobody else is looking at." We’re trying to create our identity. That's what I told her. As a team, we’ve been hanging out a lot.

Every quarter, we set some goals and when we hit them, we celebrate them. When we celebrate, we go out. I rented a house on the beach and everybody came out and I barbecued all day. They went to the beach and we're in the pool and hung out and had a place to stay and drink. We’re hanging out with each other. We try to create an atmosphere of family and trust just like you do at home. It's hard because it’s like, “They're not your real kids, Frank.” I was like, "I know they're not my real kids, but if we take care of them, it's going to turn around two folds, ten folds for you as a company.” It takes a lot of work.

You're talking about regarding culture, we've talked it about a number of times on the show. When your team members treat their work team as if they were family, that's next-level stuff. You get so excited when they'd not only bought into the company culture, they've bought into each other and they wanted to see each other succeed. They're trying to help and they're trying to promote each other and help each other out. That's the stuff that you hope for as a business owner. In order to cultivate that, it takes celebrating wins, creating goals together. I think quarterly meetings are a huge success. You can push a lot of great cultural values and unity in those cultural events if you're intentional about it and if you plan those out properly. It can gain a lot of traction. It's nice to not only implement the mission, vision and values, but then follow that up with intentional culture-building activities that show the mission, vision and values. We talk about it during those times. That's when you start seeing a culture change.

We try to do that, even when we get together casually, we'll play little games, “Who can recite all our core values the fastest?” We throw stuff out there and always relate stuff to the clinic, even joke about some things that happened in the clinic and create that atmosphere. At the end of the day, we're CEOs and that means we have to lead. We want to lead them to do great things. I used to be a coach too. We can lead them to be good, but when they overachieve and we lead them to overachieve, that makes us feel great. They want to make you feel great. They want you to be proud of them. They don't want you to pat them on the shoulder and say, "Great job." In some cases, you may not know this or they may not tell everybody, but they may have a hard life at home and work is their happy place. It says a lot about how you do that. You can lead by a lot of ways. You can lead by service. You can lead by love. I like to motivate my team. Every Monday, we do a Monday update and we do a little motivational Monday video clip. I'm big into motivating.

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The other thing I've learned that I think helps them respect you and learn a little bit about you as a boss is to not be afraid to feel embarrassed in front of them for something you did. Being in a business where I own it with my wife, I have some experiences sometimes since we work together and we live together. Sometimes you're at work and I may say something that maybe I don't realize that other people are in front and it's rude. When I realize that, I immediately will stop, apologize and make it public like, "I messed up." The faces and the looks that I get from them sometimes it's cool because they're like, "He's normal." They're not afraid of me because they know I'm just human as they are and we all make mistakes. The example is man up about your mistake and make it right or make sure that you expect them to do the same when they messed up. You're going to move on. It's okay.

Show a little bit of humility. Show them that it's okay, that we can make mistakes and we can overcome them and next time I'm going to do better. 

At the end of the day, I tell my kids, “As long as you give it 110%, that's all that matters. Give it your all.”

Is there anything else you want to share, Frank?

This is one thing that I read and I thought I want to share with my staff. I read this and I'm going to share it with them at the next meeting. It says, "If your presence doesn't make an impact, your absence won't make a difference." That goes for all of us. As a CEO, you want to make an impact on your business. You have to come in here full of positive energy, leading your team, motivating your team, loving your team, setting the mission, the vision. Make sure everybody's clear on it so that everybody can focus and go forward. As an employee, you need to do your job and make an impact in your post. When you're not there, it's not going to make a difference.

How do you want to make an impact?

When you're not there, they're going to be like, "Where's Frank?” because you made an impact.

As a leader, you want to be able to say, “I made this impact.” As a leader, especially in a physical therapy clinic, personally I didn't want my impact to be that I saw 60 patients that week. That's not the impact you want as a leader. The impact that you want as leaders is, “I've affected these people's lives whether it's patients and or employees. This is how I lead and this is how I've created a culture that inspires people.” That provides much more power than it does simply treating patients all day.

It's who you are, what are you there to do and how you're going to do it?

PTO 70 | Identifying Bad Apples
Identifying Bad Apples: If your presence doesn't make an impact, your absence won't make a difference.

Frank, thanks for taking the time. I appreciate you sharing your wisdom. If people wanted to reach out to you and ask you questions, what's your contact information? 

I'm going to give you two ways that you can opt in for any information. It's a text message. You can text MM to 844-444-1481. If people want to get onto our app and get some of the free stuff that we have on there for mastermind stuff, they can text app APP to the same number.

That's for the Next Level PT mastermind and coaching that you are doing?

Yes, correct.

It's always awesome talking about culture. I get excited about what we can do to filter out people who aren't bought in and find those people who are bought in because the sailing is so much smoother when you got those people in the right seats in the bus. 

We're still tweaking and refining because that's the process we have for the front desk, but we still got to create one for the clinic and for PT and everything else. It's a work in progress.

Thanks for your time, Frank. I appreciate it. 

No problem, Nathan. Thank you.

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About Dr. Frank Garza

PTO 70 | Identifying Bad ApplesDr. Frank Garza has been a physical therapist since 2006. After working as an employee for one year in private practice, he decided to venture into an independent private practice setting, with his wife, where he is now the CEO.

In doing so they began to see patients in their own home for about 2 to 3 years before expanding into their current outpatient physical therapy facility, Pure PT & Pilates (PPTP), which he owns and operates along with his wife, Dr. Amy Garza.

Together, they have been managing and running the practice for seven years, soon to be eight. Frank is also a founder of Next Level Physical Therapy (NLPT), a consulting group that helps other physical therapy CEOs create the time, choice and financial freedom they deserve.

In the last 2-3 years, he has been really focused on developing and refining his practice’s Human Resources Department. Frank is currently a resident of Mcallen, Texas, a small city located in South Texas, with his twins, Frankie and Tessa, as well as his beautiful wife Amy!

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PTO 66 | From PT To Effective Executive

 

Transitioning from one profession to another takes a lot of courage, preparation, and experience. Kevin Kostka, DPT, PES is a great example of someone who has excelled in the different aspects of professional growth and successfully transitioning to the next phase - from a high-achieving student (four college degrees) to specialized physical therapist (co-wrote a book) to successful PT owner (five clinics and counting). Each transition requires learning new skills, but becoming a successful business owner can be especially difficult for PTs since they typically have no prior business training. Therefore, as Kevin shows, it's imperative to invest time, money, and energy into developing a business owner's mindset, learning what tools are necessary to be successful, and what actions are most. Like many of us, Kevin also learned a little bit through the school of hard knocks, but hopefully you won't have to if you intentionally transition into your ownership role.

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Listen to the podcast here:

How To Transition From PT To Effective Executive with Kevin Kostka, DPT

I'm excited to bring on Kevin Kostka out of Chattanooga, Tennessee. Kevin is the owner of multiple clinics out in Tennessee, but I'm excited to bring him on because he's an example of someone who maximizes his potential in the different arenas of his professional career. What I mean by that is here's a guy who's gone to college and attained four university degrees, maximized his initial foray into physical therapy’s clinician to the point where he co-wrote a book and did a few studies. When it came to starting his own practice, here's something that was new to him. Like the rest of us, he spent years studying and then went to physical therapy school and spent all his time and money on physical therapy and becoming a clinician. Now he's up against something where he didn't have any education, nor any background as a business owner.

Unbeknownst to him, he used the formula that is he reached out, he stepped out and he networked. He got some coach in consulting. He got out of practicing every day so he could work on his business and he networked with other physical therapists and business owners. His story, although not unique, is impressive because he spent a lot of effort and energy to teach himself while also following the formula. It's our responsibility as business owners to teach ourselves, to invest in ourselves. To spend the time, money and energy that it takes to actually become the leaders of our companies. I'm excited to bring Kevin to you as a great example of what to do in order to become effective executives. Let's get into the interview.

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I’ve got Dr. Kevin Kostka out of Chattanooga, Tennessee. He is the owner of Summit Physical Therapy and the VPO of Next Level Physical Therapy. I'm excited to bring him on. He's a partner with Travis Robbins who I had on in Next Level Physical Therapy. I'm excited to bring him on because I think we got an important topic. First of all, thanks for coming on, Kevin. I appreciate it.

Thank you for taking the time to talk to me. Hopefully, we can help some other private practice owners out there.

I know it's going to be great. I'm sure you've got a ton of great information to share. Knowing your story and knowing how successful you are at this time, do you mind backtracking and sharing a little bit about where you started, where you came from on a professional path?

It was probably back in high school when I decided that I wanted to be a physical therapist. I always thought I wanted to own my own physical therapy company. As I was going through my high school career, I was going to different orthopedic clinics. I was going to hospital-based clinics, neuro clinics, these clinics trying to find if that was actually something that I wanted to do. Of course in high school, you got a lot of people out there that try to tell you that it's too hard to get into physical therapy school and that's something that you can’t do.

When you have read leadership books and the mindset, everything snowballs to success. Click To Tweet

That pushed me even more to want to pursue physical therapy. I honed in and along my journey in college, I was able to get four degrees along that way. I was able to get a lot of my college credits in high school. I was good enough that my high school allowed me to get quite a few credits. I did one year on a scholarship and then the very next year I got to apply for PT school and they let twenty of us in out of 400 or 500 people. I began that particular journey going through PT school. We moved to Knoxville, Tennessee, which is northeastern Tennessee. My wife had a harder time finding a job than I did. That's where her family's from. We moved up there and I had a great learning opportunity. I worked with an orthopedic clinic up there. I got to work alongside fellowship trained MDs.

One of them actually took me under his wing and he was a shoulder and elbow specialist. That was something that I was interested in because nobody was interested in the shoulder at that point in the game. I was like, “I'll take those patients.” He took me in and I'd wait after work for them and we'd work out together, we'd chat and then developed a relationship from there. Since I was inside that type of environment, he would ask me to come over and he'd show me what particular X-rays looked like. He taught me to read radiographs, showed me some MRs and taught me to read MRs. We started getting closer and closer.

We wrote a book together and then started writing a couple of papers together. I was a new grad, but still one of the highest producers there. I went to the director at that time. I was like, “I'm killing it here.” This was back in the early 2000s. I made peanuts as an undergrad. I was like, “I feel like I'm producing the most here. I’ve got a lot of value. I feel like I'm doing some good things with the doctors here.” I’m looking for a raise and trying to present it. Of course you're young, you're naive and you think you know it all. He was like, “It's like you're going to have to start your own practice to make money like you're talking about.” I'm like, “I’m going to turn him a four-week notice.” I turned in my four-week notice then came back to Chattanooga.

Can I go back a little bit simply because I think there might be a little bit of a question there? One of the things I tell people to do is to network. You took advantage of a relationship there with a physician and that was beyond your typical marketing approach. Was there something specific that you did to create that relationship with a doctor that he would take you under his wing like that? What feedback or what insight could you give us maybe recommendations for physical therapists to develop those types of relationships with their local physicians?

I was eager to learn. I wanted to learn more than anything. When I would try to write notes to him on my progress notes or my evals, of course because he’s right across the hallway there. I'd walk the patients there and that was the benefit of working in a physician-owned clinic at the time. I tried to coach patients on what to say when they would go back to the doctor as well. I would always ask the doctor after work or if I did see him, I'd always ask him, “What did you think about Mrs. Jones? What'd you think about Sally? Is there anything else I can do differently?” That's how it came about. I was getting results with his patients, so I'd ask him about particular techniques and ask him about particular tests and how to do some special tests. From a professional standpoint, that's how it started. It was more about a personal relationship that I would build with them talking about his kids or ask him what it was that he liked and that he was interested in. That’s the direction that I would go with my conversations.

I think there's some carryover there, a couple of those aspects. Not everyone works in a physician-owned physical therapy clinic where they can have that easy access to a physician. However you hear about some physical therapists who take the time to go with their patients to the follow-up appointment or maybe take the time to ask the physician about a patient if it's not at the appointment or some other time. I shadowed physicians. I loved shadowing my orthopedic physicians especially to see how they do things. Their evals are so quick and easy because they have to be. I’m like, “I wish my evals were like that.” Take advantage of the opportunity to be curious. Simply ask questions, be a part of it. What can I do better? What can I do differently? What do you like? Make it not all about, “This is what we provide,” rather, “What can I do to help? What can I do to improve? What would you like to see?” Coming at it from a different perspective is something that we can learn from your experience.

PTO 66 | From PT To Effective Executive
The ONE Thing: The Surprisingly Simple Truth Behind Extraordinary Results

You show that humility and you're selfless in that aspect. When you know that your purpose is to help people and you have a genuine interest in that and doing what you can to be able to improve yourself every day, then you'll take any approach. It came naturally to me. If I had an hour that somebody didn't show up, then I was walking next door and doing what you did, trying to shadow. I would block off the schedule for two or three hours if I could, “Do you mind if I come and shadow you during the clinic?” As crazy as it sounds, but a lot of orthopedic surgeons, they don't like the clinic. They like surgery. That's where I wanted to be too. They're in a good mood because they're in surgery. When I was there in surgery with him, he was like, “You need to go see this guy.” He would communicate back to, “This tissue wasn't that great. We need to go slow with them external rotation. Let's only take them 30 degrees,” or “Can you see on screen when I'm arranging this shoulder right here? It was only going to flexion to 90 degrees. Now you can see the stress that's going right here.” It was a great communication tool.

When I was in the clinic, he would pick up the phone, call me and say, “You're going to see Sally on Tuesday and this is what I want for the first two weeks until she sees me for that ten to fourteen-day follow up.” Having that open line of communication and that's what I brought back to Chattanooga. I found those orthopods that had similar interests that I did and try to develop those relationships based on those interests and getting into surgery with them, giving them my contact information and telling them what I had experienced in the past. Those are hopefully some takeaways.

You eventually opened up your own clinic and it was smooth sailing from then on out.

The silly thing that we did is in 2007 is when I quit. In 2007 when the housing bubble had burst, that's when I decided to open up my own practice. I didn't know. We have this perfect opportunity inside a fitness club. It's not like a gym or anything like that. It's a fitness club, a high-end facility and we're like, “We want to do this on the side of the space right here.” We went to the owner. At that point, the money that they wanted, it was well out of reach for us. I'm going to go to a bank in 2007 and ask for some money. They're like, “I'm not going to loan you any money.” Me and my business partner, we had to come up with a creative idea to start stacking some cash so that we could open a brick and mortar.

Our creative idea was to do house calls. I utilized the mindset when I was in Knoxville of getting to know the doctors and buddying up with them. I was lucky enough to come in contact with an orthopedic surgeon that had done a fellowship and a rotation and knew the doctor that I had worked with specifically. We became buddies and talked to each other since he worked with him in his clinic a little bit, shadowing them and I got to see a lot of his patients. It was like a concierge for other business owners or people that own other franchises. Those were the people that I got that didn't necessarily have time to go into a clinic. I actually would go to them.

I started from there. My business partner was in the home health line and so we started getting into assisted living facilities and offering our services there. We were delivering a good product, a better product and that was being delivered to those facilities at the time and getting good results and staying in constant communication with the MDs and the directors of nursing inside those facilities. Within a year, we had an LLC and we filed all the legal paperwork. We started in 2007, but legally it was 2008 under the Summit name and we got it protected somehow.

Now you're up to five clinics in the area.

Talking about life and interests to physicians is a great way to build personal and professional relationships. Click To Tweet

As of September 2019, we have five orthopedic clinics. We're working on one more clinic that should be open on December 2019. We still have that home health product line that we're able to offer. We still offer house calls for certain people that can't make it into the clinic.

You've made the transition. You were well-regarded as a physical therapist. I'm sure you were awesome. You transitioned over into becoming a real business owner. I'm sure it was a gradual transition. You take on patients full-time, you're running the business on the weekends and at nights and that kind of stuff. What helped you make that switch? We'll go into a little bit more about what it takes to become effective as a leader, but what did you do to make that transition from a full-time physical therapist to the owner, leader and manager a smoother transition?

As we started to grow in 2007, 2008, we're starting to hire more people. Our head is down and we're treating patients, we're trying to figure out payroll. We're trying to figure out getting people's time off covered. We're trying to figure out all kinds of things. All the arrows are coming right at us. As all those arrows are pointing at us, you're getting overwhelmed. You're out here working seven days a week. You're working from 6:00 in the morning until 8:00 or 9:00 at night and it becomes very overwhelming. It was hard to cope with that.

We decided to hire a practice manager. We're like, “That's our answer.” We can go in, we can treat all these people, we'll have somebody else doing it. Of course, we didn't know what we were doing. We thought this person knew what they were doing. We kept our head down. “How are things going?” “Things are going great. We're doing awesome.” We didn't keep statistics at the time. We didn't know. They don't teach you that stuff in PT. You treat one person an hour and you do this and it’s going to be great. You're going to change healthcare. It didn't work that way. The only thing that we could figure out is we had to start keeping numbers. We had to start keeping metrics to figure out exactly what was going on. That practice manager didn't necessarily work out. We figured out that we had to start pulling out of practice to be able to start working on the business instead of inside the business.

I think a lot of people in your situation, you think you bring on a practice manager and you're thinking that you're delegating, but what you're doing is abdicating any responsibility. There's the fallacy that, “I'll give it to this person and they'll manage it as I would.” What needs to happen is they need to come underneath you to run the practice. You need to manage them now even more closely because they don't care about it as much as you do, honestly. It's tough because we have to go through hard times like that. I’ve talked to other practice owners that go through one, two, or three practice managers before they finally figured out, “My job is to oversee the practice manager, actually, not for them to run the clinic. I'm still the owner.” You never get rid of that responsibility.

Dan and myself, we figured that out very slowly as money was leaking left and right and we weren't collecting and so that was that person's responsibility, but we didn't have any systems in place. We started pulling out slowly and our responsibilities were to get better organized, to create systems, to create policies and to create procedures as we started to grow because we were delivering a product and a lot of people liked the product. They were getting better and they were happy. They wanted to refer to friends and family and they wanted to come back and see us again. As our visit started to climb, we were hiring more people, but we didn't have those processes in place. We were leaking money and leaking things everywhere. We created those policies and those systems. We created those procedures and then we started to better organize our business. As we started to organize it into different divisions and different departments, the arrows started to go away from us as opposed to all the arrows coming at us.

PTO 66 | From PT To Effective Executive
From PT To Effective Executive: Pulling out of practice brings in more opportunities. Start working on the business instead of inside the business.

 

Were there certain tools or resources that you used, whether it was certain books that you followed or consultants or coaches that you used to help you along the way?

We definitely hired consultants. We read a lot. For about a year and a half we studied and had coaches and consultants try to help us from a business standpoint. The next year and a half, we started studying marketing because that's something else you don't learn in school, in the physical therapy world at least. To me, I think those are two key aspects that you have to have a good grip on before you start your own practice.

Were there any books that stood out to you that started changing your mindset or giving you some direction?

I probably read 50 books and I try to read as much as I can. Can I say that there's one? No. You start with a Dale Carnegie or something like that and you start reading How to Win Friends & Influence People. That one will snowball into another book and then that one will snowball into something else. You go from this personal development world and then you go into this next little stage of, “There are some business books out there. Now there are these mindset books. Now that you've got all this mindset, you've got these leadership books.” It all continues to snowball. I would hate to leave one book out and not be able to tell the context behind why I started that. When somebody starts reading that book from there and they're like, “What? That doesn't make any sense. How does that apply to me?”

It's obvious what you did. You're a smart guy and not unlike other physical therapists who are a high achiever. We haven't spent the time and money on our business education. We spent plenty of time and money on becoming a great physical therapist, but comparatively we have no business knowledge whatsoever. It's imperative that we take the time and spend the money and invest in our business education. That's what my business partner and I considered. Some of the learning that we had ended up costing us tens of thousands, maybe hundreds of thousands of dollars if you look at it over the years. Because we lost money, those were hard lessons to learn and that's not the way you should get an education about business.

When you invest in a coach, when you spend the time to study the books, when you get consultants, you name it, that's part of my mantra. Reach out, step out, network, step out of treating full-time, invest in your business education. Reach out to someone to get some help and guide you along the way because you need that education to become a business owner. I'm excited to talk to you a little bit about this because not only you become a business owner, but you have to become an executive. You have to know what you're doing. Correct me if I'm wrong, but I'm getting a sense that maybe it's hard for physical therapists to transition over to becoming an executive into that administrative role because maybe they don't know what that even looks like. We've been physical therapists for so many years. What am I going to do with my day? How am I going to be “productive” if I'm not seeing patients all day?

That was a mindset shift that I had to go through because I felt like I had to be inside the clinic to be able to help people. What I realized and what other people helped me realize is that I can only see so many people in a day. If I'm able to implement, get better organized and start to implement these procedures, then I can actually help more people. Because now I can have therapist A and therapist B inside the clinic. I can only see ten, fifteen people a day, whatever it may be. If I'm able to set up good systems and be able to deliver good products, now I can have two therapists in there that can see ten to fifteen people a day. Now I’ve helped more and then I can open up another, duplicate that same facility here and duplicate it over on another side of town and then duplicate it on another side of town. You have to have those systems in place to be able to do that. That's the mind shift that you have to go through. It's a team. You had to start to develop that culture and you have to have that leadership to be able to do that.

You have to start to develop the culture and have the leadership to be able to have a system that works. Click To Tweet

What are the first couple of steps you recommend for someone who is pulling out of treating full-time? Honestly, they say, “I finally have a full day, or maybe I have two half days. I’ve got two five-hour segments where I can do some executive work, some admin work.” What would you recommend to them to be most effective at that time?

This is something I helped Travis Robbins do. As you start to gradiently work yourself out, start with two hours, work to get to four hours. As you start to do that, a lot of the owners at that time are like, “Now what do I do?” They start twiddling their thumbs. It's about becoming better organized. Start trying to create these different divisions within your organization. What happens when that patient first walks in the door? Create a system based on that so you can take that system and do it at clinic B and do that at clinic C. What we tried to do is hone in on that. My business partner, as we started to create these divisions, he actually took the first three divisions, the next three divisions that we came up with. I started handling the operations, quality control, continuing education and external marketing. He took over the finance, the personnel and the statistics piece of it. He handled that. I handled the other piece and then we started honing in on the different pieces of that particular division.

It reminds me, I had Jerry Durham on. I like what you said about starting with where the patient comes in the door. Maybe going through the patient life cycle, it would be easy to start if someone's considering, “What do I do?” It's funny because if you were like me when I first had those initial hours, I would start catching up on my notes or paying bills. I could pay bills and track down new contracts for different vendors all day long. It's a waste of time and it's not getting you where you need to go. What Jerry Durham explained so well is going through the patient life cycle. What are they seeing, what are they doing, what are they hearing as soon as they walk in the door, or even before that? I should back up, what did the initial phone call sound like? Write it all out.

Now you're starting to develop a culture and the culture is how we do things at the clinic. As you start, you want your patients to be treated a certain way. You want them to see certain things. You want them to hear certain things. Starting from the first phone call when they're saying, “Do you take my insurance?” Is your front desk person saying, “We’re not sure,” and they hang up the phone? You don't want that. Let's start developing a script and how that looks through the plan of care. After the fact, what does the billing and collections look like? How are you going to reengage them three or six months after discharge? That goes into marketing.

I think the benefit behind looking at the different divisions like you're talking about is the patient goes through those different divisions. They're going to come across the personnel. For lack of a better term, they're going to become a statistic, but they're going to get care. They're going to be marketed to after the fact and it becomes a full circle. There's a benefit to sitting down to break down the different divisions that are responsible for different parts of the company running well and see what does the patient get to see at each point? How are we going to put them through that cycle to make it a successful encounter with each patient?

There are two things that I want to dovetail off of that. When you said you would do your finances or you'd catch up on notes, it dovetails back to one of the books that I read a long time ago, The One Thing. You get them back to the one thing and what's the one thing that I can do right now that's going to make the rest of my day that much easier? It brings you back to that mindset. You create your checklist and you go through that checklist. “I got that one thing done. I needed to create this system for when I need to create the verbiage for what we do when we answer the telephone. I want to create this whole cycle that starts here.” It goes to this point and this is the algorithm that it goes through. If she answers yes, if she answers no, this is how it goes. My ultimate goal is to get them on the schedule. You’ve got to take it to get those arrows pointing away from you and part of the executive or part of the director, part of the VP, whatever level you're at. It's all about implementing that particular system. It’s making sure that person then becomes accountable and responsible.

PTO 66 | From PT To Effective Executive
From PT To Effective Executive: Once you start debugging and changing your system, that's when the magic happens.

 

They know what that end product, it's to get that patient on the schedule. You're exactly right, that's where the metric comes from. The metrics don't necessarily have to come from patient care. It can come from my office coordinator at the front desk, how many phone calls she's handled that day and how many people actually converted to patients based off of that. It’s making sure that they're accountable and responsible for that and they have a statistic to measure their final product there.

How long do you think it took you guys to do your initial setup, systems and processes? It takes some time. I want to say it was Paul Keller that wrote that or something like that. Anyways, it’s a great book. If you can knock out that one thing, the first part of your day, it doesn't matter what you do for the rest of the day. You've already been successful. Knock out the one thing as soon as possible. How long did it take you to feel like you had a decent system in place?

It took us two and a half, three years to go through all of this. For our organizing board, it probably took us about a year, a year and a half to create it, get it up on the wall, people look at it and be like, “What in the world are these guys doing?” I would even look at it during lunchtime and be like, “How in the world were you going to get this accomplished?” You take it day by day. You take it one day at a time, hour by hour, as we would do with patient care. I would never look at the end of the day. I would just look at it hour by hour and roll with the punches. I was going to be there until 5:00 or 6:00 anyway. When I look at the organizing board, I knew that as I would take it day by day and try to break it down as slow as I could and gradiently implement things so that people didn't think I was crazy. I do it as slow and as possible as I could so that people could get a good handle on what exactly it was.

It wasn't until we started having meetings where we separate everybody out. We had different meetings for the marketing team, for the rehab team, for our office coordinators and we had people above them so we can finally debug some of these systems that we created. Once you start debugging and then you start changing them, that's whenever the magic starts happening. People take ownership over them because they are their ideas, they're no longer my ideas. Our ideas don't fly too well. They have to be somebody else's ideas. It's all about the executive or the owner or whatever role you're playing within your organization. It's all about your ability to be able to communicate that to your juniors in a sense where they want to do it. You've promoted it enough to so that it makes sense to them and they can see the greater good of it. It's a win-win for everybody.

The thing I like about your story is you recognized the issue you had with the initial manager that you brought on, the practice manager. The first thing that came to mind is, “I need to know my statistics.” One part of what you need to do on a regular basis as an effective executive is to look at your statistics. Nothing should come as a surprise eventually as you start nailing this down. Start figuring out systems, processes, and procedures and writing them down. That's a lot of grind for me, especially creating content. I hate it, but that's where the rubber meets the road. The benefit can come when if by chance you have any rock star talent on your team, is to have them write down their processes and procedures.

That might be hard for them, but it’s telling them, “Just take fifteen minutes and give me an idea of how you answer the phone,” If they're good at converting patients onto the schedule book or, “You're good at getting behind the doctor's front desk and talking to the physicians. Can you write down what you do?” The onus isn't so much on you all the time, but you can take what they've got, massage it, manage it, and then once it's written down, then you can implement it into the next person. Because there's going to be staff turnover, you can implement that and train on the next person. You essentially start working your way out of a job.

I had a wife of a very busy PT call me and she's like, “I don't see my husband anymore. He's a great physical therapist, but he is busy all the time and we can't get on top of our business.” A lot of us as physical therapists take it for granted that we treat patients well. I think there's a lot of responsibility for us to write down what we do to be successful physical therapists and get patients to come back and get high retention, completed plan cares, lower cancellation rates and that stuff. A big onus is on us to write down what we're successful at as physical therapists so that we can turn that over to someone else and put the time into the executive stuff.

Always try to improve yourself on a personal and professional level, reading and applying them to the situations you're in. Click To Tweet

I love hearing you duplicate all this stuff because that's exactly what we did. We would ask our office coordinator, “You do that well. Can you write down how you answered that phone and how you handle that objection? Can you write this down for our PTs?” We would do the same thing. It's constantly living and breathing your organization. It's constantly changing. As you know and a lot of the readers probably know as well, change is inevitable. You have to embrace it and make sure that you're okay with change. If something isn't working, then change it. That's where those statistics come in. All we're doing with those statistics is making sure that what we are doing is working or if it isn't working and we're going downtrend, then we need to make sure we change something up. It's all about communication and having that conversation about what everything looks like from the metrics because those are your answers.

I’ve got a ton of stuff going through my head, but I want to ask, did you have a lot of fallout as you started implementing the structure? Did you have a lot of kickback from the employees?

Of course, because we didn't know how to lead. We didn't know how to do any of that stuff initially. We started reading about culture and we started trying to develop a culture within our organization based off of values that we felt were important. Of course, we didn't come up with the values. We had the other people within our organization come up with the values. You can check out our website and check out our values. We have all the different definitions and different quotes behind what we feel like from a communication standpoint to a willingness standpoint, integrity, all that type of stuff. That's how you start to develop that culture. When you're in your grassroots company and you're homegrown within your city, then those values can start to seep out into the community and you can start doing community projects. That's when the team starts pulling together. When you close all five clinics down and you have 30 people show up to the soup kitchen and we’re all dispersed into different teams and are helping to make lunches for the homeless or trying to go in and fix up one of the rooms that they stay in. That's when the team starts coming together and it's all about letting the other people come up with it.

What I think you're a great example of as you started figuring out, “We need to become executives.” It’s statistics, systems and values. I'm sure a lot is going on behind the scenes. You're hiring the right people, you're running through some people who are resistant to structure and they’re like, “Don't tell me what to do.” You start gaining some traction to a point where now there's still some stuff that comes up, but I don't have to spend as much time pushing all the buttons anymore. Now I'm developing a leadership team that is bought into the culture and I can trust to do the work. You're still managing by statistics. You're still watching the stats on a weekly basis and people that have to be held accountable to them, but now you're pulling yourself up the organization board to the point where your growth is almost dependent upon the team. You guys have some leadership and you're going to have a vision. I didn't say anything about it, but everyone should have a vision. You have an ideal scene. Now, the team is pushing towards that. You're all rowing in the right direction. It's not surprising now to hear that you had your fifth clinic open. You've got another one open. Growth is inevitable at that point.

It's a matter of me and Dan getting out of the way. I think that the more we get in there and start tinkering and messing with stuff, the more things will start to slow down. Now that we have our executive team in place, we have our executive meetings every month, then those meetings trickle down and we have that culture. We have the executive team making a lot of those decisions on policy and changing the policy. We don't have to necessarily do a lot except for look for new opportunities that are out there through the networking, which you mentioned, through the network that you are doing at this point in the game. That's what happened to us.

Our Chamber of Commerce here voted us the small business of the year for a medium-sized business. That's when things started exploding, “Will you put a clinic beside me?” You get phone calls all the time. From an executive standpoint, we got to put systems in place to, “What does that new clinic look like?” We've got a checklist for that. What are we doing with the contractor? What are we doing with the PT equipment? We have checklists for all that. Where do we want to put it? When is a good time to do this? You’ve got to learn the hard way sometimes too and not grow too fast because then you get in trouble with available capital.

PTO 66 | From PT To Effective Executive
From PT To Effective Executive: If you can get everybody going in the right direction, then you're unstoppable.

 

Now you're developing processes and procedures on a higher level. I'm sure you're looking at demographics. When you're looking to open up a clinic, you have a general idea how much cash and on hand to not only open the clinic but sustain you for a period of time and then it all becomes systematized. At that point, you really can't hold back the growth. It's impressive.

The only thing that's going to slow you down is money.

What has been your most successful action in developing leaders underneath you? I want to get your two cents. You didn't jump from all of a sudden starting to run your clinic a couple of days a week to all of a sudden not seeing patients five days a week. What were some specific tips that you provide people to grow their leadership team?

To me, it's a mindset. It's always trying to improve yourself on a personal level as well as on a professional level. Always trying to read and trying to apply what you are reading to the situations and the scenarios that you're in. Once you start getting these ideas, it's all about executing on these ideas. In order to be able to do that, it's about communication. You’ve got to figure out a good communication method to persuade and presuade the way that you word these ideas so that becomes their idea, more so than it is your idea. There are certain questions that we go through to try to figure and try to lead those people in that direction, facing the facts. If we don't do this now, then what will happen or what could happen? There's a whole process that we actually teach in our mastermind on how to do that from an executive standpoint to implement a new program or to implement a new policy.

I had Travis on and you guys are starting another mastermind group with Next Level Physical Therapy. I'm sure people can go to that website if they want to learn more about the mastermind like you're talking about and some of the principles that we discussed. Thanks for sharing. I appreciate it, Kevin. It was great to talk to you and hear about your story. Are there any words of advice, anything you want to share?

I'm a personal growth guy, so I'm always looking to try to do better than I did the day before. As physical therapists and as private practice owners, the best way that we can help other people is actually making other people in our organizations responsible and accountable for their particular position and working together as that team. Another quote from another great book, “If you can get everybody going in the right direction, then you're unstoppable.” Being great leaders and learning how to do that is something that I love to see our profession continue to evolve with.

You're a great example of someone who has taken the time and effort to develop as an executive. Maybe that wasn't your idea when you wanted to open up your own clinic back in the day, but you got to understand if you're going to own a clinic, you've got to put in the time, the education, and spend the money in your education to become a successful owner. When you do so, then you can become a greater influence in your community than as a solo practitioner.

You can't be a know-it-all. There are people that have been out there. Before we got on here, I was asking you questions and you're giving me ideas. It's all about helping one another so that you can continue to grow as a person and grow as a professional.

You're doing great work. I appreciate your time with me, Kevin. Thank you for coming on.

Thanks, Nathan.

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About Kevin Kostka, DPT

PTO 66 | From PT To Effective ExecutiveKevin has an extensive educational background receiving four degrees from The University of Tennessee at Chattanooga. Foremost, he received a Bachelor’s Degree in Psychology in 2000 and Exercise Rehabilitative Science in 2001. He went on to assume his Master’s Degree in Physical Therapy in 2003 and achieved his Doctorate of Physical Therapy in 2004.

Kevin began his professional career working with the Knoxville Orthopaedic clinic, where he had the privilege to work beside fellowshipped trained medical doctors for whom he acquired valuable experience with differential diagnosis and diagnostic testing in a one on one environment with the fellowship-trained specialist.

Kevin achieved his Performance Enhancement Specialist (PES) Certification from the National Academy of Sports Medicine in 2006. He researched and assisted in the writing of a journal article with a fellowshipped trained shoulder and elbow specialist as well as a hand specialist for distal bicep tendon repairs from 2007-2008, while also working on his first publication with Edwin Spencer, MD, Post Operative Rehabilitation of Shoulder Pathologies. Kevin was a Member of the American Society of Shoulder and Elbow Therapists. He was on the board for the University of Tennessee Chattanooga Physical Therapy Department along with adjunct, associate professor and special guest lectures in the physical therapy department.

Kevin has been in private practice since the inception of Summit Physical Therapy in 2008 with his business partner Dan Dotson. They have grown their business in their hometown of Chattanooga and now partner with other local businesses to help promote local healing. Summit Physical Therapy was awarded the Small Business of the Year Award in 2015 for the category of 21-49 employees and voted on through the Chamber of Commerce Board Members. And has been voted into the Best of the Best for physical therapy in 2017 and 2018. Summit Physical Therapy currently has 5 outpatient clinics and home health product line.

Kevin is also a founding member of Next Level Physical Therapy where he helps other practice owners to improve their practices so they can help more people in their communities.

 

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